ER nurses compared to EMT's

SICU/ER NURSE · Dec 24, 2004

This is my first post on this board, so I would like to say hello to everybody. I just couldn't pass up the opportunity to get in on this discussion. Having been in both the pre-hospital, ER and ICU settings, I can tell you that it is an absolute waste of time to try to compare any of these professions. While it is true that some skills and procedures overlap each other in all these jobs, to say that an ER nurse is better than a paramedic or an ICU nurse is better than an ER nurse is just showing incompetence.

First Paramedics are still a relative young profession when compared to the nursing profession. Paramedic practices and training also varies greatly from State to State and does not enjoy the luxury of being uniform (meaning things I can do as a Paramedic in Kansas, I may not be able to do in a different state). I went to Paramedic School for 2 years and completed an Associates degree within that program. I don't appreciate being compared to other paramedics who may of only went to school for 4 or 5 months in another state and did not have to complete the same rigors clinicals and field internships that I did. Also, I can tell you that in the state I worked in, I could give any medication, as a paramedic, that was ordered by a physician, to include blood. I also did learn how to put in Foley catheters and started way more EJ in the field than I ever did in an ER setting. I can also tell you that if I was giving that medication I new how it worked, the side effects, contraindications, etc. If there are paramedics out there carrying and giving medications without knowing their use, you live in a State with very poor EMS education requirements or ran into a very incompetent practitioner. The EMS profession is making strives to become more uniform. I believe in time, degrees as opposed to certifications will become the standard for paramedics. Similar to nursing moving from a diploma to an associate or Bachelor's degree.

One other thing I must comment on before leaving. Remember every EMS service is different. EMT's and Paramedics are also different. Be careful not to lump everyone together.

teeituptom, BSN, RN · Dec 24, 2004

ER nurses are to ICU/floor nurses, as EMTs/paramedics are to ER nurses. (Meaning, "stabilize them and get them where they need to be...")
Is this a fair statement?

Not hardly

and dont be surprised if you irritate some ER nurses with a statement like that. Thats not a fair statement in any regard.

chip193 · Dec 24, 2004

I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made. For example I had someone bring in a COPD pt. on 4L of O2 because the pt. O2 sats were 90% on RA. I asked the EMT why did they put the pt on 4L as opposed to 2L. They said they were having problems breathing. I asked did you try putting the pt. on 2L to see what his sats were. And they were like, no the pt was having problems breathing. I'm sure it was just this EMT but, I was thinking hello, it's a COPD pt. I understand if they are having difficulty breathing but, they need to be on the lowest O2 as possible, duh, cause they are just going to be retaining CO2. And as it turned out, the pt sats were 100% on 2L NC, so this in my mind improves the pt's outcome.
I would say, like nurses and doctors, there are some good EMT/Paramedics and some bad ones. I believe some EMTS/Paramedics have skills that nurses on a med surg floor don't have. However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge. Likewise, in the ER the doctors are in charge because they have more education than the nurses. In our ER in an emergency setting we nurses do what we need to do if a doctor is not around, ranging from thoracostomy to EJ's to whatever. We as nurses are trained to do what we need to do in an emergency situation, it's just that whoever is the most skilled does the task. Also like someone said in another post, sometimes it's like the ICU is the ER because I have had to take care of very sick pts on vents who may be in the ER for my entire shift. Often at our hospital we are short on beds, so pt's can end up in the ER for days. It's nice to get the experience an ICU nurse, however sometimes it's tough to take care of the very sick because there is so much going on the the ER (people being shot right outside our doors, the detoxing drunks, knifes being pulled on staff, the vented patients, traumas, codes, MIs, DKA, pregnant women bleeding clots the size of a baseball cause they are having a miscarriage, etc). It's so unpredictable, that you never know what you might get. But, we are trained to handle anything. That's why I love the ER, it's an awesome place to learn. You name it, these are all some of the things that have dealt with in the ER and I have ONLY worked there for 3 months.
Okay, I'm done going on my spill.
Before I leave, I just want to say that I respect everyone's contribution to the pt.'s care because not one person can do it all (thank goodness we aren't expected to). However I do ask that everyone that is assigned a job be proficient in their job so someone doesn't have to go back to fix your mistake and to work as a team. And just because it's not your job to know something it's helpful if you still do, cause you never know if you might be the most proficient person around and be expected to save a life or do something that you normally don't do. And sometimes comparing different jobs just seems to make one profession look better than the other. And that's not what the healthcare field is about. I hope that everyone chooses their job because it's what they want to do so they can do their best rather than be envious or look down on others with different titles.

