I know this is a topic which has probably been hashed to death, but I am curious to find out nurse's views on this. Before starting, let me say please read the whole post as I do see both sides of the picture. I am an experienced medic who works for a busy fire/ems service and frequently do critical care transports (including long distance as we are located an hour from any major trauma centers and frequently have difficulty getting helicopters to fly due to weather). I have applied for several positions within hospitals to work and the only position they have been willing to give is the equivalent to a tech/aide in the ER with enhanced privledges. Many of the medics I know have made the transition from the street to the hospital in search of better pay, and while the pay does increase, the ability to perform procedures and use all of our training is severely restricted. Most have had their wings clipped to the point of being reduced to nothing more than doing a nurse's scut work and starting IV's. There is also a major arguement between the nurses and medics as to who is better suited to a hospital. Here's my thoughts on it for all it's worth. Medics are trained to the emergency environment more so than nurses are. We are trained to complete difficult procedures above what a nurse is as well as function completely independent of a physician under most circumstances (though we have ability to contact med control as needed, we work mostly under a physician's standing orders). Also, we perform procedures in the worst of environments (it's one thing to intubate or start an iv in a well lit room, another to do it in a crunched up car, in a creek at midnight). Many medics find out they aren't cut out for the job after realizing this, I can't imagine the terror of even an experienced nurse who is used to functioning in a hospital being presented with that situation. That being said, here is my thoughts for you nurses. I will be the first to say when it comes to care for a special needs patient or one with a chronic disease, you all stand far and above what any medic knows, I don't care what they say. In my transports, if it is something that I am not familiar with, or a nurse knows a patient's history particularly well, I'm all for her/him accompanying me on the transport. I can always appreciate the second set of experienced hands. I will even ask for a nurse to accompany me many times even if one is not given for this reason. I am trained to deal with emergencies, not chronic patients. My job is to keep them alive until you all can perform whatever surgery, medical treatments, etc they need. I am NOT a long term care provider on any level, therefore, I don't know a patient's history as well as you may as you have cared for them for several days many times before I transfer them out and can provide me with valuable information. During my clinicals, I was well educated by great nurses who really took the time to teach me, but also showed me the differences in the care they give and we do. I have tremendous respect for the nursing profession, but while they do have different focuses, I believe BOTH have a place in a hospital. Hear me, I am not saying that nurses should be removed from the ER, simply trained differently, more like a medic. Is why so many flight services require your paramedic or at least the EMT-basic in addition to a nursing degree is to manage the the on scene difficulties one encounters. I believe a medic is not experienced enough in care to be placed anywhere except the ER in a hospital. However, I feel in addition to a nurse, if treated equally, a medic has a definite place there. What are your all's thoughts? You've heard mine, now let me know yours ! Thanks so much.
I think the EMT's are very well prepared to go the emergent interventions and physical assessments. Nursing does well with coordinating many departments of care, anticipating and avoiding future problems for home and admission. EMT's are used to being the captain of their ship, and nurses are used to working with lots of different specialists to come out with a final total plan for the patient.
We both have something to offer- I'd prefer an EMT over an RN in a code situation, but in a multi drip, multi specialty situation I'd rather an RN.
As an RN I'd rather EMT's be responsible for their own patients. My only issue if they were used in the ER here would be that we are so close in knowledge but so different in focus that having one supervising the other would be just setting the department up for conflict.
Well In the ER that I work at we have medics, they can pass meds and do all of the tasks that the nuse does. But the patient is the resonsibility of the RN assigned to that patient. Also many of us ER nurses have EMS experience prior to going into nursing, I had to make the transition after I had my son, the 24 hour shifts and the pay were not working out. Also in the ER we have much more that we are able to do with out the doctor telling us to do it. It is not this way on other areas of the hospital. I agree that maybe the new non EMS background ER nurses need to do some ride alongs on the bus, remember, that you have the patient for a short while and get them to us alive but it is our job at that point to keep them that way. Also I have a good friend that is doing a medic to RN transition program at this time and she has been shocked at the things she has learned. I work in the ER so I dont have to deal with chronic problems, and granted the patient may have many chronic conditions, there is something acute that has brought them to me.
