Article: Paramedics equal to RNs

[SummitRN]

In an article published on the major EMS website, EMS1, an article claims that Paramedics have more education than nurses and, through unbelievable math, are nearly as qualified as a nurse with CCRN and CEN certifications.

Why paramedics are qualified emergency care providers

This article is making the rounds on Facebook as Paramedics advocate to practice with similar or greater autonomy than RNs in the hospital environment.

[TiffyRN, BSN, PhD]

Is this a measure to fill a need, decrease costs, or create jobs for Paramedics?

I repeat my earlier questions. . .

The OP's rhetoric sounds incredibly similar to what we hear from NPs. They want to practice at the full scope of their practice. Their main argument is that they are willing to fill needy areas often neglected by MDs (and yes, at a substantial cost savings).

So is the OP proposing we are short on ER nurses? We are not in my area of the country, having a bit of a over-supply at the time.

Or is he/she proposing paramedics can provide the same services more cost-effectively? That's a legitimate argument.

Or is the OP proposing this is a convenient way to open more vocational opportunities to paramedics? Also a legitimate argument but one that may ruffle some feathers because as I pointed out earlier, we've got more RNs than ER jobs at present.

How does this proposition fly with TJC? My question may make a lot of people roll their eyes, but I thought all hospital patients (even ER patients) were obliged to be under some kind of nursing care plan. Remove the nurse, how can there be a nursing care plan? I can see the proponents of the bill advocating for this and if it passes, now the ER RN has to chart on all the paramedic's patients. Reminds me of the days when LPNs were in the hospital. Not disparaging their skills AT ALL (let's be clear on that and I know they are still in acute care in some places in the country, but not much around here). But in most places, the powers that be determined that the RN (with his/her full load) had to chart on the LPN's patients. Sometimes just a note, sometimes a full assessment.

Once more, refer to the 3 questions I proposed at the top.

[TLSpaz, ASN, RN]

I don't work under a doctor. You evidently do not understand that medicine and nursing are two separate disciplines. If I worked under a doctor, I wouldn't need a nursing license.

[TLSpaz, ASN, RN]

duplicate post deleted

[nurseactivist]

Sadly, some nurses facing critical staffing shortages are willing to accept any warm body. Granted a paramedic is better than an extra social worker in the ED. However, sometimes when nurses are performing non-nursing functions, an extra clerk can be a god send. However, we need to defend our scope of nursing practice and I personally do not believe that a paramedic is appropriate in the ED. If we keep giving away pieces of our nursing practice, soon there will be nothing left. The solution is to advocate for adequate nursing staffing.

[lindarn]

That us exactly what the PTB want- that there is NOTHING LEFT OF NURSING PRACTICE!

They want our career to be split into a bunch of minimum wage, "tasks", that they can give away to the highest bidder corporation.

That is what they have been planning all along. The attack on nursing was initiated when they convinced the government, that there was a, "critical nursing shortage", and the numbers of nurses needed to be increased dramatically, to prevent it".

Now there are hordes of unemployed nurses, fighting among ourselves for jobs.

What nurses need to be doing, is fighting for staffing ratios, that will provide jobs for all of these nurses. Another day, another attack on the nursing profession.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

[BR157]

I don't work under a doctor. You evidently do not understand that medicine and nursing are two separate disciplines. If I worked under a doctor, I wouldn't need a nursing license.

I don't get why you don't think you need a license. Granted it might only be a measure that you completed all the required testing and paid your fees to the state but it also defines your state scope of practice. In some way or another a physician is involved in your job as an RN. The hospital and the medical staff (physicians and nurse administrators) will then determine which of that scope of practice you will utilize in a hospital. The doctor designated as the medical director of that unit will then sign your protocols. This also works for every allied health department in the hospital. Each and every one of them has a medical director (physician) who determines their protocols and scope of practice for that hospital.

You can find this paragraph in just about every nursing SOP manual.

The protocol must be signed by the delegating physician and must be on file and available to the nursing staff. If the tasks or functions ordered fall outside the scope of the protocol, the extender must consult with the physician to obtain a verbal order before the RN may carry out the order.

Regardless if you work in an ICU, ER or nursing home you will have a medical director who signs the protocols for that unit. Go to your protocols right now and see the name and title on them.

[BR157]

I repeat my earlier questions. . .

The OP's rhetoric sounds incredibly similar to what we hear from NPs. They want to practice at the full scope of their practice. Their main argument is that they are willing to fill needy areas often neglected by MDs (and yes, at a substantial cost savings).

