There is nothing more irritating than incompetent nurses...

[TatuICU]

Tell them that you want ACLS and PALS on there too.

It's just ridiculous. The thing is that you have to have all those certs to work in the CVICU anyway so that's like a auto mechanic wearing a name badge indicating that he can change oil, do your brakes, flush your radiator, AND rotate your tires. Isn't that what a mechanic is supposed to be able to do?????

 

[mycrofft]

Having made the mistake of equating the med tech career tree with the nursing career tree, I can tell you the two are quite separate. ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful areas available when you take advantage of a college education and not a tech school one. Been there, done both, although not as a paramedic per se.

My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.

Nonetheless, on the line, nurses, techs and docs all need to play nice and quit sniping.

 

[ffemt8978]

Wow, my first day back on the forums in a while and I get to watch a heated debate.......99 and NY, ya'll play nicely now...don't make me call in a referree

Too late, I already started reading this thread.

Wanna bet?

I've been bored lately, so I've been looking for volunteers to become the focus of my complete and undivided attention. Am I sensing that I now have two people volunteering for that?

 

[BandageBrigade]

Having made the mistake of equating the med tech career tree with the nursing career tree, I can tell you the two are quite separate. ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful areas available when you take advantage of a college education and not a tech school one. Been there, done both, although not as a paramedic per se.

My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.

Nonetheless, on the line, nurses, techs and docs all need to play nice and quit sniping.

Whoa there buddy.. I have the exact same college education that my associates degree level nursing counter parts have, me minus the nursing specific courses, them minus the paramedicine specific courses. Not every paramedic school is a tech school, or just offers a certificate.

 

[NYMedic828]

I understand the frustration. However, your report would get pulled and be up for peer review for giving NTG without a line at my former service. Of course you could explain yourself but bottom line is according to protocol you would've been wrong. The MD would've asked you something like "What if the pt was septic?" and just generally been a grumpy *** about it.


This is what concerns me about your post "Nothing irks me more than nurses thinking they are better than us just because they have a higher title."

I'm a NREMT-P/RN, BSN, CCRN currently working in a CVICU and I'm not quite sure where you're getting the idea that RN is a higher title than NREMT-P. I received the same AS with my Paramedic degree as a I did with my ADN. It wasn't until I finished my BSN (completely :censored::censored::censored::censored:ing useless BTW and got a me a hearty raise of about 9 cents an hour) that I would have considered myself as having "more education" than the average Paramedic. As a medic you have the same degree as an ADN does, so try giving yourself a bit more credit would ya?

Paramedic is not a degree in new york state. As far as I know anyway...

The nurses at the particular hospital are always self-righteous :censored::censored::censored::censored::censored:s to us. They assume that because we are a volunteer service that we must all be incompetent and half the time they could care less to hear from us what is wrong and just ask us for our paper to sign. I'm not getting a paycheck to show up to a call on my day off volunteering the least they could do is be even the slightest bit more respectful. They are a slow hospital as is. Getting patients basically annoys them because they have to do work.

The way I get treated by nurses and doctors at work vs volunteering is barely even comparable.



In regards to the nitro, our protocol

No IV but BP >120 systolic, can give nitro.

Yes IV, BP greater than 100 systolic, can give nitro.

 

[TatuICU]

ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful.....

My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.

You are incorrect. I received my AS in Emergency Medical Services after having satisfied the degree requirements which included the same sciences as of my nursing program. In fact, in terms of true usefulness, a new grad ADN is far less capable in my opinion than a new grad Paramedic. Usually their skills suck and they still have little or no concept of why they are doing the things they're doing.

I can't remember ever being handed a question on my paramedic exams where the answer was "Tell me more about how that makes you feel."

As far as the BSN, while it may help you in your arena in life, by and large it does nothing for us civi nurses. I received more of a raise for my CCRN certification than I did for my BSN. One cost $275 for a test, the other roughly $25000. One got me 50 cents, the other got me about 9 cents. I believe in board certification but frankly, the more I think about it, nursing would be better served requiring a biology, chemistry, micro, etc degree in lieu of the community health, professional nursing role, etc classes that take up (notice I didn't say "make up") a BSN program.

