interesting--emts in the ER? - page 2

From: legislative coordinator Nevada Nurses Association Attached is the proposed job description developed by the Nevada Hospital Association for a new category of personnel-- an EMT /... Read More

  1. by   -jt
    <<And where is our nursing "leadership" on this?? Does anyone see ANA>>

    But thats the only one I DID see protesting the plan!! That entire report up there blowing the lid on this whole thing & arguing it with opposing concerns was written by the Nevada Nurses Assoc/ANA legislative affairs staff who participated in the task force meeting.

    A states nurses association is the ANA at the state level. While ANA headquarters deals with DC & National issues, the state nurses associations, as constituents which compromise the ANA, deal with their own individual states issues. So yes, Id say the NNA/ANA leaders of that state were there & were quite vocal for those nurses.

    AND THEY were the ONLY ones speaking up for them! No one else at the table had any opposition to the plan.... EXCEPT the ANA consitiutent association (The Nevada Nurses Association). ONLY the Nevada Nurses Association/ANA spoke out against the plan & with all those excellent points listed in the original post. And personally, I think they did an exceptional job of representing the concerns of the nurses who would be affected.

    The Nevada Nurses Association/ANA did the right thing even though they stood alone in opposing the plan at that meeting.

    Apparently, neither the ENA specialty organization president, nor the state board of nursing director expressed concerns about the plan or spoke up for ED nurses.
    Last edit by -jt on Jul 25, '02
  2. by   NRSKarenRN
    computer crashed earlier today while posting a response here so jt got to respond before me. my thoughts recreated.

    and where is our nursing "leadership" on this?? does anyone see the ana, who supposedly has the pulse of the american nurse, protesting this move? our profession is "coding", while they're in the bathroom fixing their makeup!
    fab4fan:

    put on your reading glasses!

    author:
    from:
    legislative coordinator
    nevada nurses association


    the nevada nurses association was invited to participate in this dialogue at a hospital association meeting held on june 27 ( meeting minutes & participants attached). nna was the only participant with concerns. ......

    at the meeting i expressed concern about increasing the use of any unlicensed assistive personnel and mentioned the other current proposals of the nevada hospital association to expand the scopes of cna's, lpn's, and others in all settings and the effect that this type of work re-design has had nationwide on high nurse turnover rates this last decade. i shared the statistic that we currently have almost a half million nurses in the u.s. who are licensed--but no longer practicing in the field of nursing anymore. i questioned scott's statement that most er nurses wanted this assistive personnel and recommended that a survey of er nurses be conducted.

    i also questioned debra scotts' statement that rn's could already "supervise" any unlicensed personnel and her interpretation of "supervision" vs "delegation" and the distinctions she drew about emt's not working "under" the rn's license---but that the rn would still be legally accountable for "appropriate supervision" and ensuring that these emt's possessed the knowledge, skill, and competancy to perform the nursing tasks. debra also stated that "supervising" rn's could be disciplined by the nursing board for failure to adequately
    "supervise" assistive personnel. i questioned the semantics and blurring of these terms and requested that clarification of these terms be made by the nursing board. i asked if the members of the board of nursing had dialogued on this issue and determined that no nursing law changes were needed for implementation. debra said no dialogue had occured. i recommended that she speak to the board members as the position she had stated was a departure from previous positions of the state board of nursing.

    the representative from the state health division also stated that the previous director of the nursing board had told him it would require a change to nursing law to implement. debra told me yesterday that she later spoke with cookie bible, president of the state board of nursing and that she agreed with debra's interpretation. debra had not spoken with the other board members as of yesterday. i again requested a dialogue with the full board for clarification. i also expressed concern that the position could cause dissention and outcry from the nursing community and confusion because many staff nurses have been told by nursing managers that other assistive personnel such as respiratory techs, ekg techs, etc.. are not the rn's responsibility and that rn's are not accountable for their practice----that the hospital itself is responsible. i also shared that generally staff nurses are not informed of the educational preparation, scope, and competancy of assistive personnel such as techs and that many nurses believe and are told that they are accountable only for nursing tasks "delegated" to lpn's and cna's. i extended an invitation for the state board of nursing to submit an article clarifying this issue for the august edition of the nevada nurses association newsletter .

    at the meeting i was asked by the group to comment on any compromises nursing would be amenable to on this proposal. i stated that i was not prepared to speak on behalf of er nurses or nursing on any compromise--that i felt the nursing community and specifically er nurses needed to be informed and surveyed on this first. the group asked if nna could conduct a survey in the 10 days prior to our next meeting. i replied that that was not adequate time for a complete survey--but that i would contact as many er nurses as possible by phone for feedback.

    re the ana dig

    the nevada nurses association was on the scene. it is the state nurses assocations / now constituent members association(cma) that monitors activities within their state/area that affect nursing practice. each state has their legislative director/executive director or designee attend state legislative hearings and health care committees to provide nursing input into policies and activities. they report issues of major concern to ana who gathers data to see if national trend or local issue. ana will lend support as requested by the state association and work to influence policy/legislation needed on national level at that time. it's a big country to cover!

