Texas ENA position paper against EMS

[triemal04]

Can I make a suggestion?

The thread that turned into a bickering match about Explorer-1 was an embarrassment, not only to everyone involved in it, but to everyone else who is in the same profession.

This thread is already on track to do the same. Please don't let that happen again.

Which means that if you are going to compare the two professions here, you need to actually understand what the differences and similarities are, and not waste time blabbering about "well in MY department" or "at the ER that I go to" or "when I was a nurse" and so forth. Becuase...you know...anecdotes don't matter.

Just a suggestion.

 

[SeeNoMore]

Like others have said, the intention of the letter is pretty clear. But I think the larger problem is how vulnerable paramedics are to such accusations. If the profession never advances (education, professionalism, evidence based interventions) than we don't have much to argue with.

Of course we can all think of a service that performs at a high level of quality with experienced edcuated providers, but we can also think of many more that fall below that threshold. Overall Paramedics are less educated and regarded as lower level providers. I don't think that means we are unable to work in Emergency Rooms but I think we are better served by showing our worth rather than trying to argue how much more autonomous we are than nurses. It just seems to come from a position of weakness because we all know full well that we are still low man on the totem pole of medicine.

 

[Carlos Danger]

As I explained before, the only reason I even got involved in this discussion was to try to provide some objectivity and perspective and correct some apparent misconceptions. As far as I know, I am the only one involved in this discussion who is actually licensed as and has actually practiced as both a nurse and a paramedic, and continues to be involved in EMS even after going into advanced practice. But, if you think I just don't know what I'm talking about, that's fine. Take what I have to say for for whatever it's worth to you. I'm certainly not going to lose sleep over what a few cocky medics on some anonymous internet forum think of what I have to say.

But consider this: when you are going toe-to-toe on a serious political battle over important scope-of-practice issues, you are far better off doing so from a position of knowing as much as possible about your opponent and their possible motivations. No matter who started it or how unfair they are or how untruthful they are being, your argument is very weak if it relies at all on untrue or half-true "facts". And I can assure you with 100% confidence that if you start spewing some silly BS about how "nurses can't do anything without a doctor's permission, yet paramedics are autonomous" to someone who is really knowledgable about nurse practice issues and knows that paramedics can only operate under a set of written protocols and a physician's explicit authorization, they will tear your argument to bloody shreds and leave you stuttering, trying to find the words to save just a little face, and you will have thoroughly lost the debate in the eyes of anyone watching. I promise. If you think I'm wrong, go ahead and try to fight this battle on that premise. I'll try not to say I told you so.

I'm not going to try to list all the things that can done by RN's on standing order. But everything that has been mentioned in this thread as an example of what nurses can't do without being told........is being done right now by an RN, in a hospital, on standing order. Not to mention the RN that is intubating a blood airway in the back of an ambulance, or the RN who is starting a central line in a helicopter on the long flight to a tertiary center. Or the paramedic who is working in an ED and NOT running the code or doing the intubation, because a physician is present and in charge, and for both RN's and paramedics, degree of autonomy and the skills they perform has more to do with practice environment than anything else.

Ummmm I'm quite clear on what a nurse can do....

Obviously not, if that was a serious question about whether RN's can give morphine on standing order.

Remi, I understand that everyone is looking out for themselves, but if you expect me to sit quietly while another healthcare professional tells half truths and lies to a politician about my industry, so they can advance their agenda, well, then maybe you should go back to nursing.

I don't expect you to sit quiet and do nothing.......I don't care what you do. But being quiet probably is a better option than going off half-cocked about something you obviously know little about.

If you want to help out EMS, why don't you write a letter to a politician saying how as a credentialed nurse, a paramedics can do a whole lot more than the president of the Texas ENA chapter is claiming. I mean, you are a supporter of EMS right?

Please, spare me the guilt. I'm a CRNA in South Carolina who has never even been to Texas and has never been involved with the ENA anywhere - do you really think the Texas ENA or any legislators there give a crap what I have say in support of paramedics?

(You do know that traditionally, CRNA's and the larger nursing establishment tend not to get along very well, right? Of course you do, since you know so much about nursing practice.)