Let's see...where will I start...

The EMS protocols are written by physicians. Perhaps you would like to review said protocols before making comments about the care that is rendered. I know that in my Medic protocols that if a patient is having and kind of respiratory distress, the patient is to receive 100% oxygen by NRB mask.

As for correcting the "errors", how many times have you had to correct a deficiency from the previous shift? I know that I have. And it happens more often that I'm looking at the previous shift's chart wondering what they meant when they wrote something! Or wondering why something didn't get done.

Nurses cannot do the same work as a Medic. The training is different. The thought process is completely different. Trust me on this one - I've done both. I remember vividly the days when my wife was in an ambulance with me and we would debate the care rendered after the call. She looks at things from a nursing perspective. I look at it from a Medic's perspective. It is the difference of looking at things from the medical model and the nursing model.

When I work in the street, I work on my Medic card. I do not work on my RN. Nurses do not exist in my state's EMS code. Therefore, I do not take medical control from them (or PAs for that matter).

What state are you in that chest tube thoracostomy is in your scope of practice? I know that if I did that in my ER, they'd shoot me.

Just my thoughts.

Chip

(Just a Medic that two states were stupid enough to give an RN license to!)

jwk · Dec 24, 2004

I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made.

Remember that there is a big difference between an EMT and a paramedic. EMT=basic skills and limited independent judgment.

Paramedic=advanced skills and more independent judgment.

A basic EMT gets training in first aid, splinting, extrication, CPR, and perhaps IV's and defibrillation, depending on state laws. For the most part they are not going to get the physiology and pharmacology training at that level. Paramedics are another story - many even have 2 or 4 yr EMS degrees. They're expected to handle a lot before they call in. ACLS skills, management of multiple trauma, intubation and surgical airways, etc., etc. I promise you that while some do, many RN's are NOT prepared to handle all that on their own in the field - it's far outside their comfort zone. By the same token, you don't expect paramedics to be running the ER.

I believe some EMTS/Paramedics have skills that nurses on a med surg floor don't have. However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge.

You are correct on your first sentence, wrong on the second. RN's are not trained IN SCHOOL to handle some of the things paramedics do. And when riding on an ambulance, it is the paramedic (or EMT) who is in charge, not the RN, unless their protocols/policies dictate otherwise.

However I do ask that everyone that is assigned a job be proficient in their job so someone doesn't have to go back to fix your mistake and to work as a team. And just because it's not your job to know something it's helpful if you still do, cause you never know if you might be the most proficient person around and be expected to save a life or do something that you normally don't do.

Again, different jobs, different levels of training, different sets of skills, different levels of judgment. It's fine to be proficient in your own job - don't expect other types of professionals to be proficient at YOUR job as well. We all have our own areas of responsibility. Some of the training and skills overlap, some don't.

Aneroo, LPN · Dec 25, 2004

Agree and Disagree. I was an EMT before I was in nursing school (about to start last semester of nursing school). As an EMT basic, you're taught to load and go. You drive, you do compressions, you get the IV bag ready before you get to the scene. That's about it! As an EMT-I (this is all in the state of NC), you can do IV's, 11 meds (including O2 and charcoal), defib (using AED), ETT's, Combitube's. EMT-b's can do combitubes and AED's (the state of NC integrated EMT-B and EMT-defib). Paramedics basically get a two year degree. They're required to take a two course anatomy class. It's intensive. The basic doesn't go into any of that (enough to know you have two lungs, a heart, and a liver). Intermediate goes into some of it. I remember doing acid/base...most of the class was lost except those going into nursing who had already covered this material. Medics do a lot that RN's cannot. It's nice having standing orders. It sucks to only be able to crank the O2 up to 2lpm when you want to crank it to 15lpm.

BUT, with each level, there come a need, and a responsibility. Each team member is SO important. I remember having to tell a paramedic how to stablize a knee during my basic class. Some people forget simple things. Anyways, point was that we're all important. I plan on getting my paramedic after I graduate nursing. I love the excitement.

Point is--- the common part? We are ALL there to make that patient better/comfortable!!!

-Andrea

qanik · Dec 25, 2004

Humiliated,

I can't believe your response. Having worked as a medic for 18 years and a nurse for 15- I will say this, With a statement like that, you have alot of growing up as well as learning to do. Also, if you think the patients sats went from 90-100% because you dropped him 2 liters- OK:rotfl: .

