Tech vs. RN

[ER Soldire]

This has been eating away at me for a long time, in our ED we also have techs (who are all Paramedics) It gets really, really annoying when some techs act and talk like they know it all, or feel that what they are doing is in fact more important than other things. For example, in a code they would be more concerned about starting a 5th iv than actually moving away to let meds be pushed, or drips started. Also it seems in my experience that a lot of them just don't get acuity of a patient or importance of certain interventions.... You are going to walk a pt back to a room who is having active cp or complaining of SOB and not hook them to a monitor? Or even better not tell the RN a pt is in the room? Even after that rant I still want to say that there are good techs, I guess it's just those few who are lazy and not so with it ruin it for those who are really on their game.

[SweetMelissaRN]

Wow..really? Things must be different where I live.

Why do you say that like its a bad thing? Our techs are paramedics and are awesome at a lot of things!

[akulahawkRN, ADN, RN, EMT-P]

Wow..really? Things must be different where I live.

Why do you say that like its a bad thing? Our techs are paramedics and are awesome at a lot of things!

I think it has to do with, perhaps local?, the idea that Paramedics aren't anything more than UAP and therefore can't be delegated to do certain tasks, and aren't don't have a scope of practice any greater than any other UAP in the hospital setting. It's entirely possible (and may actually occur) that Paramedics could be allowed to utilize their entire scope of practice in certain areas of the hospital, such as the ED or function as a Code Team Leader within the hospital. It also potentially could mean that in those specific circumstances that Paramedics may be permitted to function separately from Nursing, as an extension of a Physician, much as they are used in the prehospital setting. Without careful integration, it's very easy for noses on both sides to get sore and bruised.

If you find a good medic, hang on to them as they can be developed into a very valuable member of the healthcare team. They don't think like nurses, and as such, can bring a different perspective to the table that just might come in handy some day!

[jmccr8rn]

I appreciate the "good" techs/medics & absolutely despise the lazy ones. My problem is that the bad ones as those who think that they are somehow jaded by their rate of pay & what they are allowed to do in the ED. I totally agree with some of the other posts stating that if they are so upset they truly do need to go back to school and get the degree. Those of us who went to nursing school made a choice & that choice was not only dictated by pay but that did play a role before they got their EMT or Paramedic they knew what the pay & tasks entailed.

[Meeh619]

Where I live some of those ER tech positions ate CNA's, MA's, Medic's, and 1st semester nurses!!

I was a tech and knew my stuff but I also knew my position, some ppl get cocky and think they know it all. We had some that questioned the nurses and they hated that and so would I.

[TraumaSurfer]

I think it has to do with, perhaps local?, the idea that Paramedics aren't anything more than UAP and therefore can't be delegated to do certain tasks, and aren't don't have a scope of practice any greater than any other UAP in the hospital setting. It's entirely possible (and may actually occur) that Paramedics could be allowed to utilize their entire scope of practice in certain areas of the hospital, such as the ED or function as a Code Team Leader within the hospital. It also potentially could mean that in those specific circumstances that Paramedics may be permitted to function separately from Nursing, as an extension of a Physician, much as they are used in the prehospital setting. Without careful integration, it's very easy for noses on both sides to get sore and bruised.

If you find a good medic, hang on to them as they can be developed into a very valuable member of the healthcare team. They don't think like nurses, and as such, can bring a different perspective to the table that just might come in handy some day!

I think this bears some clarification since it is often misunderstood what extension of a physician actually is and often confused with Physician Extender. Neither in the hospital nor prehospital is a Paramedic a Physician Extender. They are in no way on the same level as an NP or PA.

Paramedics work under protocols both in a hospital and out of a hospital. RNs work under protocols. An RN running a code or Rapid Response is also working under protocols. Being a Paramedic does not make them any different and it might even have some limiting factors since they may be unfamiliar with what RNs and other team members can do. They also may not be familiar with ICU protocols and drips which can be utilized for stabilization and are not always in a Paramedic's scope of practice.

