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.
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.
And, two responses after the response in reply to that, the thread will surely be locked. . .
(RN vs. EMT threads are always locked, eventually. I guess the territory overlaps too much to really, truly, stake a claim.)
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.
to have 2 medics on a truck these days is a luxury. it's usually 1 medic and 1 emt-b or emt-i.
Prehospital providers practice a tremendously difficult and stressful profession. In the EMS system, they are the "sharp end of the spear", providing complex care in crushed cars, freezing rain and cramped, dark apartments. They are called to make snap decisions in horribly complicated situations under extremely adverse conditions. I know, I did that job for many years. ER nurses practice a tremendously difficult and stressful profession. Juggling and prioritizing critical care of too many patients, some in their rooms, others crying, puking and yelling in the waiting room and more rolling in off ambulances. They are called on to make snap decisions and provide human care to patients spanning all ages, types and acuities, simultaneously. I know, I do that job now. ..... My point is that both professions are difficult and require real technical and human skills. However, while they may overlap in some ways, they are entirely different. You cannot compare them as one being harder, better, more skilled, etc than the other. For every "crushed car intubation" story a paramedic can tell, a nurse can talk about the crashing septic patient in the room next to the infant in respiratory distress. For every story a nurse can tell about handling three simultaneous codes with 27 people in the hall, a paramedic can tell you about the apneic child in the partially submerged car at night. This "our job is harder/better than your's" conversation is like listening to a football player and a basketball player argue about whose sport is better. It might be an interesting talk over a beer, but its ultimately doomed to failure - you can't compare them. Everyone should be proud of their profession, and we should be proud of our combined ability to provide care.
Prehospital providers practice a tremendously difficult and stressful profession. In the EMS system, they are the "sharp end of the spear", providing complex care in crushed cars, freezing rain and cramped, dark apartments. They are called to make snap decisions in horribly complicated situations under extremely adverse conditions. I know, I did that job for many years. ER nurses practice a tremendously difficult and stressful profession. Juggling and prioritizing critical care of too many patients, some in their rooms, others crying, puking and yelling in the waiting room and more rolling in off ambulances. They are called on to make snap decisions and provide human care to patients spanning all ages, types and acuities, simultaneously. I know, I do that job now. ..... My point is that both professions are difficult and require real technical and human skills. However, while they may overlap in some ways, they are entirely different. You cannot compare them as one being harder, better, more skilled, etc than the other. For every "crushed car intubation" story a paramedic can tell, a nurse can talk about the crashing septic patient in the room next to the infant in respiratory distress. For every story a nurse can tell about handling three simultaneous codes with 27 people in the hall, a paramedic can tell you about the apneic child in the partially submerged car at night. This "our job is harder/better than your's" conversation is like listening to a football player and a basketball player argue about whose sport is better. It might be an interesting talk over a beer, but its ultimately doomed to failure - you can't compare them. Everyone should be proud of their profession, and we should be proud of our combined ability to provide care.
I think the intent of the thread is more about medics functioning in an ER.
So, it's not really a comparison to football and, say, baseball, but whether the skills and scope of practice pre-hospital can easily translate to as high an autonomy for medics in-house, or, if you have to be Reggie Sanders to do it.
(And remember, in his heyday, Reggie couldn't have done what he did between sports without some serious management support.)
And that is where the clash occurs. At what point does the scope of practices between nurses and medics collide? At what point are we being collaborative and at what point are we engaging in a 'turf' war?
So, it's not really surprising to see most of these threads turn into 'my scope is bigger than your scope'.
Everyone put your stethoscopes back in your pants, and we'll settle this like professionals. Wheelchair races in the parking lot- midnight tonight. Be there, or be...intubated...
Well, in Indiana it's a certification not a license. Granted in Indiana now it's a National Registry also, but that's still not a license.
Anyway, joining in here. We have medics in our ER, and they even take room assignments. I think they function with pretty much the same in our ER as they do on the streets, except for intubating, which the docs do. They only have to have an RN signoff on their charting.
