Question about scope of practice for more experienced people

[VentMedic]

I have not heard of nursing being against the educated paramedic as evidenced by the many paramedics working alongside RNs on CCT (although not all is created equal in education there either). Their argument is because the paramedic's education doesn't measure up with the norm in the hospital setting that they should be limited in scope.

Nursing has their own problems with minimal education standards now. In order for them to keep up, the BSN may soon have to be their minimum. This is not a popular idea because of the shortage, but their education is low now compared with the other professionals. That is the talk on their forums now. Their ability to supervise allied health professionals is cut shorter when a Bachelors, Masters or Ph.D. is the minimum standard now for most of these professionals.

Now as far as the nursing staff model, if paramedics increased their education at the State and National level, that would level the playing field also. If their skills could get out from under the blanket, that would also prove worthy.

[Just Plain Ruff]

actually the Missouri nurses association has been consistently against using medics in the emergency room. I know they have come out publicly against it but I don't have any documentation of what their statements are.

When medics were given the ability to spike a bag of blood after going to a education class on how to do it (blood admin wise) the nurses association was against it.

They have and always I believe will be against medics in the Er working as primary patient caregivers. I used to do that and there was never any question as to whether the care I gave versus the care a nurse gave in the ER was questioned. All our care was overseen by at least 1 if not two nurses and we were in a 16 bed ER so there was always a nurse available for assistance or what not. The nurse was in charge and we never questioned it. In fact, we relied on the nurses for education and help but they also relied on us. It goes both ways and I think we can work together harmoniously but the missouri nurses association does not hold my views.

If you put a medic on the floor to take care of patients then that's a different story.

[chbare]

I think much of the problem revolves around the fact that many paramedic programs are simple shake and bake medic factories that spit out medics in 12 weeks to a year. True, well developed and executed 2 year programs exist; however, as long as this disparity with entry level paramedic education exists, I cannot see how the medical community could support medics taking on roles traditionally filled by nurses.

I agree that nurses have many problems regarding entry level education. However, the minimal education is a 2 year program across the board with a few exceptions. (ie: Net based programs that allow other providers to transition into nursing.) So, with a nurse, everybody on a level playing field regarding entry level education. With paramedics, you never know.

I hope nobody is offended by this post. This is not an attack on any single provider, just how I currently view this situation. In addition, I will be the first to admit that my profession is in dire straits and big changes may be in order. Perhaps I should make my bed before commenting on other professions, but I really do want to see EMS succeed and develop into a formally educated and recognized profession.

Take care,

chbare.

[VentMedic]

When medics were given the ability to spike a bag of blood after going to a education class on how to do it (blood admin wise) the nurses association was against it.

You just summed it up in that statement. Their arguments have been that a skill or a brief class does not equate to the broader education for the whole picture.

Inside the hospital:

There are some paramedics that will hang blood because it's ordered and never check what the Hb is or when another Hb check is necessary. There are paramedics that want to rush a pt to CT Scan/contrast and not know to check a BUN. Before CPAP joined the pre-hospital therapies, paramedics wanted to intubate right away. They didn't realize RTs have been saving people from intubation for 30 years with CPAP.

Paramedics are not always savvy to the options, methodologies and procedures available in the hospital setting. They may still function as Emergency Care providers and may not see the long haul ahead for the patient besides the obvious.

Education is key. Nursing has a strong argument that an inservice in one or two skills doesn't amount to much if there are no BASICS to back it up.

[Just Plain Ruff]

I do agree with all the subsequent posts past mine

an inservice does not a good paramedic make.

on the other hand- an inservice also does not a good nurse make.

It's the overall level of education that you get rather than all the subsequent 1 hour and 2 hours classes taught by people who have little more education than the learners they are teaching have.

[VentMedic]

It's the overall level of education that you get rather than all the subsequent 1 hour and 2 hours classes taught by people who have little more education than the learners they are teaching have.

You're right on target there.

Unfortunately that also applies to the current educational system in EMS.

[Just Plain Ruff]

Yep I believe I might just be preachin to the Choir Ventmedic

[Dustdevil]

Vent and CH have covered this so thoroughly that I really have nothing significant to add. I would just add to the specific point about nursing being opposed to EMS education, that I have never seen or heard of this. Not in any form or shape. In fact, I have never seen EMS education officially addressed by the ANA or ENA, except to say that it is insufficient preparation for working in the hospital, which is indisputable. They have never opposed the elevation of EMS. It is those who try to take EMS practitioners off the streets and move them into other professional territories that are hurting the progression of EMS. Everytime one of us tries to say that we should be allowed into the hospitals, what you are really saying to the public is that EMS is not worth staying in. That makes you guilty of hurting the profession.

An EMT or paramedic mouthing off about how qualfied s/he is to work in a nursing capacity in the hospital is really about as absurd as the Jiffy Lube tech talking about how qualified he is to be a jet mechanic. It's just so blatantly ignorant that it's embarrassing, and proof positive that you are NOT qualified.

Respiratory therapists, lab technicians, x-ray techs, physical therapists.... they all walk in nursing territory. Ever wonder why the ANA doesn't fight them? They did at one time! But those professions established PROFESSIONAL EDUCATIONAL STANDARDS that qualified them to take over that territory. Once that is done, nursing is not opposed to having a burden relieved. But anytime you are talking about taking over a duty with substandard educational preparation, you can bet that nursing is going to oppose it. That is their duty as patient advocates, and they do it well. If you are doing anything less, YOU are not a patient advocate. And if you are not a patient advocate, then you are just in it for yourself, so good riddance.

[paraloco]

I also visit nurses' listservs. I see posts about the level of esteem and respect given to physicians, and why can't they be equal. It's their world, and I didn't burst their bubbles that physicians have far more education than they do. I look at the posts and see spelling and punctuation errors that mark them as true 'professionals' (<sarcasm) . The nurses have better unity than we do, but that's not saying a whole lot. BSRNs have little regard for the 2 year nurses ( They wanna protect the value of their degree) They'd like to see a BSRN be the mininum level. They have even less regard for distance-learning nurses. How many paramedics can you name who did an Excelsior-type paramedic program, with no ride-along time and a 1 day skill check-off? Not many I'd bet. There's a paramedic to rn bridge program not far from where I live. It takes 10 months, with no pre-reqs. I'm willing to bet they are light on the liberal education/critical thinking skill requirements. I'd also wager that these standards are far less stringent than in other countries, as it apparently is for EMS (from what I read here in EMTCITY). Rn's in here, am I right? If I wanted to do nurse-type work in a hospital, I'd become an rn and go work in a hospital. They make more per hour, but they work fewer hours (mostly 12 hour shifts now, right?) I bring home more than a rn who only works 36 hours/week. I also have much better benefits and retirement. I know more than 1 paramedic who got their rn license, then worked their butt off doing overtime just to make more money. They miss the autonomy of the street. Did they really improve their quality of life?