UAP taking place of nurses?

  1. An Article in Nursing Management for April 2001 that I was reading prompted me to write this for my staff management class. The Article is "Far Out" if any of you subscribe. yes, i just read the april addition even though it is october... I am so far behind on my non-classroom reading, it just happened that the discussion today happened to match my "leisure" reading. Keep in mind I am in a BSN program, and only RNs are refered to in this paper because that was the assignment, only to react as an RN.

    Brandy Leake
    Care Coordination
    Article Review: Delegation
    10/10/01

    In the article "Far Out", a nurse from Minnesota explains a program that her hospital as instituted, in which EMTs are utilized to relieve RNs from basic technical skills in the emergency department. A registered nurse staffs the department during the day and evenings, and EMTs staff the department during the night, with the hospital's charge nurse's assistance. The author states that although there were many questions at first over responsibilities, they have had a positive experience, both for decreased time lost, and an increase in patient satisfaction.
    Entertaining the role of myself as a nurse manager, I can appreciate the need for fast effective care and increased patient satisfaction. What I can not appreciate is the loss of job security that this might have on my fellow registered nurses. I am not aware of the average salary for an EMT, but I assume that it is significantly lower than that of a registered nurse, otherwise I doubt that the hospital would be utilizing them in this capacity. Given the educational requirements for obtaining certification as an EMT, I would wager that they are not as well prepared to function outside of a purely technical environment. Registered nurses would be much better suited to fulfill the holistic needs of a patient, because of our in-depth didactic and assessment skills. Nursing is much more than performing skills, it is about critical thinking, quick accurate judgment, and knowledge of diagnostics. As a nurse manager, I would question the true thought process behind this program. This may be yet another way of utilizing UAPs to decrease the need for qualified nursing staff.
    This ED only sees 5000 patients annually. That averages out to less than 15 patients a day. In a busier ED, I am not sure that this program would be effective. With only one RN on staff per shift during the days and evenings, and less than one RN during the night, their staffing proportions would not be affective on a larger scale. If an EMT was effective to provide patient care we would not need hospitals, as the EMTs on the ambulance could provide all of these skills at the patient's home when they respond to distress calls. The patients would not be seeking the ED at the hospital unless they needed nursing assessments. If EMTs were equally qualified to provide these things, then RNs would be phased out, as EMTs could provide an identical outcome at a lower price. Fortunately, this is not true. Patients need nursing care, holistic care, and not just technical procedures. Any human with average intelligence can be taught to perform procedures, but intuitive assessment can not be taught in a single class, nor in a single year, and certainly not in the meager 10 hours of clinical experience necessary for becoming an EMT. The background course work required of registered nurses helps to complete the entire picture, without the foundation, puzzle pieces may fall through the cracks, giving a incomplete assessment, and losing valuable information. Because of these shortcomings, I do not feel that this would be appropriate for a busy ED, not is it the best care that we should be providing our patients. Quick visits should not be more highly regarded than the quality of care our patients will receive.
    I feel that even though nurses may appreciate the help for the time being that ultimately allowing EMTs to replace staff RNs will effectively shoot them in the foot. As nurses we must prove that we are needed, and that we can not be replaced. This article seems to be encouraging it. Although the author does state that this as an adjunct to nursing care, not a replacement, without further action and protest they may become just that: non-nursing aids that whittle away at the need for registered nurses.



    Reference:

    Angelucci, P., & Stolee, J. (2001). Far out. Nursing Management, 32(4), 45-46.
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  2. 13 Comments

  3. by   canoehead
    I am all for UAP's , CNA's, EMT's whatever in the hospital but I have a problem with the hospital assigning me to supervise them. If the hospital makes the decision to hire, who to hire, what they do etc, and I don't then I don't want to be responsible for their actions. If, however, the ER manager says they will hire someone to be assigned to all the nonurgent patients, and that the hospital, not I, am accountable then they can go for it. I want THEM to be responsible for their own actions, not me.
  4. by   OC_An Khe
    If I read your post correctly, the EMT (?paramedic) are actually replacing the RN in the ER not working with the RN. The answer to that is NO WAY can a EMT/paramedic replace an RN, there scope of practise is different.
  5. by   BrandyBSN
    not even paramedics, just EMTs

    112 classroom hours, 10 clinical hours. thats it.

    scary huh?
  6. by   MRed94
    As an EMT, and a LPN, I guess I want to think about this a bit.

    Our hospital uses EMTs in the ER, but they are working WITH the RNs, not WITHOUT them. They are mostly another pair of hands, and the EMTs here are very, very good at what they do.

