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.
i can't help but wonder how this thread would have progressed if it concerned an rn signing off as an md?
does anyone else get the correlation?
if you don't posses the license, you can not hold yourself out to be an rn.
if you are aware of someone holding themselves out to be an rn and they are not, it is your responsibility to report that person to your bon.
i don't know if a rn would sign off a md , i never would. ( or would want to lol ) i think this thread would of progressed the same if a rn signed off as a md( wow would that be trouble eh?). i told one of the md's at work i would never take his job, he just laughed. i do like your quote. :yeah:
i'm confused. the paramedic signed where it said RN signature? is that how they identified as a nurse? if they signed next to RN signature for triage/assessment (and the hospital P&P says they can work triage in your ER and they are being placed to work triage in the ER) and signed peter brady, NREMT-P, then that's the bad on the part of the hospital.
when i started work, all the forms said "RN signature" and i asked my boss to please change it to "nurse signature" since there are both RN's and LPN's on the floor. maybe this will help in this situation.
however, if the medic is saying, "hi, i'm jane doe and i'm a nurse", that's another story. that is not ok.
paramedics are regulated by the national registry of emergency medical technicians as well as a medical board under the state office of emergency medical services. i am licensed by my state and registered nationally, for example.
i worked in the ER and could push any IV med. i proved competency in pharmacology, med calcs and maintained my ACLS/BCLS/PHTLS/PALS certs just as the nurses there did. the scope of practice of the paramedic in the ER depends greatly on the state you live in as well as the policy and procedure of the facility. some facilities let EMT-P's function to their full scope of practice, some limitied to emergency situations or monitor/ECG technicians, some let them fuction as patient care technicians.
i would investigate this further with your hospital policies. in the ER i worked in, we rotated out with the FD and the hospital and functioned to our full scope of practice in the field including intubation, IV pushes, physical assessments, fluid resus, splinting/casting, etc.... however, if you went to the hospital about 30 miles to the south, the paramedics in the ER worked alongside PCT's and CNA's. it just depends.
Misrepresentation is a MAJOR issue that could bring them up on legal charges and possibly loss of their EMT certs. I personally would not tolerate this behavior. This would be like a PA passing themself off as an MD! Show them the door. The ER manager should be replaced and the staff re-educated in what each individual is allowed to do. Poor management and a dangerous place to work or even be a patient. JACHO would have a field day. Maybe they should be informed. Big difference on what Paramedics can do in the field and what they can do in an ER. Each state should have exact guidelines on this and ERs should follow it.
Specializes in Critical Care, Emergency, Education, Informatics.
One thing is deponding on which state your working in, the BON prob has no juristiction on what paramedics do and were they do it. The EMS act and the Hospital acts all direct this. The BON no matter how hard they would like to have no say in the matter.
If it's just them signing on a piece of paper that bothers you, get them to change the form.
Pushing lasix in 30 sec. Well let me tell you about the RN who graduated from a prestigous west coast BSN program who was giving her patients the albuterol to drink, and not nebulizing it. It's called a teaching moment people. If the provider doesn't learn, then it's time to bring it to managements attention, no matter whether it's an RN, LPN, EMT-P or what.
Now if they are specificly calling themselves a Registered Nurse, then educate them,and it it continues, then copy the nurse practice act were it says only RN's can call themselves RN's and take it up the chain. And it may not be a felony, you can't group all 50 states into one package.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
One thing is deponding on which state your working in, the BON prob has no juristiction on what paramedics do and were they do it. The EMS act and the Hospital acts all direct this. The BON no matter how hard they would like to have no say in the matter.
If it's just them signing on a piece of paper that bothers you, get them to change the form.
Pushing lasix in 30 sec. Well let me tell you about the RN who graduated from a prestigous west coast BSN program who was giving her patients the albuterol to drink, and not nebulizing it. It's called a teaching moment people. If the provider doesn't learn, then it's time to bring it to managements attention, no matter whether it's an RN, LPN, EMT-P or what.
