interesting--emts in the ER? - page 3

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   blackbelt
    The point I was trying to make was there is a place for the well trained paramedic in the ER. I also see both side of this heated argument. I am in it for the long haul I have cleaned more dirty bottoms than I care to remember! I am in my senior year of nursing school BSN program. For what ever reason ER's are short handed be it a true lack of RN's or the lack of the almighty dollar(I believe it is something in between) The er's neen help and some of us want to help that is why we continue our educations.
  2. by   RoaminHankRN
    i was cruising through this post and not going to say anything until i came across psychomania. first of all, blackbelt, i could not agree with you more.

    originally posted 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. and so to are er rn's. you do not spend the time with the patient as an icu, med surg, etc. rn would. a "little" goes a long way compared to some of the experience non licensed techs have.

    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. i would be quite comfortable with an emt-i/p assisting with a l&d patient. don't some l&d patients come in by ambulance. and who "cares" for them enroute. not a rn. as an er rn, you know how long you want that labor patient in the er???

    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.
    how often is this practiced in the er vs on the floor?

    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 same goes for nurses. i hope you can admit that there are some nurses who would like to sit and have a tech do their dirty work. it goes both ways. just as you mentioned below.

    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? will the doctor be responsible for the rn's actions? in most ems systems, the md is responsible for the actions of emt's as they practice under his/her license. 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.
    we need to stop the bashing of our "licensed" friends. no one want's emt's to be the primary care giver. they do just great in the field. but we should be more open minded to them assisting with patient care. i'd much rather have an emt-b/i/p than a "tech" with no experience. i'd even go a step farther and say a new rn coming into an er. we know it happens. too many rn's think their **** don't stink. you see it in the postings here. it's a viscious "food"chain, with the docs at the top making the most money, going to school longer, thinking they are above rn's, and rn's making more money then emt's, going to school longer....

    psycho.. this is not an attack on you, but on those that feel this way.
  3. by   prn nurse
    Amen !! RoaminHank !

    I agree with you 100 %. We have EMT's in our ER and every one of the RN's appreciates them !

    I don't know how we would manage without them. They bring skills and experience to the ER that many of us did not.

    A shift doesn't go by, that I am not grateful and appreciative of them.

    Your words re: "Food Chain", and your entire post is right on the money !!

    Tell it like it is .
  4. by   NRSKarenRN
    IMO
    Problem here is ER RN's ARE available BUT administration IS NOT HIRING THEM; instead want to expand practice of EMT'S instead of hiring available RN staff.

    Another Question/C oncern for areas where EMT's are used in ER:
    Who is RESPONSIBLE for EMT's practice. Are EMT's working under ER RN's or ER physician's license???
    Last edit by NRSKarenRN on Sep 24, '02
  5. by   psychomachia
    Blackbelt: I am in it for the long haul I have cleaned more dirty bottoms than I care to remember! I am in my senior year of nursing school BSN program.

    Me: Which is why I stated this wasn't an attack toward you. I have no problem with ER techs from ANY background, but not as a replacement for an RN. I also want to be sure that if I am responsible for someone's actions that their job description and responsibilities are well defined.

    Good luck in school and with your nursing career.
  6. by   psychomachia
    prn nurse: They bring skills and experience to the ER that many of us did not.

    Me: What skills? No really, I'm serious...What does an EMT do that you as nurse cannot? I work as both a paramedic and an RN and have taught both EMTs and paramedics, so I feel I'm familiar enough with both jobs and the level of training to make the statement. Please enlighten me, because I don't really know of any skills that EMTs perform that an ER tech or RN couldn't do.
  7. by   psychomachia
    RoaminHankRN: We need to stop the bashing of our "licensed" friends.

    Me: Friends? Maybe, if they'll help me wipe a butt. "Licensed"? No. My paramedic certificate is just that...a certificate, not a license.

    RoaminHankRN: I'd much rather have an EMT-B/I/P than a "tech" with no experience. I'd even go a step farther and say a new RN coming into an ER.

    Me: This is why the state of Nevada wants to create a new job description and change the scope of practice for EMTs. How many RN jobs would you like to see replaced with by ___ (insert allied health member of choice)? Given the choice, I'd rather train a new RN than see another nursing job turn into an ER-tech position. But hey, what do I know, I'm just the ER nurse who doesn't take care of the sick people like they do on the floors, right Hank?
  8. by   psychomachia
    NRSKarenRN: IMO
    Problem here is ER RN's ARE available BUT administration IS NOT HIRING THEM; instead want to expand practice of EMT'S instead of hiring available RN staff.


    Me: EXACTLY!! Give us a decent paycheck, with manageable workloads, and there will be plenty of nurses coming to work.
  9. by   RoaminHankRN
    [QUOTE]Originally posted by psychomachia
    [B]RoaminHankRN: We need to stop the bashing of our "licensed" friends.

    Me: Friends? Maybe, if they'll help me wipe a butt. "Licensed"? No. My paramedic certificate is just that...a certificate, not a license.



    WOW!! Here in Illinois an EMT-B/I/P is a License and not a certificate. I should know because I am looking at my wife's license right now. You of all people should know what schooling EMT's go through. (Well maybe not with a certificate.) The tests my wife took in her P class were harder than some of my tests. Maybe Nevada needs to recognize!