If given the choice I would've pursued more education and board certification as a Paramedic, but EMS is so screwed up in this country that its very tough to find programs that offer that sort of thing. Hence the move to less hours and more money as a nurse.

If you've not worked "as a paramedic per se", I would submit that perhaps you aren't the most qualified person to speak on the subject, especially if you attended a paramedic program that did not require a degree.

 

[TatuICU]

Whoa there buddy.. I have the exact same college education that my associates degree level nursing counter parts have, me minus the nursing specific courses, them minus the paramedicine specific courses. Not every paramedic school is a tech school, or just offers a certificate.

Thank you

 

[Veneficus]

nursing would be better served requiring a biology, chemistry, micro, etc degree in lieu of the community health, professional nursing role, etc classes that take up (notice I didn't say "make up") a BSN program.

If I could just point something out about that?

Those community health and nursing role type classes reinforce and add to the purpose of nursing. Which is to attend to the basic needs of life.

When you start moving into basic science as the focus of education for clinical nurses, you are simply duplicating something that already exists at a much more basic level.

If the practice of medicine based on scientific principle is really what you want to be doing, there is a school and a career path for that.

No patient is served better by a duplicate effort from a less capable provider.

If you remove the function and value of nurses, then all you do is eliminate them. After all, if they are no longer taking care of basic needs, what good are they?

 

[46Young]

Paramedic is not a degree in new york state. As far as I know anyway...

The nurses at the particular hospital are always self-righteous :censored::censored::censored::censored::censored:s to us. They assume that because we are a volunteer service that we must all be incompetent and half the time they could care less to hear from us what is wrong and just ask us for our paper to sign. I'm not getting a paycheck to show up to a call on my day off volunteering the least they could do is be even the slightest bit more respectful. They are a slow hospital as is. Getting patients basically annoys them because they have to do work.

The way I get treated by nurses and doctors at work vs volunteering is barely even comparable.



In regards to the nitro, our protocol

No IV but BP >120 systolic, can give nitro.

Yes IV, BP greater than 100 systolic, can give nitro.

I think what you meant is that NY EMS systems do not require EMS degrees for hire. Most don't.

I believe that LaGuardia and Suffolk CC both have the EMS AAS (two year) degree. I'd highly recommend getting at least that degree at the least, in case you decide one day to leave NY and work somewhere else. You may intend to do the whole 25 years right now, but things can change, priorities change. If you build off that AAS to a BA in EMS, that's really useful when applying to an out of state EMS organization as a Director or other upper management. In fact, more and more places require it nowadays. As far as credits, my local CC grants 37 credits for having my P-card (from NY Methodist '04-'05), so long as I fufill all the gen-eds and such. You can do that online at your own pace, or do KVO to be safe for sceduled classes if FDNY EMS still does that. I had a bunch of credits from Baruch ('94-'95) that expired, so find out how long your credits stay current if you do intend to take your time.

When I finished medic class, I had no intentions whatsoever of leaving NY. I nearly finished the FDNY medic hiring process, then decided to leave after one of our ex-employees came back to visit and told me how much better things were out of state.

As far as the nurses, I would suggest having your Chief, or better yet your OMD speak with nursing management or the physicians themselves to correct this undesireable practice.

 

[Scott33]

She said this happens occasionally and she just needs IV lasix, which is available on standing orders here.

What protocols are you working under? NYC REMAC moved lasix to an MC option only, in last August's update - one of the more progressive things they have done in a while.

 

[TatuICU]

If I could just point something out about that?

Those community health and nursing role type classes reinforce and add to the purpose of nursing. Which is to attend to the basic needs of life.

When you start moving into basic science as the focus of education for clinical nurses, you are simply duplicating something that already exists at a much more basic level.

If the practice of medicine based on scientific principle is really what you want to be doing, there is a school and a career path for that.

No patient is served better by a duplicate effort from a less capable provider.

If you remove the function and value of nurses, then all you do is eliminate them. After all, if they are no longer taking care of basic needs, what good are they?

And this is where theory and actual practice begin to part from another.

