Paramedic on Medical Surgical Units outside of just the ER

[ParamedicGuy]

In Michigan paramedics seem to have a very expansive scope of practice while working in the ER (at least in this one hospital system). They are able to push medications such as morphine, start critical drips such as cardizem, intubate patients, set up vents., do EKGS, administer breathing tx's, insert foleys, start IV's ect. It seems as if they are functioning more as a Nurse/RT then a medic. Granted they do these interventions in the field, but not usually in the ED. Do you think Is this because they are performing these duties via delegation from an RN or due to an expanded protocol basis from the Medical Director?

My main question however is relative to using paramedics outside of the ER realm and integrating them into the pt. care team on medical surgical units in the hospital in a supportive role to the RN team.

Meaning that they would function in essence similarly to a Nurse Tech with an expanded scope of practice allowing their skills to be used as a paramedic. Thus in turn allowing the RN work load to be lightened a bit, and letting the medic cover for Rx's, insulin, foley insertion, drsg. changes ect. Additionally they could prove to be a valuable asset on respiratory units with ventilator dependent patients - as medics are trained in vent initiation, use and maintenance as well as pt. trach care.

Another situation that seems to really stick out is when a pt. codes on a unit: staff on the unit becomes short because most are assisting in the code. However, a medic would be able to alleviate this by working on the floors code team (ACLS cert.) and provide intervention in which they are trained based upon Dr. orders. Additionally medics are trained in detailed EKG interpretation on the defib./mont.

What is your opinion on a hospital piloting the use of paramedics in this role in an acute care setting out of the traditional ER setting you find them in and on a med./surge. Unit? Of course they would not be there to step on anyones toes so to speak, but to help lighten the work load of the RN team.

Paramedic Consolidates:

• Nurse Tech
  
• Nurse Assistant
  
• ER Tech
  
• EKG / Code Team Member
  
• Lab Draws
  
• Limited Respiratory duties upon delegation
  
• Limited RN/LPN duties upon delegation
  

What do you think?

[GilaRRT]

I think paramedics bring a very unique skill set to the table when it comes to care delivery within the facility. I would have no problem working with a paramedic in the medical/surgical setting.

What about pay and benefits? The pros of leaving the field will need to outweigh the cons if a paramedic is going to take on such a role. It would be hard to leave a position of relative independent practice to work in a much more restricted role. However, I have worked with many medics in the ER that transitioned out of the field full time and enjoyed their job. However, the hospital pay was much better than the field, so this helped with the role transition.

In addition, this type of role could help to recruit future nurses. With the paramedic to RN transition programs gaining popularity, this could be a good way to provide nurses that already have a solid foundation of knowledge in the work place.

The bottom line will be how the paramedic community views working in such a role.

[getoverit, BSN, RN, EMT-P]

As both an RN and REMT-P, this is a delicate situation. Paramedics can be very helpful in an acute care setting, especially part of a code team. You have to take a look at their training and certification, not all paramedic education includes ACLS certification (although it's very rare not to, it does happen and certainly not all practicing EMT-Ps are required to

[XB9S, BSN, MSN, EdD, RN, APN]

Now when I reply please bear in mind I am from the UK and our paramedic training is probably very different to yours.

Paramedics have very unique skills and are experts in pre-hospital care, yes some of these are transferable to a hospital environment but do you not train to be a paramedic to get that pre-hospital practice.

As a UK surgical nurse I don't think that there would be any place within our hospital wards for a paramedic, yes I can see how there would be a role within EU but ward nursing is about continuing care where as pre-hospital is about that initial period before definitive care starts.

I am interested why a pre-hospital expert would want to work within a hospital. The paramedics I know would rather stick hot pins in thier eyes.

[getoverit, BSN, RN, EMT-P]

woops! accidentally hit something wrong....

anyway, not all are required to maintain ACLS certification. In answer to the question about being under the direction of an RN or expanded protocol basis from a medical director, it would be the same as it is in the field...the medic operates under standing orders from an MD.

