MICN/Radio Nurse: Why do we need them?

[JPINFV]

Here's another thing to think about with this. Just because it's the RN on the radio doesn't mean that the RN isn't also communicating with a physician to get orders through. Not all online orders in California need a physician's order, and those that do can be communicated through the MICN. I won't try to justify the system or suggest it doesn't need to be changed, but I can also see why it's there given the generally low expectations of paramedics in California.

[crotchitymedic1986]

Do not know what you are referring to Timmy but it is inaccurate.

ALL paramedics have guidelines/protocols, it is the law.

Nurses can and do initiate treatments and medications.

Maybe I am misreading the quote, and maybe you are referring to California LAW, but not all EMS agencies have standing orders or protocols (especially when you step into the volley or private ambulance world).

I think a good set of standing orders is the answer to this person's complaint, unless this Nurse also acts as the "traffic cop" and tells ambulances where to transport to. I have not worked in such an arrangement, but I know that some cities have set up a "centralized call center" where all ambulances call in report, and then they are directed to certain hospitals to try and ease or eliminate "diversion".

[firedoc5]

We always had to report to Medical Control. Very early in my career there was a problem, as stated in an earlier post, that whoever picked up on the other end may or may not have been qualified to give orders. It might have been an LPN that happened to be helping in the ER. Of course there was no way a Medic was going to take orders from an LPN. In that case it was mostly letting them know what we were bringing in and usually a doc was in listening distance to give any additional questions or orders. Eventually on qualified RN's or in rare circumstances the doc may were able to respond. MICN's came more frequently. But I found that most of the time, if the Medic was proficient enough, the nurse would just take the report and would not have to give additional orders. I always strived to give enough info that they would not have to ask more questions. But this is not always the case. There are those who may not have given sufficient treatment or relayed enough info, so the nurse may have to give additional orders or have questions to know more about the pt. and what they were bringing in.

So it's not always the case of betting orders, but to let the receiving hospital notification of what is being brought to them so that they can prepare if need be. I don't see where eliminating contacting medical control and/ or communication with a receiving hospital.

I never had a problem with being given additional orders or questions. And sometimes you may have to ask what the doctor on duty may prefer you to do.

I think the biggest issue is that whether or not the person, RN or MICN, on the receiving end is qualified to give a Medic orders. And you have to consider other services that may not be ALS and rely on medical control for appropriate treatment, especially those that may not have personnel as experienced as some others.

As far as MICN's in our area, it was not a title given to an RN that worked the ER. But rather they worked in the field and had experience working along side Medics. They are required so many hours of ride time a month. It may be different in other areas but that's how it was here.

Sorry if I rambled, been a rough morning. :?

[CTXMEDIC]

we dont have an MICN. what we do have is an 'EMS Nurse'. she answers the phone, gets a brief report (Concious/Breathing/Chief complaint) and will try and find a bed for us while we are enroute. her sole job is to expedite our departure and it works 90% of the time. I had a guy that had a bulldozer blade drop on his leg, in pretty bad shape. my report was, "Enroute with a 29 y/o male victim of an industrial accident with a near amputation of the right leg, we're gonna need a big room, ill give you more on arrival". To some it may seem like i omitted a whole lot of info. With stuff like this they know we're busy and unless we bring it up, everything else is cool. you hear other services calling report and they read off every illness the guy had back to the third grade. we sit and yell at the radio, "SHUT UP"...its supposed to be brief. If i need to paint a picture i will. when im transporting outside of our system Ill give em the whole speech.

[Niftymedi911]

Our system is set-up a bit different:

When we're on scene and transport is to be made, We notify our Shift Commander on one of our secure Tac channels. We give age, c/o, area of call, and patient's destination request. They either clear us for that destination, or can adivse us that an alertnate facility must be requested due to current offload times. We do not deal with the hospitals until we give report to the ED via telemetry.

In other words we share the load, we're rotated through hospitals (as long as the patient has no preference) that are less busy in order to prevent the busier hospitals from getting overloaded. We give report to the ED via telemetry most of the time its an RN or the unit clerk on the other end. If we need orders or adivce we ask for Medcom and we talk directly to a MD. Usually we have a bed assignment by the time we get there, but if it's busy or no open beds are avail then we sit in the hallway until we can get a bed. (offload time)

Our shift commander has a computer system that links all of the local ED's. They report their status on the computer and when a destination determination is requested. Their staus as well as their offload times are taken into consideration.

If a particular hospital has an extended off load, they try to trickle the flow of EMS through there to try alliviate the flow. Offloads greater then an hour, eliminates the the possibility of a transport to that facility unless its deemed a priority 1. Then its off to the closest hospital.

We don't have any RN's sitting awaiting to take report or give orders. We only take orders from a MD.

[ambodriver]

I can't believe the hate for these nurses on the radio. In Chicago, they are known as ECRN nurses. They write down the highlights of our radio report so the ER is ready and has the appropriate resources ready for the pt. They are also trained in our protocols so they can suggests something if you forgot it (hardly happens).

Yes it can get annoying when you have a new ECRN on the phone asking irrelevant questions but overall they are great to have. Most are on a first name basis with the medics, and we trust each other very much.

Oh yes, there are a number of ECRNs in the ER--they also have pts. Whoever is available to answer the call, answers it.