I have worked both sides of the street. I got my medic in 1990, and started working on an ambulance in 1986. I got my RN in 2001 and went straight to work in the ER. I did well, and caught on to the pace quickly. I saw other new grads not fare as well, (still there, but that's a whole other thread). About 6 months ago, I began working in an LTAC, and now I know what I didn't know I didn't know. I have learned so much from working in that environment, and I have become really comfortable with things I was always nervous about in the ER because we only had to deal with certain things every once in awhile, i.e. drawing blood from and flushing central lines, putting meds down a g-tube, flushing g-tubes, suctioning trach patients, changing central line dressings, to name a few. So, yes, I agree that new grads should do at least have to do some orientation on a med/surg floor prior to beginning work in the ER. If for no other reason than to have some experience with things they will only rare see in the ER. It probably wouldn't be a bad idea for the medics that work in the ER to do the same. Sorry, I'm hijacking this thread on a topic that has been done ad nauseum.
Anyway, I guess my point is, I think medics do have a place in the ER, and could learn a thing or two from the nurses that work there, however, the nurses can learn things from the medics to, so it's a two way street and mutually beneficial to both sides. I think all ER nurses should have to do some orientation on the ambulance just to see what the medics do go through, so they can be there when the medic is intubating a pt on a cliff while bears and coyotes are chasing them on skateboards:lol2: .
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.
Yeah, aren't those a pain? Course, you still get those everywhere in the hospital, but you usually have more people around to help.....usually!
I think the intent of the thread is more about medics functioning in an ER.
So, it's not really a comparison to football and, say, baseball, but whether the skills and scope of practice pre-hospital can easily translate to as high an autonomy for medics in-house, or, if you have to be Reggie Sanders to do it.
Yep, I agree totally. Its not a competition. So, scope of practice in an ED? As most things, I think it probably depends. I'm an RN in a busy, urban Level II center. We are fortunate to have enough docs about that we very rarely have an arrival of an emergent situation where an MD is not available. So, assuming its your child on the stretcher and there is a board-certified emergency MD, a couple paramedics and a few RN's in the room, who do you want to do the intubation and order the drugs? Now, move the situation to a rural hospital or an overburdened urban one where a doc is not immediately available and the equation changes. There may be some places where the emergency skills of a prehospital provider are needed in an ER. There are others where those emergency skills are redundant. Its really for the state boards and the hospital to decide. Now, change the situation to one where your grandmother is septic with a diminished LOC and has to wait 22 hours in the ER waiting for a bed upstairs. Now, who do you pick for the caregiver? ....... Now, to the real point - wheelchair races in the parking lot? Game on!!!!!!!
(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).
......................................... Hear me, I am not saying that nurses should be removed from the ER, simply trained differently, more like a medic.
Sorry, guess I'm just not understanding why you think ER nurses should be trained more like medics.
There are no creeks running through the ER....at least none that I have worked in..... and MVC pts. generally are removed from their crunched up vehicles before they are brought to us.
I think our training is more than adequate for what we do and the environment in which we do it.
Would just like to add one thing: The OP does recognize that nurses do bring valuable contributions to the table, but if we started training nurses and medics the same way, each would no longer have unique knowledge to contribute. For example, if we revamped nursing training and replaced some of a nurse's education with training on trauma, extrication, etc - then when the pt is brought in with celiac sprue, would the nurse still know what it was?
I agree with all of your posts ther are very informative . i think the nurses and emts are part of a well made team because if there wasnt emt or nurses then ther wouldnt be any pacitens to take care of because ther wouldnt be anyone to tkae care of them. i hope i didnt offend anyone
I have learned so much from working in that environment, and I have become really comfortable with things I was always nervous about in the ER because we only had to deal with certain things every once in awhile, i.e. drawing blood from and flushing central lines, putting meds down a g-tube, flushing g-tubes, suctioning trach patients, changing central line dressings, to name a few. So, yes, I agree that new grads should do at least have to do some orientation on a med/surg floor prior to beginning work in the ER. If for no other reason than to have some experience with things they will only rare see in the ER. It probably wouldn't be a bad idea for the medics that work in the ER to do the same. Sorry, I'm hijacking this thread on a topic that has been done ad nauseum.
Course, you still get those everywhere in the hospital, but you usually have more people around to help.....usually!
ZASHAGALKA, RN
3,322 Posts
And, two responses after the response in reply to that, the thread will surely be locked. . .
(RN vs. EMT threads are always locked, eventually. I guess the territory overlaps too much to really, truly, stake a claim.)
~faith,
Timothy.