Team Nursing with Paramedics........ - page 2

does or has anybody ever done this before, in the er? does it work well or not? if you haven't done it, have you thought about it? any suggestions on teams/patient ratios? d/t the... Read More

  1. by   CraigB-RN
    i've refrained from making any statement on this subject for a long time.

    FIrst the mandatory Bio- I've been both a nurse and a paramedic for the past 23 years. During that time, I've been a flight nurse, as well as an ICU ( Mostly trauma and surgical), Director of QA/QI for a state EMS agency, a program director for an EMS Training program, and the Multiple USAF positions including training. CUrrently I am a Flight Nurse, and a staff nurse at a rural Critical Access Hosp.

    Anytime questions like this pop up there are emotions involved, any area that hits on a percieved threat is a charged on.

    WHen you stereitype any group of people, you risk both loosing a valuable resourse andclosing your mind to potential problems. Neither a nurse or a paramedic is equiped to step into an ER, without extensive training and orientation. The problem with stereotyping is it doesn't take into account differences in education, experience or persanal ability.

    For example, my partner on my last flight was a paramedic, he graduated from a 4 year program and took the same pharmacolgy class that the nursing students at that college take. He knows more about how the meds work than I do. He teaches at the local community college. Our last patient was a 35 male who was having an anterior septal MI. As I got report from the nurse in the ER, he prepared the patient for transport. I heard him very patiently teaching on why the ASA, the Heparin and the thrombolytic and how they worked. THe nurse in the ER on the other hand, had lots of letters after her name. RN, BSN, CEN, CCRN, and had only 2 lines in this patient. BOth lines were 22 gauge, and each had 2 meds going through them. Heparin and Dopamine through one, and Activase, and Nitro through the other. My partner recognized this and quickly started more lines and separated the meds. As the patient started to crash he even put the triple lumin in the patient.

    The problem as I see it is our licensing and evalution tools are lacking. THey give us a sense of false security and limit those who have the ability.

    WOuld I take an EMT or Paramedic right off the street and put them in my ER or flying ER. Nope. WOuld I take a nurse and drop them in my ER. Nope. However, I can take anyone off the street and with the appropriate orientation, I can make them a safe and effective provider.

    Instead of closing doors, lets open them. Show these paramedics and EMT that there is a world out there beyond these certifications and make them want switch to nursing. These people are fantastic resources that would strengthen nursing. In this time of crisis, it's time to step outside the box, with open eyes and open minds.
  2. by   CEN35
    nice post craig!!! as brandy's signature says, minds are like parachutes......only work when they are open!!! (something like that :d)


    me
  3. by   Dave123
    I know its a tad late but I wanted to throw my opinion in as we have them assigned to the ER.

    CEN35- I know you didn't want it to turn into a bash fest but this topic carries with it strong emotions both ways. But you did ask.

    We have 15 paramedics, 22 basic EMTs, 7 LPNs, 14 RNs, 4 PAs, 10 Docs.

    So I think I have lots of experience as to how well it works. I will simply say I am NOT a fan of it. If you want to know more Email me and I will be happy to tell you why.

    Just my opinion

    Dave
  4. by   CEN35
    answer me this?????? your choice.........6 rn's and 21 beds, plus the usual a, b, c, d and sometimes e, f, g and h!!!!!! or add 5 emt-p's to the mix for help??? this doesn't come as a "we don't want to hire more rn's" choice........it comes as a "there are not enough agency nurses to fill the holes, and nobody is applying for the open jobs" choice.

    so let me ask you again dave? take on the whole department......with two less nurses.........or addd 5 medics to help get things done..........no other options?


    me
  5. by   Dave123
    Hey man, a staffing problem is just the way the game is played. I don't have the answers to your staffing problems.

    But I think your question was simply how well does it work putting paramedics into an ER that practices team concept care?

    You wanted to hear from people who have experience with it. Well I do and as I told you, I am not a fan. If it works for you then thats great, for "you".

    You know what they about asking questions.


    Just my opinion

    Dave
  6. by   jimminy
    I work at a level one trauma center that is also a teaching hospital so we have many different levels of experience there. I can tell you honestly, having experienced paramedics to help out is WONDERFUL! We have so many new nurses that are still learning the ropes, so many new docs that are still learning. It is a welcome relief to have an experienced person in the EC that recognizes a crumping patient. We have some great ones. Just like and job, including nurses or docs, we also have some not so great ones - that's normal in a job situation. Our paramedics do not pass meds, but they start pivs, ng tubes, foleys, v/s etc. They are told before hire that they are not working like they would on their boxes, there are restrictions. If they cant accept that, then they dont work there. We all work well as a team, and that's the secret. they work under the doctor's license. We never ask them to do something we wouldn't do ourselves if we could. This is a new program we are trying - so far so good.
  7. by   LerRN95
    I recently hired two paramedics in my ER because we could never find any nurse that wanted to work there. These paramedics also work with our local EMS and we get along very well with each other. They have been an asset to us and I would not trade them in for anything.


    We both have learned alot from each other and that only makes us to be better ER Nurses and Paramedics !!!
  8. by   mcgill01
    I am a second year bachelor of nursing student, so the reality of practicing is far away. Apart from this small matter, paramedic nursing appeals to me. Is anybody involved in this field or have any interesting information they would like to pass on. How many years nursing experience would be required to be considered for this area of nursing? I hope to receive a reply. Thankyou.
  9. by   CraigB-RN
    There is no such thing as "paramedic nursing". In reality nursing involment in these area's focuses on two parts of EMS. Pre-hospital is the emergency or 911 calls. Nursing involvment there is really based upon were you live. In places like PA there is a Pre-hospital RN certification. In others nurses can run as emergency responders but they have EMT certifications. ANd I'm sure there are many other configurationg. The second part if Transport. This is prob more common. This involves transporting patients from one facility to another. All require some experience before you can get into them.

    This is a gross simplification. BUt I think I got the basics. Correct me if Im wrong anyone.
  10. by   CEN35
    .
    Last edit by CEN35 on Oct 21, '01
  11. by   Iam46yearsold
    I like paramedics in the ER. I like having all those cute young guys running around so energetically, and helpfully. Makes my life so much easier.
  12. by   veronicajr
    We are a 35 bed Level 1 trauma center, and we have 2 paramedics in our dept who function in the same role as a nurse. They can give meds, about the only thing they don't do on their own is hang blood. However, our NM hired these people very carefully. One of them was a tech in our department for 9 years prior to taking on her current role. She is a very motivated learner and knows more about the medicines we use down here than a lot of our nurses, esp the newer ones. The other paramedic we have also works as a flight medic and has a variety of significant experience. I am fully comfortable working with either of them, and would have no problem having them work under my license. But I do think paramedics need to be used carefully in the ER...
  13. by   Medic09
    Quote from cmggriff
    Rick,
    I've never met a paramedic who understands my reluctance to take responsibility for his/her actions in the ER. On the other hand all the good LPN's and aide I worked with fully understood who was responsible.
    It isn't hard to understand, really. In the field the paramedic makes initial Dx, initiates Tx, and directs other people on scene. So the transition to a subordinate role is not natural for most. The LPNs and aides are taught to work under RN direction from the get-go.

    Personally, since I am a paramedic as well as RN, I like working with the medics. With a really sick patient we get into a groove like we would outside the hospital and get it done. BUT, the medic does have to clearly know their scope and limitations when inside the hospital. They have to understand that nursing really is different than being a medic, and neither their training nor licensure nor job description allows them to just do a nurse's job. Pushing the boundaries can cause frictions no matter who is doing it. I've had no problems with it in my limited experience. Communication helps.

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