    Most of them have been EMTs for a number of years, and I have worked closely with many of them. They are some of the best diagnosticians I know.

    I am not saying that this is wrong, but I think this needs to be looked at from all sides.

    The EMTs we have are PRE hospital care givers, most of them, and they work very hard to KEEP the patient ALIVE to get to the hospital for the nurses and doctors to do their thing.

    I think trauma care training is something that people don't realize is an intensive as it is. We are trained very highly to look for the non-obvious things that might be wrong.

    A lot of RNs in the ER only listen to the "chief complaint" and look no farther. Many EMTs find things that the RN won't, because they are trained to look more closely at the patient.

    I don't think an EMT could EVER take the place of the RN, I just think that an EMT is the best SECOND set of hands a RN could have.

    Just my humble opinion.

    Marla
  7. by   BrandyBSN
    all good points marla

    I agree that EMTs may be good second hands of nurses, but this particular hospital seems to be phasing out the need for RNs in the ED all together. They do the job of an RN, without the supervision. On night shifts an RN is no present unless requested. S/he is the hospital charge nurse, but there the whole time. Why not utilize an LPN to do these duties? They have much more clinical experience?
  8. by   MRed94
    I agree with you wholeheartedly, Brandy. I sure wish they would use the EMTs like our hospital does.

    They(we) are wonderful when utilized properly.

    No matter what, they are NOT nurses and can't be unless the name has the initials.

    Marla
  9. by   Dave123
    Well, I read the post and I am not sure I believe it as "fact". It could be, but I highly doubt it. I am sure that somewhere in there, there is an RN who is responspible.

    As for aids and basic EMT's in the ER, love em and couldn't do it without them. As for Paramedics in the ER, I can do without them. I will leave it at that as we have both.

    Just my opinion

    Dave
  10. by   BrandyBSN
    Yes, there is an RN in charge... of the entire hospital. S/he is the charge nurse. This hospital is small enough that only one change RN works the entire hospital. I encourage everyone who is interested to read that article.

    I understand the UAPs assist in many ways, and often lighten the load for nurses, but they can not act as replacements, which seems to be the direction that this hospital is going in.
  11. by   Charles S. Smith, RN, MS
    The use of Medics in the ED has some great potential. We use them in our ED with great success. The issue you seem to be addressing is the use of Medics in lieu of RNs. Well....this is a nursing practice act issue. If Medics are "practicing nursing" without a license, they can be legally sanctioned for doing so, since practicing nursing without a license is a crime. Also, the hospital administration can be legally held accountable for allowing nonRNs to practice nursing. Look at the state practice act for information on what constitutes nursing practice, then weigh the actions of the medics against this standard. You then have facts rather than supposition or innuendo.

    best
    chas
  12. by   BrandyBSN
    Thanks Charles, you stated that better. I do not object to the use of UAP or EMTs in the ED as long as they are not in lieu of RNs. I am not familiar with the NPA of Minnesota, so I am not sure if this is a violation. I just found it unsettling that replacement with less qualified persons seems to be encouraged in this article.

    Thanks!
    BrandyBSN
  13. by   ktwlpn
    Originally posted by BrandyBSN
    all good points marla

    I agree that EMTs may be good second hands of nurses, but this particular hospital seems to be phasing out the need for RNs in the ED all together. They do the job of an RN, without the supervision. On night shifts an RN is no present unless requested. S/he is the hospital charge nurse, but there the whole time. Why not utilize an LPN to do these duties? They have much more clinical experience?
    ...........As for using L.P.N.'s it seems like when cut backs are needed we are the first to go(this is in my experience) Of course as an L.P.N. I am going to say that I feel we can be better utilized in all settings.A great many nurses(including the DON and ADON at the last L.T.C. facility in which I worked)were totally ingnorant regarding the scope of our practice. We are technically proficient with a good understanding of basic nursing rationales and can free up the RN to carry out elements of nursing beyond our scope.
  14. by   Jenny P
    Brandy, can this article be pulled up online? I can't find it so far. I DO know the Minnesota Nurse Practice Act, and from what you have said, this is a direct violation of it. HOWEVER, IF the hospital charge nurse is the ER nurse, and the EMT works under her direct supervision, then they may have found a way to still be considered legal and cover themselves. As someone who once worked as a PRN night nurse in a 25 bed hospital (MANY years ago!), I know how difficult it was to be in the ER and on the floor at the same time (I was temporarily filling in while the regular RN was ill and was the only RN in the hospital with 1 aide on the night shift). An EMT would have been very helpful on a few of those nights I was there, but would have been a waste of $$ on other nights.

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UAP taking place of nurses?