Current day, in-hospital ICU nursing IS based on scientific principle. Granted that is only one area of nursing, but for those of us who are taking care of post-op CABGs and not doing informatics work for example, the educational needs are quite different. Nursing education does not reflect that. There should be more than one BSN path for nurses wanting to further their career.

I'd discuss this with other nurses on a nursing forum if I were interested in discussing it, but this was not the point of my post.

I would prefer to discuss why I couldn't for the life of me find a CCEMT-P program to take and why there are such large discrepancies between EMS educations from region to region on this forum. Or perhaps why there are those out that feel their education and job is somehow less valuable than a nurses. I have at times been accused of being a tad self-loathing as a nurse.......not sure I would argue too hard against that.

 

[mycrofft]

Good to hear some Paramedic programs are not mills, but not all are that good.

My four year articulated BSN included chem, organic chem, biochem, microbiology, statistics, multiple clinical assignments, basic psych plus one in the 200 series (I took two, family dynamics, and alcoholism)and an advanced (year 4) elective clinical (I took community health), plus the basic college underbrush (English, a science elective which for me was computer programming in BASIC, etc). This is blowing past the anatomy, physiology (two separate semesters we took alongside baby doc students), pharmacodynamics, ethics (included labor issues with mock negotiations!), nutrition, physical exam, etc.

I did NOT emerge ready to start IV's, place ET airways, defibrillate, or other technical aspects because there was no time for that. I did come away knowing why and when they were needed, with an idea of what was needed to do it. I was not oriented and indoctrinated to act and react to emergency situations, which has to come from being on the line.

I was also taught, through the culture, not to respect EMT's; as a semi- inactive EMT, this stung, and I always resisted it. (I was also culturally taught doctors were our natural opponents, but that was not as potentially serious).

At any rate, we all need to work together for the pt's betterment. Maybe the ED and fire service need to be brought together with a moderator, or hauled together by the EMSA, to talk things out when this sort of warring breaks out, because it drives off good practitioners and can lead to disconnects in pt care.

 

[NYMedic828]

I think what you meant is that NY EMS systems do not require EMS degrees for hire. Most don't.

I believe that LaGuardia and Suffolk CC both have the EMS AAS (two year) degree. I'd highly recommend getting at least that degree at the least, in case you decide one day to leave NY and work somewhere else. You may intend to do the whole 25 years right now, but things can change, priorities change. If you build off that AAS to a BA in EMS, that's really useful when applying to an out of state EMS organization as a Director or other upper management. In fact, more and more places require it nowadays. As far as credits, my local CC grants 37 credits for having my P-card (from NY Methodist '04-'05), so long as I fufill all the gen-eds and such. You can do that online at your own pace, or do KVO to be safe for sceduled classes if FDNY EMS still does that. I had a bunch of credits from Baruch ('94-'95) that expired, so find out how long your credits stay current if you do intend to take your time.

When I finished medic class, I had no intentions whatsoever of leaving NY. I nearly finished the FDNY medic hiring process, then decided to leave after one of our ex-employees came back to visit and told me how much better things were out of state.

As far as the nurses, I would suggest having your Chief, or better yet your OMD speak with nursing management or the physicians themselves to correct this undesireable practice.

To be honest, while I truly enjoy my job as much as it does suck sometimes, I am in it to be a firefighter. My promotional test date is one month away from today. Been waiting a long time...

But, in the hopes of making the cut I am planning to return to school for RN on the side of working as a firefighter unless things improve for Paramedics around here first.

What protocols are you working under? NYC REMAC moved lasix to an MC option only, in last August's update - one of the more progressive things they have done in a while.

Nassau County REMAC still allows for lasix 40mg standing order or 80mg if they are already on lasix.

I volunteer on the island work in the city. Thankfully someone made a great protocol app for the iphone so I don't make any oopsies forgetting where I am at the time.

I have never given anyone Lasix. As far as I have been taught, true fluid overload is almost never the problem causing APE. The only reason I considered it for this woman was because she stated on her own that this happens all the time, she has urinary retention and they fix it with IV Lasix. But even still, I was alone as the only medical provider on the ambulance, 5 min from an ER. It seemed a lot more practical to give a trial of nitro, and transport. By myself I would of sat on-scene for another 3-10 minutes to do an IV, reassess vitals from the nitro and draw up and administer lasix. Sure I could of done an IV enroute, but on a 94 year old woman, with squiggly veins all over...