"Don't think like nurses" ??? What is that supposed to mean? RNs are much more than the asswipers Paramedics think they are. Maybe Paramedics should think more like nurses and how to be part of a team if they want to play in the hospital environment. RNs who respond to emergencies are seeing a much broader picture since they do have more information at their access. Paramedics function with only limited information and work protocols which are simplified to not take any other information into consideration.

Hospitals have raised their standards for most of the "techs" working within a hospital doing advanced skills. Why should they go backward? Paramedics need to raise their own education level beyond a 1 year cert and master the prehospital environment which needs a lot of work in most parts of the US.

[akulahawkRN, ADN, RN, EMT-P]

I think this bears some clarification since it is often misunderstood what extension of a physician actually is and often confused with Physician Extender. Neither in the hospital nor prehospital is a Paramedic a Physician Extender. They are in no way on the same level as an NP or PA.

Paramedics work under protocols both in a hospital and out of a hospital. RNs work under protocols. An RN running a code or Rapid Response is also working under protocols. Being a Paramedic does not make them any different and it might even have some limiting factors since they may be unfamiliar with what RNs and other team members can do. They also may not be familiar with ICU protocols and drips which can be utilized for stabilization and are not always in a Paramedic's scope of practice.

"Don't think like nurses" ??? What is that supposed to mean? RNs are much more than the asswipers Paramedics think they are. Maybe Paramedics should think more like nurses and how to be part of a team if they want to play in the hospital environment. RNs who respond to emergencies are seeing a much broader picture since they do have more information at their access. Paramedics function with only limited information and work protocols which are simplified to not take any other information into consideration.

Hospitals have raised their standards for most of the "techs" working within a hospital doing advanced skills. Why should they go backward? Paramedics need to raise their own education level beyond a 1 year cert and master the prehospital environment which needs a lot of work in most parts of the US.

I understand (and I would hope that other Paramedics do as well) that I'm not a Physician Extender at anywhere near the same level or sense as a PA or NP is. I never implied that Paramedics were. Without a Physician providing medical oversight, I can't function as a Paramedic. Neither can PA's or (many times) NP's function in their roles, to their full abilities, without some kind of Physician Oversight.

Now as to "thinking like a Nurse" I'm referring to the fact that Paramedics are trained more along the lines of the Medical Model rather than the Nursing Model. It would also be a good thing if Nurses didn't treat Paramedics like they're uneducated knuckle-draggers. I think a lot of that comes from the fact that nurses generally aren't exposed to what Paramedics know or can do, and have no idea what the scope of practice is for the different EMS providers. That being said, I probably had a better idea what Nurses do than most Nurses did of me as as Paramedic. Certainly the folks I worked with understood that Nurses do a LOT more than simply "wipe butts." Since I've been in Nursing School, I've certainly gained a much better appreciation for what Nurses do.

I do agree that Paramedics in general should increase their educational level beyond a typical 1 year certificate. Some states require an Associate's Degree for licensure as a Paramedic. Now then, educationally speaking, about the only new stuff I've learned going from Paramedic to RN has been pathophysiology and some pharmacology. Both subjects would be an excellent addition to the usual Paramedic education.

My own background is that of Athletic Trainer. In that role I was more of a Physician Extender than a Paramedic is. Nurses and Paramedics would make terrible, and unsafe, replacements for Athletic Trainers. They lack the appropriate education, and to properly orient either would be prohibitively long. An NP or PA specializing in Orthopedics would probably be OK, their orientation would be a bit shorter.

[TraumaSurfer]

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Now as to "thinking like a Nurse" I'm referring to the fact that Paramedics are trained more along the lines of the Medical Model rather than the Nursing Model. It would also be a good thing if Nurses didn't treat Paramedics like they're uneducated knuckle-draggers. I think a lot of that comes from the fact that nurses generally aren't exposed to what Paramedics know or can do, and have no idea what the scope of practice is for the different EMS providers.

Nurses are exposed to much more than you think but then that is where the confusion begins.

