Should EMS be controlled so much by nurses?

[Summit]

One thing I love about this forum is even after 12 years I'm always learning of different structures or methods for EMS system models and care across the country and the world.

 

[gotbeerz001]

In regards to Nursing Hnions being opposed to paramedics filling roles in the hospital:

Any good Union should oppose a movement that would potentially place non-represented folks in positions traditionally held by Union members; don't take it personally. Whichever side has the better argument will prevail.


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[usalsfyre]

Ahh yes nursing. Extremely protective of their sandbox while actively trying to piss in everyone else's.

I love nurses....not hugely fond of nursing organizations.

 

[Alan L Serve]

In my system we are educated by MDs, DOs, and PAs. Nurses are not part of our education or protocols as we do not work within the nursing model or nursing philosophy. We instead work in the medical model and medical philosophy which puts us squarely within the domain of those who practice medicine.

 

[Flying]

In my system we are educated by MDs, DOs, and PAs. Nurses are not part of our education or protocols as we do not work within the nursing model or nursing philosophy. We instead work in the medical model and medical philosophy which puts us squarely within the domain of those who practice medicine.

This may have been touched upon before, but the idea of a separate "nursing model" that comes up now and again confuses me. Don't nurses practice medicine? What do people like Remi/Akulahawk/Summit do, witchcraft? Pardon me if this sounds incredibly ignorant.

 

[Carlos Danger]

This may have been touched upon before, but the idea of a separate "nursing model" that comes up now and again confuses me. Don't nurses practice medicine? What do people like Remi/Akulahawk/Summit do, witchcraft? Pardon me if this sounds incredibly ignorant.

Theoretically, nursing operates under a practice framework that is distinct from medicine. Nursing theory is a pretty big deal in the academic world, and is the bane of every nursing student.

On a practical level, that is all 100% useless garbage. In the real world, everyone who works in the clinical setting uses the same approach to take care of patients, whether you call what you do "practicing medicine" or practicing nursing" or anything else. Only a very inexperienced person would think otherwise.

Some people in EMS will use any excuse they can think of as a justification for not having to listen to those silly girly nurses who can't do anything without a doctor telling the them to. This thinking seems most prevalent among the "Paramedics: doing the same thing as doctors, but at 90 mph" crowd.

 

[usalsfyre]

I can go either way...the "nursing model" is at times overly check box oriented and favors those who follow the flow chart in favor of doing good bedside care. N

The same criticism could be leveled at EMS of course, however physicians seem to understand deviation more than nursing management.

Ultimately the vast majority of care providers with less education than mid-levels have no business supervising anyone, I've seen too many competency issues no matter the discipline.

 

[Akulahawk]

In my system we are educated by MDs, DOs, and PAs. Nurses are not part of our education or protocols as we do not work within the nursing model or nursing philosophy. We instead work in the medical model and medical philosophy which puts us squarely within the domain of those who practice medicine.

When I went through Paramedic School, many of my instructors were nurses. My clinical preceptor was an RN. I did NOT learn Nursing Theory or Nursing ANYTHING from them as they followed the curriculum of the program that was built around the medical model. When you take your CPR/ACLS/PALS courses, your instructors could very well be nurses. They teach the appropriate curriculum, not the nursing slant on the subject.

When you do transport to the hospital, many times your radio or phone reports are answered by nurses that are familiar with your protocols and who are authorized to tell you to proceed past a certain point in those protocols. My system here has exactly that. You may proceed down the protocol to a certain point and then you must contact a Base Hospital for authorization to proceed past that point. There are only a couple points that require a Base Physician Order and if you reach that, you may NOT proceed, even under "communications failure policy" which otherwise allows you to proceed past "Base Hospital Order" points.

Your authorization to practice comes from the Medical Director but your Medical Director may delegate day-to-day supervision/review of your practice to a nurse that is familiar with what you do and what's appropriate. Nurses are generally familiar with Medical Model... they have to implement parts of the Medical Care Plan too.

 

[usalsfyre]

lWhen you do transport to the hospital, many times your radio or phone reports are answered by nurses that are familiar with your protocols and who are authorized to tell you to proceed past a certain point in those protocols. My system here has exactly that. You may proceed down the protocol to a certain point and then you must contact a Base Hospital for authorization to proceed past that point. There are only a couple points that require a Base Physician Order and if you reach that, you may NOT proceed, even under "communications failure policy" which otherwise allows you to proceed past "Base Hospital Order" points.