    too many time's nurses think an issue is only affecting them within their hospital. that's why involvement in regional inservices, state wide meetings: i.e. yearly cma meetings and ana house of delegates meetings where nurses can gather, discuss, report and take action on issues that threaten nursing practice so you realize it's just not your hospital/facility being affected.

    legislative directors further action:

    i have been on vacation in laguna beach, ca but was able to leave messages and speak to several er nurses in las vegas and reno about this. those i contacted also discussed the issue with their colleagues at work and provided their feedback as well. below is a summary of the feedback so far from about 30 er nurses
    think that is pretty good service to her organization!


    from cathyw

    i am in favor of paramedics that do not need an rn's supervision. i feel that starting and hanging iv's and giving iv push meds, inserting foleys, ng tubes, etc., that pm's are already familiar with, should be allowed. any po meds should be given by an rn, except ntg, because pm's rarely handle po meds.

    i've concerns re this type of statement. nursing is not just the performance of tasks. it is the synthesis of data collection, nursing assessment, understanding of disease process, assessment of compliance/side effects re medications pt taking, understanding of need for early intervention to prenvent complication's death, when not to follow orders and how to move up the chain of command to get needed action for clients.

    what too many facilities are doing is hiring assistive personal in place of nurses to minimize costs. they are not hiring them as assistive personel and doing nothing re workplace issues. historically legally and under many er policies and procedures today the rn is responsible for all patient care activity for patients under her assignment including hospital assistive personel. assistive staff function under delegation of orders from the rn therefore are functioning under the rn's license.

    agree with jt's quote:

    "neither the ena specialty organization president, nor the state board of nursing director expressed concerns about the plan or spoke up for ed nurses. to make matters worse, the ena local president (an ed manager) supported the plan when his own organization & membership is against it. what kind of leadership is that?"


    thank the nevada nurses association/ana for being there and getting the message out! this is just one example of nurses advocating for nurses that goes on daily within the ana organization.


    attention all nevada nurses:
    [color] involvement/current action needed:

    1. per jt:
    there should be a mass avalanche of mail falling upon the nevada ena right now from its staff rn members in outrage for their "leaderships" comments in supporting the replacing of rns with techs.

    [quote]then the nevada hospital association and the ambulance companies plan to put this proposal forward to state lawmakers again on tuesday, july 30th at 9:30 am at a public hearing for all interested parties to weigh in on this issue and let state lawmakers know their position and concerns, and recommendations on the er divert problem.

    2. contact any all nevada er nurses you know and request they show up to express their outrage.

    3. send letters to nevada legislators.

    4. send emails to nva legislative chair, cynthia bunch:
    bunch25@aol.com

    or contact nevada nurses association

    p.o. box 34660
    reno, nevada 89533

    telephone775) 747-2333
    fax: (775) 747-1333
    e-mail: nna@nvnurses.org

    office hours: 8:30 to 5:00 pst

    monday through friday

    executive director,
    lisa black, rn
    e-mail: lblack@nvnurses.org


    p. s.:
    see what more this state has been doing re it's nursing summit.
    http://www.nvnurses.org/nursing_summit.htm
  3. by   fab4fan
    My apologies; I had misundestood and thought that NNA was one of the groups that had broken ties with ANA. I should have been certain of that before I made that statement.
  4. by   NRSKarenRN
    Glad to clear up misunderstandings.

    It's hard for us active ANA members who see the organization working so hard on behalf of it's members and all the activites the states are involved in constantly under attack by persons who have no involvement in the organization nor undertand the work CMA's do to portect assaults/ erodding of our nursing practice and licensure.
  5. by   fab4fan
    I got a call this AM from one of the execs. of the ENA...I forget her name at the moment. She expressed great concern over this issue and assured me that this is not ENA's position, Mr. Rolfe was not voicing the opinion of the ENA, and that this will be investigated. She seemed surprised and dismayed at this development.

    They have their hands tied a bit at the moment because Mr. Rolfe is on vacation this week, and they want to talk to him. She said she left an e-mail and voice-mail for him regarding this.

    I got the feeling that she was sincere; she said she would be calling me back later in the week to let me know what was going on.
  6. by   911fltrn
    Quick and to the point. IMNRN lisc. in nevada. I work er and icu and have flight experience. I will not supervise an emt or medic in the e.r. They do not have my knowledge or experience! I will not risk my liscence for hospitals that make $$$$$$$$, that they wont pay out to hire and keep R.N's. Ask me to do so and you better be able to take report cause im going home!

    "i hope and pray all your dreams unfold before your eyes"
  7. by   JillR
    Not sure about any other state, but here EMT's and Paramedics are liscenced for pre-hospital and transport care NOT for working in hospitals, and even in pre-hosp and transport, they are working under the MD's liscence. When they are hired in ER's they are legally UAP's and are working under the supervision of the RN, they are delegated to by the RN. Now some ER's give them more resposibilities than others, but they are still not liscenced for ER, so they are not liscenced prefessional in this setting. Be very careful what you delegate and to who. Like someone else previously said, it is very important to know the EMT or Paramedic.
    Don't let anyone tell you that they are not working under your liscense, be very careful. We used them in the ER I worked at and they were great, but they are not educated to work independantly of the RN. They are great assistants in the ER.
  8. by   -jt
    <Quick and to the point. IMNRN lisc. in nevada. I work er and icu and have flight experience. I will not supervise an emt or medic in the e.r. They do not have my knowledge or experience! I will not risk my liscence for hospitals that make $$$$$$$$, that they wont pay out to hire and keep R.N's. Ask me to do so and you better be able to take report cause im going home!>


    I sent a note to the Nevada Nurses Association executive director too. She responded that the NNA appreciated the support & that they have been getting a lot of heat & flack from the others involved for taking the position that they have taken in this issue. She was grateful to know that nurses are watching and paying attention.

