Why are we often looked down upon as a profession?

[DesertMedic66]

Wow, I missed that gem the first time I read and quoted his post.

Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.

I missed it also. Went back after I saw it quoted.

 

[Summit]

if the NCLEX is the bar that nurses need to pass

The NCLEX is really designed to check for minimal knowledge/reasoning competency required to not kill your patients in your first year of practice.

If the industry would like to demand more than that, then they may be operating at a level above what the NCLEX was meant to guarantee.

 

[Summit]

Nursing scope of practice varies, but it is generally extremly broad and limited by individual competency and organizational policy. That is because RNs are educated as generalists, then they specialize. This is as opposed to EMS training which creates specialized technicians, thus they tend to have explicetly enumerated scopes.

Here is an example of the CO RN scope of practice guidance from the BON.

Ask the following question: Is this task/practice within my scope of practice?

• Was the skill/task taught in your basic nursing program?
• If it was not included in your basic nursing education, have you since completed a comprehensive training program that included clinical experience?
• Has this task become so routine in the nursing literature and in nursing practice (e.g. sharp wound debridement), it can be reasonably and prudently assumed within scope?
• Is the skill/task in your hiring agency policy and procedure manual?
• Does carrying out the duty pass the "Reasonable and Prudent" standard for nursing?

If you can answer "yes" to all the above questions, the task is within your scope of practice.

See how different that is than a 15 page chart of skills with check boxes for 5 or 6 different levels of EMS training that you can get from your EMS board?

 

[VFlutter]

I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.

Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.

I will agree that on this forum we see the best of both professions and not all RNs are skilled ER/ICU clinicians just as all medics are not exceptional. It is hard to have an accurate representation of a group on an online forum. Having said that I think that your misconceptions about nursing are blatantly ignorant and not worth the effort to argue.

The scope of practice thing always makes me laugh. EMS has a broad scope of practice out of necessity, that does not mean that is deserved nor does it validate yourself as a professional. What happens to your scope of practice if you work in an ER as a Medic? Most Nurses do not need a broad scope of practice because it is not necessary working in the hospital. What happens to a Nurses scope working in the transport environment? In the military you have medics trained to the EMT-B level doing surgical crics in the field. Is that ideal? No. Is it necessary? Yes. Does the ability to do that skill make them equal to an anesthesiologist? Or superior to a Physician Assistant since they can not?

Scope of practice is a product of the environment you are working in, do not act like it justifies or validates your misguided argument. Take the ego out of it.

Even in the ICU a Physician is at a patient's bedside for literally 2-3 minutes out of 24hrs.

I do not know what ICU you did your clincals in but I invite you to check out a high level unit sometime and see what it is like. The Physician is not at the bedside. I have standing orders and adjust dialysis and replaced electrolytes off labs I draw, titrate drips, time the IABP, using PRN meds, etc all without a Physician holding my hand nor even a phone call.

 

[VentMonkey]

@Chase I have to ask:

Does this apply to all ICU, and ED RN's, or is it a case by case basis after establishing rapport with your respective EM physicians, and intensivists that you're given such leeway?

My understanding has always been, just like anywhere (and like in the field) that they begin to know and trust the more competent providers, and therefore know if such provider is in fact calling them for orders at 3 a.m. it isn't without valid reasoning behind it.

 

[EpiEMS]

Here is an example of the CO RN scope of practice guidance from the BON.

Professionals versus technicians - this epitomizes the difference, in my mind: Professionals police their own (and are expected to exercise more judgment), while technicians are regulated by others.

QUOTE="Chase, post: 643796, member: 11015"]EMS has a broad scope of practice out of necessity, that does not mean that is deserved nor does it validate yourself as a professional.[/QUOTE]

This is a great line, @Chase

EMS could learn a lot from nursing.

 

[VFlutter]

@Chase I have to ask:

Does this apply to all ICU, and ED RN's, or is it a case by case basis after establishing rapport with your respective EM physicians, and intensivists that you're given such leeway?

My understanding has always been, just like anywhere (and like in the field) that they begin to know and trust the more competent providers, and therefore know if such provider is in fact calling them for orders at 3 a.m. it isn't without valid reasoning behind it.

A little bit of both however for a lot of things (Dialysis, Electrolytes, pressors) etc is all standing orders. A new nurse on day 1 is expected to understand and follow them. But like you said, I felt more comfortable deviating or working around with certain physicians who trusted me.

