emergency dept staffing with paramedics/emts - page 4

I am the unit coordinator for an emergency dept which staffs all rn. we see over 42,000 patients yearly and we are working on certification for level 2 trauma center. my administration is... Read More

  1. by   Geeg
    Paramedics are very competent. However, I fear this is just another way to cut costs and eliminate RN's.
  2. by   PA-C in Texas
    I am against using Paramedics for this reason. They should receive a fair wage and be used for what they can do instead of trying to replace nurses. There wouldn't be the pressures to use them as cost-cutters if they earned decent money.
  3. by   Cnowak07
    You're missing the point. Paramedics are not being used to replace nurses, they are being used to ofset some of the workload that nurses have. I think that everyone would agree that in most places there is a nursing shortage and the health care industry in general is losing money. So why shouldn't the hospitals try and cut costs while at the same time provide some of the essential services....... Paramedics are just as skilled as nurses in many areas: ACLS, IV starts, EKG recognition.... I think you'll see more and more hospitals employee paramedics in Emergency departments before you see the medics moved out and back onto the street.
  4. by   ufmedic
    I don't think that administration should be looking at paramedics to REPLACE RNs, but I do believe that paramedics are a very valuable SUPPLEMENT to the ED. As both a nurse and paramedic, I agree that there is a lot that paramedics will find foriegn to them in the ED. However, a new nurse will find the same things just as foriegn. I believe that using paramedics to start IV's, insert foleys/NG tubes, EKGs, nebulizer treatments, etc helps to free up the RN for more complex care such as managing multiple medication drips, discharge teaching, triage, etc. Contrary to popular belief among nurses, paramedics do not simply follow a "cookbook" of protocols. Paramedics use their considerable critical thinking and patient assessment skills to decide on a course of treatment to stabilize the patient. It is stressed in paramedic school that the protocols that medics follow are simply a guideline and the standing orders that give us the authority to administer treatment. It is up to the medic to determine that the pt is in congestive heart failure as opposed to pnumonia and to begin the appropriate treatment accordingly. Medics so not give drugs simply because it is in the protocol. Every paramedic can tell you that he gave the NTG to reduce preload, thereby decreasing myocardial O2 demand, he gave lasix because it draws Na from the distal loop of Henle and produces diiureses, and he gave the morphine for it's secondary effects as a diuretic and it also reduces anxiety and the workload on the heart. He didn't give the drugs just because that's what the protocol says to do. it is true that they know emergency drugs inside and out, but they can learn many other drugs with no problem. What I learned about pharmocology in nursing school just skimmed the surface of a lot of drugs while paramedic school went in depth with about 100 drugs. If a new nurse has to look up a lot of drugs that they are using in the ED, there is no reason that a paramedic can't do the same.
    That being said, there is also a huge difference in the training of an EMT and a paramedic. You cannot generalize that all EMS providers have a limited knowledge base based on the fact that EMT Basics have about 2 months of training. Paramedic school is another VERY intense 1- 1 1/2 years on top of that, plus ALL paramedics are required to be ACLS certified prior to being licensed. Most also have BTLS and PALS. I agree that paramedics do not have the knowledge base to do discharge teaching for most common complaints seen in the ED, they do not have the experience to manage multiple drips through central lines, and they do not have training in patient advocacy.
    Paramedics are a valuable addition to the ED staff, but are not a replacement for RNs. Any nurse that underestimates the knowledge, critical thinking, and patient assessment skills of paramedics is doing a great disservice to patients and efficiency in their EDs.
  5. by   jackleg27
    AMEN!!!

    Quote from MedicRN
    I think the question that ntg asked is unbeliveable!!! Do you want a paramedic working on your loved one? Well let me remind ntg, if you ever call 911, you will most likely get a paramedic and/or emt. And the day they save you or your loved one's life, maybe you will realize the importance of the paramedic/emt. As a paramedic and a nurse, I know the importance of both education and experience. Because of my background in both fields, I can say that there are both good and bad paramedic's and nurse's. Depending on the competency of the person, that is who I would want taking care of me (not because of the initial's after the person's name)! Nurse's need to stop feeling threatened by the paramedic in the ER, ICU or CCU. I know many doctor's that would rather have me assisting them in the ER (because of my paramedic experience) than any other nurse. I think every nurse who is interested in critical care (ER or floor), should be required to have their paramedic licensure or have prehospital experience!!
  6. by   erjulie
    again-
    there are worker bees and then there are slugs. All professions, be it doc, RN, EMT-P, tech, etc etc etc., has some of each type. Give me worker bee anytime! I don't really care what they are, it's just really what they actually do.
  7. by   teeituptom
    paramedics and emts make good techs, but that is all
  8. by   ERNURSE4MS
    I, like others in this thread, feel like EMT-B, EMT-P's are an asset to the ED. The do not replace RN's but the supplement they bring to the ED is priceless. The ED I work has a hospital based ALS ambulance service. The EMS staff is in the ED with the RNs. The full-time staff from both sides work together well.When The EMS staff call in their reports they already know exactly what the RN needs to know and that makes triage SOOOO much easier. FOr the most part they are willing to help in any way they can. They are not glorified aides, they are intelligent well educated professionals. They make my job as an RN alot less hectic. I see things that they learned in Ems training that I did not learn in nursing school like the effects of prolonged extrication on a trauma pt and the effects of collision impact sites on bodily trauma.I intend to take the next EMT-B class in the fall to supplement my training and to benefit my pts. Because that is why we are all here isn't it? To take the best care of our pt as we can with the resourses we have been given. Just my opinion.
  9. by   Medic173
    I always get a kick out of this subject when it comes up...... Really nurses what is the difference? The big deal with Medics in the ER is that you seem to feel threatened by Medics....Why?? Because of JACHO and other governing bodies the ER will always have to have a certain number of nurses to staff it. Otherwise Medics can do the same job.