    You asked earlier what an EMT can do that a RN can't. Again you should know one thing. I/P's can intubate. (True not something commonly done by either in an ER setting) But I've seen plenty of docs during a hard intubation turn to the paramedic and not the nurse. Why? I've also seen some with better IV skills than RN's. I hate to say this but RN IV skills need a lot of help. I'll put money on the table the EMT-P newly licensed has more hands on experience than a BSN new grad RN. Does that mean hire the EMT-P to care for patients instead of the RN? Of course not. But hire them to work along side the RN. You betcha. He/she would offer a lot to the new grad just as the RN offers to the new resident.

    I wonder how other paramedics feel about your thinking? Don't take them for granted. Especially post 9/11. While we work in our comfortable settings, they are on the frontline. Again, I gladly have a "licensed friend" along side me than a new grad RN.
  10. by   RoaminHankRN
    Originally posted by psychomachia
    NRSKarenRN: IMO
    Problem here is ER RN's ARE available BUT administration IS NOT HIRING THEM; instead want to expand practice of EMT'S instead of hiring available RN staff.


    Me: EXACTLY!! Give us a decent paycheck, with manageable workloads, and there will be plenty of nurses coming to work.
    What would be a decent paycheck? (Actual dollar amount)
  11. by   psychomachia
    RoaminHankRN: I wonder how other paramedics feel about your thinking? Don't take them for granted. Especially post 9/11. While we work in our comfortable settings, they are on the frontline. Again, I gladly have a "licensed friend" along side me than a new grad RN.

    Me: Just a couple of points and then I'm done with this topic.

    First, I am both a medic and an RN, so please don't tell me whether or not I should take something for granted. I've done (still do) both jobs and I know the differences.

    Second, what's with the statement "especially post 9/11"? Is this some kind of implication that I should change my opinion due to what happened last year? Are you questioning my loyalty or respect for those in my profession (Fire-Rescue) who lost their lives? Sorry, but that isn't the topic here, so please, no lectures on how I should feel towards my fellow fire-fighters / paramedics.

    Third, if it's "licensed friends" you want in place of an RN, fine, but you may also get a few unlicensed ones that YOU are also responsible for. But, do you want them as a replacement for another RN? That's what many hospitals want, so I'm sure they'll be glad to have your support. I'd rather see more NURSES working, especially the new grads.
  12. by   RoaminHankRN
    Originally posted by psychomachia
    RoaminHankRN: I wonder how other paramedics feel about your thinking? Don't take them for granted. Especially post 9/11. While we work in our comfortable settings, they are on the frontline. Again, I gladly have a "licensed friend" along side me than a new grad RN.

    Me: Just a couple of points and then I'm done with this topic.

    First, I am both a medic and an RN, so please don't tell me whether or not I should take something for granted. I've done (still do) both jobs and I know the differences.

    Second, what's with the statement "especially post 9/11"? Is this some kind of implication that I should change my opinion due to what happened last year? Are you questioning my loyalty or respect for those in my profession (Fire-Rescue) who lost their lives? Sorry, but that isn't the topic here, so please, no lectures on how I should feel towards my fellow fire-fighters / paramedics.

    Third, if it's "licensed friends" you want in place of an RN, fine, but you may also get a few unlicensed ones that YOU are also responsible for. But, do you want them as a replacement for another RN? That's what many hospitals want, so I'm sure they'll be glad to have your support. I'd rather see more NURSES working, especially the new grads.
    How about you read before opening your mouth. In no way have I advocated replacing RN's with EMT's. So get off the notion that I am thinking that way.

    Second, I am proud to argue my point about post 9/11. Heck even pre 9/11. And as I said before you of all people should support EMT's working "ALONGSIDE" RN's. Did I ever say you were not loyal????? It's obvious from your postings how your feel about your "certified" cohorts.

    How many RN's make medications errors? And they are licensed.

    It's obvious that we will not see eye to eye on the issue. I wish you well in your career and many traumas with new grads and EMT's to wipe A$$ for you.
  13. by   SharonH, RN
    It's too bad that this discussion degenerated into a fight about who's better, who has more skills, who's more qualified, blah, blah, blah. It points to a lack of understanding about what nurses role is for one, nurses' sole value is not in whether or not they can start an IV, intubate, etc. Therefore, an EMT and a nurse are NOT interchangeable. Besides who can do more is irrevelant.


    The issue is that rather than pay higher agency fees, or overtime, or address the issues which make their facility an unattractive place to work for a lot of nurses full-time, they have chose to bring in non-nurses to "supplement". It's been said that before the health care system fixes itself and addresses the problem with nurses, they will simply change what we do or make us irrevelant. This is one example of that. They start by bringing them in to "help" as opposed to using more nurses. The next thing you know, there are more of them than there are of you. You have less power than you ever had, working conditions are just as bad and nothing's going to change. They tried it once before on the floor with UAP's. Well this is the same thing. I have nothing against EMT's. In fact, I have a lot of respect for what they do. But as nurses, we have a right and a responsibility to protect ourselves and our jobs. It's too bad that some perceive that as elitism.

    I am stunned by the way nursing management sold out on this one. Wait a minute............no I'm not. I'm beginning to believe that the phrase "nursing leadership" is an oxymoron.

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