[VentMedic]

We don't have any RN's sitting awaiting to take report or give orders. We only take orders from a MD.

We don't have MICNs, PHRNs or ECRNs in Florida. However, that might change in the future. The changes could rewrite the statute that requires a Paramedic cert to do scene response and the RNs would not have to challenge the state exam just to have the letters behind their name. They could actually have a training program established such as those for MICN and PHRN.

It depends on the size of your hospital as to what their duties will be in addition to the radio. They may also arrange for all of the CCTs to shuttle patients from one facility to another. Who better than someone who has ICU, ED, CCT and field knowledge to do this?

Not seeing the partnerships that must be established with other healthcare professionals just further alienates EMS.

In the CA hospitals I am familiar with, the MICNs will also do the transporting to the Cath Lab for the STEMIs that get "taken to the nearest facility". At least when the MICNs transport, there is not discussion about if they are allowed to give this med or work that piece of equipment. Even in Florida, the abilities of the Paramedics working the CCTs trucks vary from very limited to very broad and very good to very bad. More times than not in some areas an RN and/or RRT must be pulled from their duties at a packed facility to accompany the Paramedics. There is definitely a need for RNs trained at this level as hospitals consolidate their resources, sicker patients are being saved and technology advances as does the world of medicine. Some professions do grow. Unfortunately, California EMS hasn't be one of them and Florida with more than half of its Paramedic schools still being unaccredited medic mills hasn't gone very far either.

[Christopher.Collins]

The nurses pretty much run my area EDs... of course the Doc will always have rank above them but we mostly see them when its a serious call. I have no problem doing a med patch or handing care off to a nurse vs. a doc... these hospitals are out med control and if they feel then nurses are responsible then I hope thats good judgement.

Sometimes its not always a nurse answering the patches at one particular hospital. I recall many instances where the hospital (Level II Trauma) in town of my former EMS employer was close to going on diversion. Everyones hands were tied between trauma alerts and treoge and such and the nurses started giving orders to our senior medics to answer med patches. Of course there was always a nurse in earshot listening in in case they (incoming ambulance) needed further orders the medic couldnt give, but they were able to keep up with what they needed to do. And the notes taken from the patch would immediatley be handed off to staff. Now is that right or proper? Probably not.

[SDMedic]

"Mother-May-I" INDEED! :oops:

Here's how your (our) typical call would run:

We arrive on scene, assess Pt and treat Pt (if necessary) based on protocols.

We have 3 types of orders in SD, and must treat based on the treatments classification:

Standing Order (self-explanatory)

Base Hospital Order: issued by MICN, and based on pre-existing protocols we ALREADY know, i.e. wanting to give NTG to a STEMI with a blood pressure , 100SBP

Base Hospital Physician Order: issued by MD only, i.e. giving Epi SC to an asthma Pt >65yrs or w/Cardiac Hx

Then we proceed with the remainder of the radio report (whatever's left: age, weight, c/c, story, vitals, Hx, allergies, meds, treatment rendered, eta).

Unless it is an acute call, the MICN does little more than start Pt registration in the hospital system and perhaps advise the charge RN of our arrival.

Needless to say, there is a great deal of "us vs. them" on both sides of the radio, and medics who don't please MICN's are often subject to an inability to receive much-needed orders because of ego. While arguments are made that MICNs protect Pt's from careless medics (and I know they exist in ALL systems nation-wide), the assumption that there aren't any careless MICN's is just as uninformed.

I'm getting the impression that this whole MICN-thing is unique to SD.

San Diego EMS has a ... "difficult", yet interesting history which warranted the implementation of the MICN as an overseer. However, the comment that because they have a BS means they are able to "see" the Pt better than the medic on-scene is a faulty premise - especially if the Medic is only guilty of giving a poor radio report (which is mandatory for every call, regardless of acuity) ... how much more is there to pick up on scene vs. simply hearing the re-hashed story while sitting in a closed room at the hospital? I have both a BS and a medic license, and truth be told, the BS wasn't nearly as demanding as Medic school.

Again, it is a mother-may-I system, and the debate is growing as to the necessity of this role; which is why I was wondering if anyone else had experience with this type of system, and how it resolved itself - I'm really only looking for the effectiveness or inefficiency of this role as played-out in other systems.

And yes, while CA has perhaps the best laws to protect hospitals, clinicians and other Allied-Health care professionals from outrageous settlements, the reason we have these laws is because of the outrageous number of lawsuits here, hence the "Sue Me State" nickname.

[firedoc5]

I completely understand when it seems like an RN / MICN on the radio can be somewhat unprofessional by giving a Medic a hard time. We had one ER nurse that would tell us that she would prove a Medic wrong even if they weren't. Because of her attitude we would just be even more proficient to not give her any reason to complain. Most of the time that she did it would back-fire and she would look like the idiot. Most of us were determined to not let her have the satisfaction.

There were some others that would tend to be that way at times, but she was the worse. If MICN's or anyone at your Medical Control is making it a personal situation then it needs to be reported to a higher-up. And if that doesn't help, go higher. It is totally uncalled for and unprofessional. Also a danger to your patient. The longer it takes to address the situation, the harder it may become to get it corrected.