Should nurses be required to complete ride alongs with FD

[Akulahawk]

My old hospital based service often had ED nurses and other floor RNs ride along. It did seem to give them a bit of appreciation into what field work is like and what we do.

That's a wonderful thing! They might not like or fully understand field work, but they'll at least realize it's a bit different than working in hospital...

 

[hogwiley]

I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.

 

[chaz90]

I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.

Most ED nurses I've seen at least have some concept of the difference, but you should have seen the looks on the faces of the Med/Surg floor staff when we showed up to intubate their patient on a Rapid Response Team call.

*Not a dig at Med/Surg staff by any means. Simply a comment on how little exposure they have to EMS.

 

[Rialaigh]

Not to stir the pot with all the RN/Paramedic blah blah....there are several undisputed facts that we in EMS need to remember when talking about our RN buddies

1. On Average, they are better trained, more educated, and have a better understanding of disease processes and treatments for anything that has a longer duration than running a code. They are required to have more underlying medical knowledge prior to specializing. They have more patient contact, more physician interaction, and much more experience being involved in patient care planning. I'm not saying medics are taxi drivers but when you haul someone in who is septic, the medic does about .1% of the work and the nurses and physicians and hospital support staff will do the other 99.9% to get that patient home with some quality of life left...

2. See number 1

3. See number 1 again


I don't care if they don't know the difference between an EMT and a paramedic as long as they are good at their job. I haven't met very many medics who are comfortable running a REACH (stroke) consult, or assisting in the cath lab, does that make us bad medics...no....by the same note the majority of these RN's simply have no use at all, and would not benefit in any meaningful manner from ride time.

The only exceptions to this are RN's operating in a emergency role without direct access to a physician, see flight RN's and critical care transport...

 

[Achilles]

Where's clipper?

 

[Clipper1]

Where's clipper?

I have a life. I don't spend hours on a forum like this. I give a few minutes every 2 to 3 days and then I'm done. There are more forums which I am more interested in. This one just caught my interest since some of the issues discussed here do concern us in the hospital and on critical care transports.

 

[Clipper1]

I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.

By the time we get EMT and Paramedic figured out another new title pops up. In WA we at one time had 7 different credentials between EMT and Paramedic.

We also have a list of what ambulance services can transport what. Even with the same title of Paramedic (or EMT) some can take certain drips and equipment and some can't. You also can have EMTs on ALS trucks with expanded roles. You can also have someone with a Paramedic patch working on a BLS truck and can only do BLS with no drips or advanced equipment.

 

[Clipper1]

Most ED nurses I've seen at least have some concept of the difference, but you should have seen the looks on the faces of the Med/Surg floor staff when we showed up to intubate their patient on a Rapid Response Team call.

*Not a dig at Med/Surg staff by any means. Simply a comment on how little exposure they have to EMS.

You listed one skill you can do.

Now how much do you know about Med/Surg nurses? Have you ever seen their standing protocols and listing of all of the procedures/skill they do?

I guess if you showed up on any floor to intubate instead of regular staff I would have to ask why?

 

[Aidey]

I guess if you showed up on any floor to intubate instead of regular staff I would have to ask why?

Have you considered that he is regular staff, is employed by the hospital and is a member the rapid response team?

 

[Clipper1]

Over the years, the nurses that I've met that bash the paramedics usually have no idea what they do or the training they actually do receive. From what I've seen during my nursing training is that they're given absolutely zero education about what other care providers are capable of and their general scopes of practice. RN's are taught about appropriate delegation to CNA and LVN staff... but not to EMT / AEMT / Paramedic personnel, which they lump into unlicensed personnel.

In hospitals EMT/AEMT/Paramedic will probably be unlicensed personnel because the state EMS boards write for prehospital licensure. EMTs are usually certified regardless. If working in a hospital they will also be working under a different title like ER Tech. Their EMT or Paramedic cert might be recommended at hire but some don't require them to keep it up especially after they get the necessary hospital certs or a national/state phlebotomy cert especially if they are doing more than what a PCT can do. What this all means is that the RN would still be delegating by the same unlicensed personnel policy.

