Paramedics saying they are nurses---is this legal?

[nursebrandie28, BSN, RN]

Hello my fellow nurses,

I am not trying to knock the paramedic profession, however, I work in a small, inner city hospital that employs medics and RNs. I get so frustrated when medics introduce themselves as RNs, sign as RNs, do RN assessments, triages, discharges and then do not give our profession any respect. I am not saying ALL medics do this, however, I wonder the liability they have when working in an RN role. In my state of Missouri, I do not how the Board of Nursing allowed RNs to be "replaced' so easily. Is this legal?

And what about Medicare/Medicaid? The hospitals (in general) charge them for IV pushs, procedures performed by RNs- is the reimbursement the same if a medic gives it?? Would that be considered fraud??

I honestly respect the pre-hospital profession, however, I do not feel they have a place in an ER. For example, are they taught wound care, non-ACLS pharmacology, basic nurse skills such as NG, trachs, foleys?? Are they taught that antibiotics need to be taken all the way through when discharging a patient with a UTI?? I have watched many medics do foley caths and the sterile technique is less than desirable.

Has anybody researched what they 'legally' can do based on their training?? I am going to research this and ask my board of nursing to try to find answers. I worked so hard to obtain my nursing license and get so frustrated when people who have not suffered through all white uniforms, care plans, critical thinking scenerios, and of course the dreadful NCLEX can call themselves nurses.

Thanks for listening....

[ChristineN, BSN, RN]

No, no one except for an RN or LPN can refer to themselves as a nurse. If this is truly the case I would bring it to the attention of the ER manager, as they should be signing the paper work "Joe Smith, EMT"

However, I believe that EMT's and Paramedics Do have a vital role in the ER. Almost all the hospitals around me use them. They have a limited role, but they have been specially trained for emergencies, more so than CNA's. Plus, they can do straight caths, phlebotomy, and EKG's. They should not be administering medications, especially IVP. Meds in a hospital setting should be given only by a nurse. Same thing with patient education, discharge instuctions should be done by the nurse. These are not normal jobs for an EMT and Paramedic. If they are truley doing these things, they are overstepping their bounds.

[nursebrandie28, BSN, RN]

Thank you for their reply, but yes they are pushing IV meds- for example, the other day I watched one give 80mg lasix over probably 30 sec. Do they not realize the complications of pushing lasix too quickly?? No alcohol prep before they pushed- heaven forbid!!

I am not downplaying medics- I am just saying they are taught trauma...They probably can run trauma better than me or most nurses. However, less than 2% of all ER visits are trauma. The rest are medical/surgical/ob,etc. What in their training or liability gives them the right to take patients by themselves.

Managers know they call themselves nurses, nobody seems to care.....

I just do not understand why a medic would choose to "work as a nurse" with half the pay? I feel that hospitals are trying to find ways to cut money and hire cheap replacements of RNs. We are not replaceable.

[ChristineN, BSN, RN]

Thank you for their reply, but yes they are pushing IV meds- for example, the other day I watched one give 80mg lasix over probably 30 sec. Do they not realize the complications of pushing lasix too quickly?? No alcohol prep before they pushed- heaven forbid!!

If this is the case, I would check with your facility/state policys on paramedics giving IVP in a hospital setting. If it is indeed legal, perhaps they need a brush up class on med administration? Personally, I doubt it's legal to begin with.

I am not downplaying medics- I am just saying they are taught trauma...They probably can run trauma better than me or most nurses. However, less than 2% of all ER visits are trauma. The rest are medical/surgical/ob,etc. What in their training or liability gives them the right to take patients by themselves.

I've never seen them take care of patients by themselves. They should be working under a nurse. They do not have the legal autonomy a nurse does in a hospital to carry their own patient load

Managers know they call themselves nurses, nobody seems to care.....

That's unfortunate. Have you tried moving up the chain? If you have proof that they are signing documents "Joe Smith, RN" you could report them to your state board of nursing.

I just do not understand why a medic would choose to "work as a nurse" with half the pay? I feel that hospitals are trying to find ways to cut money and hire cheap replacements of RNs. We are not replaceable.

I agree, we are not replaceable. Every hospital I've ever worked in has used Paramedics/EMT's in the ER as highly trained PCT's. They can do a little more than the other PCT's, and they make a couple dollars more an hour, but they are by no means equal in responsibility or pay with a nurse. This situation you describe honestly frightens me.

[erjunkie8]

WOW!! These are some big concerns. I would table the subject to the Nurse managers. I myself am an EMT with a degree in Emergency Med. I have always supported medics in the ER and the vital role. The medics we work with always tell the pt "I'm Joe and I am the paramedic (or emt) working with Sue" and that is how is should go. I can see how you have sensitivity on such a brutal subject it seems in these forums. You have EVERY right to be concerned. Medics are allowed to push Lasix in the field and they all know that you can not push it that fast!!

