Opportunities for RNs in the Field

hogan4736, BSN, RN · Dec 14, 2004

I work in AZ doing interfacility xport (like a mobile ICU)

We do get EMS calls (chest pain at a nursing home) when the medics are busy...And pass by MVAs/traumas, and are required to respond (Note: I know MY limitations...9 years as an ER RN, does not a paramedic make)

In AZ, medics can't xport a pt on PEEP, on diprovan, levophed, and a few other IV meds.

And Phoenix is a big enough city, that for insurance reasons or specialty needs, pt's often require an RN xport...

The board says we can do what EMTs and medics do, as long as our company trains us

I have been trained in C-spine, central line placement, and intubation...

I have offline protocols (standing orders) from my base hospital (actually the same protcols that Phoenix Fire uses)

I love the job...

Many RNs think it's not real nursing, but I laugh at them when I take a patient to their already overcrowded ER, give report, and the go grocery shopping ON THE CLOCK...

Respect ALL RNs, no matter what they do (AND respect the EMTs and medics...try starting an IV in a moving ambulance, it's NOT as easy as all you ER nurses think that it is)

And I have also set up the RN ambulance as a clinical site for Grand Canyon University's accelerated RN program (I am a clinical instructor)

We all wish we could have done a ride-along instead of wiping a butt or passing a pill (your head to toe has to be done in about 10-20 minutes)

Interfacility RN xport is important work!

sean

edogs334 · Dec 15, 2004

Many RNs think it's not real nursing, but I laugh at them when I take a patient to their already overcrowded ER, give report, and the go grocery shopping ON THE CLOCK...

YES!!!! :chuckle That's so true

KR · Dec 17, 2004

PA is another state that you can challenge the EMT-P test as long as you are an EMT-B first and they teach you a few other skills.

KR · Dec 17, 2004

PA is another state that you can challenge the EMT-P test as long as you are an EMT-B first and they teach you a few other skills.

rn29306 · Dec 18, 2004

I also did interfac tx and trauma backup on a highly stocked MICU, including onboard DataScop IABP and that experience was awesome. Sometimes RNs at facilities (esp referring) tried to give up crap and dish things off that were not right, that is, until they saw that our badges had the words "critical care transport RN" and things usually changed at that point.

Getting in good with a local EMS, taking classes, and doing ground tx is often a sneaky way to get into the back door of flight.

Interfac tx was the second best thing I ever did to get away from bedside ICU, anesthesia being first. If it weren't for anesthesia, I would have gone full-time tx. I always wondered what made EMTs and medics do it day in and out, when honestly the value that society puts on these individuals services is piss poor - now I know. Ride one day and you'll leave the bedside. Don't label me a beside abandoner unless you have given it a shot.

Highly rec interfaq tx if available to RNs.

Here is the MIC I rode on:

http://www.puckettems.com

Click Programs/Services

Click Critical Care Transport Services

rn29306 · Dec 18, 2004

Anyone ever notice how, when you roll into a receving facility with a IABP going full boogie on a intubated pt, people part like the red sea, your name tag may as well read Moses. These guys usually go up to the cardiac cath lab (usually 2nd or 3 rd floor) and the walking distance is considerable. Guess this is up there with someone riding along the side rail of stretcher doing chest compressions.

Had one healthcare provider (shall remain without label - don't want to incite flame war) in hyperbaric chamber treatment center ask why pt was intubated and no one was bagging. Guess she had never seen a EagleVent. Look on her face was priceless.

schweetlesboogie · Jan 5, 2005

All of this information is very helpful! But what and where is Creighton University? Does anyone know of any courses offered in or around Dallas Texas?

Thanks,

Scweetlesboogie

rn29306 · Jan 10, 2005

All of this information is very helpful! But what and where is Creighton University? Does anyone know of any courses offered in or around Dallas Texas?
Thanks,
Scweetlesboogie

go to yahoo.com, type in creighton u and read the school's webpage

ufmedic · Apr 28, 2005

Although several states allow RNs with EMT-B cert. to challenge the paramedic exam, there is no substitute for actually going to paramedic school and getting the experience. Just because you have RN behind your name, it doesn't mean that you can safely RSI trauma patients, read EKGs, and put in central lines. Paramedic school will also give the RN the experience of making decisions under pressure and administering treatment with limited resources (ie, just you and your partner working a code in someone's living room as opposed to an ED/ICU with three nurses, resp. therapist, and a physician). I wouldn't want a paramedic managing my 8 IV drips and IABP without having gone through nursing school and a critical care nursing course, so I certainly wouldn't want an RN that skipped medic school making the decsion to RSI, give NTG/lasix/morphine/vasopressors, and treat my decompensated CHF without a physician looking over his shoulder.

