RN's in EMS

[Matt87]

Just wondering--I read an article the other day that mentioned that one day the future of EMS may be with RN's providing the care on an ambulance! The reasons they listed were that the Board of Nursing has their stuff together and could easily dominate the field of prehospital medicine if they wanted to! I know there is always that debate over the who's who of emergency medicine, RN vs Paramedic, but I never thought that RN's would want to start working the EMS system. I know that they are involved in flight care right now, and that they have the ASTNA (Air and Surface Transport Nurse Association), but do you think it will stop there? Are they going to remain the hospital? And if they choose to work in the field as a street medic (not critical care) will they be performing as a medic, or will they allow an RN an expanded scope? I think that the profession should continue to grow. Paramedics and EMT's are prehospital providers, RN's are hosptial based providers. Any thoughts on this?

[RaceMedic]

Matt,

this is not a new thing. RN's have been prehospital providers since the beginning. However they have evolved in to what they are now. The nurses of today are not near what they were even 30 yrs ago in many ways. and in some ways they have expanded what they do.

With that said i do not forsee RN's taking over EMS and prehospital care due to the low wages and working conditions. They do not need an expanded scope to operate in the field as most states Nurse practice acts addresses this situation. But unless the nurse has an EMS background to start with they will not pike the reality we see all day everyday.

Before i earned my RN i was working the streets in a metro area as a medic. I would always encourage the ER nurses to do a ride along with my service. Many did and not a single one made it through 12 hours. They all said the same thing as they left the station, " I dont see how you can do this for 24 hrs" " How do you deal with the BS?" They like the clean protected world of the ER and Hospital. DO not get me wrong, i know there are exceptions to this rule but i do not believe the current nursing establishment is prepared to handle our world, nor do they really want to.

Flight and IFT are totally different. they still do not pay as well as working in the hospital but in my experience they do pay better than 911. PT's are generally not as emergent, critical yes possibly but it is not the rule, and are clean as compared to when they come in to ER via EMS. The RN is not geared toward the EMS thought process until the enter in to the ER, then the do get the idea but yet come from a totally different thought process and theoretical background. It is not wrong or misled just a different focus.

We as medics and EMT's are taught and geared towards first the next 20 minutes fix and reverse what we can in that time while delivering as viable PT as possible to the awaiting ER doc and nurses. The doc continues our efforts with the assistance of the RN's, The RN is also preparing the plan for the next few hours continuing to days, including rehab, physical therapy, occupational therapy ... ect.

I think im off topic a little but again, No i do not believe we are in danger of losing prehospital to the RN's

Race

[DwayneEMTP]

Yeah, what RM said.

The good news? Should nurses ever decide to invade prehospital EMS, the educational standars will increase, the money will increase, and more than likely professional standards will uniformly raise as well.

The bad news? There won't be any medics involved....Oh wait...Maybe that's also the good news?

(Can anyone tell that I've just had my latest run in with one of my 'remote medic professional' bretheren? Fuckhead. Him, "We remote medics have to stick together! This is bullshit!" Me, "You are complaining about getting jammed up for turning an early stage tonsilitis into an emergency medivac by treating it soley with Tylenol for 5 days..."We" belongs nowhere in your statement man." It seems like, if I am to honor, "do no harm" that choking some people to death should be mandatory to safeguard future patients from them. At the very least it should fit under triage somehow...Just sayin'...)

I don't see it happening, but if it should perhaps the nursing unions have the clout and money to fight the fire unions...but again, as RM said...why would they want to?

Dwayne

[scratrat]

My wife was an EMT for years and has moved on to nursing. She has mentioned challenging the medic exam and doing that periodically more for the excitement and skills periodically. But she has also made it CLEAR that would never want to return to it full time.

Dwayne, what we need is licensure instead of certifications. That commands higher standards, and hopefully, with that comes higher respect. That NREMT test I just took wasn't too bad, but I don't think it really tested ANY of my medic skills. It was actually easier than my original written test I think (The 150 question one....this one was only 82 questions for me). AND it had a WHOLE lot less senarios in it.

[WelshMedic]

Hi all,

Here in the Netherlands EMS is nurse led. IFT trucks have RN's and ALS trucks are CCRN's (we have no BLS tier here. Front-line, it's all ALS).

I do happen to think that nurses have something to bring to the table. It starts at dispatch, there the triage nurses take the calls and advise appropriately. That means that an ambulance response is not automatic, a percentage is triaged back to the GP.Due to the broader training and education we are also far happier to treat and release patients ourselves (or refer them to the primary healthcare practioner) which makes financial and clinical sense. It does not burden the system with unnecessary transport and our colleagues within the hospital are then freed up to do what they are trained for, look after bick sick people.

