Protect your profession...

  1. Hello fellow professionals,

    May I have your attention please. An allnurses.com user by the name of nursebrandie made a valid point in the emergency nursing subforum that I would like to discuss with all of you. We were discussing the use of paramedics in the ER, and it was mentioned that the two professions were interchangeable. This is alarming to a professional nurse such as myself. We must not give give up our career roles to other specialties. Any of you that do not believe this is an issue, please consider the following:

    1. Anesthesia started out being administered by nurses, that's right, nurses...not physicians. Nursing gave this role up to physician anesthesiologists. Yes, we still have the CRNA profession, but now there is a new role out there called the Anesthesiologist Assistant (AA). It is a master's degree program that physicians created to keep the midlevel anesthesia providers under their thumbs. The position pays as well as, if not more than, a nurse anesthetist.

    2. Physical Therapy and Occupational Therapy started off as subspecialties of nursing. Yes, PT's and OT's were orginally nurses that received specialty training in the activities of PT and OT. But we gave these positions away too and now the PT has become a clinical doctorate degree and the OT has become a master's degree.

    3. Midwives originally birthed babies, not physicians. In fact, the first known male physician to witness a live birth dressed up as a woman to see the event, and when it was discovered, he was burned alive at the stake. Yes, we still have nurse midwifery, but it never should have been given to the male physician group. And also look at what CNM's get paid compared to OB/GYN physicians...for pretty much the same job.

    4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why? Nurses aren"t smart enough to use strict aseptic technique to mix drugs in an emergency situation?

    5. Why is it that nurses cannot endotracheally intubate except in an ambulance or flight nurse role? Why is it that a paramedic can put in an EJ IV line, central line, or chest tube but nurses cannot except if employed in a flight nurse or ambulance role? Why is it that are profession seems to want us more educated but we have allowed ourselves to become "dumbed down"?

    So yes, the idea of paramedics taking over the ER nurse's role is a real threat, and it should not be taken lightly. Paramedics are great to have in the ER...but paramedics are paramedics and nurses are nurses.

    Embrace your skill set, and do not allow others to take anything more away from you! You went to school. You learned the skills. You know how to critically think! Nurses are more than just well educated technicians. I am more than a butt wiping, pill pushing, bed making technician. So are all of you.

    Keep this in mind as you move through your career. Nurses need to come together, not grow apart if this profession is ever going to be something more.

    Mark
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  2. 94 Comments

  3. by   Tweety
    We need to surrender to the expertise of the various professions that are out there today in modern medicine. We don't have to do it all, there simply just isn't enough of us, nor enough time to learn it all.

    However, you bring up some very interesting points.
  4. by   caliotter3
    Excellent points, well articulated, food for thought and professional discussion. In my BSN program we had discussion about professional issues and had required assignments to write to legislators, attend a meeting of the ANA, etc. What I have found in the world of work is that most of us spend all of our worktime (and more sometimes) just trying to survive on the job. I have many times tried to get involved in quality improvement, quality assurance efforts at my jobs and have been squelched like a bug over the smallest issue. These efforts went by the wayside when having a job became the only issue.
  5. by   Marie_LPN, RN
    We need to surrender to the expertise of the various professions that are out there today in modern medicine. We don't have to do it all, there simply just isn't enough of us, nor enough time to learn it all.
    I agree with this.
  6. by   jamonit
    Quote from markdanurse

    Embrace your skill set, and do not allow others to take anything more away from you! You went to school. You learned the skills. You know how to critically think! Nurses are more than just well educated technicians. I am more than a butt wiping, pill pushing, bed making technician. So are all of you.

    Keep this in mind as you move through your career. Nurses need to come together, not grow apart if this profession is ever going to be something more.

    Mark

    amen.umpiron: umpiron:
  7. by   Tolos
    I think nursing is very demanding as it is. We have 12 hours in the max everyday to do these skills, and coordinate care with family members, Doctors, Social workers etc, so we need these other branches to work with or to share the responsibilities.
  8. by   MayisontheWay
    Maybe, just maybe it's time for nursing to change. Specializing while IN nursing school, with an appropriate education just might be the answer.

    So much of my BSN program was USELESS information. Can a paramedic, RT, OT, PT, CRNA, NM or OB-GYN say the same? Oh to have spent a year with half clinical half didactic ICU education. Instead, I have a whole lot of USELESS information about OB, community health, mental health, etc.
  9. by   traumaRUs
    Nursing and medicine has truly advanced at an astonishing pace. When I was in nursing school the first time (1977), patients with fx femurs stayed in skeletal traction, flat on their backs for 8-12 weeks! Nowadays, no one stays in bed much past 24 hours unless they are intubated, sedated and on a bazilion drips!

