MICN/Radio Nurse: Why do we need them?

[CTXMEDIC]

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

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.

Nurses arent in my food chain and they dont sign my paychecks. if some nurse ever withheld an order i knew was correct and needed i would ducument the HELL out of her non-order and push my beef up the chain as far as it would go. if that doesnt work you can always give CNN a call about the shoddy medical practices at hospital 'X'.

if you guys are already instructed on proper protocols and know how and when to perform the intervention, why in the (*^^$!()* do you need a nurse 20 miles away to give you permission?

I could NEVER, EVER work in that system. what a joke. why even have protocols?

OMG..I need a beer. this is pathetic... :evil:

[CTXMEDIC]

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.

so i just read the history of SDEMS as touted on the fire department website. after retching and dry heaving my way through how 'progressive' it is, i couldnt find the reason or the mention of MICN anchors, er, i mean, nurses. care to elaborate? what was 'difficult'?

[CBEMT]

We have no separate certifications for nurses here, and who we talk to depends on where we transport to.

At the trauma center, two nurses staff the ER Communications Center- answering the EMS phone, taking calls for transfers from MDs, and monitoring the statewide hospital diversion website. When we call in, they answer, and we tell them if we're making notification or need Medical Control. For the latter, they usually either transfer us to their partner's phone or out to Ambulance Triage for pre-arrival report ("Are they critical? No? See you when you get here."). If we need Med Control, one of the Comm nurses grabs one.

At most of the smaller community hospitals, the charge nurse answers, and transfers to the doctor's desk if we need that.

[zippyRN]

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.

a Physician does not 'outrank' a Nurse or any other health professional in civilian life unless they are a General Manager or Executive Director of the organisation in addition to being a Physician ...

in terms of radio Nurses it;s a pure symptom of the messed up way Pre hospital care in the USA is organised, professionalise paramedics and put them in a position to work to proper clinical guidelines on the strength of their own professional registration rather than under the licence of another health Professional ...

[akroeze]

a Physician does not 'outrank' a Nurse or any other health professional in civilian life unless they are a General Manager or Executive Director of the organisation in addition to being a Physician ...

in terms of radio Nurses it;s a pure symptom of the messed up way Pre hospital care in the USA is organised, professionalise paramedics and put them in a position to work to proper clinical guidelines on the strength of their own professional registration rather than under the licence of another health Professional ...

Out of curiosity do you still have physicians delegating tasks to you? In other words, are you allowed to give all treatments and medications under your license or do you need a doc to have signed a piece of paper somewhere for you to do it?

[zippyRN]

Out of curiosity do you still have physicians delegating tasks to you? In other words, are you allowed to give all treatments and medications under your license or do you need a doc to have signed a piece of paper somewhere for you to do it?

answered as a Nurse

a direction to adminster is organisationally required for certain classes of medication, and legally required for other classes of medication and Blood and Blood products - this direction to adminster can be in a number of forms , not all forms require the 'signature' of a registered medical practitioner ( a patient specific direction generated by someone with independent prescribing rights stands as regardless of the profession of the prescriber, certain of the organisationally required guidelines do not require a medical signature, where a patient group direction does at present but the legislation surrounding PGDs pre dates the exapnsion of prescribing )

other 'treatments' Nursing guidelines are written by Nurses for Nurses, Medical staff are involved in writing some of of these guidelines but equally other professions are involved where the guideline is applicable to those other professions. the UK does not have the (billing related) requirement for medical devices to be sold 'by or on the order of a physician'

a simialr situation applies with regard to who is authorised as a medicla imaging referrer although the 'practitioner' responsible for the overall management of imaging may well not be a physician as it is possible for a number of other professions to obtain 'practitioner' status under IR(ME)R it's most commonly Radiographers and dentists who are practitioners other than radiologist doctors

[SDMedic]

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.

so i just read the history of SDEMS as touted on the fire department website. after retching and dry heaving my way through how 'progressive' it is, i couldnt find the reason or the mention of MICN anchors, er, i mean, nurses. care to elaborate? what was 'difficult'?

SDEMSE is a public-private partnership between the CITY of San Diego and Rural-Metro Corporation (as well as a couple of other incorporated cities). The COUNTY of San Diego has perhaps 30+ different agencies for each of the cities, as well as areas run by an "Authority"-like FD, and CAL FIRE (which used to be California Dept. of Forestry). Likewise, AMR has it's share of presence here, working with non-transporting FDs.

So, to pin down how San Diego's history is difficult would take more time than you're probably willing to read, and more time than I'm definitely willing to write. That fact in itself should help paint a picture of how muddled the system is.

However, the long and short of it is that in the early to mid-90s San Diego City and County made budgetary and other administrative plans for a future they did not foresee: population explosion beyond anyone's wildest dreams. The resultant lack in public safety resources left them scrambling to fill positions, and therefore standards were arguably eased, especially when it came to recruitment.

The idea of the MICN, according to some, was to supervise the haphazard practices of medics coming from all parts of the state and country, and to try and promote a standard of care throughout the county. However, it seems their necessity is less prevalent than it once was. That's the crux of the argument i'm trying to find out: has anyone else had the same experience? What came of it?

So, reading SDEMSE's website might not be the best place to find out about a controversial history - it is an official website. Likewise, MICN's are employed by hospitals, not EMS agencies.