Tired of EMS thinking they can walk in!

Larry77, RN · Dec 18, 2008

There are good and bad in both all fields...I try to give people the benefit of the doubt and give respect where it's do. We have very good EMS for the most part in my area but I have worked with some that I would not trust as far as I can see them...also the case with some nurses.

I think it's very wrong to generalize statements to include "all" of EMS...they work hard and should be respected.

TraumaNurseRN · Dec 18, 2008

Last time I checked nurses do not legally diagnose either, what state do you give diagnoses in?

I neer said nurses diagnose....EMS person said they are allowed to diagnose.

TraumaNurseRN · Dec 18, 2008

ER and EMS work hand in hand. I have been so very fortunate to work with some wonderfully articulate, intelligent and hardworking EMS personnel from volunteer EMS/firefighters to paramedics. There is plenty of work for all of us. We're a TEAM!
I say this as someone who is a current pre-hospital RN who volunteers on my rural fire dept and I also work as an advanced practice nurse in an ER. I have the best of both worlds and I really appreciate EMS - if I'm hurt, ill or need 911, they are the ones I want to come and help me.
Putting others down, whether they be a CNA, LPN, ADN, BSN, etc., doesn't makeus appear smarter or more experienced, it just makes us look small.

....I never claimed to be smarter....never ever....but this (one medic) did. Which was my point in the first place.

TraumaNurseRN · Dec 18, 2008

As an RN and EMT, I know that we all must work together as the majority of us do very well. And some of the best ED providers and flight nurses I know are EMT-Ps.
But like in any profession there are doctors who think they are better than all nurses and nurses who think they are better than all CNAs and medics, and so on and so forth and I feel the way you speak of EMTs and EMT-Ps in this thread it seems you are being biased like the above statement.
And quite frankly a paramedic has more autonomy than a nurse does and does not require a doctors presence or input to facilitate interventions like a nurse does. And secondly they are licensed providers in all 50 states.
Also on another note after you ******* me out in the recent peanut gallery thread over something you had no business talking about, I definitely am begining to think you are very absent minded.

Everyone has protocols they work under....

GilaRRT · Dec 19, 2008

I think I see where you may be coming from, and agree to an extent. I have absolutely no problem working with PM's. This is especially true when I fly. In fact, I am not sure I would want to fly for a service that did not partner me with a PM. (In the US that is, Afghanistan is a little different.)

However, I have a problem with a PM taking over a RN position within the hospital. A PM essentially becoming a cheap RN is not a good precedent to set IMHO. First, I have to look after my profession and advocate for my the very thing that puts food on my table. Next, a PM is simply not an RN. It really is that simple IMHO. No offense to PM's. I feel exactly the same way about RN's who think they can waltz right into an EMS position. Finally, it is a demeaning, cheap, and disrespectful way to use PM's. I suspect many would argue because they are not crawling around in a ditch at 2 am; however, I call it how I see it.

If this is your argument, then I must agree. However, the way in which you articulate your stance is preventing you from winning the hearts and minds of the audience.

northshore08 · Dec 19, 2008

I did not read the thread this discussion is based on...so forgive me if these points were already addressed. I want to say up front that I am thankful for the great prehospital care that our local EMS provides. I have never worked with "paramedics" in the ED, but I have worked with lots of paramedics who were working as techs. So with that said....

in our defense, paramedics are usually associate's or bachelor's trained and have to pass a national registry examination. most states also require licensure.

I had 5 years of prehospital prior to graduating from nursing school (many moons ago, I confess) and I've been in the ED since. I did not continue to follow the educational requirements for EMS. I am surprised to hear that the education has moved into the associates/bachelor degree area. Things have changed a lot if this is the case. A further Google search shows conflicting information about licensure vs certification for EMT-P's; some have only one, some have both, not all states require licensure (for example, some job sites for Kansas only require certification.)

And quite frankly a paramedic has more autonomy than a nurse does and does not require a doctors presence or input to facilitate interventions like a nurse does.

IME, paramedics work under MD guidelines with protocols/algorithms. Nurses in the ED many times work under standing orders. In the field, paramedics have access to the MDs by phone/radio contact (at least they call us all the time,) and in the ED the nurses can page/yell for help if the doc is around.