This would be no different than if an RN who also held an EMT or Paramedic certification/license worked as an EMT or Paramedic for the fire department. The RN title should have no bearing especially in a fire department. For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.

 

[usalsfyre]

For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.

Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?

 

[Clipper1]

Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?

If you are working in a hospital, your job title and job description will spell this out.
If the EMT or Paramedic title is not recognized in the hospital and you are working under a different title, then you fall into the hierarchy for that title regardless of what you do on the ambulance.

Yes in the hospital there is a hierarchy between professionals depending on the circumstances and area. Each will also have their own job description and title. A Radiology Technologist with a Masters degree can oversee the Rad procedure but the patient will still be under the care of the RN who can also determine if a procedure should be stopped for the safety of the patient and for reasons which are out of the RTs area of expertise.

There are also many allied professionals who are required to have an Associates degree but are not on the same level as RNs, RRT or RTs.

PTA, OTA and some levels of Rad Technologists exist fall in a different level. There used to be a lower level in Respiratory also but I think they have gone by the wayside now or at least in this hospital. But, even for them they have different job description levels such as I, II or III similar to RNs which their level of expertise and sometimes leadership roles must be observed. All are also floated by their level of expertise and job description level. You would not put an RN I who has not ICU or ED experience in either area.

Would you put an EMT or even a Paramedic who has only done routine IFT transports on a 911 truck to do lead or be senior? I have known IFT Paramedics working on ALS transport trucks who have not started an IV or intubated in 5 years after joining that agency. They still are Paramedics. I think for Paramedics this might have a bigger influence since there is an expectation that all can do certain skills. Assuming that just because it is in your scope of practice for the state does not necessary mean you can do it either.

RNs, or most, do understand that regardless if it is in their state scope, they may not always be able to do it in their job description and those who have seen what other RNs do in specific areas like the many ICUs, they must have additional training and education.

 

[ExpatMedic0]

Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?

+1 to this
Is anyone else having VentMedic flashbacks?

 

[Achilles]

I have a life. I don't spend hours on a forum like this. I give a few minutes every 2 to 3 days and then I'm done. There are more forums which I am more interested in. This one just caught my interest since some of the issues discussed here do concern us in the hospital and on critical care transports.

Oh you do have a life, I was thinking you were a bot that was replying, silly me. :wacko:
I'm glad you answered a rhetorical question, would it be too much of a burden to answer my other one?

 

[Ecgg]

Ecgg: I hope you are only letting Clipper1's abrasive attitude drive your silly response. If so, rise above your emotions. I hope that you are not really that misinformed about the capabilities and regular practices of ICU nurses. If you think RNs are for "recording notes" and don't know anything about diagnosis, you need some perspective. Sure, RNs do not "diagnose"... just like paramedics don't "diagnose."

Sometimes it requires one to resort to ignorant extremes to show hypocrisy of one side toward the other. This was clearly evident by all the replies that ensued, yet Clipper1 states these things about medics and emts like it’s gospel and goes unchecked.

I certainly acknowledge Paramedics/ EMT’s education in critical care arena is very limited, actually none existent would be a better word. Even with my very limited ICU experience I have certainly interacted with exceptional Nurses who were instrumental to my current knowledge and helped me with the patient and with whom I consult every single time. I recently took a ICU class which was led by a ICU RN, and the presentation was excellent probably the best course I have ever took and it helped me put a lot of things I read in literature into perspective. I certainly always listen to nurses’ reports, and any information they are willing to share. Everyone pays a pivotal role in care of patients regardless of the initials after your name.

Hence why these debates RN vs Medics etc. are seldom productive. I much rather discuss solutions on how to advance education, what classes to take, what to read and improve paramedics limited ICU exposure. If we tackled clinical topics and how to address education with such vigor as we do RN vs Paramedic class hierarchy there would be many more people directed to proper resources and education.

 

[NomadicMedic]

Folks, this thread is getting very far off topic and coming very close to some personal attacks. Rein it in please.

Remember, the "first rule" is be polite.

 

[JPINFV]

Folks, this thread is getting very far off topic and coming very close to some personal attacks. Rein it in please.