I've done a lot to support the paramedic profession, but sometimes I wonder whether they need my support at all, being that so many paramedics know everything already.

 

[SandpitMedic]

As always. This is futile, Remi. Too stubborn to take off the blindfold to see the light.

One last question for you directly, keep it to a yes or a no.

In regards to the administration of Morphine... Are you suggesting, that via standing order, on a first encounter with a patient in an ER or urgent care, that an RN can just administer morphine if they deem it appropriate? Prior to that patient seeing a provider or mid-level provider? Yes or no?

 

[Carlos Danger]

As always. This is futile, Remi. Too stubborn to take off the blindfold to see the light.

You are the one insisting that you have more knowledge about something you've never even done, than someone who has actually done it. Yet I'm the one being stubborn? You simply do not know what you are talking about.

One last question for you directly, keep it to a yes or a no.

In regards to the administration of Morphine... Are you suggesting, that via standing order, on a first encounter with a patient in an ER or urgent care, that an RN can just administer morphine if they deem it appropriate? Prior to that patient seeing a provider or mid-level provider? Yes or no?

This isn't a yes or no question. But the short answer, if you insist, is yes, it is entirely possible that a protocol could exist that would allow an RN to give morphine to a patient who has not yet been seen.

When I worked in the ED I don't remember ever giving morphine on standing order before they were seen, but we did lots of other stuff before they were seen, and there's no reason morphine couldn't be added to the list of protocols. I don't know how common it is, but I do know it isn't a scope of practice issue by any means, and I'm sure there are places where it is done.

That's really a dumb question, though. Even if the answer were "no", it would not support your point. That's because in any ED where protocols do not exist to allow RN's to administer morphine prior to eval by an MD, I guarantee you that protocols would also not exist that allow an ED paramedic to do so. And any RN working outside the hospital will have the same types of standing orders to give morphine as any paramedic. So it isn't an issue of paramedic vs. nurse autonomy at all. As I explained in the last post, it has more to do with practice an environment. Paramedics give meds without the patient being seen out of necessity, bot because they are somehow better qualified to do so than RN's.

Paramedic practice and nursing practice is obviously very different. But you seem to think a paramedic is way bigger of a deal than you actually are. Do you ever wonder if that might have something to do with the perception that much of the rest of healthcare has of paramedics?

 

[SandpitMedic]

....no....

The answer is no.

Prove me wrong with fact, or stop.

I'm more than willing to be corrected...

(But I'm also not talking about some backwoods county with 1 stop sign. I'm talking a normal to low average populated urban or rural area with a decent amount of patients. And not volunteer or anything. Just find me a normal ER that has this policy in place for MS for a regular ordinary RN...And I will shut up.)

 

[Handsome Robb]

Sandpit, you're making all of us as Paramedics look ignorant. Just quit.

I'm a Paramedic. I am going to continue being a Paramedic whether it be ground, flight or fire. I have no aspirations of being a nurse and the only reason I'd go to nursing school would be to become a CRNA and I would spend as little time as possible working as an RN to achieve that. Even with that I'd rather go the route of AA, especially if they expand the regions they're allowed to practice in. So before you freak out and question my intentions I'm making my position in healthcare and my intentions in healthcare very apparent

We have less education, less clinical hours, lower entry requirements to our field and operate solely by standing orders as written by a physician. Yes, we make decisions to utilize or not utilize treatments authorized under these protocols however at the end of the day we cannot routinely go outside of those protocols except in circumstances which are extremely justifiable. Also, when we do deviate from protocol we're not doing anything outrageous or off the wall, we're doing widely accepted treatments which often require MD contact prior to doing them except in extreme circumstances.

I work in a system that is patient care oriented and to an extent allows us to be "thinking" Paramedics however if I routinely go outside of protocol without justifiable cause I will be called to the table and have to answer for my actions because at the end of the day doing so constitutes practicing medicine without a license.

This letter put us down and might not have been nice but whenever Nurses talk about challenging the NREMT Paramedic Exam we get all up in arms about it. When Nurses try to move into the prehospital realm we get all up pissy about it so why is it unreasonable to expect RNs to do the same when we attempt to step into their arena?

I like you Sandpit and Dr.P but this thread is astonishingly bad and as I said before displays a level of ignorance that you were the last person I'd expect it from.

Cool, we can give morphine on standing orders and the vast majority of Nurses cannot however I'd be willing to bet there are nurses in an Urgent Care or ER setting that can do in areas with low Physician coverage.

Cool, we can run codes however in the majority of systems to call that code we have to talk to a physician. EMS systems in some areas still require OLMD contact for things like CCBs, adenosine, amiodorone and many other drugs when the patient's condition is hemodynamically stable enough to allow for time to do so.

Our charts are still reviewed, some by a Physician in certain circumstances so while we might not "have to talk to a doctor before we do something" we damn well have to answer to one after the fact.

How is that any different?

Respectfully, a Paramedic.

 

[Carlos Danger]

I'm sorry, I am just desperate for professional recognition and it drives me to cling to the belief that I am superior to RN's in every way, and make ridiculous arguments to defend that belief.

Sandpit, I fixed your last post for you.

Look, you are pretty too, OK? Really, really pretty. And I'm sure you give great morphine. I mean it.

Now will you stop embarrassing yourself and all the rest of us? Just go back to living in your narrow-minded Paramedics of Facebook fantasy world, where you are safe and better than all the nurses.

 

[DrParasite]

blah blah blah...

But consider this: when you are going toe-to-toe on a serious political battle over important scope-of-practice issues, you are far better off doing so from a position of knowing as much as possible about your opponent and their possible motivations. No matter who started it or how unfair they are or how untruthful they are being, your argument is very weak if it relies at all on untrue or half-true "facts". And I can assure you with 100% confidence that if you start spewing some silly BS about how "nurses can't do anything without a doctor's permission, yet paramedics are autonomous" to someone who is really knowledgable about nurse practice issues and knows that paramedics can only operate under a set of written protocols and a physician's explicit authorization, they will tear your argument to bloody shreds and leave you stuttering, trying to find the words to save just a little face, and you will have thoroughly lost the debate in the eyes of anyone watching. I promise. If you think I'm wrong, go ahead and try to fight this battle on that premise. I'll try not to say I told you so.

apparently not... wait, are you telling me a paramedic is a physician extender, who can only do what the physician has told them to do? Color me amazed.... let me guess, nurses do the exact same thing? Oh wait, there is one pretty big difference: a paramedic has protocols to follow for EVERY patient, which are guidelines for how certain conditions are to be treated, based on the paramedics assessment.... while a nurse has standing orders for EVERY patient, but can only initiate many interventions after a doctor has assessed the patient and directed her how he or she wants the patient to be treated. Do you see the difference?

I'm not going to try to list all the things that can done by RN's on standing order. But everything that has been mentioned in this thread as an example of what nurses can't do without being told........is being done right now by an RN, in a hospital, on standing order. Not to mention the RN that is intubating a blood airway in the back of an ambulance, or the RN who is starting a central line in a helicopter on the long flight to a tertiary center. Or the paramedic who is working in an ED and NOT running the code or doing the intubation, because a physician is present and in charge, and for both RN's and paramedics, degree of autonomy and the skills they perform has more to do with practice environment than anything else.

please list one hospital where a RN (not a CRNA, a plain old RN) is performing intubations on a regular basis, and I will concede that are correct. I am better you can't.

I don't expect you to sit quiet and do nothing.......I don't care what you do. But being quiet probably is a better option than going off half-cocked about something you obviously know little about.

you know, for someone who claims to know a lot about paramedicine, and nursing, you are making a lot of claims, and unable to back it up with facts. Lots of theory, not much reality, just saying.

Please, spare me the guilt. I'm a CRNA in South Carolina who has never even been to Texas and has never been involved with the ENA anywhere - do you really think the Texas ENA or any legislators there give a crap what I have say in support of paramedics?

actually, I would think the texas ENA president would discard your comments out of hand... especially if you don't support their position. After all they deal in incorrect information, half truths, and anything that doesn't support their position obviously can't be right. Hey wait, maybe you two have more in common than you think.....

but I don't think your giving yourself enough credit when it comes to what the legislators think.... after all, a letter from Remi, NREMTP, RN, BSN, CRNA, might hold some weight, because it makes you sound like you know what you are talking about... well, in theory anyway....

(You do know that traditionally, CRNA's and the larger nursing establishment tend not to get along very well, right? Of course you do, since you know so much about nursing practice.)

you think it has something to do with having much more education, and a much different job description than a regular old RN?

That's really a dumb question, though. Even if the answer were "no", it would not support your point. That's because in any ED where protocols do not exist to allow RN's to administer morphine prior to eval by an MD, I guarantee you that protocols would also not exist that allow an ED paramedic to do so. And any RN working outside the hospital will have the same types of standing orders to give morphine as any paramedic. So it isn't an issue of paramedic vs. nurse autonomy at all. As I explained in the last post, it has more to do with practice an environment. Paramedics give meds without the patient being seen out of necessity, bot because they are somehow better qualified to do so than RN's.

I think it's a very valid one. You just don't like it because it goes against supporting your argument.

The texas ENA made a point to say that nurses act with more autonomy than paramedics. A paramedic is trained to work on a truck, to make decision without consulting with an MD. Yes, they have protocols, but they don't need to get a verbal order from a doctor to push morphine. They have standing orders, where based on their assessment, the patient needs it, and they are going to do it. A nurse, however, is trained to work in a hospital, where the doctor assesses and evaluates the patient. The nurse does too, but the doctor is the one who says “in this patient, if they are in pain, give morphine;" it's not the nurses call.

Paramedic practice and nursing practice is obviously very different. But you seem to think a paramedic is way bigger of a deal than you actually are. Do you ever wonder if that might have something to do with the perception that much of the rest of healthcare has of paramedics?

interesting.... so you say both practices are different, but apparently the practice of nursing is a much bigger deal than what the lowly paramedics are doing day in and day out..... maybe nursing just has a much better lobbying group?

 

[DrParasite]

Sandpit, you're making all of us as Paramedics look ignorant. Just quit.

actually, he's not. he's 100% correct. he asked a simple question. Remi said, "in theory yes. in practice, no." I think the answer is pretty clear, and it has nothing to do with ignorance. The topic in question was a nurse's assertion that a nurse is much more autonomous than a paramedic, when I think the answer to the question shows that it's not the case.

I'm a Paramedic. I am going to continue being a Paramedic whether it be ground, flight or fire. I have no aspirations of being a nurse and the only reason I'd go to nursing school would be to become a CRNA and I would spend as little time as possible working as an RN to achieve that. Even with that I'd rather go the route of AA, especially if they expand the regions they're allowed to practice in. So before you freak out and question my intentions I'm making my position in healthcare and my intentions in healthcare very apparent

We have less education, less clinical hours, lower entry requirements to our field and operate solely by standing orders as written by a physician. Yes, we make decisions to utilize or not utilize treatments authorized under these protocols however at the end of the day we cannot routinely go outside of those protocols except in circumstances which are extremely justifiable. Also, when we do deviate from protocol we're not doing anything outrageous or off the wall, we're doing widely accepted treatments which often require MD contact prior to doing them except in extreme circumstances.

I work in a system that is patient care oriented and to an extent allows us to be "thinking" Paramedics however if I routinely go outside of protocol without justifiable cause I will be called to the table and have to answer for my actions because at the end of the day doing so constitutes practicing medicine without a license.

and I don't think anyone is saying otherwise

This letter put us down and might not have been nice but whenever Nurses talk about challenging the NREMT Paramedic Exam we get all up in arms about it. When Nurses try to move into the prehospital realm we get all up pissy about it so why is it unreasonable to expect RNs to do the same when we attempt to step into their arena?

really? you get pissy about stuff like that? I have worked with several RNs who did that... if they can pass the same written exams, and clinical exams, why are you getting all worked up over stuff like that? might be a regional thing, but I have never heard of it.

I like you Sandpit and Dr.P but this thread is astonishingly bad and as I said before displays a level of ignorance that you were the last person I'd expect it from.

so you expect it from me? I'm a little hurt Rob......

Cool, we can give morphine on standing orders and the vast majority of Nurses cannot however I'd be willing to bet there are nurses in an Urgent Care or ER setting that can do in areas with low Physician coverage.

sure.... give me one example. that's all I want. where a RN (not an NP or anything, a new grad RN) in an ER or urgent care setting can do it, and I will gladly accept it as true.

Cool, we can run codes however in the majority of systems to call that code we have to talk to a physician. EMS systems in some areas still require OLMD contact for things like CCBs, adenosine, amiodorone and many other drugs when the patient's condition is hemodynamically stable enough to allow for time to do so.

Our charts are still reviewed, some by a Physician in certain circumstances so while we might not "have to talk to a doctor before we do something" we damn well have to answer to one after the fact.

How is that any different?

having physician oversight isn't the question, nor is standing orders. Because if you are called into a review session (in any level of healthcare), there is a good chance at least one of the people will have MD after their name.

Look, you are pretty too, OK? Really, really pretty. And I'm sure you give great morphine. I mean it.

Now will you stop embarrassing yourself and all the rest of us? Just go back to living in your narrow-minded Paramedics of Facebook fantasy world, where you are safe and better than all the nurses.

it's not about being condecending or looking pretty.... in fact, you're the one who is embarrassing yourself.... a simple question was asked, and you gave a pretty poor answer to justify that in theory your profession (nursing) was better, when we both know the reality and the theory weren't on the same page.

 

[DrParasite]

For the record, I don't care what the Texas ENA president says about their field. I don't live in texas, I have no intention of living in Texas, and I know the ENA president (in any chapter not just texas) is going to do whatever she can to support the nurses position.

The issue I have is when she says something to a legislator about how good nurses are, and does it at th expense of other professions, in this case, paramedics. And Yes, I have no problem supporting my industry, because I think we, as EMS professionals should speak with one voice and stand up for ourselves, especially when someone demeans our profession with half truths, inaccurate information, and downright lies.

If any paramedic thinks that legislators don't talk to one another, or Google various topics, than you are fooling yourself. If you think that a Nevada senator isn't going to find that letter and think “oh, if paramedics are that bad, we shouldn't even trust them to do xyz, and they definitely don't deserve any to get any more funding. Let's give that money to the nurses, they actually help people, I have a letter to support that” than are living in a fantasy world.

We don't have a strong national body, we don't have state lobbying groups, and the legislators consider us to be ambulance drivers at worst, and an expendable resource at best, able to be outsourced to the cheapest bidder if the budget called for it. In fact, most people don't want to fund us properly, or give us any money, until they have a medical emergency and call 911. So it is up to the individual to support the profession until some state or national leadership group is formed (probably won't happen in my career lifetime, but a man can dream).

For the record, I don't think paramedics are better than nurses. They both do their jobs well, and are trained for the environment they typically work in (paramedics in the field, and nurses in a hospital). And yes, when their environment changes, adaptations need to happen, and many paramedics work well in a hospital, while nurses work well out in the field.

But I don't think a nurse should be lobbying against the modification of a paramedic's scope of practice. I don't think that just because a paramedic goes from their field to a hospital they should have their hands tied and have their scope of practice legally reduced, because that is how the nurses operate in a ER (sorry if the truth stings a little to those who are going to deny it). If you want to advance your profession, why don't you try doing it without stepping all over ours?

If you still don't get it, read the actual letter posted at http://unwiredmedic.com/2015/04/24/texas-enas-unprofessional-attack-on-ems/ then read the blogger's resposes. Instead of citing opinion, it cites several facts, points out the author's half truths, and pretty much says “you know where the letter says this? Yeah, it's BS, and here is why....” giving accurate information, instead of the inaccuracies the original author implied.

Ignore everything that was posted in this thread, read the letter for yourself, and read the blogger's responses. And draw your own opinion.