If you are at a cardiac arrest scene or slid into the back of a bloody MVC starting a line and giving meds in the dark I don't expect that you will be on the phone with the doc. Conversely, if a cardiac arrest or a major trauma is lying in my ED stretcher and the doc is busy at the other end of the department, I will institute the lifesaving measures needed without his presence or direct orders. Sounds similar to me.

All in all, we make a great team. I love working with EMS. :twocents:

vamedic4, EMT-P · Dec 19, 2008

This thread has evolved from a pevious thread of EMS (one in particular) thinking they are more than qualified to work right along side a licensed RN in the ED just because they.....scoop and tx pre-hospital, or observe licensed RNs in the ED to BE A REGISTERED RN. Note: this person is currently in nursing school because their state requires additional education to become an RN like every other state in the USA! Ticks me off that this medic feels justified that his/her nonlicense schooling qualifies he/she to be licensed as an RN....Ignorance is bliss I guess!@#$%%^:angryfire:banghead:......

You're making assumptions again. Scoop and treat is not the sole scope of practice of a field medic. The field paramedic is the eyes, ears and hands of the physician outside the hospital. There are certain things that paramedics can absolutely do right alongside nurses, because the scope of practice in many places allows for this to happen.

It's not hard to get an inflated view of yourself. But the same is true on the other side of the coin. Who made you so great just because you are an ER nurse?

Many states now require some national certification, degrees in the field, and continuing advanced education to work EMS. My state allows me to be licensed as a paramedic because I have a degree in the field. I took the same A/P, micro, chemistry, psychology courses as the RN students, my education focused on prehospital emergency care, not nursing care. You are licensed as a nurse, which allows you to practice in the hospital and implement physician orders and nursing interventions. Field EMS workers have protocols and standing orders that give them guidance and options in their treatment of patients as well.

I wonder if you have the same view of RNs who graduated from non degree diploma programs? Do you think you're better than they are too?

EMS workers take a lot of flack, and many of them volunteer their time to be EMTs and paramedics. Some of them have chips on their shoulders because they know that their actions have kept the patient in Trauma I alive until they got there to you. That may have included intubation, any manner of drug therapy, IVs, EKGs, and continuous reassessments.

Why can't we accept that even though our "titles" differ, some of our responsibilities and skills overlap?

Of course anyone who thinks about it for half a second isn't going to choose a paramedic to do some of the things that nurses do very well, like care for them in the hospital. As you said, we're not trained for it. But that doesn't make us "less than", and it doesn't mean that field providers can make incorrect assumptions with inflated egos about what they could do in the hospital.

I agree. Play nice or leave the sandbox.

nghtfltguy, BSN, RN · Dec 19, 2008

that is what i was thinking mmutk....

what state can nurses legally diagnose in?

i want to live in that state... "would they pay me more?"

i diagnose all the time...

but i confir w/ the doc and then they sign off on it.. my state would never let a nurse diagnose...

and since you are a trauma nurse... i have a question for you?

MAJOR TRAUMA?.. how do they get to your ER?..... POV?

im gussing it is from ems via ambulance....

just guessing... cause i worked as a medic for many years before i became a nurse..

you should ask your hospital if they allow *ride alongs* or something like that to where you can go work pre-hospital and see what they actually do....

as was stated above... yeah... paramedics have a LOT more autonomy than ER nurses... they know their stuff...

just a word of advice... be very nice to them... they are doing a job just like you...

don't think you are better than them because you are an RN and make more money.... don't EVER think that.....

sorry if i am sounding mean... i don't want to come off as a mean person..

i just take hits on EMS ppl very seriously...

:cool:

GilaRRT · Dec 20, 2008

that is what i was thinking mmutk....
what state can nurses legally diagnose in?
i want to live in that state... "would they pay me more?"
i diagnose all the time...
but i confir w/ the doc and then they sign off on it.. my state would never let a nurse diagnose...
and since you are a trauma nurse... i have a question for you?
MAJOR TRAUMA?.. how do they get to your ER?..... POV?
im gussing it is from ems via ambulance....
just guessing... cause i worked as a medic for many years before i became a nurse..
you should ask your hospital if they allow *ride alongs* or something like that to where you can go work pre-hospital and see what they actually do....
as was stated above... yeah... paramedics have a LOT more autonomy than ER nurses... they know their stuff...
just a word of advice... be very nice to them... they are doing a job just like you...
don't think you are better than them because you are an RN and make more money.... don't EVER think that.....
sorry if i am sounding mean... i don't want to come off as a mean person..
i just take hits on EMS ppl very seriously...

