Question about scope of practice for more experienced people

[Dustdevil]

Cut Ray a little slack, I am sure that their training him as the ER Tech was pretty in depth.

I'm not questioning Ray's capabilities. I'm questioning the wisdom of the facility that is misutilising (yes, I just made that word up) techs for a process that is not within their JCAH scope. That is why I wonder if he is doing this strictly for his own experience and educational purposes (no problem with that), or if it is actually within his job description (big problem with that).

[PRPGfirerescuetech]

I'm not questioning Ray's capabilities. I'm questioning the wisdom of the facility that is misutilising (yes, I just made that word up) techs for a process that is not within their JCAH scope. That is why I wonder if he is doing this strictly for his own experience and educational purposes (no problem with that), or if it is actually within his job description (big problem with that).

Now were actually getting to the true root of the problem.

[rayemtjax77]

I'm not questioning Ray's capabilities. I'm questioning the wisdom of the facility that is misutilising (yes, I just made that word up) techs for a process that is not within their JCAH scope. That is why I wonder if he is doing this strictly for his own experience and educational purposes (no problem with that), or if it is actually within his job description (big problem with that).

They are not "misutilising" (I like that word) techs.. I was hired because I was an EMT but I was not hired AS an EMT. It does not say EMT on my work badge. It says Patient Care Technician. I have been shown what to look for by Neuologist and ER Drs since patietns see me first in the waiting room. THat way if something is wrong I can let people know in a rapid manner. My job discription here is not in questions.. my position as a Triage tech (which only a few people are trained to be out there), has me doing neuro assessments on people that NEED it. If they come in saying I have had a stroke, they get seen nexted and I check them in and do a quick neuro assessment on them. If nothing seems to be wrong, I still tell the triage nurse immediately and then they see the patient.

[katbemeEMT-B]

I don't think hiring EMTs in the ED is a financial position as they also hire nursing students. My understanding when I did my clinicals was that they hire these people (EMTs, nursing students, RT students) not just because they don't have to pay them as much, but to further their clinical experience and education. I know that the hospital I was at offered monies to pay for schooling to advance to the next level of training in your field. ie: LPN could go for RN, EMT could go for Paramedicine. Many hospitals utilize nursing assistants, medical assistant, and the like to do the humdrum day to day stuff that the nurses don't want to do. Does this make it right? Probably not. Would I do it? Not a chance in hell! But as with any thing, that's the American way.

[Dustdevil]

I don't think hiring EMTs in the ED is a financial position as they also hire nursing students. My understanding when I did my clinicals was that they hire these people (EMTs, nursing students, RT students) not just because they don't have to pay them as much, but to further their clinical experience and education.

The difference is that a nursing or RT student has an education. An EMT-B does not. And, except for vital signs and CPR, what little training an EMT-B has is irrelevant to clinical care. I'd rather have a CNA. Any nursing or RT student past their first semester is capable of performing many relevant duties in the clinical arena. And their education is continuous, assuring their competence is ever increasing. Conversely, an EMT-B (unless he is also one of said students) is at an educational dead end with no promise of developing into something more useful in the future.

A major reason that hospitals will hire nursing and RT students is not because they are cheap labour, but because it is a recruiting tool. A great many of those students will stay on as permanent staff after graduation. There is no such benefit from hiring EMT-Bs.

Apples and oranges.

[AZCEP]

Emergency departments using "un-licensed" staff are doing so for the dollar. They are typically unable to recruit enough nursing staff to manage the patient load, and the nurses they have need help.

Nursing students are their to continue their education, and as a recruiting tool, as Dust mentioned. A basic EMT is done with their education, and can't be expected to reduce any of the workload for the licensed staff.

[katbemeEMT-B]

The difference is that a nursing or RT student has an education. An EMT-B does not. And, except for vital signs and CPR, what little training an EMT-B has is irrelevant to clinical care. I'd rather have a CNA. Any nursing or RT student past their first semester is capable of performing many relevant duties in the clinical arena. And their education is continuous, assuring their competence is ever increasing. Conversely, an EMT-B (unless he is also one of said students) is at an educational dead end with no promise of developing into something more useful in the future.

A major reason that hospitals will hire nursing and RT students is not because they are cheap labour, but because it is a recruiting tool. A great many of those students will stay on as permanent staff after graduation. There is no such benefit from hiring EMT-Bs.

Apples and oranges.

I can't disagree with you. As I stated, placing an EMT in an ED is probably not right especially if they are not interested in furthering their education. They are basically glorified babysitters. I personally wouldn't want that job. It comes down once again to not viewing EMS as a profession but rather a hobby.

[PRPGfirerescuetech]

...i have to suggest that utilization of EMS personnel in ED's might be why nurses are so against the progression of the education standards of EMS personnel...?

[VentMedic]

...i have to suggest that utilization of EMS personnel in ED's might be why nurses are so against the progression of the education

standards of EMS personnel...?

There were probably over 100 degreed (2 year) EMS programs in the US when nursing decided to go from diploma to the degree as their standard for licensing and professional standards. EMS did not. EMS could have had the head start on the education market for minimum licensing standards even though the nursing profession was older. Since then, EVERY health care profession has passed EMS up in education. Even the entry level Nursing Assistant or Patient Care Tech now which used to be 100 hours of training is now almost 600 hours or 7 - 9 months.

There was a demand increase for EMTs and EMT-Ps in the 1980s. The medic factories started cranking them out either at the ambulance companies, FDs or private techs. The community colleges that offered the 2 year programs then established the "certificate" track to keep up with production. Now when there is a chance for some one to obtain a degree just like all of the other professions, they take the quick way out. Why? Because some currently employed paramedics tell them all that B.S. education is not necessary. It's not nursing or RTs telling the new EMTs that. You can read some of the comments posted on the education threads on this forum and see that for yourself.

Now if you want to talk financial value, the EMT and Paramedic, since they are primarily recognized as certificates for licensing, they are not recognized for re-imbursible services in the hospital by the State and Federal agencies. In the hospital, every profession is looked at like a separate business according to their re-imbursible worth. Every department manages their area like a business in terms of revenue that their services generate. EMTs and Paramedics are hired usually in the nursing department. Nursing is a blanket service but the number of services they pick up from say Respiratory depends on whether RT is losing money providing those services. Nebulizers and EKGs are not always money makers, so nursing lumps them into nursing services provided. RT then picks up HBO, intubation and A-line placement which are all re-imbursible for them. If the extra tasks strain the nursing personnel, RT is asked to take them back, maybe at a loss. Departments in the hospital restructure and adjust everytime there are new re-imbursement guidelines handed out by the government and insurances.

[PRPGfirerescuetech]

Vent, good post, however you completely missed my pointe.

I understand and agree that we are our own problem when it comes to the expansion of education, however, when nursing is so against the expansion of across the board minimum education increases for EMS providers, does that correlate directly to EMS'ers inclusion in many ED's staffing models...?