I have had many issues with RN's posting on this site about the PM incompetencies. I am a new GN and have seen both sides. I am glad that you have voiced your concern with the great respect that they all are professions.

Just approach the NM and tell her you "have a concern" make it like a question to them and not like you are trying to tattle. Know what I mean? I have foudn that management loves to answer questions more than address issues.

hope that helps and thank you :)

[Batman24]

You should take this up the chain of command in writing where you work or call your BON and report it. Every time they sign as a RN if they aren't the documentation is inaccurate and false. If any of these patients sue they will have employees misrepresenting themselves and the records will all be called into question. This could be a legal nightmare down the line for all involved. Has anyone just asked the paramedics why they are doing this in a

non-confrontational way?! I would start there and let them know why this is a problem.

[ChristineN, BSN, RN]

You should take this up the chain of command in writing where you work or call your BON and report it. Every time they sign as a RN if they aren't the documentation is inaccurate and false. If any of these patients sue they will have employees misrepresenting themselves and the records will all be called into question. This could be a legal nightmare down the line for all involved. Has anyone just asked the paramedics why they are doing this in a

non-confrontational way?! I would start there and let them know why this is a problem.

I agree. This ER is setting itself up for a major lawsuit. And when it comes, they are going to look like idiots.

[Neveranurseagain, RN]

Paramedics are more than trauma orientated. They are also ACLS trained and can give Lasix as well as many other IVP meds, including MS. In some states where they work in rural areas with long transport times they also administer the "clot busting drugs," based on standing orders.They can externally pace, start central lines and external jug., needle a chest to relieve a tension pneumo, and give fluids intra os. They can do emergency trachs, run SVN's. They also also trained in OB, and deliver babies out in the field. They recieve extensive training in other medical problems also. So they are not just trauma orientated.What they actually can do is limited by the state they are in and most of the time they work off of standing orders.

But they should NEVER sign their name as RN unless they are an RN. It is against virually every states BON law and needs to be reported!

I used to be a RN and also a paramedic. When I worked as a paramedic and helped out in the ER when they were busy, I was limited to doing JUST what a paramedic could do out in the field, and signed charts as CEP (certified emergency paramedic). I was limited to hanging or pushing the 21 meds we carried in our medic drug box, and was not allowed to push or hang any other meds (even though I was also an RN). And I could not even straight cath as it was not an approved CEP procedure.

What exactly is their title? If it is paramedic, then they should only be doing the skills they were taught to do. If their title is PCT, then they should do just what the usual duties of a PCT is, which probably dies not include IVP meds.

Call the paramedic cert board and find out if they are allowed to do duties outside their scope when working in an ER and notify the BON!

[ChristineN, BSN, RN]

Paramedics are more than trauma orientated. They are also ACLS trained and can give Lasix as well as many other IVP meds, including MS. In some states where they work in rural areas with long transport times they also administer the "clot busting drugs," based on standing orders.They can externally pace, start central lines and external jug., needle a chest to relieve a tension pneumo, and give fluids intra os. They can do emergency trachs, run SVN's. They also also trained in OB, and deliver babies out in the field. They recieve extensive training in other medical problems also. So they are not just trauma orientated.What they actually can do is limited by the state they are in and most of the time they work off of standing orders.

But they should NEVER sign their name as RN unless they are an RN. It is against virually every states BON law and needs to be reported!

I used to be a RN and also a paramedic. When I worked as a paramedic and helped out in the ER when they were busy, I was limited to doing JUST what a paramedic could do out in the field, and signed charts as CEP (certified emergency paramedic). I was limited to hanging or pushing the 21 meds we carried in our medic drug box, and was not allowed to push or hang any other meds (even though I was also an RN). And I could not even straight cath as it was not an approved CEP procedure.

I think hospital policy also depends here though. In the hospitals I've worked in, paramedics weren't allowed to give meds, if they were working as ER-techs, regardless of what they could do "in the field."

[nursebrandie28, BSN, RN]

Does anybody know where to find what medics can and cannot do in the ER setting for each state? Nobody seems to know.

And they introduce themselves as nurses. They sign paperwork that says

RN signature ________________________.....they do not actually sign Joe Smith RN.

How are the medics liable? Who regulates them/??

[SecuredFloorNurse]

Are they EMTs or Paramedics? Paramedics in VA have a lot more training and school time than an EMT. Paramedics here are taught more than just trauma and what to do in emergencies. EMTs are not.

[nursebrandie28, BSN, RN]

They are paramedics.