There is nothing more irritating than incompetent nurses...

[mycrofft]

Corky...right on about prehospital situation and nurses.

Most (not all) nurses will either freeze or maybe go down swinging at a traffic accident...except the former-EMT-B or P's! (Or military veterans who worked in a combat zone). Hard to tell that to a dollar conscious administrator sometimes, though!

 

[usalsfyre]

Not sure what you're talking about as it refers to myself as I was a paramedic loooooooong before I was a nurse. Secondly, my reference to board certification was in response to another poster stating that RNs were "jacks of all trades, masters of none."

A neither new nurse or a new paramedic is particularly specialized.

There is no push that i know of to move into EMS by nursing. I can't imagine anyone in their right mind wanting to work more hours for much, much, much less money and little to no respect, so I'm not sure where that's coming from.

911 response? No. Transport medicine? Ask an ASTNA board member what they think of a dual paramedic or paramedic-led aircraft.

And lastly, nursing pushes back in any attempt to play in their sandbox because they have something that is completely foreign to EMS; competent, cohesive leadership that actually advocates for nurses and protects its profession. EMS does not have that which is why our local medics, regardless of their education , make about 10 bucks an hour and subjects to the whims of the ambulance owners association that takes care to make sure they can work them to death for no money......which is why they leave, usually for nursing. The NREMT is a U-S-E-L-E-S-S organization that does nothing to actually advance EMS as a profession, which is why its in the shape its in now.

I can't say I particularly disagree, although as you note earlier, they are cohesive to the point of idiocy at times (see Jean Watson's energy theories).

Also, in my heart of hearts I think that a lot of this board certification process is just a racket so that these organizations can make money. I just looked up that BCCTPC website and anyone can take that test just so long as they're willing to join the org and pay or not join the org and pay more. Same as with most, but others require letters of reference and audit their candidates.

The ENA is not exactly any different with the CEN, CFRN or CTRN certifications. Pay your money, pass the test, and your certified.

I can assure you through first hand experience the FP-C is no cakewalk.

 

[DrankTheKoolaid]

Tech versus professional. Sigh.

There are many unprofessional nurses (and doctors, lawyers, school teachers etc), and many many techs who are top-notch professionals. This blurs it.

I have participated in multiple drawn out threads here about the divide between a profession and a technical field. Nursing barely makes the cut as a profession and the more technical it gets the less of a distinct profession it is.

A unique field of research, knowledge and practice; self-governance to a degree; and the ability and expectation to make decisions and direct others based upon this field of knowledge; these are three bedrock elements. Like the difference between a 2nd Lt and a MSgt, which one has the depth of training and the expectation/duty/right to decide and lead?

Prehospital EMS (PEMS) and the use, in abrogation of the NHTSA nomenclature, of Emergency Medical Technicians (B or P) in non-emergency roles, is predicated on protocols based upon medical research, written by (or approved) and enforced by doctors. The ability to self-govern really makes the difference. If the AMA decided today to eliminate the current EMT system, there is a good change that they could really make a dent, whereas there is NO EMT association (NREMT is not) to protect EMT's or take the fight back to offending entities.

If the prep for Paramedic is the same as for nurses and makes them equal, why can't paramedics just take the NCLEX and get that RN tacked on for higher average pay, wider geographic employment opportunities, openings for administrative and research jobs? Because preparation in nursing college (read posts above by nurses) is broader and not just based upon technique. Or at least it shouldn't be. There are cram course and books to study for NCLEX to allow "nursing technicians" (nursing mill grads or nurses from countries where standards are not so high) to get their license who ought not to, in my opinion.

If you aren't a nurse, you do not know what preparation is entailed and what the difference is, but try this: if a paramedic walks into a hospital, can (s)he give a nurse an order? On the other hand, nurses in hospitals often give or pass on orders to techs. A nurse CANNOT accept a second hand/verbal order, but techs customarily do. Professional autonomy.

This sounds like the threads about guns and tattoos; when the advocates are asked pointblank, their response is "You just don't get it, do you?".

Again and again and again: neither specialty is superior, and the people who can't cooperate and are nasty with other care team members for whatever reason (race, gender, certificates, religion, tribal or clan affiliation etc.) need to go play by themselves.

PS use SEARCH

Thanks for your response. I know about the other threads, I was just looking for your opinion was all.