I have to disagree with you on that one big dog. EMS providers follow protocols, guidelines, and online medical direction. Nurses follow hospital policy, procedure, and direct physician orders. It is simply not a matter of "mine is bigger than yours." Autonomy is a rather subjective topic. Nurses can be quite autonomous; however, nursing is quite different from EMS.

Unfortunately, as much as I love a good discussion about which profession has more machismo, :no: I do not think this should be the point of the current discussion. You can look through another thread that went down this path if you want trash talk.

I still stand by my point that paramedics simply are not educated to take over the role of a nurse. It seems such a simple concept? The reverse is true when considering RN's who think they are PM's. Obviously, cross over exists and some providers can transition into some of the roles of the other. However, it's called paramedic or nursing school for some reason, no?

Iam46yearsold · Dec 21, 2008

I think Nurses and Paramedics compliment each other very well working together. Do PMs want to be RNs usually not. Do RNs want to be PMs , usually not. But we can and do work together well as a team. Like A tossed salad with Blue Cheese dressing. Goes well together. And that is what we do work well together. Really life is simple why complicate things. There is plenty of work to do as is. Why let egos gum up the works.

HappyPediRN · Dec 21, 2008

trauma perhaps what goes around will come around and someday when you're in need of emergency medical services, the EMS responder will remember your attitude and give you the treatment you feel they provide...ya know, unlicensed, uneducated, unprofessional treatment..."oh, you're having a heart attack? i'm sorry i can't do much, i'm just a medic. ya know, a lowly, glorified tech so your heart will just have to give out since assessing would be out of my scope of practice."

TraumaNurseRN · Dec 21, 2008

You're making assumptions again. Scoop and treat is not the sole scope of practice of a field medic. The field paramedic is the eyes, ears and hands of the physician outside the hospital. There are certain things that paramedics can absolutely do right alongside nurses, because the scope of practice in many places allows for this to happen.
It's not hard to get an inflated view of yourself. But the same is true on the other side of the coin. Who made you so great just because you are an ER nurse?
Many states now require some national certification, degrees in the field, and continuing advanced education to work EMS. My state allows me to be licensed as a paramedic because I have a degree in the field. I took the same A/P, micro, chemistry, psychology courses as the RN students, my education focused on prehospital emergency care, not nursing care. You are licensed as a nurse, which allows you to practice in the hospital and implement physician orders and nursing interventions. Field EMS workers have protocols and standing orders that give them guidance and options in their treatment of patients as well.
I wonder if you have the same view of RNs who graduated from non degree diploma programs? Do you think you're better than they are too?
EMS workers take a lot of flack, and many of them volunteer their time to be EMTs and paramedics. Some of them have chips on their shoulders because they know that their actions have kept the patient in Trauma I alive until they got there to you. That may have included intubation, any manner of drug therapy, IVs, EKGs, and continuous reassessments.
Why can't we accept that even though our "titles" differ, some of our responsibilities and skills overlap?
Of course anyone who thinks about it for half a second isn't going to choose a paramedic to do some of the things that nurses do very well, like care for them in the hospital. As you said, we're not trained for it. But that doesn't make us "less than", and it doesn't mean that field providers can make incorrect assumptions with inflated egos about what they could do in the hospital.
I agree. Play nice or leave the sandbox.

I never thought I was better than anyone else, and have made the same comments in the previous thread I was referring to.....to a medic who thought because they were a medic, they could transition into working as an RN in the ER with ease, and without graduating from nursing school......and they are not aloowed in my state unless they do, and pass their boards. So, From the very beginning, I have said I have tremendous respect for our medics and enjoy working them. But.....and I am done repeating this...Our medics are not allowed to work in the ER as medics or RNs, they are forced to work as techs....Not my rule....On the previous thread this medic also was stating they were more knowledgeable than an RRT as far as respiratory care. So, if you don't have issue with this....that's fine. I would never presume to beable to walk in a medics shoes (and have said it time and time again), so I'm taken aback when a medic makes a bold statement that they are qualified to walk into nursing without going through the process, and they also thought they could walk right into an RRTposition. So, actually, I was being nice, until I recieved messages and posts with a higher than thou attitude, accusing me from coming from the backwoods, etc. Yes, I agree, play nice or leave the sandbox....It wasn't my ego that was the problem...