Quote from GracefulRN
I have never heard of an RN/medic. What would you do as an RN/medic? It seems to me that your either one or the other? What advantages does it have? I mean what do medics know that nurses don't?
Again, I apologize for my ignorance, but I would really like to know.
As far as knowledge base is concerned, there is no question that an RN's knowledge base is far wider than that of most paramedics. Most paramedic didactic hours are concentrated mostly on emergency pathophysiology and pharmacology, and some factors of disease processes (common meds, common complications, etc.) that are more chronic are picked up through experience.
Scope of practice, on the other hand, can sometimes be very different. Paramedics practice under the medical license of an MD, and so I think of paramedics as an extension, as it were, of an MD; we play the role of the MD's eyes, ears, and sometimes hands, out in the field. We can intubate on standing orders, which in my experience, at least in New York, RN's typically do not. We defibrillate and pace on standing orders, and administer several medications on standing orders, as well (epi, atropine, albuterol/atrovent, D50, narcan, sodium bicarb, etc). We can take verbal orders for controlled substances. Given clear signs of pneumothoraces, we can perform needle decompression. I know that in some regions, paramedics perform RSI, cricothyroidotomies, sternal IO lines, NG tubes and foleys, and external jugular IV access, and in some more metropolitan areas, some emergency surgical techniques are being piloted as we speak.
I personally feel that paramedics and advanced EMTs provide a vital and necessary service to the community, and many, if not most, of the medics and AEMTs with whom I have worked are very competent with their skills. A complication comes in to play, however, when medics and AEMTs are introduced into the ER setting. As a Critical Care AEMT in New York, working in a rural hospital, the door to the ambulance bay marks a transition into a very different world. Whereas in the field I am able to perform many of the abovementioned skills, once I hit the door, I practice as a UAP, and my skills are limited to EKGs, phlebotomy, patient transport, and bedpan service.
Now, I understand that in many cases, it is inappropriate for a UAP to perform more invasive skills. OJT is simply not sufficient to perform something such as foley catheter insertion or IV therapy. But does it make sense to limit the scope of practice of someone who is qualified to perform many of these skills? I understand that bean counters would pray for the day that they could replace RNs with something cheaper, but wouldn't it make more sense to lobby for regulations on staffing proportions, and not on the skills of those qualified?
Sorry to turn this into a rant, but I merely wanted to express frustration over the fact that a certain group of UAPs, namely hospital-based medics and EMTs, could really come in handy in an emergency. We aren't enemies. And we of course recognize that when it comes to comprehensive patient care, an RN can't be beat. But that doesn't mean we are not capable and trained to do a little more.