As to this, I meant the pre-requisite coursework IE Anatomy, Physio, Micro, Chem, Psych, Soc, Eng 1, Psych 1 + 14, Nutrition, Health span, etc etc etc etc.
I know the programs themselves are completely different with completely different views and perspectives. The same can be said though about new grad RN's being able to pass NREMT-P with no other training, just simply wont happen in 99% of cases unless they had some other experience as their training focus is completely different.

 

[Veneficus]

"my nurses"

Why is a paramedic considered a "tech" and not a professional in your eyes when some of us completed the exact same pre-requisite coursework as ADN/ASN nurses?.

I think this is easily answered, though it might not nbe the answer you want.

You might be educated to the basic level of an RN, but many (read vast majority) of your peers are not.

In my hometown alone nearly 100 paramedics that met the state's 750 hour required education for paramedic graduate every semester.

There are many places where paramedics are supposed to be and are treated like "techs" still. Many large places. (check out some of the forum posters here)

Untill all paramedics have as a minimum education that of an entry level nurse (or other healthcare provider) then they do not possess a significant specialized body of knowledge to make the move from tradesman to professional.

Strangely enough I am reading a book on the history of surgeons that demonstrates how they began as basically less than barbers and their climb from tradesman to medical professional. There are some very striking similarities between the two groups. (too many to name here) The most striking is that at one point the were banned from medical university and then when finally admitted decried how they didn't need it. (Sounds like when paramedics tried to enter degree programs and count the vocational certificates for credit and now complain they don't need more education.)

but we are masters of emergent pre-hospital care as we should be.

Sorry, but...no... You are not the master of it. If you were the master of it, you could decide what the treatments would be and when you would use them. If you were the master you could demand the practices that have been demonstrated to not work be removed as well as institute new ones when you demonstrate their value.

As it stands, you simply cannot. Paramedics are still at the mercy of other professionals. (both nursing and medical)

Let see that wide bottom NOC RN that is considered a professional even consider putting herself out into a unfamiliar situation and gladly accept the challenge. You as well as I know that isn't going to happen.

Nor do paramedics without extra training and education function well outside their preferred environment.

And with the exception of MICU/ICU/STICU/ED RN's I know, actually attempt to continue learning, instead of just settling in and being happy as the MD's puppet taking orders.

I think this is a very unfortunate characterization of nurses and nursing.

Both patients and medical staff appreciate the contributions of the bedside nurse. So much so, that giving grief to the nurses of a doctor is sort of like an attack on the King's soldiers. You will also not impress patients by criticising the nurses that took care of them either.

The point of nursing is to take care of basic life needs. (I don't know them very well offhand, because I was not exposed to them as much as nurses are) But bathing, eating, dressing, the ability to carry on some level of activity, health awareness and promotion (like public health management as an extension so people will not get sick enough to need a doctor, which is the basis for the NP angle) and helping to take the prescribed medication, along with spiritual/social interaction and the efforts to help reduce pain is the nurses body of knowledge. It is what makes them professionals. (and also incidentally what got them into anesthesia)

The role of the nurse is to help the patient (sometimes by doing it for them) follow the instructions prescribed by the doctor and to report to the doctor the success of, failure of, complications of, and potential hazards of during the course of patient care.

It is not the "decision making" that they assumed as the need for standing orders came about in medicine. It is not the specialized skills that they learn when functioning in the ICU or other technically advanced environment.

The role of the prehospital paramedic is to follow standardized guidlines of patient care in the absence of a physician until that person can be taken to one.

(in fact back in the day when I went to paramedic school, a paramedic was defined as: "The prehospital care provider in the absence of a physician")

It is in my opinion terribly unfortunate that EMS is not truly part of the continuum of patient care. (lip service is paid to it, but in practicality it is not) The patients journey through healthcare oftne starts over as soon as they reach the hospital. Even when you take them directly to the cath lab or trauma surgery.

Many of the "prehospital treatments" that are perpetuated because of "the environment" and "If we didn't do this we wouln't do anything so give us something to do" would not even be considered by in house care providers. (including facilities smaller than hospitals)

I do not consider myself anti-paramedic. Actually I am rather pro-paramedic. The thing is though, I can call a spade a spade, and the medicine that US EMS has to swallow in order to become true professionals is going to taste really bad, and have a few unpleasant side effects.

But when you attack the way a nurse carries out the prescriptions of a doctor, because you do not like the treatment or method, then you are attacking the decision maker too.(the doctor)

As a paramedic, I can tell you that you definately do not have the body of knowledge required to do that.