They function as EKG techs, not only tele but acquiring 12 leads. Additional education would be needed to cover insulin, both SSI and infusion; also ventilator usage and care. I have seen a pilot program that never really took off because the paramedics were offered CNA1 positions but were required to take a 65 hr. course before they could function. 100% of the people who were interested found it insulting and withdrew their application.

As far as the pay, most places are underpaid and a CNA is equivalent $$ with a paramedic. So that would be enticing.

The paramedic community has a lot of misunderstanding about nursing roles and RNs often have a superiority complex against paramedics. that being said, I think part of the way to be successful at integrating medics into a hospital setting is to set specific initial education requirements (e.g. must have college A&P-some programs do not require or provide this, 2 semesters of Pharmacology, ACLS, etc.) then providing tailor-made training to the expected job requirements, as opposed to making them obtain a nursing assistant certification.

[XB9S, BSN, MSN, EdD, RN, APN]

woops! accidentally hit something wrong....

anyway, not all are required to maintain ACLS certification. In answer to the question about being under the direction of an RN or expanded protocol basis from a medical director, it would be the same as it is in the field...the medic operates under standing orders from an MD.

They function as EKG techs, not only tele but acquiring 12 leads. Additional education would be needed to cover insulin, both SSI and infusion; also ventilator usage and care. I have seen a pilot program that never really took off because the paramedics were offered CNA1 positions but were required to take a 65 hr. course before they could function. 100% of the people who were interested found it insulting and withdrew their application.

As far as the pay, most places are underpaid and a CNA is equivalent $$ with a paramedic. So that would be enticing.

The paramedic community has a lot of misunderstanding about nursing roles and RNs often have a superiority complex against paramedics. that being said, I think part of the way to be successful at integrating medics into a hospital setting is to set specific initial education requirements (e.g. must have college A&P-some programs do not require or provide this, 2 semesters of Pharmacology, ACLS, etc.) then providing tailor-made training to the expected job requirements, as opposed to making them obtain a nursing assistant certification.

Not entirely familiar with the abreviations but is what you are saying that paramedics generally are only paid the equivelent to a nursing assistant and because of that finacially they would be better off in a hospital.

If that is the case what a huge waste of a vital resource, why take our pre-hospital expertese away from where it is needed. Our paramedics are paid the same pay band as a basic qualified nurse which is why I find it surprising that any would opt to work in a hospital as it is not what they have trained for. As far as accountability goes in the UK paramedics are state registered and therefore responsible and accountable for thier own practice. I would never dream of supervising a state registered paramedic they are practitioners in thier own right.

In fact in my last job I taught trauma and resuscitation for my hospital and community trust and my boss was a paramedic

[CRNA2007]

To be honest I really couldn't see a paramedic being very satisfied working in a med surg unit and I doubt they would stay very long.

[getoverit, BSN, RN, EMT-P]

XB9S,

first of all, nice looking motorcycle!!

and yes, when I worked as a paramedic I made LESS than a nursing assistant. In fact there are some areas where the pay is close to minimum wage. Another bad point is there is often very little room for advancement. I worked as a paramedic with a guy who had been there for 16 years longer than I had and he only made $0.10/hr more than I did. You can imagine his resentment.

I flew on helicopters for about 8 years and made fairly good $$ compared to riding at a fire dept, but going to nursing my salary increased almost 35%. If I had been still working at a fire dept, it would have increased by close to 55%. Of course this is dependent on the area of the country and I know paramedics who make more than I do as an RN, but the cost of living there is much higher and I'm sure it's relatively equivalent.

I agree with your statment "why would anyone opt to work in a hospital as it is not what they have trained for". This is something that a lot of paramedics think, "if I wanted to work in a hospital I would have gone to nursing school." but RNs do supervise paramedics in many areas of the country. Which is part of the misgivings and misunderstandings between the two professions.