 

[TatuICU]

ethics (included labor issues with mock negotiations!)

We did the same and it was the first time since I was in high school that I actually thought that a physical altercation was going break out, lol. We had a local legislator come in and we also had one of the local scumbags from the ambulance owners association (the mob that keeps pay down and regulations loose so that they can work medics 72 hours at a time) as a guest. Interesting to say the least

 

[mycrofft]

5 min., pt basically stable, I agree.
RN is a good fallback from firefighter, can't swing from ropes or drive a pumper all your life. I wish I'd gone into environmental health or something like that, though. PM if you want the story posted hereabout in dribs and drabs.:rofl:

 

[Veneficus]

And this is where theory and actual practice begin to part from another.

Current day, in-hospital ICU nursing IS based on scientific principle. Granted that is only one area of nursing, but for those of us who are taking care of post-op CABGs and not doing informatics work for example, the educational needs are quite different. Nursing education does not reflect that. There should be more than one BSN path for nurses wanting to further their career..

In theory isn't that the role of the clinical nurse specialist?

I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?

I would prefer to discuss why I couldn't for the life of me find a CCEMT-P program to take and why there are such large discrepancies between EMS educations from region to region on this forum. Or perhaps why there are those out that feel their education and job is somehow less valuable than a nurses. I have at times been accused of being a tad self-loathing as a nurse.......not sure I would argue too hard against that.

I could suggest the reason is there is no state level accredidation for a level higher than paramedic.

I could also suggest that there is no recognized CC curriculum for paramedics.

As I understand, there are basically 2 seperate courses which compete for students. But these courses are measured in days. In effect being prolonged ACLS and similar courses.

(which is why I always laugh at people when I see them put CCEMTP after their name)

 

[Maine iac]

My protocols state "Do not delay nitro to establish IV access" for suspected adult pulmonary edema.

There are going to be slow people in every profession. Who knows, maybe that nurse got worked on the over night shift and the coffee machine is MIA.

Coming out of High School I worked in a pizza joint. Small town with D1 collegiate hockey so things could busy fast. Me and this guy would work the front together, either rolling the pizza dough or working the tiller. As soon as things got busy it was faster for me to roll the dough AND work the cash by myself and just have the guy step out of the way, because he made too many mistakes and in general slowed things down. He was a good guy to have around, but... slow.

Everybody has their niche and maybe you found the nurse who is great at pt care but just not complex pt care.

 

[NYMedic828]

In theory isn't that the role of the clinical nurse specialist?

I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?



I could suggest the reason is there is no state level accredidation for a level higher than paramedic.

I could also suggest that there is no recognized CC curriculum for paramedics.

As I understand, there are basically 2 seperate courses which compete for students. But these courses are measured in days. In effect being prolonged ACLS and similar courses.

(which is why I always laugh at people when I see them put CCEMTP after their name)

Around here in NY i believe a critical care paramedic usually just has a little more pharmacologic knowledge usually things like sedative drips of propofol. They also have training in the maintenance of ventilators and balloon pumps.

 

[Veneficus]

Around here in NY i believe a critical care paramedic usually just has a little more pharmacologic knowledge usually things like sedative drips of propofol. They also have training in the maintenance of ventilators and balloon pumps.

Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?

Either way it doesn't matter for this discussion, neither are recognized.

If they have their own program, I suspect the use of the CC is just a way to identify paramedics who have been locally upskilled by the authority of local/regional medical direction.

That method is really no different than the practice of local medical autonomy, similar to places like Texas.

Outside of your jurisdiction, it really doesn't mean crap.

 

[NYMedic828]

Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?

Either way it doesn't matter for this discussion, neither are recognized.

If they have their own program, I suspect the use of the CC is just a way to identify paramedics who have been locally upskilled by the authority of local/regional medical direction.

That method is really no different than the practice of local medical autonomy, similar to places like Texas.

Outside of your jurisdiction, it really doesn't mean crap.

Honestly I have no idea, but I think its an appointed title by the agency you work for and not a real title of any value.

North Shore for example has people who are critical care, and people who are 911.