 

[DrankTheKoolaid]

You might be educated to the basic level of an RN, but many (read vast majority) of your peers are not. Fair enough


Sorry, but...no... You are not the master of it. If you were the master of it, you could decide what the treatments would be and when you would use them. If you were the master you could demand the practices that have been demonstrated to not work be removed as well as institute new ones when you demonstrate their value.

As it stands, you simply cannot. Paramedics are still at the mercy of other professionals. (both nursing and medical) Sigh, also fair enough



Nor do paramedics without extra training and education function well outside their preferred environment.




I think this is a very unfortunate characterization of nurses and nursing.

Both patients and medical staff appreciate the contributions of the bedside nurse. So much so, that giving grief to the nurses of a doctor is sort of like an attack on the King's soldiers. You will also not impress patients by criticising the nurses that took care of them either. Not something i ever do, and especially to a patient.

The point of nursing is to take care of basic life needs. (I don't know them very well offhand, because I was not exposed to them as much as nurses are) But bathing, eating, dressing, the ability to carry on some level of activity, health awareness and promotion (like public health management as an extension so people will not get sick enough to need a doctor, which is the basis for the NP angle) and helping to take the prescribed medication, along with spiritual/social interaction and the efforts to help reduce pain is the nurses body of knowledge. It is what makes them professionals. (and also incidentally what got them into anesthesia)

The role of the nurse is to help the patient (sometimes by doing it for them) follow the instructions prescribed by the doctor and to report to the doctor the success of, failure of, complications of, and potential hazards of during the course of patient care.

It is not the "decision making" that they assumed as the need for standing orders came about in medicine. It is not the specialized skills that they learn when functioning in the ICU or other technically advanced environment.

The role of the prehospital paramedic is to follow standardized guidlines of patient care in the absence of a physician until that person can be taken to one.

(in fact back in the day when I went to paramedic school, a paramedic was defined as: "The prehospital care provider in the absence of a physician")

It is in my opinion terribly unfortunate that EMS is not truly part of the continuum of patient care. (lip service is paid to it, but in practicality it is not) The patients journey through healthcare oftne starts over as soon as they reach the hospital. Even when you take them directly to the cath lab or trauma surgery.

Many of the "prehospital treatments" that are perpetuated because of "the environment" and "If we didn't do this we wouln't do anything so give us something to do" would not even be considered by in house care providers. (including facilities smaller than hospitals)

I do not consider myself anti-paramedic. Actually I am rather pro-paramedic. The thing is though, I can call a spade a spade, and the medicine that US EMS has to swallow in order to become true professionals is going to taste really bad, and have a few unpleasant side effects.

But when you attack the way a nurse carries out the prescriptions of a doctor, because you do not like the treatment or method, then you are attacking the decision maker too.(the doctor)

As a paramedic, I can tell you that you definately do not have the body of knowledge required to do that.

That I know, the more I learn the more I realize I don't know jack and am the first to admit it. But do try to improve

 

[TatuICU]

I think this is easily answered, though it might not nbe the answer you want.

You might be educated to the basic level of an RN, but many (read vast majority) of your peers are not.

In my hometown alone nearly 100 paramedics that met the state's 750 hour required education for paramedic graduate every semester.

There are many places where paramedics are supposed to be and are treated like "techs" still. Many large places. (check out some of the forum posters here)

Untill all paramedics have as a minimum education that of an entry level nurse (or other healthcare provider) then they do not possess a significant specialized body of knowledge to make the move from tradesman to professional.

Strangely enough I am reading a book on the history of surgeons that demonstrates how they began as basically less than barbers and their climb from tradesman to medical professional. There are some very striking similarities between the two groups. (too many to name here) The most striking is that at one point the were banned from medical university and then when finally admitted decried how they didn't need it. (Sounds like when paramedics tried to enter degree programs and count the vocational certificates for credit and now complain they don't need more education.)




Sorry, but...no... You are not the master of it. If you were the master of it, you could decide what the treatments would be and when you would use them. If you were the master you could demand the practices that have been demonstrated to not work be removed as well as institute new ones when you demonstrate their value.

As it stands, you simply cannot. Paramedics are still at the mercy of other professionals. (both nursing and medical)



Nor do paramedics without extra training and education function well outside their preferred environment.




I think this is a very unfortunate characterization of nurses and nursing.

