What do you think of using paramedics for nursing shortage

ZASHAGALKA, RN · Apr 22, 2006

Depends on where you are talking.

RE: Paramedics: their national scope of practice model is specifically addressed to out-of-hospital care. Unless your state specifically lists an in-hospital scope of practice for them, then they are literally UAPs in-house.

RE: LVNs - My hospital hires many LVNs for the routine floor areas and they work just fine. But TX has a very liberal LVN practice guideline: some states are much more strict. So, it would depend on how restricted LVN practice is in your state, and what area you are talking about.

On both of these questions, the KEY question to first ask is: what is the limitation by State Regulation to these ideas.

~faith,

Timothy.

ZASHAGALKA, RN · Apr 22, 2006

A little research: you said in a previous post that you live in GA.

GA annotated Code:

"31-11-59 G

*** CODE SECTION *** 12/03/01

31-11-59.

Emergency medical technicians, paramedics, and cardiac technicians

may render any service which they are authorized to render under

Code Sections 31-11-53, 31-11-54, and 31-11-55, respectively, in any

hospital. Such services shall not be rendered in lieu of the

services of a physician or a registered professional nurse and shall

only be rendered in a hospital at the discretion of and after the

prior approval by the hospital governing authority on the order of a

physician or, if a physician or registered professional nurse is

present, at the direction of a physician or registered professional

nurse, provided that such hospital has a currently valid permit or

conditional permit issued by the department pursuant to Article 1 of

Chapter 7 of this title. The provisions of this Code section are

cumulative and are not intended to limit the rendering of services

by emergency medical technicians, cardiac technicians, and

paramedics in any area in which they are already authorized to

render such services."

allnurses Guide · Apr 22, 2006

We are considering the use of Paramedics and LPNs to help with the nursing shortage. Is this something that you would be comfortable with. Do you think that an RN would then be responsible for the paramedic. What areas do you think this would work in and not. I need your help to present this at our next meeting if it's a bad thing I would like to make sure it doesn't happen.
Thanks!

LPNs/LVNs are nurses and can be used with RNs in any department in the hospital (depending on your hospital policies, but they can't replace the RNs). The only difference w/ the LPNs is in the curriculum the LPN curriculum usually doen't go into as much depth in critical care/ER/OB. Also, your states scope of practice may limit the LPN/LVN to certain areas.

Paramedics are a different case all together their training is different and they usually aren't allowed to work outside of the prehospital area. Where hospital/local policies allow it paramedics sometimes work in the ER.

There are things you can do assist the RNs in their jobs, but there isn't a replacement/alternative for him or her.

In my opinion we should make the transition to RN more plausible for both of these groups. A paramedic's education shouldn't be ignored as it is in most cases and they should be allowed to go thru a transition course(s) and then sit for their RN license.

llg, PhD, RN · Apr 22, 2006

I certainly agree with Timothy's post above. To add to it ...

I work for a hosital that uses EMT's, paramedics, and LPN's -- but only in certain areas and only for certain functions. It works well in certain situations, but we can see that it would not work well in others.

For example ... we have paramedics on our transport team (along with RN's and RT's). That works well. We also have paramedics in our Emergency Department where they check people in, do an initial assessment, start IV's, and participate in other procedures. It works well there.

We also use EMT's in a nursing assistant role (like a CNA). This role can be held by CNA's, EMT's, or nursing students with at least 2 full semesters of clinical experience (and the state does not require licensure for this type of position). Using EMT's does not always work well because some EMT's don't like the restrictions placed upon them in that in-patient role. They became EMT's with a desire for a more autonomous role and sometimes have a bit of a "cowboy attitude" -- a little too willing to jump in and do things they are not qualified to do. Other EMT's accept the limitations of the nursing assistant role and do fine.

As for LPN's, I work in a tertiary care center and many of our patients have needs beyond what the LPN can meet. However, we do have some units that have some patients that enable us to utilize a few LPN's and they do just fine. However, we have found it troublesome to have all 3 "levels" of personel working together on the same team -- RN, LPN, and nursing assistant.

Too many people with too many roles gets confusing. People have trouble getting organized and assigning taskes. It works best for us if there are only 2 levels of direct personel with any one group of patients at a time.

llg

Medic/Nurse, BSN, RN · Apr 22, 2006

As the prior post notes, paramedics are regulated very differently than nurses. As a nurse (RN) the ability to practice in ALL states is fairly standard. Once a nurse has a license in one state, either through the "compact" or specific state license the nurse can practice anywhere. The NCLEX is standard and for most, if not all, RN's now hold a degree. Medic standards are different for many states. Some states recognize the National Registry as the standard for state recognition, other states do a version of their own exam. It's not so easy to go from state to state as a medic. Education of paramedics varies, also in some states are paramedics are certified, in others they are licensed. (Important as it relates ti individual practice)

This topic (as it relates to in-facility paramedic) has been addressed by many states in the past 10 years - and some states have regulations in place that allow paramedic to practice in other settings exclusive of the prehospital. In other states the mere mention of a paramedic invading the hospital has sparked strong opposition from many.