[GilaRRT]

XB9S, much of your question is related to the fact that both UK paramedics and RN's have a different education when compared to their US counterparts. Paramedic education in the US is highly varied. Entry level paramedic education can be a 12 week "shake and bake" school to a 2 year program.

In addition, paramedic pay is pathetic in many systems. I know medics that make $13.00/hr or less. So, when they are offered $20.00/hr to take a job that has regular 12 hour shifts in a nice warm ER, where the paramedic no longer has to freeze his butt off in a ditch extricating some drunk out of a car at 2 am, you can see why paramedics may want to give up working in the field.

In addition, US paramedics face an uphill battle at present. Many of the nursing associations with pull in the policy department do not support non nurses filling roles generally provided by nurses. For example, check out this position statement by the ENA. http://www.ena.org/about/position/PDFs/UseNon-RN.PDF This; however, does not apply to the topic at hand, as the paramedic would be working in an assisting role. However, this does show that paramedics face many obstacles in the US that their UK counterparts may not.

[lindarn]

Why do I see this as another example of hospitals trying to replace nurses with lesses educated/skilled personnel? Any excuse to find a reason to use unlicensed personnel to "fill in" for an RN because there is such a "nursing shortage". Gag me with a spoon!

There is no reason to use paramedics in ERs, ICUs, Med Surg, ad nauseum. There are more than enough nurses to work in these positions, but not enough nurses to willing work for paramedic pay. Pay nurses more and you will have enough nurses to work in these areas, and then some. Paramedics have no education taking care of patients in an in- hospital setting, med surg, etc. Their expertise is in acute pre-hospital care in the field. It is not in their scope of practice to be dealing with insulin drips, etc. Why do we want to give away another piece of our professsion?

Lindarn, RN, BSN, CCRN

Spokane, Washington

[flashpoint]

Why do I see this as another example of hospitals trying to replace nurses with lesses educated/skilled personnel? Any excuse to find a reason to use unlicensed personnel to "fill in" for an RN because there is such a "nursing shortage". Gag me with a spoon!

There is no reason to use paramedics in ERs, ICUs, Med Surg, ad nauseum. There are more than enough nurses to work in these positions, but not enough nurses to willing work for paramedic pay. Pay nurses more and you will have enough nurses to work in these areas, and then some. Paramedics have no education taking care of patients in an in- hospital setting, med surg, etc. Their expertise is in acute pre-hospital care in the field. It is not in their scope of practice to be dealing with insulin drips, etc. Why do we want to give away another piece of our professsion?

Lindarn, RN, BSN, CCRN

Spokane, Washington

I don't disagree that paramedics should not be replacing nurses...especially in areas outside of the ER. I think paramedics can be very helpful in the ER...not to replace nurses, but in addistion to nurses. Paramedics are able to perform some skills that an RN cannot (at least in my state). Paramedics can intubate, do needle crics, needle decompression, and can insert IVs in the EJ and lower extremities...RNs cannot. In a small hospital that doesn't have a physician in house 24/7, a paramedic can make a big difference. And it is in my scope of practice to manage an insulin drip...I can also manage cardiac drips, give antibiotics, and give blood. We are six hours away from the closest "major" hospital...not everyone is sick enough to transfer by air, so our lowly ground medics are required to do a lot...we take a lot of extra classes and our medical director watches us like a hawk.

[GilaRRT]

This is good, this shows just how ignorant many of us are in regards the paramedic.

First, in many states paramedics are in fact licensed. So, using the blanket term of UAP to describe all paramedics is not accurate.

Second, saying something is or is not in somebodies scope of practice should be based on what the state EMS board or similar agency that governs EMS SOP states.

Third, paramedics deal with critical care patients on a daily basis. Look to many of the flight services, and you will find paramedics working as a critical care provider. They are administering insulin gtts and vasoactive medications, transducing invasive lines, working with IABP's and managing complex ICU patients. True, these paramedics have allot of experience and additional education in most cases; however, is that not what we are talking about in this OP?

Finally, no where in the OP was it mentioned that paramedics would be "filling in" for the RN.