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.

[lindarn]

This was in ICU, so everyone has a foley. This happened a long time ago. If I remember, i think that the K level was just OK, and that is why the doc, ordered K boluses after giving the patient a large dose of Lasix. I forgot to mention that. She had something like 120 mg of IV Lasix given, that was why she needed the extra Potassium. Or so the doc thought. I don't know what the BUN and Creatinine was. She was not a kidney patient. She was not my patient. I just remember sitting in the nurses station, charting, and the monitor alarm went off.

I looked up, to see the QRS complexes on the monitor, getting wider and wider, until it just flatlined. It took only seconds for this. She hit the code button, we got the crash cart, as usual, it was a Cecil B. Demille cast of thousands, with all of the residents responding.

As I said, it was not a pretty sight. You sometimes hear RNs saying that, LPN/LVNs, who go back to school to become RNs, continue to have an, "LPN/LVN, mentality". It is not meant to be derogatory. It means that they have not adapted/developed, the critical thinking skills that make the difference between an RN and an LPN/LVN.

As usual, JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN, (ret)

Somewhere in the PACNW

[psu_213, BSN, RN]

I have confidence in my local EMS…I am confident that if my loved ones or me go down in public, these prehospital professionals will do their very best to give me a chance to live.

However, and I am sorry since some are offended by this, I can cite several examples of situations where paramedics did not demonstrate good critical thinking. Also, perhaps just as importantly, I know of many situations where paramedics did not provide compassionate care for patients, particularly those with mental health issues. For these reasons, I would not be comfortable with paramedics "replacing" RNs in the ED setting.

[BR157]

I think that BR157 actually believes he/she is actually convincing others and "scoring points" with the incessant diatribes and continuous blowing of smoke, along with the personal attacks against anyone who disagrees. Pretty transparent and sad...

You initiated this discussion against Paramedics. You wanted nurses to side with you against Paramedics since you failed to get much reaction out of your fellow EMT-Basics on the EMS forums and FB. You got a few responses here from a handful of people but it doesn't seem to be the bash a medic presence you probably were hoping for. You probably didn't expect any support for Paramedics on a nursing forum.

Even the ENA apologized for one of its' members attacking Paramedics. Even without you, Paramedics will advance their profession.

There is no smoke to blow. The Bill says it all. It is real. You should have read it before initiating this discussion.

[BR157]

This nurse was not, "set up to fail". She went through, and passed a Critical Care Orientation. If she was not safe to practice, she would not have been allowed to pass.

There was another case, when I worked in California, concerning a med surge/telemetry nurse, who wanted to be an ICU nurse, came to work on my unit, went through an ICU orientation, was let loose on the PM shift. Her care was sketchy, she did not seem to, "be getting it". No one intervened and put her back on orientation.

She proceeded to kill a patient, who she was administering KCL boluses, over a few hours, did not think to check,make note of, connect, that her urine output was scant, the patient was not diuresing like she should have, and continued to administered the KCL boluses until the patient coded from hyperkalemia.

All she kept saying in her defense was, "if the doctor wanted me to hold the potassium if the patient did not diurese, than he should have written that into the order like that"! She was fired the next day. THAT is also an example of a nurse, who just did not, "get it".

I am not saying that paramedics cannot function in a critical care environment, but there are aspects of their education/training, that are part of every nursing program, that are NOT part of a paramedic program.

JHMO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

I don't know what you are expecting me to say about the examples of nurses messing up.

Paramedics can be trained just like a nurse. In fact, Paramedics are in a much better position for ER, Rapid Response and Code teams than any of the nurses you mentioned.

Who is on your flight and CCT teams? Most state laws will not allow just nurses. I bet most of the interfacility transports of critically ill patients are done by Paramedics. Paramedics are also now a huge presence on pediatric and neonatal critical care transport teams.

There are training programs and certifications for CRITICAL CARE PARAMEDICS. There are both Flight and Ground Critical Care Paramedics. Some states have even added Critical Care Paramedic to their state licensure/certifications.

Here are examples:

TN

Tennessee Department of Health: Emergency Medical Services

WV

Personnel Certification

[Red Kryptonite]

Unfortunately, there are plenty of examples of RNs not exhibiting critical thinking either. I'm not sure that's the place to sink your stake into the battlefield.

