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.?

[Medic09, BSN, RN, EMT-P]

cmggriff said:

Rick,

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.

It isn't hard to understand, really. In the field the paramedic makes initial Dx, initiates Tx, and directs other people on scene. So the transition to a subordinate role is not natural for most. The LPNs and aides are taught to work under RN direction from the get-go.

Personally, since I am a paramedic as well as RN, I like working with the medics. With a really sick patient we get into a groove like we would outside the hospital and get it done. BUT, the medic does have to clearly know their scope and limitations when inside the hospital. They have to understand that nursing really is different than being a medic, and neither their training nor licensure nor job description allows them to just do a nurse's job. Pushing the boundaries can cause frictions no matter who is doing it. I've had no problems with it in my limited experience. Communication helps.

[paramedk41]

I researched to find answers to the same question and came upon this site and everyones responses. As an experienced paramedic I wondered why physicians and ers were not hiring paramedics instead of nurses. In these first few responses I have seen that it can work with the correct mentality and design in guidance and education. What I do see is a large amount animosity by nurses not accepting the fact that a paramedic can function on an equal level as they do. I can see a paramedic being put in an ER setting and handling the situation if allowed to at the same level as a nurse...IF NOT MORE! Now I just heard all the nurse take a huge gasp! Yes its true. If you read all of these strips you see a lot of jurisdictions think of paramedics as subordinate in skill and knowledge and therefor subordinate in the medical food chain. I am hear to tell you that, (I am not trying to offend as I have so many nurse friends), that a paramedic can be put in an ER and adjust faster than a Nurse could in an ems setting. I also see other jurisdictions are letting these paramedics stitch and cast. I don't see any nurses stitching. In fact, when was the last time a nurse did a chest decompression, ej, intubation, or I.O? With the proper amount of designed protocols accepted by the physician or facility they work for, paramedics could be hired to fill roles and responsibilities that nurses and even nurse practitioner or PA's even fill. i.e. stitching, intubations etc. Yes you would need "x" amount of years as a paramedic with recommendations etc and they pass the required training program by the facility but by offering them the same pay scale as a full time nurse, you will eliminate the high cost of hiring agency nurses and you would solve the slower difficulty of finding qualified nurses to fill the positions. You would save even more money by not allowing paramedics to be full time, thus saving benefits expenses as well. Its time to become progressive like several of these departments I am reading about on here. I applaud the forethought and ingenuity and hope to hear more about their programs!

[erjunkie8]

This responce is to the general posting and not to anyone in particular. This is my point of view using the knowledge I have been privledged with pertaining to paramedics and nurses.

The initial post questioning paramedics in the ER was just a way to stir the pot here. I find it to be unfortunate that there is so much tension and animosity between the two roles.

I have worked in the ER for 11 years. I am an EMT, I have a degree in Emergency Medicine (paramedic) and have recently graduated from nursing school. I have never understood why it is that nurses have always looked down on medics. I believe that a lack of knowledge on the nursing end is what fuels the fire in this debate.

What nurses do not understand is what a paramedic is really capable of. Nurses attend nursing school just as paramedics attend paramedic school. Paramedics have the ability to do and be more proficient at skills a nurse would never be allowed to do in the hospital setting. Nurses work off of their own liscense and paramedics work off of a doctors.

Nurses have always had this "hollier than thou" attitude when it comes to the capability and education of a paramedic. Paramedics put their life on the line everytime they are in an ambulance running code 3. Even something as simple as running code 3 down a major expressway with a needle trying to start an IV on a crashing patient can harm the paramedic. Nurses have this sweet little setting in a unit with a roof over their head. I believe that the only people who should have any kind of opinion on this topic is one who is EDUCATED in both fields knowing what both titles are capable of. If you truly understood the responsibilities of a paramedic than there would be no ignorant responces here.

There are many calls that medics go on where the patient doesn't go to the hospital. The things there on that scene are things that are sometimes uncomprehendable. Paramedics must be "on the spot" and competent in not just skills and protocols. You must be well rounded in all areas to properly treat and conquer the unexpected. It is a myth to think that paramedics just have protocols and skills. If for one second you think that a medic is just to take them to the hospital and not have to THINK you lack knowledge in what you put here.

Nurses have a tendancy of minimizing paramedics. Paramedics have never been given enough credibility. If you have never worked as a paramedic I must ask if you have ever seen the paycheck of one? They are not recognized as they should be nor are they paid for the kind of work they do under many different conditions (weather, location, tradgedy...etc) putting their own life at risk sometimes.

I have never understood why a paramedic can not work under their own license in the ED. Yes, they are under the supervision of a medical director but there is a medical directory in every ER.

Unfortunatley there will always be a battle of who is better, who is competent, who has the ability to think more critically in this field. We are all forgetting one key point here.... the patient. Yes, we all sometimes forget about the one common denominator.