If you have a chance to go to a CTICU look at the Post-CABG Nursing standing orders. Everything is done off protocol. The surgeons drop off a case and are in the OR for the next. There is no calling for orders unless it is an emergency.

Initial vent settings then weak to extubate within 8 hours. Hemodynamics: Index less then 2 start Dobutrex then Primacor. MAP less then 60 give 500ml bolus then albumin then start levophed and add Vasopressin and Epi if needed. ACT over 200 give protamine A fib give amio bolus and start drip is stable cardiovert if unstable. etc etc

 

[VentMonkey]

EMS could learn a lot from nursing.

This is beat to death everyday. The truth is as one profession to another this could be held true with any industry.

We could stand to learn a lot from other "blue collared" organized professions as well. The biggest lesson we stand to learn on the whole has nothing to do with EMS vs. nursing, it has to do with the fact that in any, and every profession the professional is not defined by their skill set, but moreso their individual character as it relates to the profession, and moreover the definition of professionalism itself, not heroism, professionalism.

Now, back to the OG topic:

Where does that leave guys (and gals) such as myself who are vastly outnumbered in this particular industry?

 

[EpiEMS]

Where does that leave guys (and gals) such as myself who are vastly outnumbered in this particular industry?

At this point, I would guess that teaching (or FTO'ing) is the way to go. Or perhaps advocacy for changes in training pathways - NASEMSO is pulling together a new national scope of practice doc now.

 

[VentMonkey]

At this point, I would guess that teaching (or FTO'ing) is the way to go. Or perhaps advocacy for changes in training pathways - NASEMSO is pulling together a new national scope of practice doc now.

Right, but what if neither of those are what I, or someone similar wanted? I get "sucking it up" as door number 3, but surely implementing change is more than just legislation, and pencil pushing.

FWIW, I did the FTO/ preceptor thing for 5 years, and it instilled less hope in myself than anything else. Again, these are all my viewpoints.

 

[DrParasite]

The analogy to EMS would be that everyone takes the same NREMT-P exam, but then some of the more motivated paramedics go on to earn a 4-year degree in EMS or a related field. That degree probably won't help them do a better job with their basic paramedic role or score better on the NREMT recert exam, but it has other benefits. If there were more 4 year degree initial paramedic programs, it'd be the exact same situation as nursing.

that's kinda my point..... if the entry level bar is the NREMT-P, should we make the curriculum harder or longer, or raise the bar, making the program who aren't long enough or hard enough die because they aren't preparing their students enough for the exam.

The nurse can tube adults/pedi, needle/surgical cric, RSI, needle T/chest tube, and much more but as a medic I am limited to adult intubation and needle T.

NJ ground medics can tube anyone, surgical cric (as a last minute option), RSI, and needle T.....if you can't do any of those things as a flight medic, well, that's a conversation you should have with your medical director.

BTW when we are comparing nurses, I think ER and ICU nurses are awesome. Can you say the same about ortho nurses? what about med/surg nurses? the running joke at my former trauma center was when nurses moved upstairs they lost their brains.... and i met too many of them that I wouldn't trust to change a bandaid.

 

[NysEms2117]

Where does that leave guys (and gals) such as myself who are vastly outnumbered in this particular industry?

Where would you like to be left? If you can describe the Job in EMS you always wanted what would it be? Requirements for said job? How would you like to regulate it ect.

 

[DesertMedic66]

NJ ground medics can tube anyone, surgical cric (as a last minute option), RSI, and needle T.....if you can't do any of those things as a flight medic, well, that's a conversation you should have with your medical director.

The issue with CA is that it is not up to the agencies medical director. It is based on the state scope for paramedics and then from that state scope the individual counties pick and choose what they want their medics and EMTs to do. Surgical cric and RSI medications are not on list for medics.

 

[VentMonkey]

Where would you like to be left? If you can describe the Job in EMS you always wanted what would it be? Requirements for said job? How would you like to regulate it ect.

I don't care about regulations right now. Honestly I'm tired of all the dead end talk. Do we need people like @EpiEMS ? Absolutely.

What about the professional currently surrounded by the egocentric "heroes" that they may have once been themselves, but have since outgrown? The guys and gals "fighting the good fight" day in and out, and who overall like field work too much to move up, or on? Realizing what it took to get where they are, yet being constantly thwarted, and bombarded by such pompously immature coworkers?

