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.
I'm not for it at all. It's not that I'm biased against paramedics (my brother and uncle are both very competent paramedics) my problem would be taking away more interventions from nurses. I'll try to stay off my soap box on this subject, but I don't feel comfortable delegating nursing practice to non-nursing personnel. My fear is that before long all nursing interventions will be delegated out and nurses will become professional charters.
I understand that everybody has their place and role within the healthcare system, and I think that it is great that there is enough variety to allow people to find their niche and do what they like.
That being said, I would not support expanding paramedics into other areas of the hospital. Granted my view may be jaded since I work in an academic teaching hospital, their is never a doc, RT or experienced nurse far away to deal with any situation. I also understand that paramedics are not "ambulance drivers" and have their education and skills to back them up.
However, their education and expertise is geared towards pre-hospital care. In good 'ole NC I as an RN cannot challenge the paramedic exam any more than the paramedic can challenge the NCLEX, that to me says that my education and training is not the same as theirs and vice-versa. A paramedic is an excellent provider for the person thrown from their car and wedged in the ditch. I am the provider for when the aformetioned person makes it through surgery and winds up in the unit. We each provide expert care, just at opposite ends of the continuum.
To put it simply, if you want to work in the hospital and function in a nursing capacity, go to nursing school.
However, their education and expertise is geared towards pre-hospital care. In good 'ole NC I as an RN cannot challenge the paramedic exam any more than the paramedic can challenge the NCLEX, that to me says that my education and training is not the same as theirs and vice-versa. A paramedic is an excellent provider for the person thrown from their car and wedged in the ditch. I am the provider for when the aformetioned person makes it through surgery and winds up in the unit. We each provide expert care, just at opposite ends of the continuum.
To put it simply, if you want to work in the hospital and function in a nursing capacity, go to nursing school.
I agree with your statement. An RN does not belong in the field working as a paramedic any more than a paramedic belongs in the hospital working as an RN. However, I do not see where the paramedic is taking over the role of the RN in the OP. It looks more like a CNA that can provide additional interventions under the direction of an RN. In this case, the educationa of a paramedic would be a great asset. I fail to see a problem here?
True, I think many paramedics would find the situation insulting; however, why are so many nurses against such an idea?
although most of my experience is in the ER, i have been pulled to the ICU and tele units.
no i don't do assessments, no i don't push a med cart, no i dont do per-say "bedside nursing care" (although i am more than happy to give bed baths or clean poo, and i would function as a CNA if necessary). i am not trying to be an RN/LPN, because i'm not. i can do IV pushes and drips, start IVs, etc, etc., and i have been pulled to these units to function basically as an equivalent to a nurse tech i guess. i was there to make the nurses lives easier.
i was also a member of the hospitals code team. when a code was called on any floor, i would respond with 2 nurses and a RRT. an RRT or a medic can intubate, in the hospital setting (or atleast that one), an RN/LPN cannot. i was usually responsible for either: maintaining the airway, pushing drugs, or monitoring rhythm and defib. as necessary. again i was not there to be a nurse, i was there to be a medic, and help the nurses....for which they were always grateful.
in the ER, my scope was pretty vast. i had alot of responsibilty. i am licensed and nationally registered, but i did whatever the ER doc/PA/NP/RN/LPN requested me to do,which was anything from insert a foley, put in an EJ, intubate a patient, mop up vomit in the waiting room, whatever. on the floors, it was more limited, but i never cared about having to be floated. it was a nice break, and i enjoyed doing more patient care...
many times ive been called a peon. in the ER, i was treated as an equal. outside of the ED, usually in ICU or PCU setting, where the popular belief was that EMT-P=UAP that is "less educated". but ive never refused to follow an order to push morphine or to empty a urinal. i was always the best peon i could be.
ive always worked for pitiful pay and had an incredible amount of work to do, that yes, an RN /LPN probably could do, but i make their workload less, and because i am cheaper than hiring another nurse i guess.
i might be cheaper, but i sill maintain my own license, am still a college graduate.
I like the idea of the code team, on the unit. that would help a lot, and save many lives! i don't see anything wrong with allowing them to participate on the unit within thier scope of practice.
Specializes in ICU, CCU, Trauma, neuro, Geriatrics.
A facility I worked in used paramedics in the ER as many do and one on the critical care floor (ICU,IMCU and telemetry/step-down) to transport patients to tests that were on cardiac monitor, the medic could transport many of the drips we used too. The paramedic stayed with the patient during the testing and brought them back to the unit. It sure was nice to not have to leave the rest of my patients for 30+ minutes for an X-ray, MRI, ultrasound, CT scan etc. When all 4 or 5 patients needed tests that took up 2 to 3 hours of my already busy day.
Thanks Jess1983 i brought the issue being discussed on this forum about paramedics on units in my hospital to the nursing admin. and they love the idea and are considering piloting a program of having one medic on every unit functioning as a CNA with extra medic intervention ability - and the code team is a big one - waiting on the house officer to arive and an RT sometimes just takes to long when a medic could have allready intubated, and shocked the patient out of vfib. The pay scale has also been looked at and the medic/cna would be paid the same as a nurse tech at my hosp. which is more than any medic makes in the streets. Its around $18 an hour. Ill keep everyone posted.
Thanks Jess1983 i brought the issue being discussed on this forum about paramedics on units in my hospital to the nursing admin. and they love the idea and are considering piloting a program of having one medic on every unit functioning as a CNA with extra medic intervention ability - and the code team is a big one - waiting on the house officer to arive and an RT sometimes just takes to long when a medic could have allready intubated, and shocked the patient out of vfib.
