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.
well I will start and say that this specific blog is about paramedics and falsifying documentation and representation. Lets not get carried away with job descriptions.
A medic can sign a form joe smith, PM and that is it. Problem is many ER's are so busy that RN's sign off becasue they get a little too trusting and lax. I knew of 2 RN's and 1 PM who were immediatley terminated for RN signing off on PM pushing a cardiac med in a code. Now, we all know that in a stressful time you have to do stuff quick. The unfortunate part was 2 people from management were the ones that "fried" the other RN's and PM. (they were there when the medic pushed the code) One of the RN's was a nurse manager who was terminated for trying to defend the other RN. She was terminated for not supporting management. The other RN was term for falsifying documentation that she gave the med when the PM really did. The code was a pre-mature delivery and the baby was the code. Scary situation. Both RN's fired were the best of the best they had there. Many people were upset about it. You never know who you can trust and who is watching you "not" do something... please be careful!!
This is a legal nightmare. I believe that if it is NOT reported to the BON anyone involved can have discipliary action taken against them for not reporting.
The job description varies from hospital to hospital. Where I work PM are basically techs who can start IV's. Eventhough their experience is way beyond that most places dont like to hire PM for the simple fact that they have such restricted limitations and sometimes "forget". I can understand that. So much they are capable of and not allowed to do.
Where I am, eventhough I am an EMT. I am not allowed to put O2 on a patient becasue it is considered a "medication" and it should be done and documented by a RN. I don't get that...
it depends on the hospital policy.
Lets try and redirect to the legal matter here.. if management does not care there is someone in management who does... keep going even if you have to call the annonymous report line. You can cause harm on yourself for not reporting. If you report it use documentation that you did and when. CYA!!
You will never be in trouble for reporting, it's when you don't that you do..
Easy way to remember this.. EMT's have a Certification. They are BLS ONLY! Paramedics have a license. They are ACLS, etc. EMT's can only provide basic care, paramedics can provide medications and are taught to perform invasive life saving skills.
If EMT's get a code all they can do is CPR and call ALS. ALS can intubate, IV, meds, read 12leads etc. Now there is what is called a EMT-I (intermediate) who are EMT's that can start IV's.
EMT's think BLS, Paramedics think ACLS. If an EMT tells you they can give meds, they are lying. In most cases EMT's drive, can do blood sugars, immobilization, O2. However they work under the medic license. EMT's go to school for one semester, Paramedics go to EMT school and than an additional one year.
Your board of nursing should list the skill set approved for the paramedics to practice in the ER. Paramedics are not allowed to introduce themselves as a nurse and should never sign RN after their name. Most states have an approved scope of practice that outlines the skills and defines the scope of practice of EMT's and medics in the ER and it is usually more limited than their scope in the EMS setting. Your facility will then take the scope of practice defined by the board of nursing and decides what they will limit EMT's and medics from doing in their facility.
As far as medics just being trained in trauma that is completely incorrect. If the majority of the people you get in the ER are medical or non-trauma patients. Who do you thinks care of them during the ambulance ride to the hospital? Medics can push plenty of different meds IV and we are trained just as nurses in multiple medical illnesses. I am both a medic and an RN but when working in one scope I can't cross lines and practice outside of that scope. As a RN in the ICU I can't intubate or do a surgical cric. on a patient. I can on the truck as a medic if I have to. Just the same, I can't push a drug on the truck as a medic thats not in my scope just because I can in the hospital as an RN. I think medics are of great use in the ER setting and would be a great source in triage. Triage is what medics do in the streets. They make the call if something is emergent or not. Does it need to be fixed now or can it wait?
Again, look up your State board of nursings designated scope of practice for medics in the ER. If you would like to know the entire scope of practice of paramedics you can also visit your state office of EMS website and it should list all skills and medications that are in the scope of practice of paramedics in your state.
Easy way to remember this.. EMT's have a Certification. They are BLS ONLY! Paramedics have a license. They are ACLS, etc. EMT's can only provide basic care, paramedics can provide medications and are taught to perform invasive life saving skills.
If EMT's get a code all they can do is CPR and call ALS. ALS can intubate, IV, meds, read 12leads etc. Now there is what is called a EMT-I (intermediate) who are EMT's that can start IV's.
EMT's think BLS, Paramedics think ACLS. If an EMT tells you they can give meds, they are lying. In most cases EMT's drive, can do blood sugars, immobilization, O2. However they work under the medic license. EMT's go to school for one semester, Paramedics go to EMT school and than an additional one year.
Hope this helps...
This is not really true....