I think the point of this message was missed. What I was trying to find out was IF you thought medics had a place in the ER. I was trying to point out the differences in training, and as I said, I believe both can and do have a place. In my state, we are LICENSED, not certified. I work in primarily a rural area with transports that typically exceed 30 min to even the basic hospital. It is common that we get called to assist with a code in the ER, or even on a floor, and yes I have intubated patients (as a medic) rather than a doc, when he could not get the tube. I've seen it several times, that's not to say he was a bad doc, just maybe having a bad day, I know I've had 'em as well. Is why I have a partner to back me up. We work in pairs so there is some accountability. For those of you that stated you worked as an EMT prior to becoming a nurse, most simply spoke on the basic level as you gave comparissons of treating patients on that level. I agree a basic's limited knowledge does not prepare them for an ER appropriately. I would like to see the basic's level of training expanded as I feel they aren't ready when they get on the street either. As a medic, I have very advanced protocols which allow me to hang dopamine, levophed, administer fentanyl, versed, even do RSI. I have CPAP machines I may use, and a number of other things which are helpful. We are trained in how to use each of these and the continuing ed is amazing. You are correct in saying that nurses are trained differently, and as I said, I would welcome an experienced nurse accompanying me on a transport. But on the same token, you speak of all patients not being trauma, the same holds true for us. We have the sole contract for our county meaning we do all the doctor's runs, basic transports, and everything else in between. The majority of our runs are not trauma. I was told when I started EMS that if I was getting into it for the guts and the gore and the glory, I picked the wrong profession. They told me "it's sheer boredom mixed with a few moments of sheer terror." I have found that to be oh so true. I did not start this post to enrage or begin an arguement, simply to see what people's thoughts were. It seems it has turned into nothing more than an arguement of who's better. I agree that there is the problem of not having medical direction within an ER. You are functioning under several physicians at any given time, and what one may approve you to do, another may not. It does present a significant issue to be addressed. The issue that I am addressing is nursing (at least in my area) seeing us as nothing more than people sitting around eating chips all day, sleeping and occasionally throwing someone in the buggy and driving them to the hospital. There is NO respect for my profession. I am not seen as a healthcare professional (which yes, medics are one), but rather as the butt of emergency services by nurses, doctors, and much of the healthcare field alike. There are the few that appreciate what I do, and for them I am thankful, but ultimately I didn't get into this job for recognition, I got into it because I truly enjoy what I do, but I would like to know there is more of a career besides a buggy or engine after I get too old to lift that 400 lb patient between just my partner and I. I appreciate your thoughts and comments and respect them. Thanks again.
I an RN who just moved to the ER from neuro. We have RNs, EMT-Ps, and techs in our ER. RNs take the main responsibility for patients. Techs help out with ADLs, EKGs, and transporting non-monitored patients. We use EMT-Ps for two main things: traigae and transporting monitored patients. We have both an RN and a medic at our triage desk so that when people come in, we have 2 different people to decided their priority and whether they go to the main ER or Express. We also use medics in the main ER if we have more than 1 scheduled. They start lines, put people on monitors, get fluids set up, and transport patients who need monitored to tests and to the floor or ICU if they are admitted.
Our medics have told us that they money is better, but they feel like they lose some of their skills because they are usually stuck in triage. We have only had medics in the department for about a year and are constantly revising what they do. Our philosophy is if we are short an RN, we would gladly take a medic any day. Our hospital doesn't permit them to do meds or full asessments, but I feel medics are very valuable. They can check on patients and giv me a much better description of what is going on than a tech can.
This just brings up the point of the cooperation between pre- and hospital personnel that is needed in order to provide patient care. One is not better, faster, stronger or anything else, its a cooperative effort.
Specializes in CCU, Trauma and forensic, Home Hospice C.
as an EMT/Tech now ER nurse I do agree with a lot you are saying,However the ER nurses where i work are extremely qualified for the ER. Many were EMTs at one time, others have to do a critical care/ICU rotation for a year to get considered for the ER. I think the extra emergency skills training is a good idea if needed.Especially the fieldwork.:)
An EMT's scope of practice is 'out of hospital' based. Basically, unless your state specifically sets standards for an EMT operating 'in-hospital', their scope of practice doesn't apply indoors. The result: few facilities are going to allow an EMT the same latitude in house as they would be allowed in the field for fear of being accountable for actions that might not be covered under state law.
Under the heading "scope of practice for EMS personnel functioning in non-traditional roles" it specificially states that in order to use your scope of practice 'in house' the state regs have to be clear that such is allowed.
I think their certainly is a role for medics in the ER. It would be nice to replace the techs with Paramedics so they could do IV starts, EKGs and other procedures within their scope of practice. I do not however believe they are functional equivalents and a nurse should not be displaced by a medic so the hospital can save money.
Shouln't have said that, now we wil be getting the EMS providers telling you every call he/she goes on is an overturned bus full of children in a ditch at 3am in the morning and all of the 50 kids are trauma codes.
the only beef i have with medics is:
out in the field, you'll have 2 medics for 1 pt.
in the er, you'll have 5 pts to 1 nurse!:icon_roll
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vamedic4
canoehead, BSN, RN
6,909 Posts
I think the EMT's are very well prepared to go the emergent interventions and physical assessments. Nursing does well with coordinating many departments of care, anticipating and avoiding future problems for home and admission. EMT's are used to being the captain of their ship, and nurses are used to working with lots of different specialists to come out with a final total plan for the patient.
We both have something to offer- I'd prefer an EMT over an RN in a code situation, but in a multi drip, multi specialty situation I'd rather an RN.
As an RN I'd rather EMT's be responsible for their own patients. My only issue if they were used in the ER here would be that we are so close in knowledge but so different in focus that having one supervising the other would be just setting the department up for conflict.