Your authorization to practice comes from the Medical Director but your Medical Director may delegate day-to-day supervision/review of your practice to a nurse that is familiar with what you do and what's appropriate. Nurses are generally familiar with Medical Model... they have to implement parts of the Medical Care Plan too.

I'm sorry, nurses have no business doing any of this. It should be educated and experienced medics, not a nurse with a short "MICN" class. Consider if the situations were reversed and medics were giving RNs orders, would you be ok with that situation?

Medics are fully capable of performing the role described. If I call for advice, I don't want to talk to an RN who may or may not have less background on the subject than I do.

 

[Akulahawk]

I'm sorry, nurses have no business doing any of this. It should be educated and experienced medics, not a nurse with a short "MICN" class. Consider if the situations were reversed and medics were giving RNs orders, would you be ok with that situation?

Medics are fully capable of performing the role described. If I call for advice, I don't want to talk to an RN who may or may not have less background on the subject than I do.

I didn't say that medics can't do any of this. I would be OK with educated/experienced medics filling the same role as an MICN does currently. If an RN is functioning in the field, under the same protocols as any Paramedic and had to call in and an authorized Paramedic answered the radio, I'd be OK with that. What I did do is describe the situation as it is currently, nothing more, in answer to the assertion that nurses aren't involved in EMS protocol. Currently, they are, even if only to the extent that they answer the radio when you ask for the OK to proceed past a certain point, in some systems like mine. Other places have the MICN simply taking the report, asking clarification questions, and sometimes getting the Base Physician on the radio for issuance of medical orders...

 

[RocketMedic]

Meanwhile, in Texas, there are systems going to paramedic-initiated finger thoracotomies, field ABX are a thing in some places, and we have nurse-free cadaver labs where medical directors speak of amazing things to come...

 

[Summit]

/

Meanwhile, in Texas, there are systems going to paramedic-initiated finger thoracotomies, field ABX are a thing in some places, and we have nurse-free cadaver labs where medical directors speak of amazing things to come...

I've done a finger thora on a cadaver... it's as easy and more reliable than a needle.
Protocol based antibiotics are nothing amazingly complex either. Is it Vancocin/Zosyn for every suspect sepsis in yours or are you doing Ancef? Or are you doing IM or PO because you don't have time to finish an IV run in the field?
What's a nurse free cadaver lab? All my cadaver labs were taught by MDs, PAs, or PhDs.

Moreover, how does this relate to the thread?

 

[ExpatMedic0]

One thing I learned after moving from the U.S. and working alongside medics and nurses from places like the UK, Canada, Australia, New Zealand, South Afirica, Denmark, Germany, ect... was that the relationship between nurses and paramedics is nothing like it is in the U.S. One thing that surprised me was that In many other English speaking countries, paramedics often make more than nurses, have more clinical education than nurses, and are seen as a somewhat different ( arguably higher level of care) than nursing. The "nurse phenomenon" in the U.S. really is incredible. In my personal opinion nurses have absolutely no business running or managing anything in EMS, and they often don't in most other countries (where EMS specific providers exsist). Dual certified providers such as RN/NRP is silly and unnecessary in the rest of the world and is mostly an American thing. However, at the same time... the education, professional standards, and political clout of EMS providers needs to grow substantially in the U.S. This will never happen with out the backing and advocacy from MD's, more highly educated EMS providers, and a continued reform of the healthcare system (especially regarding reimbursement and discharge at home options). However in its present state... it is what it is

On a side note: The nursing influence and representation in EMS (even within the U.S.) appears to be very regional.

 

[Carlos Danger]

Meanwhile, in Texas, there are systems going to paramedic-initiated finger thoracotomies, field ABX are a thing in some places, and we have nurse-free cadaver labs where medical directors speak of amazing things to come...

Congrats, you've almost caught up to many of the hospital-based HEMS programs from the mid-90's. Many of which were run or heavily influenced by nurses.

 

[Alan L Serve]

This may have been touched upon before, but the idea of a separate "nursing model" that comes up now and again confuses me. Don't nurses practice medicine? What do people like Remi/Akulahawk/Summit do, witchcraft? Pardon me if this sounds incredibly ignorant.

No, nurses do not practice medicine. They practice nursing. This is why they are licensed by nursing boards and not medical boards through their states. I don't think witchcraft is part of nursing.

 

[Summit]

No, nurses do not practice medicine. They practice nursing. This is why they are licensed by nursing boards and not medical boards through their states. I don't think witchcraft is part of nursing.

I reiterate Remi's point that making such distinctions is only relevant bureaucratically or in online pissing contests.

It is an irrelevant in real world practice.