Now, to answer the ?? of "using paramedics for nursing shortage". Do shared skill sets (medic:nurse) equal shared practice?

I think there are specific instances where paramedics could excel in hospital based patient care. Paramedics in the ED, medics that function as a part of an IV Team or Rapid Response team would do well.

Now, as to the practice delineation. Unless the state will allow - most paramedic guidelines restrict their official role to the prehospital setting. As such, medics that wanted to practice in the hospital would be UAP. Their practice would be under the direction of a RN or MD, with well written facility policy.

Is this an answer to the nursing shortage? Probably not. Medics are used to being more independent in their practice - I know some who would welcome a hospital job with some type of pay that rewards their skills. I know many more that would not like facility based practice due to the limits on them. (Most would not welcome to have to practice "under" a RN)

Is this an issue that is worth exploring in a local manner? Absolutely. Your state may already have an approved system in place. I believe that a strong and progressive plan for your facility would be vital. Recruit medics for this type of "progressive" opportunity, pay 'em good and recognize their professional practice - and then you may have a great synergy in patient care.

burn out · Apr 22, 2006

I could see maybe using them in some kind of tech. role but not nursing. They may be skilled for in the field situations but once a patient arrives to the hospital it is a whole new ballgame with a completely different range of equipment and technology available that paramedics are not even taught. I could see how they could assit in things like starting IV's and task oriented'thing but not assessments and coordinating the care of a large volume of patients that come through the ER daily. A one year training program that paramedics take can no way or should ever compare to the

to the training required to be a RN. A Paramedic certificate does not equal

an RN education or license . Why is our healthcare system so bent on using less qualified, less educated personnel than spending more money on

educating and properly training Nurse and Doctors that can continue to give quality health care . Why do we have to lower our standards? In the long run you get what you pay for.

Geeg · Apr 23, 2006

Unfortunately, the healthcare system is using a business model: do more with less. Crank up the output with the least expenditure possible and hope nobody realizes that the quality stinks!!!!!!!!

fotografe · Apr 23, 2006

I think as a poster said above the prior education and experience of paramedics should be accounted for in the transition to the RN role. I have 2 paramedics with over 15 years experience in my nursing program. Much of the first year has been marking time for them. One of them even taught us an EKG class as a study group (and he got the majority of us through that test with flying colors). I think there could be a simpler transition program for them that would take a year and not the full 2. WOuld it solve the nursing shortage? No, but it would put more of the paramedics ready to get off the street into the hospital more quickly.

burn out · Apr 23, 2006

I think as a poster said above the prior education and experience of paramedics should be accounted for in the transition to the RN role. I have 2 paramedics with over 15 years experience in my nursing program. Much of the first year has been marking time for them. One of them even taught us an EKG class as a study group (and he got the majority of us through that test with flying colors). I think there could be a simpler transition program for them that would take a year and not the full 2. WOuld it solve the nursing shortage? No, but it would put more of the paramedics ready to get off the street into the hospital more quickly.

To whose advantage is it that paramedics get off the street and into the hospital faster? Certainly not to the patients on a Med-Surg unit,I don't think that paramedics are really taught how to tcdb a patient, put in foley catheters, monitor swan-ganz lines or set up cvps. Why should anyone be given a fast track to nursing . How can that render good quality of care. Sure they may be able to do it but do they but will they understand why

they are doing it.Make them learn it and pay for it just like the rest of us have had to struggle and do, it means nothing if we just hand out license

to just anybody.

fotografe · Apr 23, 2006

To whose advantage is it that paramedics get off the street and into the hospital faster? Certainly not to the patients on a Med-Surg unit,I don't think that paramedics are really taught how to tcdb a patient, put in foley catheters, monitor swan-ganz lines or set up cvps. Why should anyone be given a fast track to nursing . How can that render good quality of care. Sure they may be able to do it but do they but will they understand why
they are doing it.Make them learn it and pay for it just like the rest of us have had to struggle and do, it means nothing if we just hand out license
to just anybody.

I didn't say hand out a license to anyone. I said take their prior education and experience into account for those wishing to transition. It makes no sense to have them mark time in class while others in the class learn skills in which they are already proficient. THere are already fast track MSN programs that put non-medically experienced persons into the hospitals in a year. A year transition program is reasonable for a paramedic with 15 years experience.

burn out · Apr 23, 2006

Just to play devil's advocate then I'll stop.

Putting a paramedic in a nurses role is like putting a auto mechanic designing cars.