zippyRN

good job you don't have NMC or HPC registration ... becasue potentially it;s you that faces the professional discipline ...

yes i do and the upshot of it is that do not assume that Nurses are incapable of practice in pre-hospital care good job you don't have NMC or HPC registration ... becasue potentially it;s you that faces the professional discipline ... no it;s not, it's about working together , some of utter rubbish talked aobut Health professionals on this forum cannot and should not go unchecked... why 's that - becasue i don't roll over and let one staff group continuously libel awhole other professions? the significant factor is your position i nthe chain is important on the basis who who you carry the can for and the issues of transfer of care and having accountability for the actions of others when you do transfer care. Emergency care , both in and out of hospital WM PS -This is meant as good advice, not a opening to attack me, by the way...

the ANA says http://www.nursingworld.org/MainMenuCatego...Regulation.aspx "The registered nurse’s practice flows through several levels of accountability in order to ensure safe competent practice. At the base of this pyramid of accountability is the Scope and Standards of Nursing Practice, developed and vetted by ANA on behalf of the profession. The Scope and Standards create the foundation for specialty practice standards and inform the State Nurse Practice Acts, which provide a second layer of accountability. Rules and regulations promulgated by individual states, based upon each state’s nurse practice act, may restrict the RN’s practice. Further restrictions upon practice occur because of the nurse’s accountability to the institution or agency for whom she/he employed, via institutional policies and procedures. A final level of accountability for RN practice occurs via the individual nurse’s own self-determination of those aspects of practice she/he believes herself competent to perform. " as a random example from a Nurse practice act http://www.arsbn.org/pdfs/NURSEPRACTICEACT_2007__5_.pdf "(6) “Practice of professional nursing” means the performance for compensation of any acts involving: (A) The observation, care, and counsel of the ill, injured, or infirm; ( The maintenance of health or prevention of illness of others; © The supervision and teaching of other personnel; (D) The delegation of certain nursing practices to other personnel as set forth in regulations established by the board; or (E) The administration of medications and treatments as prescribed by practitioners authorized to prescribe and treat in accordance with state law where such acts require substantial specialized judgment and skill based on knowledge and application of the principles of biological, physical, and social sciences; ... (8)(A) “Practice of registered nurse practitioner nursing” means the delivery of health care services for compensation in collaboration with and under the direction of a licensed physician or under the direction of protocols developed with a licensed physician. ( Nurses shall be authorized to engage in activities as recognized by the nursing profession and as authorized by the board. © Nothing in this subdivision (8) is to be deemed to limit a registered nurse practitioner from engaging in those activities which normally constitute the practice of nursing, or those which may be performed by persons without the necessity of the license to practice medicine. 17-87-103. Exceptions. This chapter does not prohibit: (1) The furnishing of nursing assistance in an emergency; (2) The practice of nursing that is incidental to their program of study by students enrolled in nursing education programs approved by the board; (3) The practice of any legally qualified nurse of another state who is employed by the United States Government or any bureau, division, or agency while in the discharge of his or her official duties in installations where jurisdiction has been ceded by the State of Arkansas; (4) The practice of any legally qualified and licensed nurse of another state, territory, or foreign country whose responsibilities include transporting patients into, out of, oror through this state while actively engaged in patient transport, that does not exceed forty-eight (48) hours in this state; position paper from the same board of nursing "3. The delivery of healthcare services which require assessment, diagnosis, intervention, and evaluation fall within the professional nurse scope of practice. ... 5. The nursing decision to carry out a health care act should always include consideration of: A. Degree of immediate risk to the client if the action is not carried out when appropriate professional personnel are absent. B. The overall complexity of the client's healthcare problem. C. The degree of invasiveness of the act. The more invasive into the anatomical or physiological integrity of a client a task or activity is, the greater the liability of the nurse and the greater the risk to the public. D. The reversibility of the action. E. Prompt access to medical support. F. The nurse's ability to prove by documentation and appropriate knowledge and skill base that the nurse is competent to perform the act. plus of course the NCBSN says https://www.ncsbn.org/NursingRegandInterpretationofSoP.pdf "Practice areas of different health care professionals are not exclusive: there are numerous overlapping areas and activities that constitute the practice of nursing when performed by a nurse and the practice of another profession when performed by another licensed healthcare professional. What is unique for nurses is the configuration and breadth of nursing practice, both independent aspects of practice and the implementation of health regimens prescribed by other authorized providers."

what wendy says

thrombolysis ( of MI, massive PE or stroke) has very little to do with VTE prevention ...

the implication was you give the report required by medical control and then refuse to give a handover to the practitioner who is taking over care of the patient, if the ED uses paramedics i nthe ED then that is your equal levle of care - the next question is are the paramedics allowed by the facility to undertake initial assessment in the ED ....