Remember, the "first rule" is be polite.

Coming close to personal attacks? How about we go back and reread the passive aggressive personal attacks that Clipper is flinging, mmkay?

 

[BandageBrigade]

In hospitals EMT/AEMT/Paramedic will probably be unlicensed personnel because the state EMS boards write for prehospital licensure. EMTs are usually certified regardless. If working in a hospital they will also be working under a different title like ER Tech. Their EMT or Paramedic cert might be recommended at hire but some don't require them to keep it up especially after they get the necessary hospital certs or a national/state phlebotomy cert especially if they are doing more than what a PCT can do. What this all means is that the RN would still be delegating by the same unlicensed personnel policy.

This would be no different than if an RN who also held an EMT or Paramedic certification/license worked as an EMT or Paramedic for the fire department. The RN title should have no bearing especially in a fire department. For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.

I suggest you do some research before making blanket statements. I am licensed and I work in an ER. My title is Paramedic, no ER tech. I work alongside the nurses in the ER and the work alongside me. neither of us is 'higher' than the other. In my state we are considered licensed and as such can work in any health care facility or setting.

 

[Clipper1]

I suggest you do some research before making blanket statements. I am licensed and I work in an ER. My title is Paramedic, no ER tech. I work alongside the nurses in the ER and the work alongside me. neither of us is 'higher' than the other. In my state we are considered licensed and as such can work in any health care facility or setting.

Post your state and the statute.

Here is one example.

http://www.llr.state.sc.us/POL/Nursing/AdvisoryOp/AO49.pdf

The Board of Nursing for South Carolina recognizes that it is NOT within the role and scope of the registered nurse (RN) or licensed practical nurse (LPN) to supervise emergency medical technicians (EMTs) and paramedics in the emergency department (ED) while functioning as an EMT or paramedic. In the state of South Carolina, the Department of Health and Environmental Control (DHEC), Division of Emergency Medical Services (EMS), authorizes EMTs and paramedics to perform certain described procedures and acts. They perform these procedures and acts while employed by a licensed Emergency Medical Services provider and under the guidance of an approved Medical Control physician. The EMT or paramedic certification does not apply within a medical facility or agency. EMTs and paramedics are not allowed to wear any designation of such certification while working as an employee within a healthcare facility or hospital. When employed by the hospital or healthcare facility, they should follow the guidelines for unlicensed assistive personnel related to nursing supervision and oversight.

Texas

http://www.bon.texas.gov/practice/faq-paramedics.html

The rules governing EMTs and Paramedics are located in Title 25, Texas Administrative Code, Section 157.2. This rule limits the scope of practice of EMTs/Paramedics to performing duties in the "pre-hospital and inter-facility transport" settings. Therefore, whether certified or licensed, the BON delegation rules view EMTs, Paramedics, or other similarly trained staff as "unlicensed assistive personnel" (UAPs) when working in acute care settings, such as the ED.

Kentucky

http://kbn.ky.gov/NR/rdonlyres/989D2CE9-B548-44E0-825C-4F6E2ACA6AB1/0/aos15.pdf

A Registered Nurse may delegate a task to a Paramedic employed in a hospital Emergency Department....

At your job, can you manage a patient who is admitted to ICU but is still in the ICU? An ICU ventilator? Hang blood? Give all the same pressors as an RN? If so it sounds like you hospital is working on the cheap. This is not something I would brag about since you are being used. Just remember your prehospital immunity will not apply in a hospital.

 

[BandageBrigade]

At your job, can you manage a patient who is admitted to ICU but is still in the ICU? An ICU ventilator? Hang blood? Give all the same pressors as an RN? If so it sounds like you hospital is working on the cheap. This is not something I would brag about since you are being used. Just remember your prehospital immunity will not apply in a hospital.

Yes (I assume you mean admitted but still in ED) Yes, but in all fairness whether a nurse or medic has this patient an RT will handle vent work majority of the time if available. Yes, and Yes. How are we being used? We earn the same wage as the ED RN. What "prehospital immunity" are you referring to?

I will post statue as soon as I get home.