EMTs and Paramedics believe RNs should know what their scope of practice and prtocols are even though they vary from state to state, county to county and company to company. Some EMTs function like Intermediates in one place and barely above First Responder in others.

EMTs are quick to make it well known they HATE routine transfer and nursing home patients. They usually do this in front of the patients whom they might believe are "not with it" even though they haven't bothered to speak to them.

It is always fun to watch EMTs and Paramedics talking in graphic detail about the cool trauma or code they just worked with the family and other patients within hearing distance.

If an RN thinks a Paramedic is a knuckle dragger, rarely will they call them that name in public. But, EMTs and Paramedics are quick to scream "ASSWIPER" to any nurse or CNA they believe disrespected them by asking them a question. I recently saw a video of an EMT going nuts when a Security Guard asked if he was the driver of the ambulance parked in the area needed for another emergency vehicle. Some just don't see the importance or responsibility of driving an ambulance. The same goes when asked if they are the Ambulance Driver when there are Taxi Drivers, Van Drivers and Community Assist Drivers all waiting for a patient. In the past the Ambulance Driver also had the responsibility of the paperwork and the billing codes which made them the important go to person for transports.

[Christy1019, ASN, RN]

WOW! I haven't seen this much stereotyping or generalizations of people in quite some time. This thread turned into a lot of bias, non-factual, crap... I'm an RN who loves working with my medics in the ED. They may not understand the pathophysiology of how lab values relate to my plan of care but you can be sure they will be some of the first people to jump in and run a code with you if needed.

All this petty crap you guys are slinging back and forth are issues of individuals professionalism, not a true reflection of nursing and medic roles.

[FDW630]

WOW! I haven't seen this much stereotyping or generalizations of people in quite some time. This thread turned into a lot of bias, non-factual, crap... I'm an RN who loves working with my medics in the ED. They may not understand the pathophysiology of how lab values relate to my plan of care but you can be sure they will be some of the first people to jump in and run a code with you if needed.

All this petty crap you guys are slinging back and forth are issues of individuals professionalism, not a true reflection of nursing and medic roles.

Yes! This over again. This thread got really petty, really quickly. It speaks more of you than the person you're talking about when you stoop to generalizations.

[TraumaSurfer]

WOW! I haven't seen this much stereotyping or generalizations of people in quite some time. This thread turned into a lot of bias, non-factual, crap... I'm an RN who loves working with my medics in the ED. They may not understand the pathophysiology of how lab values relate to my plan of care but you can be sure they will be some of the first people to jump in and run a code with you if needed.

All this petty crap you guys are slinging back and forth are issues of individuals professionalism, not a true reflection of nursing and medic roles.

This is exactly my point. Even some Paramedics themselves are convinced they do not need to know any of the "whys" and all that book learning stuff is crap. You just do the tech skills and run the protocols by street smarts. If a Paramedic wants to run on equal status in the hospital as RNs, doctors, RTs and other professionals, they should know some of the whys. If you want to run to Rapid Responses lab values are important. In the hospital there is an expectation that professionals will utilize the data which is available to make a more informed treatment decision even in an emergency.

[SweetMelissaRN]

This is exactly my point. Even some Paramedics themselves are convinced they do not need to know any of the "whys" and all that book learning stuff is crap. You just do the tech skills and run the protocols by street smarts. If a Paramedic wants to run on equal status in the hospital as RNs, doctors, RTs and other professionals, they should know some of the whys. If you want to run to Rapid Responses lab values are important. In the hospital there is an expectation that professionals will utilize the data which is available to make a more informed treatment decision even in an emergency.

Dude, you totally missed the point of that post. Most techs don't get paid to know that information. And actually, all of the techs I work with have a pretty good idea about important lab values. Quit generalizing. All of our techs know the first thing to check in a rapid response is blood sugar.

Have you ever heard of the saying if you have a problem with everyone, maybe you should look at the common denominator in the equation?

[Christy1019, ASN, RN]

^^ totally agree with this post!!