given that paramedics in the US are not (Registered) Practitioners i think you might well just find that an RN is 'equal or higher' in the food chain ...

do you need to re-phrase that ... an RN is an RN regardless becasue they are a registered health care professional - their core scope of practice does not rely on being employed or being employed by any specific employer ... maybe it's different in leftpondia but in rightpondia we've had a few problems with none -registered staff trying to 'remove' sober, competent Nurses or Doctors from the scene of incidents despite the fact that once a registered Health Professional is hands on to a patient they and they alone can decide if and when to release care of a patient - as any come back will be on them for inapprorpaite delegation of care ... however trying to hijack your supplies is a different matter ...

from a rightpondian point of view aobut capacity and consent the law assumes people have capacity and therefore can consent - this is definitely the case once you are 16 and may be the case before that age the concept of 'Gillick competence' often referred to in he Uk however there is a common law duty of care to act i nthe best interests of patients which can include undertaking interventions if it is felt that someone does not have capacity it is a minefield for the unwary regarldess of the exact locally relevent statutes

as the OP states he is in the Uk it's unsuprising that he is worried about driving reuirements given that to even get anywhere nearthe driving seat of a Uk ambulance whether VAS or NHS organisational policies require a full licence approrpaite to the weight / seating capacity of the vehicle and anywhere between 1 and 3 years of driving experience. ( standard post 1997 EU 'car' (cat licences only cover to 3500kg gvw and 8+driver seats) many organisations will only allow One driving offence endorsement (and only a 3 point endorsement) on entry to the organisation ( and in some cases with the voluntary sector - will pull driving authorisation if you exceed 3 points regardless of role or position - 12 points earns you are minimum one year driving ban and the minimum amount of points issued is 3 at a time - ) i'm not sure how he has worked as the equivalent of an LPN in the Uk as nvq 3 HCA is not a professional nurse role and the UK (along with the rest of the EU hasn't trained second levle nurses in the past 15 or so years) and NVQ4 roles in nursign environments are extrermely rare and still not considered a professional nursing role instead an associate / assistant practitioner role ...

like many things where religion is cited as a reason it has more to do with the mis application reglious standards and jurisprudence 'bare below the elbow is exactly that - all all tiem when ininvolved with patient contact UK health care staff are now supposed to not have any clothing below the elbow unless a. 'Scrubbed ' and gowned as for surgical procedures b. in the field where thre are other overriding h+S concerns ( e.g. during extremel cold weather or extrication)

although i am considered a 'manager' in my volunteer EMS work - becasue i can and do undertake bronze and silver cliinicla and operational roles and have ongoing responsibility for parts of our clinicla audit programme) i'm not a manager if i'm there as ambulance crew or as the only nurse / health professional on the duty ...

as has already been said - it deepdnds on the whole story i'm wondering given the discription made whether the Trauma team thought he'd got a head injury and was combative ... hit o nthe forehead by a wooden beam s and combative sounds like a very good indication for a tube and ride on the donut of death like the time a patient's realtive acused me of 'shouting at' and 'assaulting' the patient ... that would be the patient with an intracerebral bleed who was on regular neuro obs and at that time was GCS 8 (e1-2 v1-2 m5 depending on the assessment at that time) ... ( think about it , how do you assess someone's GCS)

from the point of view of a rightpondian volunteer sector provider - annual revlidation exams arean integrated part of our training system NHS techs while not revalidated as subject to fiedl based assessment and have ongoing CPD ,Paamedics depending on employer also have similar arrangements as well as the requirements of the HPC to meet. As an RN i have to be able to demonstrate relevant skillsknowledge and experience in the areas i have practice in... so the annual revalidation from the voluntary sector plus relevent CPD activties count ( and the CPD can include assessments especially when we are talking alphabet soup courses)

although rightpondian i am a RN and Ambulance crew qualified - i think AZCEP has hit the nail bang square on the head there...

abuse is more than the actual act of causing harm - Neglect is abuse and failure to seek appropriate medical help in a timely manner is Neglect in every state, territory or country with child protection laws perhaps you ought to remember the first rule of being a student , two ears and one mouth ... needless to say those who have posted aobut what constitutes Abuse and neglect and how it impacts on this scenario are doing so from a possition of far more education and experience in emergency care .

i'm with the Doc on this ... ( as i said earlier)

question for scott and welshmedic - how long have you been out of UK practice? a hell of a lot of stuff has changed in the past 5 years and there is a still quite a lot on inconsistancy between trusts - also MMC has changed the balalnce of power even further with junior doc rotas which aremuch more F2 heavy in some clinical areas reducing the experience available

and as for hospital security ... they haven't seen some of the dubious specimens we have in the Uk - needless to ay they are worse than useless especially as in some places they aren't even SIA basdged so can't touch members of the public or patients