PSS -"In our ER in an emergency setting we nurses do what we need to do if a doctor is not around, ranging from thoracostomy"

Didn't know chest tubes were part of the ED nurses training these days- and next your going to tell me you have a protocol for ED nurse thoracostomy right, and insurance to cover you?

Sometimes my own profession scares me to the bone.

Qanik

mommatrauma, RN · Mar 6, 2005

I'm not sure where you work but, in our ER the nurses and those that bring the patients in (paramedics and EMTs) are very different. I would say that the prehospital care is very important, however many times I have had to go back and correct mistakes some paramedics/EMT's have made. For example I had someone bring in a COPD pt. on 4L of O2 because the pt. O2 sats were 90% on RA. I asked the EMT why did they put the pt on 4L as opposed to 2L. They said they were having problems breathing. I asked did you try putting the pt. on 2L to see what his sats were. And they were like, no the pt was having problems breathing. I'm sure it was just this EMT but, I was thinking hello, it's a COPD pt. I understand if they are having difficulty breathing but, they need to be on the lowest O2 as possible, duh, cause they are just going to be retaining CO2. And as it turned out, the pt sats were 100% on 2L NC, so this in my mind improves the pt's outcome.
I would say, like nurses and doctors, there are some good EMT/Paramedics and some bad ones. I believe some EMTS/Paramedics have skills that nurses on a med surg floor don't have. However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge. Likewise, in the ER the doctors are in charge because they have more education than the nurses. In our ER in an emergency setting we nurses do what we need to do if a doctor is not around, ranging from thoracostomy to EJ's to whatever. We as nurses are trained to do what we need to do in an emergency situation, it's just that whoever is the most skilled does the task. Also like someone said in another post, sometimes it's like the ICU is the ER because I have had to take care of very sick pts on vents who may be in the ER for my entire shift. Often at our hospital we are short on beds, so pt's can end up in the ER for days. It's nice to get the experience an ICU nurse, however sometimes it's tough to take care of the very sick because there is so much going on the the ER (people being shot right outside our doors, the detoxing drunks, knifes being pulled on staff, the vented patients, traumas, codes, MIs, DKA, pregnant women bleeding clots the size of a baseball cause they are having a miscarriage, etc). It's so unpredictable, that you never know what you might get. But, we are trained to handle anything. That's why I love the ER, it's an awesome place to learn. You name it, these are all some of the things that have dealt with in the ER and I have ONLY worked there for 3 months.
Okay, I'm done going on my spill.
Before I leave, I just want to say that I respect everyone's contribution to the pt.'s care because not one person can do it all (thank goodness we aren't expected to). However I do ask that everyone that is assigned a job be proficient in their job so someone doesn't have to go back to fix your mistake and to work as a team. And just because it's not your job to know something it's helpful if you still do, cause you never know if you might be the most proficient person around and be expected to save a life or do something that you normally don't do. And sometimes comparing different jobs just seems to make one profession look better than the other. And that's not what the healthcare field is about. I hope that everyone chooses their job because it's what they want to do so they can do their best rather than be envious or look down on others with different titles.

Ok friend...you can tell by your post, you have only worked in the ER a short time....I disagree with alot of what you say...where to start...at the beginning...Unfortuantely in nursing school, they beat into your head that COPD=CO2 retention...but that is not true...as a matter of fact...a small amount of patients that have COPD actually retain CO2...so therefore, the "smallest amount of oxygen" is no longer the gold standard...by decreasing the amount of O2 your patient was getting certainly would not in any way make the O2 sat increase....maybe you didn't have a good pleth or the pts fingers were initially cold...but I can gaurantee it wasn't cause the O2 was too high...Also, I have never ever ever in my career ever seen a pt CO2 narcotized from 4Lnc...there have also been studies that show that the amount of time a pt would have O2 on in a prehospital setting is so short usually within an hour, that it would have little or no effect on a patient that was a CO2 retainer and that it would not cause the level of CO2 to rise to a dangerous level in and of itself....that being said...as both an ER nurse and a pre-hospital provider...I would challenge an ER nurse w/no pre-hospital training to do what I do in a heartbeat..just to prove a point...because I once was a young buck like yourself and thought such misguided things...but you live and learn...just don't let any medics hear you talking like that, or you may lose your credibility altogether...As for nurses in the prehospital setting....unless you have a Pre-Hospital certification as either a PH-RN or a an HP )Health Professional, depending on what your state calls it, you have no authority to give any orders on the street whether you are talking to a medic, emt, or a dog...With that being said...as a PH-RN or a HP...when in a pre-hospital setting if we are talking about "rank" in that case the nurse would be the highest rank, but where that comes into play really, is in interfacility transports....and really the only difference in the medic and the nurse...is the meds they can give...As for nurses being able to do thorcostomy's...stop watching MASH....I'll give you the EJ, because in some ERs that is allowed....the residents can't do a thorocostomy without an attending present, what the heck makes you think as a nurse we are qualified to do it in the ER...If the doctor's not available in that situation...then either get some holy water for the patient or ask for a raise, cause you are working over and above your scope of practice...

