EC/RN/Paramedics and my Rant

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i did not want to highjack any of the other threads with my concerns/rants, but i just have to get this off my chest. i have been reading a lot about ec and how specifically how ca bon has rejected ec grads. also several other states will only let lvn's that do the rn transition program thought ec gain reciprocity in there state.

my rant:

why are paramedics completely left out of the picture??? i'm sorry maybe i'm skewed in my view, by my skills/standing protocols right now are 200% above and beyond a lvn/lpn in any state.

i perform;

endotracheal intubations, digital intubations, start iv's, start interossous (io) when needed, start nasogastric tubes for gastric levage, have 40+ iv/im medications on standing order that i give based on my clinical judgment, formulate a dx, and tx the patient all with no medical (md) control or order. i can decompress someone with a pneumothorax, i can start a needle cricothyrotomywith upper airway obstructions, and yes i can even do surgical airways in the desperately ill patients. this is all based on the national standard for a paramedic that is trained in medicine. i have to established pt repore to be able to do anything with any patient. on a average day i have 10-12 patient contacts (45mins-1hour each) and i work 5-6 six days a week, on average i see 100 patients a month and i have been in ems for 8 years (for you math freaks yes that is 9600 patient contact hours).

here is my local protocol;

http://srems.com/site/protocols/als_protocols-2004_revisions_cpap.pdf

now what lvn/lpn can say they have anywhere the experience/patient contact that i have had over the last 8 years. ohhh and to top it all off, i have a b.s. in biology (northern arizona university) and a a.a.s (broome community college) in paramedicine!

as a paramedic in the field, i function comparable to a experienced ccu or icu rn. i function with in protocols (rns following a md's orders) and make my clinical judgments based on my assessments (a rn working within parameters in a ccu/icu to manage a patient)

forgive me for being a little upset, but why is my experience not up to parr with a lvns/lpns, because i have never given a patient a bed bath, packed a grade iii decub, or help a patient to the bedside comode?

i bring this up because most states except for ca are letting ec grads in if they were lvns/lpns.

and now on to my next point, why if i have graduated from ec, sat for the same exact nclex-rn as ever other rn, hired in ny worked 3-4 years in a ccu/icu/er and then try to gain reciprocity from ca they will deny me??

that my friends is a load of crap. if in 4 years i have not had my privileges suspended or revoked by any state board of nursing, why on gods green earth would i not, be an "acceptable" rn, i have demonstrated my knowledge by taking the standerized nclex-rn and demonstrated my proficiency/clinical skills in another state for many thousands of hours, yet that is not acceptable?

further because i take a "non" traditional rn school a "traditional" rn grad is better prepared for patient care, this i guess i highly disagree. i would pit my patient care/assessment up with any rn at this point functioning in a critical care area. i may not have the clinical experience to set up a swan/ganz catheter, or help a new resident start a central line in the icu, but my independent assessment and patient care is equal.

so again i state.............how can i not take my clinical experience in the field, learn/gain knowledge into nursing theory/hospital operations and then apply that in hospital. how is that any worse than a gn coming out of any nln rn school in the us (which by the way ec is a nln certified nursing school!)

my purpose is not to start a pissing war with the lpns/lvns (although i know i will have a few flamming me) on this board but as most of the public, people are just not educated on the level of profecience of a paramedic or even how ems operates (i still have some er rn's asking me "you can do that!") just a little food for thought.

thanks for listening to my rant

chris

I would like to see each state's RN disciplinary rates for the different catagories of education. I would be hard pressed to believe that EC rates are any higher.

My state actually causally mentions it. In Louisiana we have over 700 EC grads and 21 them have been disciplined.

Specializes in ICU.

Dream_nurse

does your state mention the displinary rate for non-excelsior grads?

Dream_nurse

does your state mention the displinary rate for non-excelsior grads?

No, I haven't seen it on their site.

Also they don't make it clear whether the 21 is from the over 700 currently practicing, or 21 ever.

The other interesting thing to determine is whether these were mostly practice issues or whether they were RN's disciplined for failing to pay child support, forgetting their one hour of disaster CE, etc.

The other interesting thing to determine is whether these were mostly practice issues or whether they were RN's disciplined for failing to pay child support, forgetting their one hour of disaster CE, etc.

Yes Eric, that is so true. I'll try to so some more searching on the site, and give them a call, or drop by their office tomorrow.

Forgive me, but as someone with a lot of college credits, a recent LPN and now studying via Excelsior to become an RN, I find nursing theory to be a load of crap. Anyone who needs to be taught how to instruct the new mom who is having a hard time getting her breasts to let down milk needs a new woman (or man) card.

Specializes in Med/Surge, Private Duty Peds.

and along those lines that stated i would be a good er rn. i'm 150% sure that any er rn can 'smoke' any floor med/surg rn when it comes to patient care/multi-tasking/patient care skills.

so sorry but that is not true!!! right now i know of er nurses that can't even put in an iv, can't even remember the pt's name when calling report and when asked about certain md hx info, reply oh i don't know i didn't think to ask.

yes there are some er nurses that can work med/surg, but i really would like to see them take care of 8-9 pt, with 6 of those being total care, draw labs on those pts, plus do all the danged paperwork.

sorry, but i don't see er nurses 'smoking" med/surge nursing!!

The problem is that RN is a generalized degree designed to demonstrate competence in an entry level nursing position (for the new grad) in any number of positions. All of the advanced skills will only help, but it is a different focus if you work as an R.N in case management, hospice, oncology diabetes management etc... Instead of focusing on the major important things to stabilize the patient you have to become aware of the long-term effects of the pathophysiology, the co-morbid diagnoses, the family situation, the financial situation etc... in order to provide optimal nursing care. We have 2 paramedics in our ADN class right now and they have had a big adjustment in thinking about the long term, big picture and finding best treatment. Having said that, I don't see why this can't be taught at excelsior. A lot of the skills that they would focus on teaching, a paramedic would already have, so more time could be spent on holism and pathophysiology, evidence-based practice etc..

why would you be afraid for me take care of your grandmother? if she is in icu/ccu most likely i took care of her in the pre-hospital environment. stabilized her and transferred her in a professional manner implementing standardized medicine to stabilize her based on my assessment skills (critical thinking skills), but you would be concerned if i took care of her in the icu because you think i would walk away from her when she needed to go to the bathroom? do you not think i talk/take care of my patient in the pre-hospital environment? do you think that patient never have to go to the bathroom in the field (that is laughable, because if you know anything about increased stress, you know that not to be true)? do they stop having needs because they call 911? i'm pretty sure they don't.

if you don't think i don't use "nursing" skills in the field i challenge you to ride along with our local ambulance to get a sense of what really happens (again i even have er rn's clueless about what we do in the field).

let me ask this question, when you or your loved one is in a critical condition or in a desperate time of need, as in cva/ami/cardiac arrest, who is the 1st person you call? that would be 911? i'm pretty sure a paramedic would arrive at your door. and you're telling me you are scared for that person to take care of your grandmother?

okay so now you say that all i'm in this job is for the "glory." i'm having a hard time seeing that, because i'm paid 30k a year to deal with the blood/guts/puke/crap in a thankless job, that let me state, a service that ever one demands we have. go to any community in the us and state "we are going to get rid of there ambulance/911 system and the highly trained personnel that run those ambulances" and then stand back to watch the fire works. not going to happen.

what if i told you in my aas degree, the same degree as most lpn's receive, that i spent 1200 clinical hours in-hospital spending 400 hours in the er, 100 hours in ob/gyn, 300 hours in pediatrics, 200 hours on the med/surg floor, 100 hours in the or, and 100 hours in phlebotomy/lab/autopsy's. working right along the same precepting rn's that all the nursing schools use. learning the same patient care techniques/nursing skills as those lpn's and even more!

now i ask you how is my clinical worse, because i didn't learn concurrent nursing theory behind my clinical skills. i really beg to differ.

what is the nursing theory; it is what i call critical thinking skills (adpie)

assessment

dx (nursing dx)

planning

implementing

evaluating

that in my assessment is what the whole nursing theory revolves around. but because i didn't learn this specific critical thinking process i would put your grandmother in jeopardy in a hospital environment?

the two for me just don't connect. what i tried to convey is that i have 'as good as' clinical assessment skills/critical thinking skills to take care of patient that is at par with any lpn/lvn, and even some rn's.

i'm the 1st person you call to take care of your dieing grandmother at your house but i'm clueless when it comes to taking care of her in the hospital. doesn't make sense to me......................

again you state that "the entire reason why lvns/lpns are required to return to school is because they do not "in theory" know those critical thinking skills."

so i cannot go to the same school and learn those same theories in school? and how (please provide proof) does that make me any less of a rn when i graduated from the same nln certified program, took the same cert exam (nclex) and work in the same hospital environment gaining the same rn experience?

what i meant by putting down what i'm trained to do is not to show that "hey i'm a bad ass, and can do cool stuff in the field," it was to show that i have been highly trained in patient care too:

assess a patient based on there current s/sx

dx using the evidence i have accumulated

plan on how this will affect pt outcomes (goals)

implement those procedures

evaluate those procedures and determine if those outcomes (goals) have been met

sounds an awful lot like the nursing process doesn't it?

and along those lines that stated i would be a good er rn. i'm 150% sure that any er rn can 'smoke' any floor med/surg rn when it comes to patient care/multi-tasking/patient care skills.

again this isn't by any means a flamming post, to me this is a logical well formulated agrument, and if you disagree (with my posts) please do so, that is what discussion/informed debate is for. please keep the personal/side attacks out of this thread

thanks

chris

i'm in your corner here, and i'm ready to get flamed over this.

i get sick of hearing "critical thinking", as though the nursing profession has cornered the market on it or trademarked the expression.

i was scared to death when i started ns - until i realized that all this "critical thinking" is is reasoning using specialized knowledge. using knowledge to make inferences and decisions to hopefully gain the desired outcome.

nursing doesn't own the turf on this one, folks.

i was an air force cop. i can assure you i used "critical thinking" all the time. i know lpns use it, emts/paramedics use it, teachers use it, physicians use it - anyone who drives a car uses it.

it's not magic - it's finely tuned reasoning. professions call it different things, but it's something they all do. the only thing that makes it different is the knowledge base being used to do it, and potentially the breadth to which the thought process must be carried out (as in the case of lpns, who may not know that x action can, down the road, produce y outcome). but "critical thinking" is not solely used by nurses, and for us to continue to think so is, imho, completely ridiculous. we don't own the process, only the knowledge that we use to carry out our version of the process.

sorry - not trying to hijack the thread. but this has bothered me forever. an emt could probably be argued to not have a specific knowledge base, but i doubt it could be said he/she can't "critically think".

now that i've completely alienated and annoyed countless individuals on this board, i'll gracefully step off my soapbox.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

You haven't alienated everyone. I completely agree. My biggest problem with nursing school was the instructors treating us 40-something students as though we were fresh out of high school and needed to taught to think critically.

passing NCLEX-RN=minimal competency.

what are the changes that you refer to here? i have heard rumours of clinical hours in approved schools, but i asked EC about it and they said "no". just curious, if you are referring to the same thing. thanks kim d EMT-P

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