So is the OP proposing we are short on ER nurses? We are not in my area of the country, having a bit of a over-supply at the time.

Or is he/she proposing paramedics can provide the same services more cost-effectively? That's a legitimate argument.

Or is the OP proposing this is a convenient way to open more vocational opportunities to paramedics? Also a legitimate argument but one that may ruffle some feathers because as I pointed out earlier, we've got more RNs than ER jobs at present.

How does this proposition fly with TJC? My question may make a lot of people roll their eyes, but I thought all hospital patients (even ER patients) were obliged to be under some kind of nursing care plan. Remove the nurse, how can there be a nursing care plan? I can see the proponents of the bill advocating for this and if it passes, now the ER RN has to chart on all the paramedic's patients. Reminds me of the days when LPNs were in the hospital. Not disparaging their skills AT ALL (let's be clear on that and I know they are still in acute care in some places in the country, but not much around here). But in most places, the powers that be determined that the RN (with his/her full load) had to chart on the LPN's patients. Sometimes just a note, sometimes a full assessment.

Once more, refer to the 3 questions I proposed at the top.

Summit is the OP but he has his own agenda to continue something which the ENA has already apologized for.

I already posted a link to Carol Twombly's letter who represented the Texas (San Antonio Chapter) ENA. But here it is again.

An Urgent Call To Texas EMS Professionals - Ambulance Driver Files

I posted the links to the actual bills (Texas HB 2020 and SB 1989) earlier and you can see who the has sponsored the bill. This is really no different than those passed in other states where Paramedics can use their knowledge and scope of practice in the ER. It really is not that uncommon for Paramedics to start IVs, intubate and given medications when working in the ER. Paramedics should not be limited to just clerking as one nurse (nurseactivist BSN) here wants Paramedics to do.

Read the links to the Bill and find out more detail. My state and the neighboring state, as I mentioned earlier, already allows Paramedics to work in the ER with their scope of practice.

The ENA did apologize for Carol Twombly's letter and have worked with EMS to come up with wording agreeable to both. Ms. Twombly's strong words of opposition against Paramedics actually helped propel the Bill forward by bringing out such strong support (and from nurses) for the Paramedics after her letter was published nationally.

Anatomy of a grassroots EMS movement

Ultimately, both the national Emergency Nurses Association and

the Texas Emergency Nurses Association disavowed Twombly's letter,

saying they do not agree with its content, and never sanctioned its

promulgation. NAEMT is currently working on a joint statement with ENA.

Some substitutions were made to the bills as a concession to ENA,

after which they voiced their support for their passage. The

substitutions do not give paramedics carte blanche to practice as

paramedics in hospitals, but if passed, the legislation allows

paramedics to use emergency medications, vascular access, intubation and

other ALS skills in resuscitations and other emergency situations under

physician oversight. At the very least, it will pave the way to

paramedics acting as full members of hospital rapid response teams.

In other words, not everything we wanted, but a lot more than we had

before. I think it is safe to say that Twombly and ENA never anticipated

the furor her letter caused. Had it not been for Texas paramedics

voicing their support in such numbers, the bills would have died a quiet

death in committee, and few would have ever known of their existence.

The wording is nothing new and it is what Paramedics already do in other states in their ERs.

One thing Summit's discussion did prove is that so few nurses are aware of what is happening in their world when it comes to pending legislation and then get an emotional knee jerk reaction if it is not to their liking. Carol Twombly's letter was sent to the members of the Texas ENA. I also posted the link to this legislation a few weeks before Summit started this discussion.

Join your professional associations and find out what is going on in your part of the nursing world. You shouldn't have to hear about it from the EMS world first.

[ixchel]

I don't get why you don't think you need a license. Granted it might only be a measure that you completed all the required testing and paid your fees to the state but it also defines your state scope of practice. In some way or another a physician is involved in your job as an RN. The hospital and the medical staff (physicians and nurse administrators) will then determine which of that scope of practice you will utilize in a hospital. The doctor designated as the medical director of that unit will then sign your protocols. This also works for every allied health department in the hospital. Each and every one of them has a medical director (physician) who determines their protocols and scope of practice for that hospital.

You can find this paragraph in just about every nursing SOP manual.