For anyone interested, one of the UK journals did a special on EMS in Holland. You can find it here:

www.ambulancetoday.co.uk

WM

[DwayneEMTP]

I hate your system WM...It's stupid, and can't possibly work...

(Do you hire American Immigrants??)

Dwayne

[WelshMedic]

I hate your system WM...It's stupid, and can't possibly work...

(Do you hire American Immigrants??)

Dwayne

You get yourself off to Dutch conversation classes and I'll do the rest....

[DwayneEMTP]

Heh...my last gig was on a Dutch drilling vessel, the Maersk Developer. Part of my job was to enter the comings and goings of personnel into a maritime program in Dutch....Good God!!!

Aside from your horrid taxes, and you're not understanding that there is never, ever a reason to put 6 vowels in a row in any given word, I could find nothing not to love about the people, or the company. Very kind, people before pennies (my saying, as well as my impression, which could of course be wrong, having only been with them three months.), hard workers. I felt welcome from the moment I stepped on board and I was sad to leave.

But deep down, I'm American through and through. I'd get claustrophobic in a country that you can ride a bicycle across...

But I'm grateful for the offer brother. And it holds here as well should you decide to come this way...

Dwayne

[WelshMedic]

Heh...my last gig was on a Dutch drilling vessel, the Maersk Developer. Part of my job was to enter the comings and goings of personnel into a maritime program in Dutch....Good God!!!

Aside from your horrid taxes, and you're not understanding that there is never, ever a reason to put 6 vowels in a row in any given word, I could find nothing not to love about the people, or the company. Very kind, people before pennies (my saying, as well as my impression, which could of course be wrong, having only been with them three months.), hard workers. I felt welcome from the moment I stepped on board and I was sad to leave.

But deep down, I'm American through and through. I'd get claustrophobic in a country that you can ride a bicycle across...

But I'm grateful for the offer brother. And it holds here as well should you decide to come this way...

Dwayne

Dwayne,

Gosh, I always thought Maersk was a Danish company! Even I can learn a thing or two, it seems,haha!

You're right the tax thing is horrendous. It went up to 52% income tax at the beginning of the month. But the bike thing can be quite handy.. I was in Delaware a few weeks ago and had the idea to rent a bike to cycle to Philly (you must be getting visions of a bloody stupid European by now..). I got as far as the state line and then turned back. I had a near miss with a 24 wheeler at least 3 times in the intervening periode. I had visions of going home in a box.....

Oh, when you are at home, I may just take you up on that offer.. I hear Colorado is a swell place and I've always wanted to go rafting!

Carl.

[RaceMedic]

WM,

I would imagine that your nurses there are well trained and have a better understanding of independent practice than ours do here. that is one of the issues we have in the US with our RN programs. We are beaten over the head with "Do nothing with out an order" " if the doctor didnt say it then you dont do it" .

Sounds like a great system to get some experience in but i don't mind the non emergent calls. This is where the American system fails terribly. instead of getting pissy with the little old ladies and people that do not know that they could have made it to the Dr. office or hospital on their own. We should be using these calls as a time to educate the patient on what 911 is for. Instead we put on a fake smile hiding the irritation telling them "no no call us anytime" then as we walk back to the unit cussing and making fun of the PT for not knowing.

PT education is a huge part of nursing education. I know it is not done a lot even by them but i try every opportunity that i have especially on the ambulance.

Again i am rambling and this is probably something for another thread ...

Race

*edit*

Licensure is only a step, that alone wit no command higher education, wages and respect. THe reason why i say this is because many states already have licenses for medics. Texas and Missouri are two of them. The wages are not higher than i make in Kansas as a certified medic.

TO get what we all want for medics as far as wages, education, and respect. We need to have a united front. We need to separate completely from the fire service. We need to learn how to stand on our own. As an industry we are much older than the "30yr old" kid that refuses to leave home. We are now entering the 40 something creepy guy in the corner with the horrid comb over, shirt unbuttoned to the navel complete with gold chains trying to pick up on the 21yr old college girls at the local dive bar. We need to go get implants clean up our act, get a new wardrobe and educate ourselves in competent college programs. Sorry 600hr six month medic programs do not cut it.

Damn rambling again ....

Sorry

Race

Edited October 21, 2011 by RaceMedic