Both patients and medical staff appreciate the contributions of the bedside nurse. So much so, that giving grief to the nurses of a doctor is sort of like an attack on the King's soldiers. You will also not impress patients by criticising the nurses that took care of them either.

The point of nursing is to take care of basic life needs. (I don't know them very well offhand, because I was not exposed to them as much as nurses are) But bathing, eating, dressing, the ability to carry on some level of activity, health awareness and promotion (like public health management as an extension so people will not get sick enough to need a doctor, which is the basis for the NP angle) and helping to take the prescribed medication, along with spiritual/social interaction and the efforts to help reduce pain is the nurses body of knowledge. It is what makes them professionals. (and also incidentally what got them into anesthesia)

The role of the nurse is to help the patient (sometimes by doing it for them) follow the instructions prescribed by the doctor and to report to the doctor the success of, failure of, complications of, and potential hazards of during the course of patient care.

It is not the "decision making" that they assumed as the need for standing orders came about in medicine. It is not the specialized skills that they learn when functioning in the ICU or other technically advanced environment.

The role of the prehospital paramedic is to follow standardized guidlines of patient care in the absence of a physician until that person can be taken to one.

(in fact back in the day when I went to paramedic school, a paramedic was defined as: "The prehospital care provider in the absence of a physician")

It is in my opinion terribly unfortunate that EMS is not truly part of the continuum of patient care. (lip service is paid to it, but in practicality it is not) The patients journey through healthcare oftne starts over as soon as they reach the hospital. Even when you take them directly to the cath lab or trauma surgery.

Many of the "prehospital treatments" that are perpetuated because of "the environment" and "If we didn't do this we wouln't do anything so give us something to do" would not even be considered by in house care providers. (including facilities smaller than hospitals)

I do not consider myself anti-paramedic. Actually I am rather pro-paramedic. The thing is though, I can call a spade a spade, and the medicine that US EMS has to swallow in order to become true professionals is going to taste really bad, and have a few unpleasant side effects.

But when you attack the way a nurse carries out the prescriptions of a doctor, because you do not like the treatment or method, then you are attacking the decision maker too.(the doctor)

As a paramedic, I can tell you that you definately do not have the body of knowledge required to do that.

I mostly agree with this. Now how does EMS change? Do we toss the NREMT since they have proven their existence to be utterly useless and in no way, shape, or form beneficial for EMS professionals? If they were conditions would not be as they are here in my town. Who takes the reigns and says, "Ok, from now on we're requiring degrees, etc" ?

 

[mycrofft]

Wish we could all pop a beer or soda and look across and realize we're in accordance.

(can't find equiv for females under fifty)

 

[Veneficus]

I mostly agree with this. Now how does EMS change? Do we toss the NREMT since they have proven their existence to be utterly useless and in no way, shape, or form beneficial for EMS professionals? If they were conditions would not be as they are here in my town. Who takes the reigns and says, "Ok, from now on we're requiring degrees, etc" ?

I started numerous threads on this and took part in many more.

the latest was a 10 year plan on how to get paramedics a 4 year degree.

By far not a perfect plan, but I described several steps which were successful for the fire service in promoting its members to get fire science degrees.

You can read it here:

http://www.emtlife.com/showthread.php?t=28207&highlight=year+plan

 

[JPINFV]

Sigh.

The NREMT is not a professional organization. The NREMT is akin to the National Board of Medical Examiners who puts on the US Medical Licensing Exam. The NREMT develops their tests based off the standards set elsewhere, specifically the NHTSA.

The NAEMT is the current national EMS association. Want to [complain] and moan that the national EMS organization isn't progressing the trade to a profession? [Complain] and whine at the NAEMT as it's NOT the NREMT's job to progress EMS.

 

[Canadian Travel Medic]

I was dispatched to transport a 73 year old male on a day pass from palliative care (over christmas), that has a Hx of Lung Ca, Emphysema and has little to no distal circulation in his extremities d/t extreme frostbite when he was younger. He's on Home 02 and ways about 115lbs and looks sick to begin with normally. We'll I get the guy back into his room and i'm giving report to the Dr in the hallway, and this grad nurse walks in and hooks up her NIBP and Sat probe and gets a reading of 72% on 2L. Well she loses it, pages respiratory stat and hits the code button, so me and this Dr going running in. We get in and here's this poor guy, laying down? with an NRB on and cranked up to 15Lpm, saying he's fine and talking in full sentences with a reps rate about 20 and no audible acute distress. I gave her the benefit of the doubt, assuming she had never seen this patient before and didn't know about his circulation problems.....she said she had him all last week. I just laughed inside and walked away haha.