Paramedics place their life on the line every time you see a siren. They never get praise or respect from the ER nurses. They bring the pt in, who knows what kind of mud they just had to go through to meet the Golden Hour timeline.

Back to the ones who never make it to the hospital. How would you as a nurse handle your job having to stand and watch guard over a yellow tarp in the middle of the road waiting for an hour or so (for the medical examiner to come on scene) with a young kid underneath who was all mangled up from an auto vs ped? OR better yet a ped vs train!!!

The best nurses and paramedics in this field are the ones that don't place a rank on the other. You both have a job and if a paramedic does not think as critically as some of you have assumed here in this chat than they are the ones responsible. I have chosen the field of nursing and am a little embarrased by other nurses who tend to think paramedic is just a list of protocols. I have experienced both and just want to know what makes any one of us better than the other? We all have to critically think. The medical field is a big tub of critical thinking.

Paramedics in the ER? Absolutley. Nurses on an ambulance? Absolutley. The only way this will or will not work is by the way you work together. Trust me I have seen enough paramedics who have walked by a room and saved a patients life while the nurse sits there at the nurses station drinking their coffee.

Why is it so difficult for this profession to work together? Insulting eachother and arguing over who is better than the other only shows ignorance. Learn from eachother. Those willing to welcome new opportunities by sharing knowledge together would make an easier flow with the already overloaded and over-abused system. I mean if you think that paramedics are just "cookbook", how confident are you with your own capabilities?

In my opinion the knowledge of a nurse and paramedic are the same. Those who feel they are more educated than the other lack education.

A paramedic and nurse working together as an assignment is overall a better operation. What one does not recognize the other does.

Stop being so critical of rank and be a team. A nurse and a paramedic complement eachother, it's too bad we are too busy trying to show the other how much better we are...

[erjunkie8]

paramedk41 said:

I researched to find answers to the same question and came upon this site and everyones responses. As an experienced paramedic I wondered why physicians and ers were not hiring paramedics instead of nurses. In these first few responses I have seen that it can work with the correct mentality and design in guidance and education. What I do see is a large amount animosity by nurses not accepting the fact that a paramedic can function on an equal level as they do. I can see a paramedic being put in an ER setting and handling the situation if allowed to at the same level as a nurse...IF NOT MORE! Now I just heard all the nurse take a huge gasp! Yes its true. If you read all of these strips you see a lot of jurisdictions think of paramedics as subordinate in skill and knowledge and therefor subordinate in the medical food chain. I am hear to tell you that, (I am not trying to offend as I have so many nurse friends), that a paramedic can be put in an ER and adjust faster than a Nurse could in an ems setting. I also see other jurisdictions are letting these paramedics stitch and cast. I don't see any nurses stitching. In fact, when was the last time a nurse did a chest decompression, ej, intubation, or I.O? With the proper amount of designed protocols accepted by the physician or facility they work for, paramedics could be hired to fill roles and responsibilities that nurses and even nurse practitioner or PA's even fill. I.e. stitching, intubations etc. Yes you would need "x" amount of years as a paramedic with recommendations etc and they pass the required training program by the facility but by offering them the same pay scale as a full time nurse, you will eliminate the high cost of hiring agency nurses and you would solve the slower difficulty of finding qualified nurses to fill the positions. You would save even more money by not allowing paramedics to be full time, thus saving benefits expenses as well. It's time to become progressive like several of these departments I am reading about on here. I applaud the forethought and ingenuity and hope to hear more about their programs!

I think that the reason you have never seen any nurses doing the skills you listed in your posting because in the ER they are not allowed, in fact I don't think that they are allowed at all!! I am a graduate nurse and have 11 yrs ED experience with EMS background. I love patient care and emergency medicine. I agree with a lot that you said and now just watch the ignorance in others who have a hard time comprehending that a "little" paramedic doesn't have to pull rank to feel confident about what they do when they clock in!!

Good Job!!

[traumaRUs, MSN, APRN]

Ok - let's reopen this and keep to the topic and not personalize the issue. Thanks everyone for your understanding.

[erjunkie8]

Dave123 said:

Hey man, a staffing problem is just the way the game is played. I don't have the answers to your staffing problems.

But I think your question was simply how well does it work putting paramedics into an ER that practices team concept care?

You wanted to hear from people who have experience with it. Well I do and as I told you, I am not a fan. If it works for you then thats great, for "you".

You know what they about asking questions.

Just my opinion

Dave

I used to work for a nurse manager who refused to hire EMT/paramedics becasue she felt that paramedics wern't as "caring" as CNA's or PCT's. I never understood that. Have you ever heard of that? I think that the profession, no matter the title, is for the purpose of caring. I just wondered if anyone agreed with that or have had other managers think that way.

(no difference to me.. just wondered)