CCRN,BSN,NREMT-P

hogan4736, BSN, RN · Apr 28, 2005

Although several states allow RNs with EMT-B cert. to challenge the paramedic exam, there is no substitute for actually going to paramedic school and getting the experience. Just because you have RN behind your name, it doesn't mean that you can safely RSI trauma patients, read EKGs, and put in central lines. Paramedic school will also give the RN the experience of making decisions under pressure and administering treatment with limited resources (ie, just you and your partner working a code in someone's living room as opposed to an ED/ICU with three nurses, resp. therapist, and a physician). I wouldn't want a paramedic managing my 8 IV drips and IABP without having gone through nursing school and a critical care nursing course, so I certainly wouldn't want an RN that skipped medic school making the decsion to RSI, give NTG/lasix/morphine/vasopressors, and treat my decompensated CHF without a physician looking over his shoulder.
CCRN,BSN,NREMT-P

On this note, I have 2 good friends that were (and still are) medics, and now practicing RNs...

Both did EMS and private ambulance...

Both agree, that as a medic, they thought that they were capable of transferring a sick ICU patient (vents, multiple drips) by ground ambulance. Now as RNs, they BOTH tell me they were unprepared to deal with these patients as a medic.

Kind of an "I don't know what I don't know" problem...

Not knocking medics, this is their perspective...

I live in Phoenix and am an RN on a "critical care ambulance"

There are many ICU nurses (in our 26 hospitals) that won't xfer care (ambulance or air) to anyone BUT an RN, and a nurse unit gets requested for a medic level call (In AZ, medics can transport most drugs, except levophed, insulin, integrillin, propofol, and a few others.)

where does everyone stand on the sending RN deciding who transports his/her patient?

shadowflightnurse · Apr 29, 2005

On this note, I have 2 good friends that were (and still are) medics, and now practicing RNs...
Both did EMS and private ambulance...
Both agree, that as a medic, they thought that they were capable of transferring a sick ICU patient (vents, multiple drips) by ground ambulance. Now as RNs, they BOTH tell me they were unprepared to deal with these patients as a medic.
Kind of an "I don't know what I don't know" problem...
Not knocking medics, this is their perspective...
I live in Phoenix and am an RN on a "critical care ambulance"
There are many ICU nurses (in our 26 hospitals) that won't xfer care (ambulance or air) to anyone BUT an RN, and a nurse unit gets requested for a medic level call (In AZ, medics can transport most drugs, except levophed, insulin, integrillin, propofol, and a few others.)
where does everyone stand on the sending RN deciding who transports his/her patient?

First thought is that it is not up to the nurse to decide who transports the patient. The sending doctor is responsible for deciding the appropriate level and type fo care during transport. That being said, it is hard once you are at a sending facility and the nurse is refusing to transfer care. What do you do, call her boss, right her up?? Yeah right. I worked in the Phoenix area and like many others it is a very competitive market. If one service upsets a sending facility, they'll just stop calling that agency.

As for the RN to Medic issue, I think it is all about the reason it's being done. If "nurse x" wants to work for "Company A", and "Company A" requires RN's to have EMT-P cert the easiest way is for "nurse x" to challenge. But if the company is requiring RN's to have EMT-P cert, but not requiring experience, they are setting themselves up for problems.

I am already working as a flight nurse (and have been for nearly 5 yrs), the state where I currently work is considering requiring nurses to have either EMT-B (or maybe even P) cert. I am considering an RN to Medic course. Not to go out and declare myself as a paramedic, but to fulfill a job requirement. Just by taking (and hopefully passing) this course, I would not consider myself a competent medic. On that same note, I have to question the growing number of correspondence courses for Medic to RN. Medics typically feel strongly about their profession, just as nurses feel strongly about their's. They are 2 distinctly different fields, with different backgrounds/ways of thinking. It seems that most of the discussion on this topic on this site (and others) comes from people needing to fulfill a job requirement dictated by ADMIN sitting in "The Ivory Tower" and saying THIS IS HOW IT IS.

Wow, I just looked back at this reply and realized how long it was! Oh well, the debate will never end.

hogan4736, BSN, RN · Apr 29, 2005

Shadow,

I would respectfully disagree about it being up to the doctor to decide the appropriate ALS level (rn/medic)

(Even ALS vs BLS is up to the medic/RN picking up at sending facility. A doc may have ordered an ALS ambo for a 12y/o rule out appy at the urgent care going to peds m/s, but I pick up the kiddo, and give BLS care during the xport, and bill the call as BLS...

The doc really ONLY decides the safety of the transfer at the time of the order he/she writes (along with the RN's input - though if the pt is unstable at the time of the scheduled xfer, the RN will decide, as the doc is at home because he wrote the order at noon, and it's 2100 now)

The dispatch departments at ambo companies have clear, defined guidelines about what a medic can xport, and what a medic cannot xport in that particular state.

For example, the sending facility calls for a xfer for a patient on an insulin gtt and a vent w/ a peep of 7...

In AZ, a medic CANNOT xport insulin at all, and a peep of more than 5. DHS (and scope of practice) regulations. Besides, the doc would just order an ALS xfer. He doesn't know who can take what...

sean