An Article in Nursing Management for April 2001 that I was reading prompted me to write this for my staff management class. The Article is "Far Out" if any of you subscribe. yes, i just read the april addition even though it is october... I am so far behind on my non-classroom reading, it just happened that the discussion today happened to match my "leisure" reading. Keep in mind I am in a BSN program, and only RNs are refered to in this paper because that was the assignment, only to react as an RN.
Brandy Leake
Care Coordination
Article Review: Delegation
10/10/01
In the article "Far Out", a nurse from Minnesota explains a program that her hospital as instituted, in which EMTs are utilized to relieve RNs from basic technical skills in the emergency department. A registered nurse staffs the department during the day and evenings, and EMTs staff the department during the night, with the hospital's charge nurse's assistance. The author states that although there were many questions at first over responsibilities, they have had a positive experience, both for decreased time lost, and an increase in patient satisfaction.
Entertaining the role of myself as a nurse manager, I can appreciate the need for fast effective care and increased patient satisfaction. What I can not appreciate is the loss of job security that this might have on my fellow registered nurses. I am not aware of the average salary for an EMT, but I assume that it is significantly lower than that of a registered nurse, otherwise I doubt that the hospital would be utilizing them in this capacity. Given the educational requirements for obtaining certification as an EMT, I would wager that they are not as well prepared to function outside of a purely technical environment. Registered nurses would be much better suited to fulfill the holistic needs of a patient, because of our in-depth didactic and assessment skills. Nursing is much more than performing skills, it is about critical thinking, quick accurate judgment, and knowledge of diagnostics. As a nurse manager, I would question the true thought process behind this program. This may be yet another way of utilizing UAPs to decrease the need for qualified nursing staff.
This ED only sees 5000 patients annually. That averages out to less than 15 patients a day. In a busier ED, I am not sure that this program would be effective. With only one RN on staff per shift during the days and evenings, and less than one RN during the night, their staffing proportions would not be affective on a larger scale. If an EMT was effective to provide patient care we would not need hospitals, as the EMTs on the ambulance could provide all of these skills at the patient's home when they respond to distress calls. The patients would not be seeking the ED at the hospital unless they needed nursing assessments. If EMTs were equally qualified to provide these things, then RNs would be phased out, as EMTs could provide an identical outcome at a lower price. Fortunately, this is not true. Patients need nursing care, holistic care, and not just technical procedures. Any human with average intelligence can be taught to perform procedures, but intuitive assessment can not be taught in a single class, nor in a single year, and certainly not in the meager 10 hours of clinical experience necessary for becoming an EMT. The background course work required of registered nurses helps to complete the entire picture, without the foundation, puzzle pieces may fall through the cracks, giving a incomplete assessment, and losing valuable information. Because of these shortcomings, I do not feel that this would be appropriate for a busy ED, not is it the best care that we should be providing our patients. Quick visits should not be more highly regarded than the quality of care our patients will receive.
I feel that even though nurses may appreciate the help for the time being that ultimately allowing EMTs to replace staff RNs will effectively shoot them in the foot. As nurses we must prove that we are needed, and that we can not be replaced. This article seems to be encouraging it. Although the author does state that this as an adjunct to nursing care, not a replacement, without further action and protest they may become just that: non-nursing aids that whittle away at the need for registered nurses.
Reference:
Angelucci, P., & Stolee, J. (2001). Far out. Nursing Management, 32(4), 45-46.