    I think it is okay that we have shuffled some of the more specialized tasks to specialists. Most of my RN experience is in ER (level one trauma center) and I had to know a little about a lot. However, it did not mean that I could care for a septic infant over the long haul or that I could care for an ICU patient when they got orders to start CVVH. However, it did mean I could stabilize the patient and transport the patient to the specialists.
  10. by   Tweety
    I think in some areas, nursing has evolved. Time was only an MD could start an IV. There were certain medications that only an MD could administer. I remember getting an IVP in 1979 an the doctor saying "this dye can only be given by a physicision". Nurses didn't read EKGs, didn't make detailed head-to-toe assessments, and didn't really use their brains much.

    Gotta give ourselves some props for advancing our profession over time.


    The OP asks some good questions that got me thinking "hmm.....why aren't I allowed to intubate? Why was that skill dropped from ACLS?".
  11. by   ZootRN
    I'm kind of glad we don't have to intubate, mix drugs, do a physical therapy, put in central lines and what else is in a list. Imagine having 6-7-8-10 patients, 12 hours shifts and having to do all of that. No, thank you.
    I guess, roles in the health care are blending. Doctors don't like NP role either, for the same reasons you mentioned.
  12. by   burn out
    Here I go again, it seems I always take the opposite side of the argument on here. However, I believe that if paramedics take over the nurses job in E.R. it is because the E.R. nurse is letting it happen. The E.R. nurses at my hospital have totally isolated themselves from the other departments to the point that they seem arrogant. They never get pulled to do bedside nursing on the floors or units because they are ER nurses (does that mean they don't now how to do pateint care?) When patients have been admitted and they are being held (sometimes a day or two ) in ER for a bed, the nurses never even touch the admission orders because they are ER nurses. Once the supervisor told the ER nurse that a patient needed a bedpan (the nurse was reading the paper at the desk). The ER nurse replied "I didn't spend 60 thousand dollars to go to nursing school to put people on the bedpan." If all ER nurses have this attitude someone has to do patient care in the ER and it looks like the paramedics are going to try. We all take the same test and we all go to the same schools and learn the same things but it seems that the ER nurses are putting themselves in a very tight and limited position. If you are not going to "Nurse" then it proves that you are not needed and will be replaced with something else.
  13. by   ckben
    Quote from markdanurse

    4. RN's used to be able to mix drugs in piggybacks for I.V. administration. Now pharmacists have completely taken over that arena too. Why is this important? Well, just this...did you ever need a drug in an emergency situation, like Mannitol, but had to wait for a pharmacist to mix it and you get it back in 30 minutes when you could have mixed it in 5 minutes flat? Look around you...nursing's skill set is being taken away, but our nursing leaders are demanding us to have more education. Why? Nurses aren"t smart enough to use strict aseptic technique to mix drugs in an emergency situation?
    there's a very good reason that nurses aren't allowed to mix drugs on the floor anymore - many, many, many critical med errors that resulted in patient injury and death. yeah, it sucks to have to wait for meds, but unless your pharmacy has severe problems, they should be able to get emergency drugs to you pretty quickly. to tell you the truth, there are plenty of nurses i know that, if i was the patient, i wouldn't trust to give me the right drugs in a regular situation. add on to that the stress and hurry of an emergency, and it's a recipe for disaster.

    maybe the system isn't perfect, but in this case i definitely think we should leave the mixing of drugs to the pharmacists. it is, specifically, what they went to school for, and the more checks there are in the system the more safe it is for the patient.

    i wonder why we're so worried about losing our skills to other professions. i know that i am personally extremely grateful to PT and OT, for example, for everything they do. i know that i could not do everything i'm supposed to do as a nurse and also perform these duties. that's why it's called an interdisciplinary team. we work together to do what's best for the patient. nursing isn't going anywhere for a long time. why do we so jealously guard what is considered "our" territory when the best interests of the patient clearly lie in having the most qualified people perform each task, rather than one semi-qualified person performing it all? or, if you're arguing, for example, to have a nurse whose only job is to perform physical therapy on a floor, do you really believe that the nursing shortage is a lie, and that there will be enough supply to teach nurses to do all these things and thus put these other people out of a job?
  14. by   Indy
    About emergency drugs: the hospital needs a pharmacist 24/7. One, some emergent drugs are in the code box, which is when we need them. Two, we have some floor stock, and it's clearly labeled (only one strength of heparin goes in there) and we know what these drugs are for. Three, if I call pharm and say I want X drug here now for an emergency they will send it and I'll write their orders when I have time. I've gotten dopamine bags in under five minutes, from four floors down.

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