Should EMS be controlled so much by nurses?

[NUEMT]

Spelling + punctuation would make this a better argument.


Sent from my iPhone using Tapatalk

Sorry. Phone has small buttons. Ill try to keep up with the grammatical giants here.

 

[NUEMT]

There are plenty of similarities between nursing and paramedicine, but they are too different to say that one is "higher" or "lower" than the other.

Nurses receive a very broad and general education and then most go on to specialize and develop expertise in a specific area of nursing, such as critical care. Paramedics receive a very narrow and focused education and then go on to care for every type of patient in existence. Kind of backwards, in a way.

The whole thing about "nurses need orders and paramedics do not" is a myth perpetrated by those who have no idea what most acute care nurses actually do.

I wish that myth would die and be buried alongside "if we were licensed instead of certified, we'd be better off as a profession".

You make a valid point and I should clarify that I have no dellusions like those you mention. The point of the sentence in general was to say that we do closer to the ssme work snd thus nursing is as you say, simply more specialized. But thanks for echoing a good wish for the death of that particular flagtantly used argument.

 

[NUEMT]

Well it looks like among you gents.. this is not the perception and I bow to your forum-ju.


Although not sure exactly how I came off as a low paid disgruntled EMT in a service I am not happy with. Probably my tone in my writing. So my fault.

I will say though that i resist the idea of the idealist not being able to change anything. Wanting change for the better is something that should be cultivated and supported despite being difficult... Or even impossible.

It also doesn not automatically mean somone is unhappy. It might just mean they want change.

 

[DesertMedic66]

As everyone has stated already this is going to vary greatly by your service and location. The only involvement we have with nurses is when they come to teach CE classes (ACLS, PALS, PEEP, ITLS, etc is all taugh by paramedics here). Aside from that the only other involvement with nurses is when we contact the base hospital and we have a Mobile Intensive Care Nurse answer the radio.

Luckily our MICNs are required to do several shifts on a paramedic unit so that they understand how things vary.

 

[NUEMT]

As everyone has stated already this is going to vary greatly by your service and location. The only involvement we have with nurses is when they come to teach CE classes (ACLS, PALS, PEEP, ITLS, etc is all taugh by paramedics here). Aside from that the only other involvement with nurses is when we contact the base hospital and we have a Mobile Intensive Care Nurse answer the radio.

Luckily our MICNs are required to do several shifts on a paramedic unit so that they understand how things vary.

Thats a good policy. Our facility has residents do an EMS rotation as well.

 

[MackTheKnife]

Sorry. Phone has small buttons. Ill try to keep up with the grammatical giants here.

yeah, some people like to pick on the small sh*t that doesn't matter or realize that perhaps your fingers got in the way cause you were using your phone.

 

[MackTheKnife]

I'm not sure how long you have been doing this, but the nursing profession is very good at lobbying and inserting themselves. This isn't just limited to EMS but to the hospital also. I think it comes down to cost an desire. Most physicians want to see pts, it's the reason we went to medical school. I'm not saying nurses don't but there is a unique cohort in the nursing field that has their eyes set on admin. It also cost the system a lot less to put nurses into these roles that it does a physician.