I still fail to see why the addition of the paramedic would be a huge asset, especially on the code team. Maybe I am misunderstanding who your code team consists of, in my hospital the code team is the CCU fellow, CCU charge nurse, MICU resident, RT supervisor, and the RTs from the closest ICU to the code. In addition the nursing and physician staff already on the floor has generally started BLS interventions.
I may be reading too far into your intent, but it seems to me you feel that nurses on the floor would be lost without the paramedic nearby to bail them out in an emergency.
I do understand that your intent is to pilot a program that would potentially lighten the workload of the nurse. However, rather than having the additional responsibility of delegation to yet another provider, I would rather the hospital pony up the cash and hire more nurses, period.
I stand by my earlier statement, if you want to provide nursing care in the hospital environment, go to nursing school.
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.
It must depend on the state because the RNs where I work do EJ and lower extremity sticks all the time in my ICU and ER. We are a level one trauma center so that may make a difference as to what our RNs are trained and allowed to do. The RNs also trained to do IO sticks. Maybe RNs should be trained to intubate? We never have the need to do that though, I work in a teaching hospital and there is MORE than enough RTs, RNs, MDs, students of all sorts in on codes (the room is packed).
I don't think paramedics should be outside the ER though. I think nurse techs are fine and can fill in the gaps as needed.
The main problem is what someone mentioned before--RNs are not paid enough by FAR! Pay RNs more and the shortage would magically be over.
Specializes in Spinal Cord injuries, Emergency+EMS.
several isues strike fro mthe rightpondian point of view
US hospitals use paramedics becasue they are cheap, this wouldn't happen for cist reasons in the Uk as Ukparamedics arepaid the same as Nurses and other AHPs becasue of the national terms and conditions and job evaluation system...
stuff like Lower extremity IVs, EJIV, needle cric and chest decompression have bene mentioned - and that RNs can't do these ... odd that RNs in the rest of the wrold do do these if they work in approrpaite clinical environments ... perhaps the US needs to alook at how it views scopes of practice .. the irony here being that the Uk is propbably the 'land of the the free' when it comes to scope of practice with established profession independent systems of expanded and extended scope, no 'ring fencing' of interventions except a few rear guard actions by the anaesthetists, true Nurse independent prescribers ...
I still fail to see why the addition of the paramedic would be a huge asset, especially on the code team. Maybe I am misunderstanding who your code team consists of, in my hospital the code team is the CCU fellow, CCU charge nurse, MICU resident, RT supervisor, and the RTs from the closest ICU to the code. In addition the nursing and physician staff already on the floor has generally started BLS interventions.
I may be reading too far into your intent, but it seems to me you feel that nurses on the floor would be lost without the paramedic nearby to bail them out in an emergency.
I do understand that your intent is to pilot a program that would potentially lighten the workload of the nurse. However, rather than having the additional responsibility of delegation to yet another provider, I would rather the hospital pony up the cash and hire more nurses, period.
I stand by my earlier statement, if you want to provide nursing care in the hospital environment, go to nursing school.
I agree with you. I will have to say the some of the most clustered codes I've ever seen were on hospital floors, (not ERs or ICUs) and if a paramedic had performed at the same level they would more than likely have been remediated by their medical director. that being said, a seasoned paramedic has probably worked more codes than a nurse with the same # of years experience...of course dependent on the setting of their practice.
It also brings up the debate of who's responsible for whom and for what. You mention the responsibility of delegation to yet another provider. It may not have to be that way, if the paramedic was functioning under the direction of a physician then they wouldn't necessarily have to answer to the RN. Before I became an RN, I brought in a patient who had arrested in a dialysis chair. We resuscitated him, initiated a Dopamine and Bretylium drip (yes, it was a while ago!) prior to arriving at the ER. The MD was busy with other patients and told me to "run the code, let me know if he needs to be admitted." The doctor was my medical director and I had known him well for many years. I ordered labs, gases, vent settings, and ACLS meds as the pt. coded 2-3 more times before we got him into the ICU. The resistance of one RN was painfully obvious, but the rest of us worked together as a team. This case is a unique example at a small community hospital, but it can be applied to other situations.
Someone posted that paramedics wouldn't be very satisfied working in a med-surg floor or other acute wards of a hospital and that's probably true. Medics make great assistants in the ICUs as well as ER, but they are out of their element as the training for prehospital care is completely different from nursing. Which was my point in an earlier post about setting a minimum education requirement and then additional coursework/competency evals/etc.
Dicey questions and great discussion!! I'm glad to be a part of it. The other side of the arguement is RNs working on an ambulance. How does anyone feel about that? Some states refer to them as PHRN (prehospital RN). While working for a helicopter service, I have ridden in ambulances with patient's when the weather is down and some medics have had a huge problem with the fact that my RN partner was only certified as an EMT-basic and tried to contest them from providing care in the back of an ambulance. I know that's not only incredibly trivial, but also makes things out to be about something other than the patient's well-being.
I'm kind of on the fence on this question... I think they would be a valuable asset but I also worry that management would see this not as a way to lighten the nurse's load, but as a way to increase the number of patient's a nurse must care for. And what legal ramifications would this have for the nurse if the paramedic made a mistake?
ramonmalino
59 Posts
I'm not for it at all. It's not that I'm biased against paramedics (my brother and uncle are both very competent paramedics) my problem would be taking away more interventions from nurses. I'll try to stay off my soap box on this subject, but I don't feel comfortable delegating nursing practice to non-nursing personnel. My fear is that before long all nursing interventions will be delegated out and nurses will become professional charters.