[BrandonLPN, LPN]

Yes but many aspects are the same.

There is actually very little overlap between the pre-hospital setting and the hospital ER setting. And almost none between the pre-hospital setting and the inpatient hospital setting.

I don't think you understand what nurses actually do. Have you ever observed what the average nurse actually does over the course of a shift? Very little of it, often none of it, involves first responder skills

[CraigB-RN, MSN, RN]

Pretty much the only utility threads like this have is entertainment value and as an example of the darker side of the internet.

Psychologist have coined a term called Online Disinhibition. Although it's a complex topic, it covers the fact that the anonymity of the internet allows people to say things they would never say face to face, and it gives the foundation to what we now call Trolls.

People make blatant statements that are so far from reality, and in many cases actually believe what they are saying. There are however ways to see those statements for what they are. If the posters gives reasons why they won't identify themselves, that pretty much gives all the credence their stands deserve. If they were to actually believe and be able to support their claim, they would be happy to admit who and where they are.

They post to these forums, basically because they figure no one here will know enough to be able to contradict them. Unfortunately there are many people on this forum that either are also Paramedics or were paramedics before they became nurses. There are also plenty of Emergency Dept nurses here who work with and deal with paramedics on a daily basis. To those of us who fall into that category, well lets say that in my department we got a good chuckle out of the posts.

There are GOOD medics out there that could step into a nurses job with almost no hiccups. I know that they could pass the CEN exam, I see that happen every day. There are medics who without knowing it are motivating and moving themselves along Benner's novice to expert pathway. They are the ones that go to PA school, nursing school, they become flight medics, faculty in EMT-P programs etc. They read and probably know more about many things than I do.

The other thing to remember is just because the law allows it, doesn't mean it's going to happen. There are other regulatory factors. ie Liability Insurance, CMS and other regulatory bodies.

I'd suggest to the staff that the thread has pretty much ended it's usefulness and entertainment value.

[BR157]

They post to these forums, basically because they figure no one here will know enough to be able to contradict them. Unfortunately there are many people on this forum that either are also Paramedics or were paramedics before they became nurses. There are also plenty of Emergency Dept nurses here who work with and deal with paramedics on a daily basis. To those of us who fall into that category, well lets say that in my department we got a good chuckle out of the posts..

Most of those posting the negativity against Paramedics on this discussion are EMT-BASICs, not PARAMEDICs. There is a big difference. Perhaps if they had gone on to be Paramedics, their posts would be very different. Would you accept a couple of nursing assistants as the spokespersons for all RNs? Medic_5 on here pointed out his education and was attacked for believing in higher education for Paramedics.

Paramedics also deal with ER nurses all day and can say some of it is chuckle worthy also.

There are GOOD medics out there that could step into a nurses job with almost no hiccups. I know that they could pass the CEN exam, I see that happen every day. There are medics who without knowing it are motivating and moving themselves along Benner's novice to expert pathway. They are the ones that go to PA school, nursing school, they become flight medics, faculty in EMT-P programs etc. They read and probably know more about many things than I do..

Everyone has their favorite providers. There are nurses who probably know more than the doctors and then there are some who I would not trust with a band aid.

CEN? Paramedic is a certification, as well as a degree, in Emergency Medicine. The Paramedics, such as in Texas, can have an Associates degree, just like nurses, and its specialty is in Emergency Medicine. Nurses do not come out of school being ready to go straight into an ER.

Why are you so against Paramedics doing in the ER what they do by themselves in the back of an ambulance everyday? Some seem very happy to have Paramedics working in the ER doing only CNA work but that is a gross under utilization of their knowledge and skills.

Nurses have gone and are still going through something similar. Some have wanted to work on ambulances and even on flight teams. But, their state regulations said they had to have an EMT or Paramedic cert. Only a few states have created shortcuts for nurses to get a Paramedic cert without taking the whole class. A couple of states have allowed RNs in rural areas to work on ambulance under a limited scope of their own license. A couple of others created the PHRN. Paramedics would just like to work as Paramedics in the ER. Now that their own scope of practice is changing and expanding, this is the time to move forward.

The other thing to remember is just because the law allows it, doesn't mean it's going to happen. There are other regulatory factors. ie liability insurance, CMS and other regulatory bodies.

I'd suggest to the staff that the thread has pretty much ended it's usefulness and entertainment value.