From someone who has worked in the scope of practice as an EMT-Basic, EMT-Intermediate, EMT-Paramedic and RN:
The medical director over the EMS agency is who limits the scope within which an EMT may practice. EMT's that tell you they can give meds are not lying. EMT's can give and assist patients in taking certain medications, the list of meds is short but they do have training in medication administration. If EMT's get a code their interventions again depend on their location and medical direction as to what they can do. An EMT-B can insert a combitube in most places if in their scope of practice if it is neccessary.
EMT-Intermediates are not just EMT's who can start IV's. They have a much wider scope of practice depending on their location. They can administer many more medications than EMT-B's, provide cardiac monitoring, start IV's and infuse fluids. I intubated many patients as an EMT-intermediate. I could teach a person working the drive-thru at burger king how to start an IV in less than an hour, my EMT-I class was over a semester long...
You shouldn't call someone a liar if you don't know for sure their scope of practice. Just like working as a RN, if you switch facilities your scope may change based on hospital policy. You may be able to access a portacath at one hospital while at another only the IV team may be allowed to do this. Just because one medical director doesn't allow his EMS agency to perform one skill doesn't mean the next will limit it as well.
From someone who has worked in the scope of practice as an EMT-Basic, EMT-Intermediate, EMT-Paramedic and RN:
The medical director over the EMS agency is who limits the scope within which an EMT may practice. EMT's that tell you they can give meds are not lying. EMT's can give and assist patients in taking certain medications, the list of meds is short but they do have training in medication administration. If EMT's get a code their interventions again depend on their location and medical direction as to what they can do. An EMT-B can insert a combitube in most places if in their scope of practice if it is neccessary.
EMT-Intermediates are not just EMT's who can start IV's. They have a much wider scope of practice depending on their location. They can administer many more medications than EMT-B's, provide cardiac monitoring, start IV's and infuse fluids. I intubated many patients as an EMT-intermediate. I could teach a person working the drive-thru at burger king how to start an IV in less than an hour, my EMT-I class was over a semester long...
You shouldn't call someone a liar if you don't know for sure their scope of practice. Just like working as a RN, if you switch facilities your scope may change based on hospital policy. You may be able to access a portacath at one hospital while at another only the IV team may be allowed to do this. Just because one medical director doesn't allow his EMS agency to perform one skill doesn't mean the next will limit it as well.
I have attended EMT school, Paramedic School and Nursing School... they have taught me the same in all of them. I have worked in the ER and in EMS since 1998 and know the P&P very well. I know what is required and not allowed. A lot of times nurses ask for the EMT and PM to do jobs they all well know are not allowed. Stand up and tell them no you can't no matter what. You never know who will back you. It is YOUR certification/license.
Maybe it varies from state to state and agency to agency. Check your department of health site defining each job responsibility for the job. Overall, most will tell you the same. The state I am in does not even recognize an
no they can't sign as a RN or a LPN inless they have a license. i don't care what kind of training they have. i would turn it into the nurse manager. my brother is a paramedic and i know he would never think of doing such a thing. i think i would copy the paper work they signed and give it to the nurse manager. keep us posted on how this turns out.
no they can't sign as a RN or a LPN inless they have a license. i don't care what kind of training they have. i would turn it into the nurse manager. my brother is a paramedic and i know he would never think of doing such a thing. i think i would copy the paper work they signed and give it to the nurse manager. keep us posted on how this turns out.
I agree. That would be false representation. I have never seen anyone do that.. I have seen where EMT/medics have done the assessment and RN looked over and signed... still not a good idea. Just play safe and tell them no you can't no matter how well you think you know someone..
I once saw a new nurse in triage check a pt in. He looked horrible, pale, diaphoretic, breathing hard. She wrote on the sheet "unable to obtain BP" and put the kid back in the lobby. He was 20 with non-hodgkins. I went and told the charge nurse about it and asked him to "eye-ball" the kid just for my own relief. He looked at the kid. RR rate was 52, she wrote 18. They brought him to the back almost immediatley where he almost coded and was intubated.
If you are unsure about something and have that "gut" feeling. Grab the charge nurse, don't tell anyone and ask them to just "look" and it would make you feel better. Ever since than that charge RN told me that he earned a great amount of respect for me.
One word Felony in most states. And thats coming from one as well as currently licensed as an RN. Its also a felony in a lot of places to call yourself a paramedic and not be one as well.
i also work as a charge RN and have worked down in the ER , if i noticed or had one of the RN's on staff come to me with this problem. I would have the paper work copied and turn it into the nurse manager who would turn it into the board. i would make sure it was followed up on. nurse is a protected title, and we work hard for it.
ozoneranger
373 Posts
Missouri Emergency Medical Services
P.O. Box 570
Jefferson City, Missouri 65102
(573)-751-6356
[email protected]
http://www.emt-national-training.com/missouri-emt.php