Nurses working in EMS system?

[Ridryder 911]

Now, you can understand the laxity attitude when someone announces that they have passed ACLS, or any of the AHA programs. As Dust describes it was never designed as a teaching course, only that you have successfully completed a course designed by AHA and that you understood the ECC recommendations.

At least one can say in the early years, that successful participants had a knowledgeable understanding of emergency cardiac care. The test was much more difficult with questions on ABG interpretation, difficult arrhythmia interpretation as well as several lab skills of pass/ fail including central lines, intubation, and intense mega code for example. There usually was about a 40-50% pass rate, and the text was in a 3 ring binder due to the large quantity of material.

I was one of the first non-physician ACLS instructor and I can assure, during that period of time passing it usually meant that participants had a basic understanding of emergency cardiac care.

Now, the current course has improved the methodology of less stress, however has totally lost its credibility. I have seen nurses and medics complete the course, then after lunch not be able to recognize what a PVC was. That is why I believe as others, that we need to eliminate the AHA ACLS for re-registration for NREMT/P and replace it with another type emergency cardiac care program.

R/r 911

[ccmedoc]

I have never, ever in my career, heard an RN of ANY education or experience level mouthing off about how they could/should work EMS without some extra education and training in pre-hospital care. Never heard one trying to find a way to get around the additional requirements. All that I know of went at least to EMT-B school at a minimum, and many of them went to full paramedic schools rather than challenging the exam. You simply don't see this "I don't need all that book learnin'" mentality in nursing.

This, and the following comments in his post, are the norm in my experience also..Most ED nurses are not trained to, nor do they want to be trained to, effectively participate in the pre-hospital part of EMS. I do not look for the " RN on every ambulance" to be the norm any time soon....I also do not believe a Paramedic license to be a lesser license to RN, and I'll probably catch poo for that. . They are apples and oranges...I do believe that to be taken seriously as a medical professional, Paramedics will be required to complete educational requirements beyond Medic school, as nurses do with their pre-requisites. Hour for Hour, most paramedic schools, I stress "schools", are clinically on par with an ADN program and some BSN programs, with a different focus. The difference is made through the additional science, math, and basic language skills not required by most paramedic programs..

To be effective in the field, an RN should absolutely complete a paramedic course..start to finish. This does produce a superior Medic, IMHO.

In my state, to my knowledge, a nurse practicing in the EMS field, must also be a licensed paramedic. Thus, they practice as a paramedic not an RN.The additional latitude they are granted is generally pharm based, due to the extended education they recieved in pharmacology as a nurse..

This being said, there are good paramedics that run circles around supposed seasoned nurses..throughout the hospital. The difference is that more nurses admit the need for the additional training than do paramedics...sound familiar??? :roll:

Just my opinon..

[Scaramedic]

I just saw an interesting commercial on CNN. A Johnson & Johnson sponsored commercial promoting this website showed three different nurses portrayed in action. One of them was bagging an intubated patient in the back of a rolling ambulance. Another was kneeling beside a motorcycle accident victim on a highway. Only one of the three was in a hospital. I have to admit that I am far removed from nursing politics these days, so I don't know if there is some current initiative to push nursing into a bigger EMS role. Quite probably, the commercial was just sensationalising nursing to appeal to those people who would never consider the field because it is stereotyped as boring by most. Regardless, it is interesting.

Be afraid!

Dust I equate those commercials to the snazzy commercials the US Navy has. The Navy always shows a group of SEALS going up some third world jungle river or an F-18 launching off the deck of a carrier. They never show the guys in the kitchen of said carrier preparing dinner with the same equipment that prisoners at San Quentin use. They never show the guys changing toilet paper rolls or cleaning 'cinnamon swirls' off the toilets. It's always the glamour they show to entice people to join.

The J&J commercials are no different they want to equate Nursing with the 'heroic' images of medicine. Do you really think they are going to show a Nurse ramming a donut down their throat or taking a rectal on a 90 yo ALZ pt? Like you said it's all about the perception not the reality.

Peace,

Marty

[VentMedic]

I just saw an interesting commercial on CNN. A Johnson & Johnson sponsored commercial promoting this website showed three different nurses portrayed in action. One of them was bagging an intubated patient in the back of a rolling ambulance. Another was kneeling beside a motorcycle accident victim on a highway. Only one of the three was in a hospital. I have to admit that I am far removed from nursing politics these days, so I don't know if there is some current initiative to push nursing into a bigger EMS role. Quite probably, the commercial was just sensationalising nursing to appeal to those people who would never consider the field because it is stereotyped as boring by most. Regardless, it is interesting.

I am writing this under nursing supervision at the nurses' station.