nyccemt-p · Mar 14, 2005

In NY, RN's are only allowed to assist EMS, they are not allowed to be incharge of patient care, including interfacility transports. To help deal with the lack of critical care training in the regular associates degree Paramedic programs, we supplement with UMBC CCEMT-P courses which teach invasive pressure monitoring, IABP, art lines, ICP monitoring, ordering/interpreting labs/x-rays, placing (yes, placing) chest tubes, etc. We do often run with an RN on "the team", but in the end, its the Paramedic who gets blamed if something goes wrong. Thats not to say that RN's are not important on these transfers, because they are typically more comfortable with the critical care setting than most Paramedics when they first start. As far as field emergency calls, my opinion is that the Paramedic education and experience far outways that of most RN's.

Dixielee, BSN, RN · Mar 14, 2005

"As far as field emergency calls, my opinion is that the Paramedic education and experience far outways that of most RN's."

It would be hard for paramedics NOT have more experience in field calls than RN's. I don't know of any RN programs (and I could be wrong) that has any field experience at all. Ours is all hospital, or community based (clinics, schools, etc.)

I hate to see turf wars like this. I have been an ER nurse for many years and have never had a problem working with Paramedics, EMT's techs, etc. We each have our area of expertice and practice. Sometimes it overlaps, but we are all working toward the same goal. And I will never turn away help!

If I am in a MVC, and I had the choice of the average RN or the average Paramedic stabalize me and get me to the hospital in one piece, give me the Paramedic any time! That is what they are trained for. I don't know how to put someone into a KED, apply a Hare traction splint, etc. I don't need to. I work inside!

So to all you medics out there, don't take it too personally if the RN's aren't particularly kind to you, they aren't particularly kind to each other either! Just look at the ADN vs BSN threads, or LPN vs RN's. Some folks apparently have too much time on their hands, and too little confidence in themselves and look at others to criticize.

Anna57 · Mar 25, 2005

Regarding the RN doing chest tubes, in our state, Flight RN's can do them and if trained ER nurses can too. Yes, you have to have an order.

On the other hand, in our ER we have MANY standing orders and protocols for every situation imaginable (or unimaginable).

I try to keep this in mind.... Without the patient, we dont have a job. The paramedics and EMT's bring us the patients. I am not proficient in their job, nor are they in mine. It takes us all to provide continuity of care for our patients. It takes Prehospital, Doctors, Nurses, Techs, Housekeeping, laundry, dietary, the whole 9 yards to make it happen.... No one person is more important or better than the other. :balloons:

Anna57 · Mar 25, 2005

ER nurses are to ICU/floor nurses, as EMTs/paramedics are to ER nurses. (Meaning, "stabilize them and get them where they need to be...")
Is this a fair statement?

Not only is this unfair, but it is WRONG. There are many patients in my ER that need to be there, in fact our ICU wont take them until we have them stabilized. But I am probably not as proficient in extended care for the patient as the ICU nurse is.

Rambob · Mar 26, 2005

Regarding the RN doing chest tubes, in our state, Flight RN's can do them and if trained ER nurses can too. Yes, you have to have an order.
On the other hand, in our ER we have MANY standing orders and protocols for every situation imaginable (or unimaginable).
I try to keep this in mind.... Without the patient, we dont have a job. The paramedics and EMT's bring us the patients. I am not proficient in their job, nor are they in mine. It takes us all to provide continuity of care for our patients. It takes Prehospital, Doctors, Nurses, Techs, Housekeeping, laundry, dietary, the whole 9 yards to make it happen.... No one person is more important or better than the other. :balloons:

I wished you were working in my ED back when I was on the street.

:rolleyes:

Spread the word.

Retired Medic - Rambob