Paramedic Practitioner: Is this where we should be heading?

[paramedicmike]

Interestingly enough, and not entirely removed from the discussion up to this point (just mostly removed), I saw this article today in the Washington Post.

The nursing lobby is on a roll. It'll be interesting to see what happens next.

[chbare]

This level of autonomy is not new. Let us be clear, these are often nurses with little basic sciences beyond what is taught in undergraduate nursing and an additional pharmacology class beyond their undergraduate experiences rolling with less than 1,000 hours of clinical experience. Yet they are in some areas working completely independently of a physician without even a collaboration or chart review requirement. They are in essence, working as a physician.

[paramatt_]

Paramedics are prescribing antibiotics? How much pharmacology training do they have to know which ones to prescribe? Or how about checking against current meds? I'm sincerely curious as to what training they're getting before being allowed to go out and be a community paramedic.

Honestly, I'm not 100% certain. The paramedic practioner pathway is still in the infancy stage, though I think a few states have had internally run programs for atleast a few years. Currently, the federal government (this is Australia i'm speaking about) is running a two year trial in selected areas, but in terms of education requirements, I couldn’t tell you what they currently are. There is definitely no registration of any kind (nor as there are with a normal paramedic) and a quickie google search only came up with one university that's currently running a master degree specific course.

I would hazard a guess that most of the staff selected to participate in the trials already have a post-graduate level of education and have a very strong fundamental

understanding of pharmacology, plus whatever additional/specific training they've received prior to commencement . I know of one person who is currently undertaking the trial who is a former RN and also a pharmacist. Nursing to paramedicine down this way is a very common transition...but that's a whole different topic

Anyways, if I speak to someone that has some better insight of the program, I'll findout what the current training and scope of practice is or maybe one of the Aus members can chime in. It does look like the masters level will be the norm as these programs start to expand.

[ERDoc]

This level of autonomy is not new. Let us be clear, these are often nurses with little basic sciences beyond what is taught in undergraduate nursing and an additional pharmacology class beyond their undergraduate experiences rolling with less than 1,000 hours of clinical experience. Yet they are in some areas working completely independently of a physician without even a collaboration or chart review requirement. They are in essence, working as a physician.

Even the DNP programs don't add any additional basic science or medicine. If you read the descriptions they are classes on nursing management and research, nothing clinical.

[scubanurse]

What additional sciences are you guys looking for? My program we took Chemistry, Microbiology, A&P I&II with cadaver lab. I know a lot of nursing programs out there are even looking to get rid of chemistry.

I'm just wondering what further sciences should be required?

[chbare]

If nurses want to be doctors, why not a full on premedical curriculum complete with a year of general chemistry, a year of organic chemistry, genetics and a year of physics? Then add in science based courses that focus on biochemistry and so on. Aside from that, the clinical requirements are laughable with some NP's doing direct entry programmes and graduating with less than 1,000 hours of experience. Frankly, I am ashamed of what is going on in nursing. There is a huge push for indi practice and much work going into DNP programmes, yet we are struggling to bring well educated, entry level nurses to the bedside. It's almost as if nursing has lost it's way when it comes to being the backbone of health care.

[scubanurse]

I was shocked when I heard some BSN programs getting rid of chemistry. Adding science requirements to the advanced practice providers would be ideal. It makes sense. There are nurses out there who have very limited pathophysiology experience. I haven't looked into DNP programs because I'm going the NNP route and this is the program I am looking at http://regis.edu/RHCHP/Academics/Degrees-and-Programs/Graduate-and-Doctorate-Programs/Neonatal-Nurse-Practitioner.aspx#.UVBRLFsjp28 It requires advanced pathophysiology, genetics and more pharmacology.

What's interesting about the nursing profession is that the specialties are so specific. Doctors, once you become a MD can work in any field after a residency. If you change your mind later on in your career, you can. Nursing you can't. The way I understand it, is when I get my NNP, I will only be a NP for neonates. I could not work with adults or even older children really in the NP role.

As this relates to the Paramedic Practitioner, what type of NP is out there? Are they FNP? GNP?

[chbare]

All advanced practice nursing (NP) curricula mandate a core of three classes consisting of parhophysiology, pharmacology and assessment. All of which can be completed in a single semester. FNP's have a pretty broad scope of the lifespan. Interesting thing is that a typical residency will be longer than an entire nurse practitioner programme. Heck, I've seen post residency fellowships that rival the length of an entire NP programme.

Edited March 25, 2013 by chbare

[Arctickat]

Paramedics are prescribing antibiotics? How much pharmacology training do they have to know which ones to prescribe? Or how about checking against current meds? I'm sincerely curious as to what training they're getting before being allowed to go out and be a community paramedic.

Medics have been dispensing (not prescribing) antibiotics and other meds up here for years. We do have access to the client's chart though and consult with medical control. The idea is to provide them with sufficient meds to get them to someone who can provide the prescription. This is in the clinical setting though, not prehospital. We've got a pretty significant expansion to the pharmacology scope when we're working in the facility. It's quite a good foundation for the move to the pre and post hospital environment.

[scubanurse]

I agree with the situation you described. Sounds thorough with enough safe guards in place. I agree also it is a good move. I know there is a pilot program at a clinic just up the road from my house that utilizes paramedics as nurses essentially. They function in the same way, except they have the paramedic protocol so they can intubate and run codes independently since the clinic only has two doc and could easily get overwhelmed in an emergency.

I was just curious about the other situation presented, but makes more sense now knowing they are from Australia.