 

[Carlos Danger]

actually, he's not. he's 100% correct. he asked a simple question. Remi said, "in theory yes. in practice, no." I think the answer is pretty clear, and it has nothing to do with ignorance. The topic in question was a nurse's assertion that a nurse is much more autonomous than a paramedic, when I think the answer to the question shows that it's not the case.and I don't think anyone is saying otherwise

really? you get pissy about stuff like that? I have worked with several RNs who did that... if they can pass the same written exams, and clinical exams, why are you getting all worked up over stuff like that? might be a regional thing, but I have never heard of it.so you expect it from me? I'm a little hurt Rob......

sure.... give me one example. that's all I want. where a RN (not an NP or anything, a new grad RN) in an ER or urgent care setting can do it, and I will gladly accept it as true.having physician oversight isn't the question, nor is standing orders. Because if you are called into a review session (in any level of healthcare), there is a good chance at least one of the people will have MD after their name.

it's not about being condecending or looking pretty.... in fact, you're the one who is embarrassing yourself.... a simple question was asked, and you gave a pretty poor answer to justify that in theory your profession (nursing) was better, when we both know the reality and the theory weren't on the same page.

Don't worry, Parasite.....we see you too, and you are also pretty.

 

[SandpitMedic]

Don't worry, Parasite.....we see you too, and you are also pretty.

"When the debate is lost slander becomes the tool of the enemy."
-Socrates

I've been warned by moderators for getting a little too coarse with my language, and substituting the word pretty for ******* may fool them... But it isn't fooling me.

And look here- just because you were the captain of the political debate team, and you can spin every answer you give into a pearl of information that seems to support your causes doesn't make you right. You're the one that is being ignorant, you're just articulate while ignorant. You may be fooling people like Robb (who I will address later) into dropping their arms and stepping on their ****s, but you aren't fooling me.

Mostly everything you said was assumption, theory, or a flat out lie. You stated very few facts. Spin it how you want; you should be president. #Remi2016!

You and the author of that letter are making a claim that the autonomy of RNs exceeds that of a Paramedic and that RNs hold some sort of eliteness - I asked you a simple question to challenge that and also demonstrates that those claims are not true. I'm also defending all paramedics, not myself.

What I said earlier was I am willing to be "corrected." I should have said I am willing to be educated - demonstrate a factual case in which a normal RN has the same autonomy... You can't. Because they don't.

This is not a **** measuring contest, nor it is a slam on any nurses. I have many nurse friends and will soon even be married to one. It is not even prudent for me to tell you that, because I have no need to defend myself against "nurse bigotry" to you, but just to add that little tidbit before you dive deeper into that slander. Nurses are doing a fabulous job, and an important job very well. But they are not "better" than paramedics, and paramedics are no "better" than nurses. Shoot, we even have EMS-RNs here... And I'm not up in arms about it- they're great!

However, that's not the focus of my points. My point is similar to what Dr.P is saying. I know we look prissy to you down here from up there on your high horse, but if the situation were reversed you had better believe it would entice the same response from the RN community.

I don't care about you. I don't care about Texas. I don't care about what other medics in ERs do. I also don't plan on being a paramedic forever.

However, I also am not gonna take a barrage of incorrect insults and insinuations about our profession to make another appear grandeur laying down. If we allow that collectively or passively, we set a further establish the precedent that a.) it is true, and b.) that it is okay.

It is not.

 

[Summit]

Sandpit, Dr P, seriously, stop. Your attitudes and arrogance reflect extremely poorly on EMS. So does your double standard.

You are being intellectually dishonest by claiming that "RNs can't" then when told that they can, you switch your argument to "well, most usually don't" and then insinuate that is tantamount to "can't."

 

[Carlos Danger]

"When the debate is lost slander becomes the tool of the enemy."
-Socrates

Slander requires 1) a spoken word, and 2) an intentional mistruth about someone.

What I did was not slander, it was mockery. Big difference.

You and the author of that letter are making a claim that the autonomy of RNs exceeds that of a Paramedic and that RNs hold some sort of eliteness

This could not be further from the truth.

Apparently, your poor reading comprehension skills rob you of the ability to understand that I was squarely on the side of paramedics at the beginning of this thread, and was simply warning against using "but nurses can't do anything without a doctor telling them to, and we are autonomous" as a defense against the ENA's letter, because it's demonstrably untrue. That is all.

But that was just too much for some of you to be expected to grasp, I suppose.

What I said earlier was I am willing to be "corrected." I should have said I am willing to be educated - demonstrate a factual case in which a normal RN has the same autonomy...e

I gave several examples. Re-read my posts.