Times are changing. Maybe you are not aware that your own hospital is contracting with EMS to have Paramedics (Community Paramedics) follow their more complex patients when released from the hospital. This includes patients who have CHF, COPD, recent surgery and the frequent fliers. Legislation has already been passed in several states with plans in place for reimbursement. It is a huge win for CMS to be behind this.

Here is the link for Arkansas.

Arkansas Community Paramedics | EMSWorld.com

People make blatant statements that are so far from reality, and in many cases actually believe what they are saying. There are however ways to see those statements for what they are. If the posters gives reasons why they won't identify themselves, that pretty much gives all the credence their stands deserve. If they were to actually believe and be able to support their claim, they would be happy to admit who and where they are.

The President of one of Texas' ENA started the mud slinging and the ENA has since apologized. If you were as informed as you say, you would know more about this and the Bill in question.

The author of the article Summit posted used his real name. Summit did not here. When Summit posted with his Facebook name, he was much less inflammatory towards Paramedics. People have been cautioned not to post their real names and titles on this forum. You are not posting your full name. Even if I did post my full name I would not expect you to nor would I even encourage you to. However, if I write something in a national magazine or journal for professionals to read, I will use my real name just like the author of the initial article.

[applewhitern, BSN, RN]

Why do people want to be thought of as an RN, do everything an RN does, get paid as an RN, but don't want to simply go to nursing school and become one?

[Red Kryptonite]

Why do people want to be thought of as an RN, do everything an RN does, get paid as an RN, but don't want to simply go to nursing school and become one?

Great question.

[BR157]

Great question.

Not really because not one Paramedic has mentioned here about wanting to BE A NURSE.

Why do people want to be thought of as an RN, do everything an RN does, get paid as an RN, but don't want to simply go to nursing school and become one?

Why would a Paramedic want to be an RN? They have their own very extensive scope of practice in emergency medicine which is what the bill is about. If they have the same amount of education since nursing is still only an Associates, and can do many of the same skills plus more which nurses in the ER do not why not make close to the same money?

Why is it so unreasonable for some here to have a Paramedic functioning to the fullest extent of their scope of practice in the ER? Do you think Paramedics are useless on ambulances also? I really don't see why you are so against this except for turf protecting. For 50 years Paramedics have been starting IVs, giving medications, placing central lines, intubating and many other skills in the field. They also have been transporting ICU patients with multiple drips, balloon pumps, ventilators and many other things.

There have even been some saying that they had to ask a Paramedic from the ambulance to start an IV, EJ or IO in the ER when they couldn't get it. It is also not that uncommon to have a doctor ask the Paramedics do a difficult intubation. In some of the smaller critical access hospitals, Paramedics are frequently called to the hospital to assist in the ER or on the floors intubating and setting up bipap or a ventilator.

But this discussion is going nowhere because the few who are commenting have not read the proposed Bill. Some of those responding here are only responding emotionally over turf and personality conflicts over not liking someone rather than being informed by reading the actual proposed legislation. If you aren't in EMS, you probably haven't kept up with the changes. That is no reason to say Paramedics can do something and can not advance their education and profession.

[BrandonLPN, LPN]

I have no experience in the ER, but I'm puzzled as to what exactly a paramedic performing to the full extent of his scope in that setting would entail. Sounds to me like a tech who can perform a wider range of of technical tasks. A paramedic in the ER isn't going to administer medication or be responsible for carrying out physician orders, because once the patient is out of the ambulance and in the hospital that becomes a nursing task. The paramedic cannot take a patient assignment in the same sense an RN can. When and if a paramedic performs nursing tasks in the hospital, it will be under the delegation of an RN. Simply put, once a patient hits the hospital, the provision of care falls squarely under the nursing model.

What are you thinking a "full scope" paramedic in the hospital would look like? That they'd assume a role of "separate but equal" importance or authority as an RN? That's not going to happen. It would be an auxiliary role, because care of the patient in this setting is nursing by nature and by definition.

By the same token, an RN cannot say that because they are BLS/ALS certified and they know first aide that they are just as qualified as a licensed paramedic to ride on an ambulance and be a first responder. The education and training of a nurse in that setting is of limited value. Just as the training and education of a paramedic is of limited value in the hospital. They're two different disciplines for a reason.