 

[EFDUnit823]

Sorry wasn't aware it was dbag day on the forum.

Bibasilar rales is a commonly used term around here. It is entirely possible to only have fluid present in one lung and not both. The term is obviously used to distinguish between the two possibilities. Sorry they don't use such terminology out by you. Feel free to google it, it is an actual term.

Basal or basilar crackles (not to be confused with the basilar artery of the brain) are crackles apparently originating in or near the base of the lung. Bibasal or bibasilar crackles refer to crackles at the bases both the left and right lungs. Bilateral basal crackles also refers to the presence of basal crackles in both lungs.

Also, rales and crackles are the same god damn thing. My PCR has a box that says Rales, not crackles. So obviously someone feels it is still an acceptable term.

And at 8am, a call for dsypnea usually has you thinking APE. Of course that doesn't mean anything till you see the patient. Its just a general size up of the call type prior to arrival.

I also wasn't aware that we only gave nitroglycerin for suspected infarctions. Last I checked it was the first line pre-hospital treatment for pulmonary edema.

Also, please inform me how you plan to diagnose pnuemonia in the field on a patient who isn't coughing or febrile. Has rales, not rhonci and commonly gets pulmonary edema with a history of CHF. I really hope you don't show up for my grandmother.

LoL...OWNED! On a side note, I work on an ambulance service where we work ED when not on the ambulance. I feel your pain in regard to the nurse’s sense of “superiority” over EMS!

 

[jjesusfreak01]

I was dispatched to transport a 73 year old male on a day pass from palliative care (over christmas), that has a Hx of Lung Ca, Emphysema and has little to no distal circulation in his extremities d/t extreme frostbite when he was younger. He's on Home 02 and ways about 115lbs and looks sick to begin with normally. We'll I get the guy back into his room and i'm giving report to the Dr in the hallway, and this grad nurse walks in and hooks up her NIBP and Sat probe and gets a reading of 72% on 2L. Well she loses it, pages respiratory stat and hits the code button, so me and this Dr going running in. We get in and here's this poor guy, laying down? with an NRB on and cranked up to 15Lpm, saying he's fine and talking in full sentences with a reps rate about 20 and no audible acute distress. I gave her the benefit of the doubt, assuming she had never seen this patient before and didn't know about his circulation problems.....she said she had him all last week. I just laughed inside and walked away haha.

I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.

 

[TatuICU]

I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.

Whoa, intense, good thing you were to help the doc out.

 

[exodus]

I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.

Why not just stick him on capnography =/

 

[jjesusfreak01]

Whoa, intense, good thing you were to help the doc out.

They would have eventually figured it out when the monitor started alarming hardcore. The doc's a friend of mine. I had the benefit of getting to stare at the patient for five minutes while he charted and the nurse saw to her other patients. Its a lot easier to figure out what's wrong with a patient when you get to observe them for a longer period of time.

Why not just stick him on capnography =/

While a good idea, most ERs (at least where I live) do not use ETCO2 as a standard monitoring tool. In my local hospitals, only the trauma/resuscitation rooms have capnography built into the monitor.

 

[Aidey]

Why not just stick him on capnography =/

It might not be available without calling respiratory for a monitor. None of the mounted vitals monitors in our 4 local ERs originally had capnography built in. 2 of the hospitals now have a couple each but you may not get a room with one. Capnography is truly something that was adopted faster pre-hospital than in the ED.

 

[46Young]

I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.

I'm suprised that sidestream quantitative capnography is not used more often to monitor the pt's respiratory status. For example, a pt on opiates can be breathing at 24/min but shallow, and will be trending towards respiratory failure. Another pt can be breathing at 8/min but deep, and be fine. SPO2 has too much of a delay; ETCO2 is in real time.

 

[46Young]

Why not just stick him on capnography =/

Funny, I just said that, and then read your post.

 

[46Young]

It might not be available without calling respiratory for a monitor. None of the mounted vitals monitors in our 4 local ERs originally had capnography built in. 2 of the hospitals now have a couple each but you may not get a room with one. Capnography is truly something that was adopted faster pre-hospital than in the ED.

Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.

 

[TatuICU]

They would have eventually figured it out when the monitor started alarming hardcore.

Still though, always nice to avoid the apnea alarm if at all possible.