The protocol must be signed by the delegating physician and must be on file and available to the nursing staff. If the tasks or functions ordered fall outside the scope of the protocol, the extender must consult with the physician to obtain a verbal order before the RN may carry out the order.

Regardless if you work in an ICU, ER or nursing home you will have a medical director who signs the protocols for that unit. Go to your protocols right now and see the name and title on them.

As much as I get what you are saying, do you realize that a massive part of how orders get made in the first place comes from what nurses do, say, request, and observe? A true physician/nursing staff team doesn't consist of simply protocol and physician directed care. Physicians rely very heavily on the nursing scope of practice for their role in the care team.

I would never say we could replace them or their expertise, but I will say that yes, nursing practice is very different from medical practice, and they are very inter-dependent in the acute care setting. I may not fully know the scope of practice of a paramedic, but I imagine that that isn't part of it. We contribute far more than fulfilling protocols.

[BR157]

For an update on the legislation, this was posted on the Association of Texas EMS Professionals' website.

06/20/2015

Your Association of Texas EMS Professionals Legislative Update!!!

We are very pleased to announce that Governor Greg Abbott signed SB 1899 into law yesterday!!! ...

This what the final draft looks like:

Sec. 773.0496. SCOPE OF EMERGENCY MEDICAL

TECHNICIAN-PARAMEDIC AND LICENSED PARAMEDIC DUTIES. (a) In this

section:

(1) "Advanced life support" means health care provided

to sustain life in an emergency, life-threatening situation. The

term includes the initiation of intravenous therapy, endotracheal

or esophageal intubation, electrical cardiac defibrillation or

cardioversion, and drug therapy procedures.

(2) "Direct supervision" means supervision of an

emergency medical technician-paramedic or licensed paramedic by a

licensed physician who is present in the same area or an area

adjacent to the area where an emergency medical

technician-paramedic or licensed paramedic performs a procedure

and who is immediately available to provide assistance and

direction during the performance of the procedure.

(b) Notwithstanding other law, a person who is certified

under this chapter as an emergency medical technician-paramedic or

a licensed paramedic, is acting under the delegation and direct

supervision of a licensed physician, and is authorized to provide

advanced life support by a health care facility may in accordance

with department rules provide advanced life support in the

facility's emergency or urgent care clinical setting, including a

hospital emergency room and a freestanding emergency medical care

facility.

Please continue to send us your job descriptions for those of you who already currently work in this capacity across the United States. And thank you so much to those of you who have already taken the time to respond. We are still in the process of developing framework for implementation. Please continue to "Like and Share" our page as there will be several other updates very soon!!! Thank you for your continued support

[BR157]

As much as I get what you are saying, do you realize that a massive part of how orders get made in the first place comes from what nurses do, say, request, and observe? A true physician/nursing staff team doesn't consist of simply protocol and physician directed care. Physicians rely very heavily on the nursing scope of practice for their role in the care team.

I would never say we could replace them or their expertise, but I will say that yes, nursing practice is very different from medical practice, and they are very inter-dependent in the acute care setting. I may not fully know the scope of practice of a paramedic, but I imagine that that isn't part of it. We contribute far more than fulfilling protocols.

Are you saying you have no protocols in place to initiate anything before a doctor is contacted with your observations? Don't you have any protocols to titrate drips or get labs if you think they are needed? Giving oxygen? Do you have to call the doctor for all "orders"?

If a patient came into the ER with chest pain or shortness of breath, can't you start some treatment under standing orders or protocols?

Protocols can be used as guidelines and not merely recipes.

The state scope of practice for a nurse can be extensive including intubation and initiating central lines but that does not mean YOU can do those in your hospital.

Physicians rely heavily on Paramedics to assess and initiate appropriate treatment for a prehospital patient or the patient they want taken to another hospital who is in critical condition. Paramedics do not have labs, xrays and other professionals in the field. They must rely on their assessment and if they must call for medical direction, that physician relies on the Paramedic's assessment. Not all patient's are found within a few blocks of an ER and might be as far as an hour away. Now that the Community Paramedic is making house calls, the physician is also very reliant on their assessment to provide the correct continued care.

[ixchel]

Are you saying you have no protocols in place to initiate anything before a doctor is contacted with your observations?

No. If you'd bothered to actually read what I wrote and keep it in context, you would know that.

I stopped reading after this question, as it is clear you only debate in absolutes, which I find irrational and not worth the effort of continuing to respond to beyond this.

[noelly10]

Oh..well, don't mind me. Just here to read some comments...