    Nurses = 2yr degree Medics = 2 yr degree

    So what really is the difference?? The ER that I work in has the same amount of Medics as nurses staffing it. We have the identical job description. The only except is that the Medics have extended roles as "Physician Extenders" under the MD License, along with having our own license. We take our own Pts, Triage, take written and verbal orders, admin drugs, call report and transport our Pts to the floor. We also do Emergency cut downs for airways, Chest tube insertion, Needle decompression, ETT, Central lines, and run all in-house codes, to name a few things that nurses can't do. (These are the things that fall under the MD license). Now I am in nursing school, only to get a raise in pay. (That's due to the shortage of nurses, and that they can demand more money.) But I will never get rid of my Medic license. And the EMTP will come before the RN behind my name. Now I know that this post will cause a lot of stink, but lets face it, times are changing, lets just except it and move on. And I do appreciate Nurses, I would gladly love to have one work beside me any day.
  10. by   mattsmom81
    Quote from teeituptom
    paramedics and emts make good techs, but that is all
    Gotta agree and this is how they should be looked at in ER. They should never replace a nurse. I worked ER in DFW waaay back when they brought in parameds to replace nurses as a 'cost saving measure.' The nurses were told they were responsible for the paramedics...yeah that went over real well.

    I moved to ICU and never looked back. They lost 6 nurses over this little cost saving measure...hope it was worth it.

    I have nothing but respect for paramedics, and their expertise in stabilization out in the field, but that role does not fit well in the ER setting IMHO.
  11. by   RoxanRN
    Quote from Medic173
    We also do Emergency cut downs for airways, Chest tube insertion, Needle decompression, ETT, Central lines, and run all in-house codes, to name a few things that nurses can't do. (These are the things that fall under the MD license).
    What state teached medics to do central lines? Personally, I don't know of any and believe it is totally out of the EMT-Ps scope of practice.

    I understand your point about being a 'Physcian Extender,' but I think you are embelishing the EMT-P abilities just a bit.

    Please don't take offense. It's just my . Please take note of my signature line *before* you flame.

    Roxan
    EMICT, RN

    This arguement has been around since before Adam was even a twinkle in God's eye. This topic is so :deadhorse Please let us grow past being playground enemies.
  12. by   FirewalkerRN
    I don't feel threatened in the least that medics are working in the ED. I have worked in different settings and some have them working as techs which I think is absurd!!! I currently work in a ED that lets them do what they are trained to do. I think it is very handy to have someone who can and will tube someone in the blink of an eye. The mask will rarely touch the patients face which I can appreciate. I don't think it is about us vs them. It's a matter of focusing on each of our strengths and working as a TEAM. I have learned a lot from Medics in the past while working in the fire service and I am sure I have been able to help them with some things/processes that are not taught in EMT-P school.

    The medics I work with I would trust with my life or the life of my children. Yes, they are that good!!! I also feel they would say the same about me.

    Everywhere I go there is always a nurse who feels threatened by someone who should be their colleague.

    I say hats off for the help the Medics can provide and I shall fax an order for Miralax to the nurses who can't deal with it.

    $.02

    Scott
  13. by   ufmedic
    [QUOTE=RoxanRN2003]What state teached medics to do central lines? Personally, I don't know of any and believe it is totally out of the EMT-Ps scope of practice.

    I understand your point about being a 'Physcian Extender,' but I think you are embelishing the EMT-P abilities just a bit. [end QUOTE]

    FL and GA both train paramedics to do central lines, rapid sequence intubation, needle thoracostomy, ventilators,and surgical/needle crics for the ground paramedics. The flight medics can also do chest tubes/cook catheters. You can check out the Volusia County, FL protocols on the EVAC ambulance website
    www.evacamb.org

    Look under the documents section, there is the protocol for internal jugular, subclavian, and femoral central lines, as well as pericardiocentesis.

    RN,BSN,NREMT-P

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