    I also received a reply from the UAN that the situation is being monitored at the national offices & the NNA has the support of both the UAN & the ANA headquarters in the position they have taken.
    Last edit by -jt on Jul 25, '02
  9. by   -jt
    <I had misundestood and thought that NNA was one of the groups that had broken ties with ANA.>

    Every single state in the country, plus Washington DC & the US Virgin Islands has a state nurses association that is part of the ANA. Only the union branch of just 3 state associations ever separated (Nevada was not one of them) - the rest of those 3 associations remained with the ANA. All 50 states have respresentation in the organization.

    And I think the ones in Nevada did a great job on this one. I hope they get the support they need from other Nevada nurses - sending in letters, calling the legislators, etc to add clout to the position they have taken in questioning the plan to make up for the missing ED RNs with EMTs at the bedside.

    The solutions to the staffing crisis should be focusing on fixing the problems that are driving RNs away in the first place & attract them back.
    Last edit by -jt on Jul 25, '02
  10. by   -jt
    well I guess we'll be watching the allnurses news for more on this one.
    Last edit by -jt on Jul 25, '02
  11. by   NRSKarenRN
    See Missouri's response to EMT's in ER:

    Non-Nurse Caregivers in Emergency Department
    http://www.ded.state.mo.us/regulator...ng/nurcare.htm
  12. by   blackbelt
    I am in nursing school, but I have been an EMT and a Paramedic that worked in an ER. I think that the nurses that have a problem with us working with them, and helping them have more than a little problem with being closed minded! The ER were I worked could not beg enough nurses to staff it. The nurses that were willing to work pm shifts were very glad I was there to help! It was the day shift nurses that pitched a fit about unlisenced asssitive personnel and actually quit working! An experienced Paramedic has seen a little of everything-who would you want working on you if you had an MI a L&D nurse pulled to the ER to cover a short shift or the Paramedic?
  13. by   psychomachia
    Blackbelt: An experienced Paramedic has seen a little of everything-who would you want working on you if you had an MI a L&D nurse pulled to the ER to cover a short shift or the Paramedic?

    Me: I agree with part of you statement - "an experienced paramedic has seen a little of everything" - the point here being the word "little." Granted, some paramedics do try to learn about what occurs after dropping someone off at the hospital, but most are only being exposed to ___ (name your disease) for a short period of time.

    You made the example of a paramedic taking care of someone with an MI vs a nurse who works primarily in L&D. Using the same logic, who should take care of a pregnant pt., the medic or the L&D nurse? Not everyone who comes into the ER is having an MI.

    Yes, many paramedics understand the initial treatment of an MI (ECG, IV, O2, ASA, NTG, perhaps even Retavase), but how long are you as a paramedic prepared to assume care of that pt? Are you ready to take the admission orders, prepare the pt. for a cath, or admit them to a CCU? Manage the Heparin? Give GP IIB-IIIA inhibitors? Know when to call the cardiologist?

    And that's just an MI. How about person in DKA? Wanna start an Insulin drip, evaluate ABGs, other labs/electrolyte changes? How about a renal failure with a K of 7.0? Maybe a person with hepatic encephalopathy? Or maybe try to manage someone in DIC who is receiving FFP / Platelets / Packed RBCs? I seriously doubt many paramedic programs teach the pathophysiology needed to manage these types of pt.s.

    I could go on and on, and I'm sorry if it seems I'm bashing paramedics. Trust me, I'm not. I happen to be one myself and one of the first things I learned in nursing school is that I DON'T know it all and even though I have many years of experience as a paramedic, still have much to learn as a nurse.

    Finally, and I know this is a bit of a stereotype, but some paramedics only want to show up for "the good s**t" (codes, trauma, etc) and don't want to be bothered with the boring s**t. Are you going to stick around when it's time to wipe a butt? For the fifth time? Maybe, and that would make you a big help, but I hope you can admit that some paramedics do not.

    The idea of a paramedic working in an ER is OK with me; I'm happy to have extra help, but will I, as an RN, be responsible for that paramedic's actions? This is part of the problem many nurses find with using paramedics/EMTs/UAPs/Etc. Just as there are good and bad nurses, there are good and bad paramedics. The paramedic's role needs to be well defined and understood by both the nurses and the paramedics.

    I hope you understand this is not an attack against you, but only an explanation of why some nurses seem "close minded." It's OUR licenses that may be on the line for someone else's actions. We only want adequate staffing with nurses and to not be replaced by paramedics/EMTs.

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