However, that's not the focus of my points. My point is similar to what Dr.P is saying. I know we look prissy to you down here from up there on your high horse

You don't look prissy, you look desperate. And you look ignorant about nursing practice. It is of course fine for someone who isn't a nurse to be ignorant about nursing practice......but you shouldn't pretend not to be.

However, I also am not gonna take a barrage of incorrect insults and insinuations about our profession to make another appear grandeur laying down.

I haven't insulted "your" profession once. I still love EMS and have great respect for paramedics, which is why I hang out here. I learn from paramedics all the time, and like to think that I am able to share some of what I know.

What I have no patience for is the repulsive combination of ignorance and cockiness that unfortunately afflicts so many individual paramedics, and makes life hard for all the good ones.

 

[SandpitMedic]

Cockiness has nothing to do with it. I know my role. You should check your fire. The ENA is full of so much BS, period. And I don't know why you can't just concede that a field paramedic has more autonomy than an RN...

You said ignorant, desperate, and cocky... I think "spoken word" translates into written word via forum in this case, but whatever.

Like I said, I don't care what you have to say about me personally. I'm all out of ****s to give. You can "hang out here" all you want- sometimes you know what you're talking about. I enjoy those times. #Remi2016!

 

[SandpitMedic]

Deleted

Paramedics who want to keep on being treated like kids and disrespected... Reap what you sow.

Over it.

 

[triemal04]

I just don't understand this. I really don't.

To anyone who actually understands the medical field, the letter that sparked everyone up is nothing more than an embarrassment to the author, and the group she represents.

Many of the response's here just further that embarrassment, for BOTH professions.

While there should be, and needs to be a public rebuttal to the false allegations and half-truth's put out by the ENA, countering with ignorance and hyperbole is counterproductive.

 

[triemal04]

Maybe somebody could actually do something like point out the differences and similarities between the 2 professions.

Differences:
RN: require an associate's degree.
Paramedic: require about a year's worth of schooling.

RN: taught primarily as a generalist with supportive care; if it was a field of medicine, it would be closest to family practice, with maybe palliative care I'd say.
Paramedic: taught primarily about emergency medicine.

RN: focus on working primarily in a controlled setting with abundant resources.
Paramedic: focus on working primarily in a less-controlled setting with limited resources.

RN: focus on working in a team setting under more direct control.
Paramedic: focus on working individually under indirect control.

Similarities:
Work under the supervision (direct or indirect) of a doctor.
Cannot function in their capacity as a paramedic or RN without the above supervision.
May provide higher level's of care in their capacity as a paramedic/RN in specific settings.
Require OJT or courses beyond the scope of their primary education for specific settings and functions.
Can work in multiple settings, including in/out of a hospital.
At the base level, with some exceptions, can administer the same meds and perform the same interventions.

There. No hyperbole, no exaggerations, no miss placed anecdotes about local areas or settings. No confusing extra training and advanced care settings for the basic level that is taught.

If anyone wants to add something to those lists, please feel free.

 

[Summit]

I think Triemal made a good post. I'll make some additions:

Average age of a Paramedic: 35
Average age of a RN: 45

RN: require an associate's degree.

>50% of new graduate RNs have a BSN or MSN and this is growing.
>50% of all RNs have a BSN, MSN, or DNP.
Most hospitals are asking for a BSN minimum in order to work in acute care, an increasing trend.
~3% of new nurses enter the profession without a degree, instead completing a 3 year hospital diploma program. Of the total RN population, 10% of all RNs have no nursing degree.

RN: taught primarily as a generalist with supportive care; if it was a field of medicine, it would be closest to family practice, with maybe palliative care I'd say.

I agree with the generalist training, but family practice + palliative is not quite the closest analogy. The primary aim of most RN programs which is inpatient acute and procedural care. Back in school, 90% of my 1200 hours were critical care/ER/acute/procedural(OR/IR/EP). The other 10% were public/community health.

~60% of RNs work in the hospital setting. The other ~40% are divided between public health, home health, community health, nursing education, transport nursing, ambulatory care, nursing homes, policy/case/insurance/legal etc.