Now if they are specificly calling themselves a Registered Nurse, then educate them,and it it continues, then copy the nurse practice act were it says only RN's can call themselves RN's and take it up the chain. And it may not be a felony, you can't group all 50 states into one package.
Yep, every state is different.
In some states "Registered Nurse" is a protected title and there is legislation (at that particular state's level) making it illegal for someone to use the title illegally. I am not versed on which states or how many - but in some it is a matter of law.
do you think that this can be compared to nurses and port access? It is taught to RN's how to access a port and it is in your scope of practice. At the hospital I work at you are only allowed to access a port if you are "port certified".
On another note, I would have never though of signing MD to my name or anything other. This is just crazy that anyone would think that.
another thing too is that most places are going to 100% computerized charting. Any education, discharge, treatment, etc. is signed off by what you are listed under. I believe that is a way to prevent these kinds of legal nightmares. Even the MD's are going to computerized script writing. In the long run this may/may not help with this.
Computerized charting can open doors for more error. What is your take on that?
another thing too is that most places are going to 100% computerized charting. Any education, discharge, treatment, etc. is signed off by what you are listed under. I believe that is a way to prevent these kinds of legal nightmares. Even the MD's are going to computerized script writing. In the long run this may/may not help with this.
Computerized charting can open doors for more error. What is your take on that?
Yes and no. Yes if you chart on the wrong pts chart. But a good system is only going to let you document what you want and need to document. It also is going to allow you to change any incorrect documentation appropriately, i.e. it's actually corrected like you would on paper but hidden.
Someone mentioned RN's signing MD's names. This isnt that but I know in the ED we frequently after the fact have patients request work/school/gym excuses and the doctor's will ask that we just do them. Myself I will print the MD name on the form and cosign my name in the given space.
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!!
ARGHHHHH! Holding head, running in circles, and screaming at the same time.
In Missouri, paramedics are allowed to function in a role very similar to that of an RN in house. They can take patient assignments and give any medication an RN can. Their training encompasses much more than many of you are giving them credit for. In addition to being able to perform all the skills and tasks an RN can many facilities allow their paramedics to perform skills an RN can not do in the ER such as intubations.
It sounds like this is just a document problem. The document just needs to updated with RN/EMT-P signature rather than just RN.
Paramedics are taught to give Lasix S_L_O_W IVP and the reason why. I've also seen nurses disregard what they are taught too. Sounds like a teaching moment was missed. Anytime you see someone being unsafe in caring for pts, it should be reported to the charge nurse if you don't feel the person is approachable.
Having attended both nursing school and paramedic school, I can appreciate how paramedics are trained. Learners who are not focused or dedicated are weeded out early. No drama, mostly practical hands on skills as well as INTENSIVE book learning, turns out a health care provider that is ready to work out in the field with a minimum of preceptorship. And they don't have to do HOURS of care plans that are sometimes useless...nursing schools could learn a lot from paramedic training programs.
In Missouri, paramedics are allowed to function in a role very similar to that of an RN in house. They can take patient assignments and give any medication an RN can. Their training encompasses much more than many of you are giving them credit for. In addition to being able to perform all the skills and tasks an RN can many facilities allow their paramedics to perform skills an RN can not do in the ER such as intubations.
It sounds like this is just a document problem. The document just needs to updated with RN/EMT-P signature rather than just RN.
How do you know this? Where is this all documented at? I have looked at the board of Nursing, Missouri Hospital Association webpage and EMT sites, I cannot find this anywhere.
I started this post to find out where the rules were documented and could be found, not to debate RN vs Medic.
If it is legal for them to "play nurse" that is fine, if they want to do to my work with less pay, that is FINE WITH ME! I just sit back and watch them "play nurse" at $17/hr while I AM a nurse at $32/hr!!
I do not think it is legal and just want to know where to find the information at.
ohmeowzer RN, RN
2,306 Posts
i don't know if a rn would sign off a md , i never would. ( or would want to lol ) i think this thread would of progressed the same if a rn signed off as a md( wow would that be trouble eh?). i told one of the md's at work i would never take his job, he just laughed. i do like your quote.
:yeah: