Team Nursing with Paramedics........

[CEN35]

Does or has anybody ever done this before, in the ER?

Does it work well or not?

If you haven't done it, have you thought about it?

Any suggestions on teams/patient ratios?

d/t the difficulty in finding available staff nurses to fill positions, adm is pushing to try this out. I think the agency costs are killing them......because we have been getting most everything covered through them for about 3 months now.

I know my thoughts......lets hear yours.?

[debbyed]

We have several Medics that work as ER Techs. Besides routine tech duties our ERT's also start IV's, draw bloods and do all the splinting/casting with accompaning teaching.

Most of the Medics work out great and are willing to stay within their job description boundaries even though they can not practice the same as they do in the field.

You must however be careful in your hiring and during orientation to weed out those who will continue to push the boundaries. We have had a couple that didn't work out because they had difficulty in accepting what they could and could not do within the job title. Make sure their roles and responsiblilities are clearly defined and spelled out.

Over all I wouldn't trade any of the medics we currently have working and wish I had many more like them.

[rkg]

Hello. I have been a Paramedic for 17 years and now I am in Nursing School. For 3 of those years I worked in the ER of our local hospital. We worked side by side with the nurses, and had our own patients. We had to go through orientation just as any new employee would and then be checked off on procedures. After all that we just did our jobs. It has worked out well and this ER still uses Paramedics. Some of the nurses had doubts when the program first started but it works well now. This ER doesn't hire new Paramedics and all of the ones that work in there have many years of experience. That way the nurses were more comfortable with thier abilities and skill levels. If you don't know what your doing in the field, the ER staff will certainly know it. The medics must also maintain certifications such as ACLS, BTLS, and PLS. Many ER's in North Georgia currently use medics also. Hope this helps , good luck with the program.

[janine3&5]

We have a few paramedics working in our ER; they function in the same position as nurses with their own pt assignments.

However, they can't give any meds! I'm not sure of the rationale behind that.

Our ER rooms are staffed by acuity levels, i.e. LPNs/medics work ortho/suture/OB/gyn intermediate care rooms. They team with an RN to staff critical care rooms.

But they're awesome- do a great job!

[JJFROG]

We use paramedics as often as we can. They function in a "resourse position". IV starts, blood draws, transport of monitored pts to the units or CT etc..., and as an extra set of hands in the trauma rooms. Our medics at one point were able to give meds, however new admin came in and that luxury was taken away with no real good explaination.

[cmggriff]

Rick,

I've been at this a little while. It seems to me that sometime back in the 80's JCAHO came out with some kind of ruling that all critical care areas (this would include ER's) had to be all RN staffed. Several of the LPN's and aides I worked with were to be phased out through attrition. I don't know if this policy is still in effect or not.

The problem I have always had with this is delegating patient care. If something goes wrong the SBN will hold the RN responsible. I've never met a paramedic who understands my reluctance to take responsibility for his/her actions in the ER. On the other hand all the good LPN's and aide I worked with fully understood who was responsible.

I'm against it. Raise the wages until everyone wants to be an RN. Then the shortage will go away. Gary

[spudflake]

I would check with your State. UAP (Unlicensed assistive personnel) have to be under a licensed person. Some States - under the MD's license..others, the RN's license. I love the paramedica I work with BUT I'm NOT putting them inder MY license:o Sorry

:o

[duckoutofwater]

Well, I worked in the er for about five years and was always solo in a small county hospital where I live(beside the fact that the chg nurse was back up before they got the idea of having a supervisor for every shift.

Anyway, whenever the emt's brough a patient in or I had one(they use to be in house in the hospital). I knew I could always count on them to be there for me.it was wonderful!we respected each other and got along very well (I'm an lpn). They never once left me with a serious patient or a potential abusive one for that matter. I'm proud of our emt's--they're the very best in Georgia!

[annies]

Why would a paramedic want to replace a nurse, especially one that is verbally abusive, rude and closed minded? Perhaps a little anger management would be in order?

[debbyed]

"You just have to learn to accept their inbred limitations "

There is no such thing as imbred limitations..never has been, never will be.... I can't believe an educated person could ever use that term. By using such language/terms you portray yourself as a closed minded, self absorbed idiot. Is that really how you want people to see you or were you just having a brain fart?

Of course Medic's can not replace nurses in nursing situations just as nurses can not replace Medics in field situations. However, one can be both a medic and a nurse with the proper education and inititive. I would never trade the Medics that work with me just as I wouldn't trade the nurses. We are team members, all equally important for the education, experience, training and desire we bring to the job.

[CEN35]

what a diverse number of responses? i see all your points........... however, one thing i will say right now.....this was in no way intended to be a slamming thread.....so stop now!!!

in response to those of the anti-medic opinions, consider these options. currently, there is an avaerage of 1 rn to three patients in the er. this has been the way it is in the past. however, we have not been able to get people in as new employees. this could make it more like 4 -5 atients per nurse. knowing this, would you want 5 patients to yourself............or would you like 4 patients and a medic as your partner to help?

sorry, in my book, on a busy day, ar a crapped out patient, i will take the help :)

have a nice day!!!!!! :) me

[JillR]

Wow, where did that attitude come from tee? Feeling a bit insecure are you? Because that is exactly how you sound, like an insecure, uninformed person who thinks that Medics are not able to think, reason and make decision. You really need some educaion about this subject.

Okay, now to the point.

Medics and EMT can have a very productive role in the ER, that is if they are working with RN's that will respect them for the knowledge and capabilities they do have an allow them the time, mentoring and support they would need to succeed.

I do not feel that medics should independantly take on patients, however, they would be very helpful with patient care. They know emergency care, they know what to look for and what should be done about many different problems. They are very good at prioritizing, thinking outside of the box and have great abilites to be inovative. Team them up with an RN and you could have a great team for a patient. They could perform some basic assessments, give some medications. They know trauma, are terrific at stabilizing broken limbs, c-spine. They know that they do not give meds without first know about the med. Contrary to what this tee person might think, they do know how to read and know when they need to find information they need to treat a patient effectively.

Another thing, yes they have protocols in the field, but anyone who workd ER, knows that rarely does anyone present with textbook cases, so they medics need to make decisions on what protocol to use and when to stray from protocols. They need to make informed, snap judgements without the benefit of having the docs there to oversee what they are doing out there.

We do not have paramedics in our ER, but we do have ER techs that must be EMT-Intermediates. They give meds that they have been signed off on, or that has a written order and the dosage is checked by the RN. They assist with suturing, they teach crutch walking, apply dressing and bandaging, assist with casting. They help with the paperwork, do vitals, insert IV's and foleys, do blood draws if needed. All of this is delegated by the RN. Add all of these thing up and it really free's me up for assessments and critical patients. Treat them respectfully and there is nothing they would not do for you or the patient. Treat them like they are just another nursing assistant, don't expect much from them. They have skills and knowledge way beyond what I have written here, but I think you get my point.

Should they work independantly in the ER? No, they do not have the educational background and licence to do so. But they can be great assets to any ER, if done right and they are not treated like they are some kind of ignorant inbred scum that should bow to the RN's. If that is the case, you might as well not bother. It would be a waiste of their skills, knowledge and time to bother working in an ER with that kind of attitude.