Doc, you are absolutely correct vis-a-vis lobbying and inserting themselves. I am from "several worlds" when it comes to medicine. Navy Hospital Corpsman, Paramedic, TCCC Instructor, and now a nursing graduate and current EMT. First off, in the Navy we used to say that nurses had "terminal PMS". The nurses had a hard time accepting that Corpsmen were able to diagnose, prescribe, order/interpret diagnostics, suture, do minor surgery, etc. These capabilities bewildered the RNs with a BSN since the Corpsmen had a 10 week school and on the job training. I was doing a multi-layer closure on a 3 yr old's head laceration when the ER Charge nurse came in and starting telling me "you can't do that!" The Navy plastic surgeon who trained me had stepped into to the cubicle and told her to back off, "I trained him". As a full-time paramedic, we ran into the occasional ER nurse who didn't like the fact that we had standing orders in the field. After all, they couldn't do what we did, even with an order. In the field we were doing crics, thoracentesis, EJs, central lines, intubations, etc. There was some jealousy. I think perhaps that nurses, who have a different mindset than medics, have found their forte in administration, lobbying, etc. I just received my copy of the Emergency Nurses Association magazine (ENA Connection) where the ENA supported H.R. 4365 (sponsored by Rep. Richard Hudson, R-NC) that would allow the continuance of standing orders in the field for the administration of analgesics and anti-seizure meds. So nurses can be supportive of EMS while inserting themselves into the political/lobbying arenas. The nurses have a voice and aren't afraid to use it.

 

[NUEMT]

Interesting. And now for the onslaught of keyboard rangers who know far more than you do.

Read the reference. This bill passage would set the stage for the nurse being in the back and the medic driving.


Yall still want to stand around and belittle the role of organizing and being recognized as a profession. I believe it is still not fedetally recognized as such.

 

[NUEMT]

Correction and retraction:

The previous statement in regard to the "stage being set" was a mistake on my part. I am familiar with a few different bills and mistook 4365 for another.

HR 4365 is an important and critical piece of legislation.

And jeez the typing on this thing. Apologies.

 

[StCEMT]

At least in my limited experience, I don't see nurses taking over or over stepping EMS here.

I have two people involved in running my medic class that are EMT-P/RN's, but once came TO EMS. The rest of the adjuncts are just diverse medics with everything from SWAT medics, HEMS folks, a childrens specialty transport guy, fire medics, and former military medics/corpsmen. I've met coordinators who were medics that switched over to hospital and use their background as a bridge between the two, some as nurses and others as medics. And ER clinicals, there are just more nurses available to be a preceptor than medics. However, I have also followed medics around since in my clinicals since I follow whoever I feel like based on whats going on. Honestly though, I like the people who are EMT-P/RN's. They see both sides of the coin and are generally realllllly active in working the prehospital-->hospital stuff.

That's not to say that nurses aren't more prevalent in the fore mentioned things elsewhere, but here it isn't really the case.

 

[NUEMT]

Excellent to hear.

 

[johnrsemt]

While I was in Medic class we had 1 nurse/medic that was an instructor, and most of the in house hospital clinical hours was overseen by nurses: but besides that we never had nurses deal with EMS.
At least in Indiana that is the way things were done 12 years ago, don't know about now, it has been 8 years since I worked there.
Here in Utah, I don't see nurses in any way in EMS

 

[Summit]

I think someone already pointed it out... most RNs don't have a lot of interest in going into the field because it is lower pay and less respected with less time with patients (even if it is more exciting sometimes). EMS will never have the pay of a hospital because of simple economics: in the hospital, a RN can be assigned 1,2 5, 7 patients for 12 hours straight for 1 RN.

In the field, 2 EMS providers spend less than 25% of their combined shift caring for a patient. 25% is a very generous number for a nonstop urban shift. I've worked for departments where we didn't get a 911 and only 1 IFT in a 24. 48 hours of labor and 1.5 man hours at 1 patient's side.

Do the math again if you have to calculate 8 fire medics showing up for every 911.

There is a reason MDs don't do house calls anymore. It isn't economical.

The "mighty and powerful RN lobby" (and it should be, there are 12x as many RNs as EMS providers in the US and a higher proportion of them are employed in their field) isn't interested in prehospital medicine from anything I've seen, despite the fact that in some other countries use RNs in EMS.

 

[NUEMT]

I think someone already pointed it out... most RNs don't have a lot of interest in going into the field because it is lower pay and less respected with less time with patients (even if it is more exciting sometimes). EMS will never have the pay of a hospital because of simple economics: in the hospital, a RN can be assigned 1,2 5, 7 patients for 12 hours straight for 1 RN.

In the field, 2 EMS providers spend less than 25% of their combined shift caring for a patient. 25% is a very generous number for a nonstop urban shift. I've worked for departments where we didn't get a 911 and only 1 IFT in a 24. 48 hours of labor and 1.5 man hours at 1 patient's side.

Do the math again if you have to calculate 8 fire medics showing up for every 911.

There is a reason MDs don't do house calls anymore. It isn't economical.

The "mighty and powerful RN lobby" (and it should be, there are 12x as many RNs as EMS providers in the US and a higher proportion of them are employed in their field) isn't interested in prehospital medicine from anything I've seen, despite the fact that in some other countries use RNs in EMS.

Again its not that they want to do EMS. Its that some of their positions are supportive of policies that help EMS, while simoultaneously blocking the advancement of the field. I would agree that they generally have no interest in ridding on the box.. but they do see some facilities utilizing medics more and more and have been against that.

Although i will point something out. NAEMT puts the number of EMS practioners of all types at 849,000 ... With 8% being nurses.

Comparitively there are 2.9 million nurses.

 

[Summit]

Although i will point something out. NAEMT puts the number of EMS practioners of all types at 849,000 ... With 8% being nurses.

Comparitively there are 2.9 million nurses.

You know, I think I was thinking Paramedics and I was thinking of that stats fro ma few years ago before I99s either upgraded or went away.

I guess if we are going to include EMTs and AEMTs, we should add in CNAs and LPNs...

Again its not that they want to do EMS. Its that some of their positions are supportive of policies that help EMS, while simoultaneously blocking the advancement of the field. I would agree that they generally have no interest in ridding on the box.. but they do see some facilities utilizing medics more and more and have been against that.

Ah. Here we go. We got to the crux of the matter.

You are annoyed that RNs are opposed to hospitals cutting costs by replacing RNs with Paramedics in the ED.

Cry me a river.

Then when you are done, explain to me how RNs vs Medics in the ED equates to prehospital providers being "CONTROLLED BY NURSES!"

Then explain to me why the "advancement of the field" of EMS is defined by EMS providers getting jobs in hospitals.

Where in the world did you get this idea? The reason that EMS exists and does what it does in the field instead of PAs or MDs or RNs is because it is uneconomical to have those providers do it?

 

[Carlos Danger]

I always think these paranoid "why do the nurses want to control us / why do nurses hate us / why are nurses so jealous of us" things are comical.

90% or more of nurses have no interest in or knowledge of EMS whatsoever. They don't want to do it, they don't want to control it, they don't know much about it, and they don't like it or dislike it. It just isn't on their radar. At all.

The only nursing entity that I am aware of having anything at all to say about EMS or paramedics is the ENA. And while I would completely agree that some of what the ENA says is unnecessarily anti-paramedic, some of it is also quite reasonable and is sincerely in the interest of patient safety. Simply questioning the appropriateness of paramedics doing certain types of interfacility transfers that they have little or no training on is not "anti" anything. And at any rate, the ENA is only one of probably 10 or 20 major nursing associations (as well a many smaller ones), and none of the others ever address EMS at all in any way, to my knowledge.

The whole "why don't ED nurses want paramedics working in the ED" thing is, to put it frankly, a stupid question - of COURSE nurses don't want someone else being hired into their positions. Show me a single worker in any industry, anywhere, who is cool with that. How many paramedics would be cool with EMS agencies hiring LPN's to do things that are traditionally done by paramedics?

 

[mgr22]

Again its not that they want to do EMS. Its that some of their positions are supportive of policies that help EMS, while simoultaneously blocking the advancement of the field. I would agree that they generally have no interest in ridding on the box.. but they do see some facilities utilizing medics more and more and have been against that.

Although i will point something out. NAEMT puts the number of EMS practioners of all types at 849,000 ... With 8% being nurses.

Comparitively there are 2.9 million nurses.

NUEMT, can you give me an example of a nursing position or policy that blocks advancement of EMS? Also, how did you conclude that "they see some facilities utilizing medics more and more and have been against that"?

 

[Akulahawk]

We have quite a few RN/EMTP folks here and the vast majority of them clearly see both sides of things. In my role as an ED RN I usually see 3-4 patients at a time, for the majority of my shift. On a very busy day I'll see somewhere north of 18 patients. That means I end up doing 18+ assessments, coordination of services for all of those patients (radiology, ultrasound, lab, meds from the pharmacy, medical providers...), then implementation of both nursing and (parts of) the medical care plan for each of those patients, do much charting, and either discharge home (with appropriate teaching), transfer out to another facility (along with calling report), or moving the patient to an inpatient room (could be ICU, could be Med/Surg or anything in between). The nurses among us know how much work that is.

When I was working as a Paramedic, I would see (usually) a single patient about 25% of the time. I'd get between 8 and 10 patients, but typically have them under my care for about 35-50 minutes, sometimes a LOT less. I got very good at leading a team of people to get many tasks done very, very quickly. My scene times were usually in the neighborhood of 8 minutes with (often) a line in place, 1st meds given, vitals done and interpreted as necessary, and packaging. When you have a good crew, it's very possible. But it's also ONE patient with many hands available right then.

A couple other people touched on this subject. I had protocols that I followed in the field that helped direct my care. In the ED I'm lucky (in a way) that I have some protocols setup that allow me to begin providing care right away to most patients before they're seen by the provider. In both instances, the protocols are signed off by the Medical Director and agency/department administration.

Here's where things get different. Paramedics and Nurses have different scopes of practice and their scope is driven by the type of job they do. I've seen more than one nurse's eyes pop out of their heads when I showed up in the ED with an EJ in place. They consider those lines to be "central" while EMS usually considers those to be "Peripheral."

In any case, my scope simply depends upon what I've been trained to do! I'm a specialist nurse now... but I was trained as a generalist so that I could go to work in nearly any field and receive follow-on education for that particular field. This generalist training also allows me to shift to a different job later if I so choose. As a Paramedic, I'm a specialist right out of the box and in that regard, I'm ready to go (mostly) within days or weeks of finding a job. It's harder to shift to another job when your training is entirely as a specialist.

Could a Paramedic work well in my ED? Sure, once they've figured out how to rollerskate between patients like the nurse do. If they worked as full-scope Paramedics and NO extension of skills past that, they would (at times) make the nurses a little irritated simply because of the differences in scope of practice. Also, by design, the medics would work under the direction/supervision of the MD, not the nurses...

Is EMS controlled by nurses? Not really. Nurses usually just have more experience juggling things and they're quite good at playing politics. If more medics would get the managerial/business education needed along with a much broader base of education, they'd be equally good in any position in an EMS agency with the exception of Medical Director. Once Medics get organized politically to the same degree as nurses, they'll be able to do a LOT of pushing (with success). It's just that we tend to try to be very independent-minded folks so getting EMS folks organized on a large scale is more difficult than herding cats.

 

[NUEMT]

NUEMT, can you give me an example of a nursing position or policy that blocks advancement of EMS? Also, how did you conclude that "they see some facilities utilizing medics more and more and have been against that"?

I'll have to search. I ran across a state nursing association position paper that outlined reasons not to include paramedics in the hospital setting. The argument was originally in response to the use of medics on code teams in that state.

 

[NUEMT]

"If more medics would get the managerial/business education needed along with a much broader base of education, they'd be equally good in any position in an EMS agency with the exception of Medical Director. Once Medics get organized politically to the same degree as nurses, they'll be able to do a LOT of pushing (with success). It's just that we tend to try to be very independent-minded folks so getting EMS folks organized on a large scale is more difficult than herding cats."


Excellent comment and dissection of the fields overall.