End of CCT Nurses in California? - page 2

It looks like the California EMSA is advancing its proposal for the Critical Care Paramedic in California. This provides for an expanded scope of practice which may surpass that of the RN even... Read More

  1. by   akulahawkRN
    Quote from DramaMomma
    On a side note, MOST people have no clue what the different levels of transportation are EMT vs ALS vs CCT. Maybe that should be taught across the board
    Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P. I've worked as a Paramedic for quite a while and in my experience, most nurses don't know that EMT and Paramedic are two different levels with very different scopes of practice for transport. All they know is that the "Ambulance Drivers" are here for the patient. I have had to refuse to accept a patient for transport because the patient required monitoring that was out of my scope of practice and it could be something as simple as having a patient on a potassium drip. Depending upon my Paramedic scope of practice for a given EMS system, I'm either not allowed to monitor any potassium drips and PIV only, OR I can monitor potassium drips up to 40 mEq/L through a central line.

    Sure we can teach the basics of what each scope of practice is for each level of EMS provider but to go beyond the very basics, you'd have to be able to explain the scope of practice for all the different EMT/Paramedic personnel in all the different EMS systems in existence. What's driven into the heads of every EMT, AEMT, and Paramedic student is they must know their scope of practice because nobody else will and that they're not to exceed that scope. Ever.

    Incidentally, this thread is about 5 years old and since the thread began, CCT-RN work hasn't decreased... even with the use of the CCT-P. The CCT-RN isn't going away any time soon.
  2. by   heinz57
    Quote from akulahawkRN
    Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P.
    This is an old discussion but some attitudes don't change.

    In all fairness, most EMTs and Paramedics have no clue about the many different specialties of nursing or any other hospital or clinic health care professional either. Many in EMS are clueless about the scope of practice of a flight or critical care nurse and assume all nurses must call a doctor to hold their hand for every order and procedure.

    EMS has also changed some of its titles or has so many titles you need a continuously updating app to keep up with the "EMT-I is now EMTA (sort of) although it is more of an EMT-B, which is now EMT, with some of EMT-I but not quite. Some use the NREMT and some still don't. The Paramedic varies from State to State, county to county, city to city and company to company. Privates hate the fire department EMS. Fire department Paramedics think the privates are stupid and only good to transport BLS even if they have a Paramedic patch. Don't put this all on nurses for not knowing every little detail of your scope of practice for you patch. When contracts are negotiated, a cheap sheet should be given to the hospital to avoid confusion. It is really not that difficult. I will say the hospitals which have their own CCT teams with CC trained RNs are the easiest to deal with so I hope they stay or even expand more into transport.

    OMG don't get me started on the "Ambulance Driver" bullpoop! "The "ambulance driver" got a ticket" or "Tell the Ambulance Driver to move their rig" and you get holy heck raining on you even if it does not pertain to anything medical. Who cares what their medical certification is if they were doing a 100 mph in a school zone going back to the station? The person driving the ambulance (Ambulance Driver) probably has the most responsibility of all getting everyone where they should be safely in a timely manner regardless of which EMS title they hold. This includes the routine medical transport rigs which have to keep on schedule to get patients to their schedules appointments.
  3. by   PeeWeeQ
    It's never NOT going to be about the money. EVER. Like it, hate it, or indifferent, SOMEONE has to watch the bottom line--it DOES matter. And, the person or people doing it, are going to have to make unpopular decisions and no matter what, there will always be those who disagree. I wouldn't want to have that job/jobs, would you?
  4. by   CSUSM10
    5 years from the original post and CCT RNs are still here in So Cal!
  5. by   drewseph92
    @CSUSM10, Yep! And there are definitely still CCT RN's up here in Nor Cal!
  6. by   LG1137
    Hospital based? EMS based? Private or government?
  7. by   akulahawkRN
    Quote from akulahawkRN
    Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P. I've worked as a Paramedic for quite a while and in my experience, most nurses don't know that EMT and Paramedic are two different levels with very different scopes of practice for transport. All they know is that the "Ambulance Drivers" are here for the patient. I have had to refuse to accept a patient for transport because the patient required monitoring that was out of my scope of practice and it could be something as simple as having a patient on a potassium drip. Depending upon my Paramedic scope of practice for a given EMS system, I'm either not allowed to monitor any potassium drips and PIV only, OR I can monitor potassium drips up to 40 mEq/L through a central line.

    Sure we can teach the basics of what each scope of practice is for each level of EMS provider but to go beyond the very basics, you'd have to be able to explain the scope of practice for all the different EMT/Paramedic personnel in all the different EMS systems in existence. What's driven into the heads of every EMT, AEMT, and Paramedic student is they must know their scope of practice because nobody else will and that they're not to exceed that scope. Ever.

    Incidentally, this thread is about 5 years old and since the thread began, CCT-RN work hasn't decreased... even with the use of the CCT-P. The CCT-RN isn't going away any time soon.
    Quote from heinz57
    This is an old discussion but some attitudes don't change.

    In all fairness, most EMTs and Paramedics have no clue about the many different specialties of nursing or any other hospital or clinic health care professional either. Many in EMS are clueless about the scope of practice of a flight or critical care nurse and assume all nurses must call a doctor to hold their hand for every order and procedure.
    While it is true that most EMT's and Paramedics have no clue about the many specialties of nursing or much of whatever else happens in hospital, they do know one thing about Flight/CCT nurses: their scope of practice is incredibly wide and they are expected to function nearly independently, relying primarily on standardized procedures/protocols and only calling for specific orders when necessary... just like the Paramedics do.

    Quote from heinz57
    EMS has also changed some of its titles or has so many titles you need a continuously updating app to keep up with the "EMT-I is now EMTA (sort of) although it is more of an EMT-B, which is now EMT, with some of EMT-I but not quite. Some use the NREMT and some still don't. The Paramedic varies from State to State, county to county, city to city and company to company. Privates hate the fire department EMS. Fire department Paramedics think the privates are stupid and only good to transport BLS even if they have a Paramedic patch. Don't put this all on nurses for not knowing every little detail of your scope of practice for you patch. When contracts are negotiated, a cheap sheet should be given to the hospital to avoid confusion. It is really not that difficult. I will say the hospitals which have their own CCT teams with CC trained RNs are the easiest to deal with so I hope they stay or even expand more into transport.
    If it's difficult for to keep track of all the capabilities of transport personnel, it's going to be difficult to keep track of all the non-transport personnel. I didn't put anything on the nurses for knowing all details about what I can do as a Paramedic. The easiest way to find out if a given provider is OK to transport a certain patient is to ask. It's not a difficult thing to ask whoever is coordinating transport, "hey, this patient has 3 drips, is on a vent and has a chest tube, can you take this?" Where I currently live, that's a CCT-RN thing. In other states, a Paramedic can do it without batting an eye.


    As far as doing Interfacility transports, hospital-based teams are fantastic because they can either extend the care of a given hospital to the patient (retrieval teams) or they can continue care of a patient until the patient reaches the other facility. CCT programs that aren't hospital affiliated will usually have transport contracts with certain facilities and EMS systems and these contracts often delineate the scope of practice that is used. The "worst" part of those is usually Paramedics have to be accredited for each county and will have to follow those protocols whereas a flight nurse follows only a single set that the company says "if we're to play here, these are our rules for our nurses."

    Quote from heinz57
    OMG don't get me started on the "Ambulance Driver" bullpoop! "The "ambulance driver" got a ticket" or "Tell the Ambulance Driver to move their rig" and you get holy heck raining on you even if it does not pertain to anything medical. Who cares what their medical certification is if they were doing a 100 mph in a school zone going back to the station? The person driving the ambulance (Ambulance Driver) probably has the most responsibility of all getting everyone where they should be safely in a timely manner regardless of which EMS title they hold. This includes the routine medical transport rigs which have to keep on schedule to get patients to their schedules appointments.
    Oh, and the "ambulance driver" stuff isn't about the medical certificate. It's one thing to ask for the ambulance driver to move the ambulance and another thing to announce to staff, patient, etc that the "Ambulance Drivers" are here. It's better simply to announce that "transport for XXXX" is here. This is because you might actually have a CCT crew or a Paramedic crew, or an EMT crew picking up the patient. The term "Ambulance Driver" really needs to back to the 1970's and stay there.

    Is that a bit of a "sore spot" for folks that work in EMS? Yes, it most certainly is. Where I work, we do work very well with EMS providers, public and private. This is because I work in the ED and we get a number of our patients by EMS and we do send a lot of patients out by EMS. This frequent contact means we also know their scope of practice and knowing this makes it easy for us to ask for the correct type of transport for a given patient.

    Given the rate at which the State of California changes the scope of practice for EMS providers, it's going to be a very long time before CCT-RN disappears from the scene in this State. In order for that to happen, the State would have to allow CCT-Paramedics to have a scope of practice that would allow them to transport any patient from any ICU to any ICU anywhere. That's not going to happen for a number of reasons, not the least of which is the pushback from CCT nurses.

    A good CCT-P program would, in theory, allow for better utilization of CCT-RN tranport resources. I've yet to hear of a very good CCT-P program in California that actually accomplishes this in a significant way. This is because the CCT-P in California is far behind what many standard Paramedic programs can do elsewhere in the US.
  8. by   heinz57
    Quote from drewseph92
    @CSUSM10, Yep! And there are definitely still CCT RN's up here in Nor Cal!
    After reading Akulahawk's post, I doubt if CCT RNs have anything to worry about.

    Akulahawk, Stop worrying about being called an Ambulance Driver if it is in reference to the "one who drives the ambulance". I can see you getting out of your ambulance to scold the child who gets excited watching someone he thinks is cool driving an ambulance. Nurses have learned to accept the rude remarks and even laugh about it when Paramedics call them butt wipers and bed pan specialists. They know it is part of their job and not their entire identity as professionals. Work as a nurse and you'll be called a lot of things.

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