Nurse attending to motorcyclist: Must make patient comfortable; pillow under head, warm blanket

Nurse bagging intubated patient: darn RTs wouldn't let them use the ventilator again.

Seriously though, one of our RNs from our smaller ICU/ERs makes at least one trip per shift with a patient to one of the bigger hospitals. We have a wide variety of CCT crews. It is hard to get one with an ICU/ED trained nurse. Many are paramedic teams who are restricted to what meds they can haul attached to the patient yet they are supposed to be critical care transport. Ventilator or even trached patients are other examples. If the patient is on anything but a conventional volume ventilation mode (which is so yester-year), an RT or RN has to go. Also, if I am placed on an ambulance from my hospital position to accompany the patient, I follow my RT medical director's protocols which gives me more protocols than as a paramedic. I am working as an extension of my ICU.

So yes, you do see alot of non-EMS people in the back of an ambulance. However, it not by the choice of the non-EMS personnel. We get drafted and our work load suffers. Better training and education of the paramedic would keep us off the trucks.

I will say that Flight and Mobile ICU nurses are highly trained mobile professionals. Also the specialty teams with air and ground transport nurses have excellent education, knowledge and many, many skills. Let us not forget some of the the military nurses. Many of the Flight and CCT nurses may also have a big trauma specialty since many of their transports may be recent trauma from the little ERs. The helicopter RNs also do scene response. Many of the states do not require them to have a paramedic license.

Also a flight nurse and a flight paramedic usually must have 3 - 5 years experience in their respective fields. If a flight paramedic gets his RN license, he/she may not apply for a flight RN position (in most employment situations) until they have completed the requirements of a flight RN - 3 -5 years ICU/ED experience. An RN may get a paramedic certificate as just that, another certificate. Many companies, unless it is a mandatory requirement, may not pay for a nurse to get a paramedic certificate because it is a lesser or equal (if A.S.) degree.

[thbarnes]

Georgia is talking about letting RNs staff ambulances after completing the airway, trauma, communications, ethics, and scene safety units of the Paramedic curriculum. They must also have ACLS and PHTLS/BTLS.

This presents a problem in mind.

Case 1: They are going to pay the ambulance-based RNs the same hourly rate as RNs receive in the ER or ICU, which is where they most likely moved over from. This wouldn't make sense, because there are already numerous EMT-P with their RN who don't receive the hourly rate as ER and ICU nurses.

2. They are going to pay the RNs on the ambulances the same hourly rate as Paramedics, many of whom also have their Bachelors. In which case, are these RNs total fuck ups?

[chbare]

I worked for a ground transport service a RN, and my wages were no where near what I was making working as a RN in the ER. With the poor paramedic wages nearly across the board in this country, why would an EMS system fork out RN facility wages just to have a RN in the back of an ambulance? That seems rather.....strange?

Take care,

chbare.

[VentMedic]

With the poor paramedic wages nearly across the board in this country, why would an EMS system fork out RN facility wages just to have a RN in the back of an ambulance? That seems rather.....strange?

Take care,

chbare.

Bargaining power for better reimbursement rates from the private, State and Federal insuring agencies.

The paramedic carries very little weight because of ther lack of licensing standards across the board when it comes to asking for reimbursement for individual professional services. When I have to do a transport on the ambulance as an RRT, the hospital bills the insurance or medicare separately for my services. The same for an accompanying nurse. This may seem unfair to have the patient billed twice for the same transport, but there are some ALS/CCT teams that are only that in name and not ability.

The nurses on our HEMS program make a good "nursing" wage since the helicopter is hospital based. Another HEMS that is county based through the Sheriff's office is offering the nurses the same pay they make in the hospital also which is 2x the paramedic wage. This service is a money loser across the board but necessary. They need the interfacility transports along with EMS to stay afloat. The hospital based CCT nurse makes her/his hospital nurse wage. These teams do have a different reimbursement/billing code for professional services.

[Dustdevil]

2. They are going to pay the RNs on the ambulances the same hourly rate as Paramedics, many of whom also have their Bachelors. In which case, are these RNs total fuck ups?

That's the exact same question we keep asking about all the volunteers out there who do it for no pay at all.

[rangermedic]

The original system i started in like ?20 years ago had Paramedic nurse [nurse had to be a EMT] teams on the truck. while it had its positives there were down side to. agrrsivness time spent on a call lifting ability and so on the biggest was pay there base was 30% higher than a medic.

[VentMedic]

The original system i started in like ?20 years ago had Paramedic nurse [nurse had to be a EMT] teams on the truck. while it had its positives there were down side to. agrrsivness time spent on a call lifting ability and so on the biggest was pay there base was 30% higher than a medic.

There should have been enough female Paramedics around 20 years ago to help the male nurses with the lifting and that aggressive time thing.