That is certainly another reason.
Consider this, What seperates an RN from a Paramedic, skills wise? Foley insertion for the RN - Intubation for the Paramedic unless a RN is specialized there is no other seperation as we access and use central lines, give IV/IM/SQ/IN and PR meds and can monitor TPN and blood along with hanging more units of blood while in transit. The glaring difference with medications is the Abx and Insulins. Give those to Paramedics and then what is the justification for staffing a ER or other floor with more expensive RN's when the medics can do it at a cost savings.
Dont take this as me questioning a RN's knowledge as that isnt my point. I completed all the same pre-req's and know the work they went through to get into school. But in reality in most ER's you could remove 2/3 of the RN staff and replace them with Medics if they were given Insulin and ABX abilities at a huge savings to hospitals while the left over RN's do anything out of bound like the odd med and *cough* foley insertion.
Essentially you are saying replace all the BSN RNs (which is now over 60% in California) with the 1000 hour trained Paramedic?
What about all of the other skills and knowledge the RN brings to the assessment of a patient. The foley is well within a Paramedic scope of practice but not many have ever cared to utilize it. What about all of the patient educaiton? None of that is covered in Paramedic school. You can just replace education with skills jockeys and expect the same quality of care for the long term. Nothing in EMS training prepares the Paramedic for the admission and plan of care. Ask any Paramedic to assess the decubitus on the butt of a diabetic quad and they will probably tell you to go to hell. I think that was exactly what the state of TX EMS regulator said when they came up with their own community Paramedic legislation. Since EDs are now the holding wards for the ICUs, Paramedics can not assume all the responsibilty of an ICU nurse especially in California.
You need to separate the skills from the knowledge. In California the RN has a very broad scope of practice and any skill a Paramedic can do so can an RN. But, there are not very many medications that a Paramedic can give while the RN can give whatever medication provided they have competency in that area. There is also a big difference between monitor or babysit a med and actually have the protocols and expertise to titrate the meds. The Paramedic is limited by their state's scope of practice while an RN may have a very broad scope of practice and are only limited by the area they work in. RNs can intubate by most states' scope of practice but may not need to.
You are also seeing one tiny part of what a nurse can do in an ED and the hospital you are near might be a small community type.
Take the CCEMTP course and get a little taste of critical care medicine even if you have to take it at AMR NCTI. Take one of the nursing Trauma or Advanced Trauma courses. Find a good neuro hospital and try to take one of their assessment courses for nurses. You might be enlightened to know RNs do alot more than push antibiotics and insert foleys.
Your attitude is exactly what is wrong with the US system for EMS educaiton. You believe the few skills in EMS supercedes all of the education stuff and intubation makes you more valuable than someone who has assessment knowledge in may areas. This replace all the educated personnel who can easily expand their skills with someone who is votech trained sets health care back to 1970 which is where EMS in California has stayed. At some point EMS has got to see the value of education.
All the other professions have moved forward and have received their compensation by reimbursement and wages. EMS still sells "skills" and we can do it cheaper mentality.
Not trying to push RNs but rather trying to show you where statements like yours have kept EMS at barely acceptable education standards and at minimum wage unless you also fight fires.