How about instead of talking about where we need to be headed all of the time---which I believe we can all agree upon---we focus on the now? I'm not the only one that feels this way, nor is this a new thing, but I would like to know what can be done now aside from what has been beaten to death time, and time again?

As far as where I would like to be? I am where I want to be, yet still surrounded by less the professional, and more the Facebook posting goon, so what's say you? What's the solution other than ignoring such behaviors?

 

[EpiEMS]

What's the solution other than ignoring such behaviors?

Well, I did neglect to add an idea - there is the possibility of moving to management at your organization? As a field supervisor, you can help a lot, no? Of course, this might involve stepping back somewhat from clinical duties, but not always!

 

[VentMonkey]

Well, I did neglect to add an idea - there is the possibility of moving to management at your organization? As a field supervisor, you can help a lot, no? Of course, this might involve stepping back somewhat from clinical duties, but not always!

I have done this as well, it's been a pretty long time, but still will occasionally.

It's also hardly a step back clinically. We're on an ambulance all day, every day especially if and when working as metro paramedic supes.
Tack on the front-line managerial tasks as well, the full-times definitely earn their pay.

 

[NysEms2117]

@VentMonkey I agree on most of what you said, more importantly I feel we need to give folks like you, who have battled through people yelling at you for years, the benefits/pay/respect you EARNED. I do think there needs to be a plan though, this topic has been beaten to death and I think it is safe to say that anybody who is a medic who wants to be a nurse, will become one---vice versa too. You don't feel that there needs to be regulations so your surrounded by other people like yourself? Quite honestly I can't tell you what the solution is I haven't been in EMS long enough, he'll I probably couldn't tell you the le solution. Whatever the solution I do know that if it doesn't involve getting people that actually care, actually want to learn more, and don't have the I'm in it to save lives mentality, that EMS will lose respect. Do I think it deserves to? Ofc not, I'm in ems and trying to make it better. Youthful ignorance maybe, but I'm trying. I think there should be a senior spot, past fly car past all that stuff, that says "hey you've been with our company for 15 years WE TRUST YOU, go do your thing". Which in my experience in the "real world" trust is a word nobody really throws around.


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[EpiEMS]

It's also hardly a step back clinically. We're on an ambulance all day, every day especially if and when working as metro paramedic supes.

Gotcha! I think the field supe concept differs from place to place. My service has something similar. FDNY, though, for example, puts field supervisors in nifty pickup trucks and they drive around not doing too much patient care (anecdotally).

think there should be a senior spot, past fly car past all that stuff, that says "hey you've been with our company for 15 years WE TRUST YOU, go do your thing".

Wake's APP, perhaps?

 

[VFlutter]

BTW when we are comparing nurses, I think ER and ICU nurses are awesome. Can you say the same about ortho nurses? what about med/surg nurses? the running joke at my former trauma center was when nurses moved upstairs they lost their brains.... and i met too many of them that I wouldn't trust to change a bandaid.

Absolutely but it goes both ways. I have met many medics I wouldn't trust.

 

[VentMonkey]

@EpiEMS we have supes the same as FDNY as well. @NysEms2117 I appreciate your thoughts, here's the thing- my question was full of rhetoric. It holds different meanings for every individual.

This job is what you make it to be. A steppingstone, a lateral, a career ladder, or anything in between. If I really, and truly could not stand it to the point that I let some newcomer and their naive ways drive me away, well, that says more about me than the noob.

For me, I paved every single road in this career path I have chosen so far. Is it always easy to hear some of these blissfully ignorant fresh new faces who are flush with false notions fed by their instructors? Nope, but it isn't their fault entirely either. So like @NomadicMedic eluded to: walk it, don't talk it. That's the best a field schlub such as myself can do.

If I truly believed I was deserving of some "special position" because I am a tenured employee at my respective service, then again, I would be filled with no less self-entitlement than some of the newer folks. Creating change when you're completely unaware is perhaps some of the best practice one can employ. I highly doubt many leaders spent their waking moments wondering what kind of rewards awaited them in the end, most were (are) truly selfless.

And before this becomes a tiresome EMS vs. nursing debate, I'll only say that part of being a critical care paramedic is leaching off of, and learning from the sharper RN's. In a perfect EMS world our egos would not be so shallow that we always needed to compare the two. They're apples and pears, if you blend them together it's an awesome hybrid.