I never said that , i have said i can adminster medication on my own initiative - this is via PGDs - although our Cardiac NPs are all Independent prescribers, our Elderly 'inreach' NPs are prescribers and some of the Emergency Dept NPs are Prescribers ... the rest of us just have to make do with PGDs in termso f hands on practical skills a lot of the junior doctors are lacking especially compared to the Emergency care / unschedueld care / assessment unit Nursing staff ... yep penny pinching equals compromise in that the numbers of NPs in the ED is bare minimum to provide 12-14/7/365 , in that they have removed the 'specialist nurse' Emergency care Staff Nurses to save money ( well they've moved us and are still paying our specialist nurse salaireis but as pay protection and we're still doing the parts of our role that can be applied to our new clinical areas - and looking at reintroducing some of the skills but adjusted to the new areas e.g. IR(ME)R referrer status ...

sorry that is utter utter rubbish, most RNs have forgotten more than the average US EMT ( regardless of letter after their name ) has been taught RNs do invasive 'goss' ( i preseume the OP means gross ) life saving skills every day IF they work in Emergency care , it's very easy to compare people who work in one or two settings with people who work across a huge number of settings and specialities, there are doctors who haven't cannulated since they got onto their higher specialist training but it doesn't make them 'lacking' as an Doctor unless they choose to misrepresent themselves ... compare like with like, to be told i'm lacking when the only thing i'm lacking is the employer paid for thetre placement to get my advanced airway knowledge converted into better experience ... given i have an indepdent scope of practice can adminster medication on my own initiative andperform all the skills and more of the 'normal' Paramedics, plus all the other skills i have to have to work as an RN in an emergency care setting ... ( it starts with the AMTS and ends with closing wounds in layers after performing regional anaesthesia via urinary catheters, plaster of paris and removing foreign bodies from eyes / wounds ... several of our registrars and consultants prefer me to assist them with procedures such as tube thoracostosmy rather than another Doctor on the basis of experience and they'd rather i asssit a new to the procedure doc with them hands off supervising when it comes to teaching ...

is a child a chattal of it's parent ? have a look at some of the chases of child neglect across the developed world and then you might understand why law enforcement , health and scoail services are going in hard and fast to safeguard the welfare of children and young people, rather than respecting the old fashioned view that a child (or wife ) is a chattal of the the father / husband ... so you don't think an RTC knock down deserves a full and appropraite assessment by a health professional ? i trust military medics as far as i can throw EXCEPT when under fire ... most military medics are sorely under educated, yes they are trained to perform certain tricks under fire where their (relative) expendability is a major asset As Iunderstand it the second amendment is met in full by each of the states who have a National Guard, a well regulated militia under control of local government n'est pas?

except many nurses don't work in controlled environments nor in hospitals ... the Emergency Department is not a controlled environment home health, Primary care, Occupational health ( and response roles attached to OH), military, event medicine doesn't occur in the hospital <snip> as can be seen world wide with community first response models and the use of the voluntary sector in specific supprting roles to a paid professional service... through local and national taxation in most cases on a world wide developed world view... event licencing needs an equivalent tothe Uk para 712 of the purple guide which tells event organisers that their event must not adversely impact o nthe routine emergency services and hospital Emergency department cover offered to the local population which is how many services world wide achieve their degree level entry qualification for Paramedics ... there is space for a vocationally trained assistant grade ... but this assistant still needs more training and education than the 110 hour glorified first aid course that is the US federal minimum for EMTs... <snip> ever heard of 'FIRST DO NO HARM' a cavalier attitude to wards oxygen therapy in patients with COPD can result in someone requiring a cirticla care admission rather than a ward admission or prolonging their ward admission to deal with the sequalae of their deranged blood gases all becasue some glorified first aider with a nice big patch belived 'oxygen doesn't do any harm ' this is what holds US EMS back ... where elsewhere in the world EMS is part of a continuum of Emergency care and there are few clear lines in the sand of 'ambulance man jobs' 'nurse jobs' and 'doctor jobs'

wrong answer ! as Eydawn says remember the defintions in use of neglect and abuse, plus the reported mechanism of injury ... here in right pondia SWAT would be an overreaction, but Social Services, EMS and the police would work cooperatively to enable a proper Emergency Department or field based Health professional ( e.g. Emergency care Practitioner or field MD) evaluation of the child ... but thanks to the 2nd amendment misinterpreters in the USA SWAT is a proportionate response to toa ex military man who refuses to allow his child to be properly assessed following a potentially life threatening (mechanism of) injury

the evidence base usggests that paracetamol + an opiate works better and either reduces the doses of the opiates needed / increases effiacy WHO analgesic ladder anyone?