What do you think of using paramedics for nursing shortage

[sweetpooty]

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!

[ZASHAGALKA, RN]

Where I work, paramedics are being used to function as equals to RNs and over LPNs. Their duties include but are not limited to: Taking verbal and telephone orders, administering medications, treatments and a wide variety of other duties. They are being paid $1 an hour more than RNs. They often let us nurses know that "Paramedics save 'em, nurses bath 'em". I feel that because our administrator once drove an ambulance might be one reason why so many signatures are now ending with "EMT-P" as opposed to LPN or RN.

There is literally no chance that paramedics are being paid a buck more an hour than RNs - anywhere in the States.

That's not a slam on paramedics; it's simple supply and demand.

Hospitals would pay paramedics minimum wage if they could get away with it. But lest paramedics feel put upon, that same hospital would pay RNs minimum wage if they could get away with it.

They can't because of the Law of supply and demand. And that same law dictates that paramedics are paid less than RNs. It really has no bearing whatsoever on skill-sets; it's what the market will bear.

If paramedics were really being paid 25-30 bucks an hour (roughly in the buck an hour more than RN range), the line of paramedics waiting to apply for that job would stretch around the State. And that line, in and of itself, would drive that salary back down.

Paramedics being paid a buck more an hour simply isn't credible: BECAUSE THERE ARE MORE PARAMEDICS THAN RNS; not because of the skills either bring to bear. Although, there is an indirect comparison. RNs are more rare because their school is longer.

In fact, this is one of the arguments for BSN-entry: making schooling more exclusive would have the effect of tilting supply and demand even greater towards RNs (with the result of greater pay and prestige). But, the counter is the law of unintended consequences. When PT did that, the 'graduates' became managers and day to day PT is now being done by 'techs'.

As RNs become more rare and thus, more expensive, 'creative' alternatives like UAPs and 'Paramedic as RN' will become more prevalent. But let's be clear: hospitals don't want to hire paramedics in order to pay them RN wages - they want to hire them in order to AVOID RN wages.

~faith,

Timothy.

[Hellllllo Nurse, BSN, RN]

Most of the paramedics I know are so hung up on all the technoogy stuff and skills that anything less is tedious and boring...as evidenced by the foley catheter comment. Not many paramedics jumping to put that foley in but boy let someone need intubated and they are like a pack of dogs after a ##### in heat. Nursing is an art that requires education, very strong assessment skills,and use of scientific process indiviualized to meet the needs of patients, not to mention skills. A paramedic thinks of coding a patient; an RN tries to prevent it . One thing I can do that a paramedic can not is sign RN after my name

Exactly. You're right on the money, burn out.

[lindarn]

There is literally no chance that paramedics are being paid a buck more an hour than RNs - anywhere in the States.

That's not a slam on paramedics; it's simple supply and demand.

Hospitals would pay paramedics minimum wage if they could get away with it. But lest paramedics feel put upon, that same hospital would pay RNs minimum wage if they could get away with it.

They can't because of the Law of supply and demand. And that same law dictates that paramedics are paid less than RNs. It really has no bearing whatsoever on skill-sets; it's what the market will bear.

If paramedics were really being paid 25-30 bucks an hour (roughly in the buck an hour more than RN range), the line of paramedics waiting to apply for that job would stretch around the State. And that line, in and of itself, would drive that salary back down.

Paramedics being paid a buck more an hour simply isn't credible: BECAUSE THERE ARE MORE PARAMEDICS THAN RNS; not because of the skills either bring to bear. Although, there is an indirect comparison. RNs are more rare because their school is longer.

In fact, this is one of the arguments for BSN-entry: making schooling more exclusive would have the effect of tilting supply and demand even greater towards RNs (with the result of greater pay and prestige). But, the counter is the law of unintended consequences. When PT did that, the 'graduates' became managers and day to day PT is now being done by 'techs'.

As RNs become more rare and thus, more expensive, 'creative' alternatives like UAPs and 'Paramedic as RN' will become more prevalent. But let's be clear: hospitals don't want to hire paramedics in order to pay them RN wages - they want to hire them in order to AVOID RN wages.

~faith,

Timothy.

Except the Physical Therapists who open up the "free standing" Physical Therapy Centers, and bringing in a six figure salary as Independant Contractor. If nurses went to a BSN as entry practice, their would be more time in their program to include business classes on opening up your own practice, working as an Independant Contractor, learning how to work on legislative matters, to impact and pressure the legislative to favor nurses (which would help nurses learn how to impact our elected officials to mantain control over our practice. They could offer classes on Employment Law, and Administrative Law. We don't have to hand over our practice to UAP's, and nursing techs. We have the power to prevent it, we just don't use it.

In other words, we would have the knowledge to positively impact the nursing profession, and take it back. We would have knowledge of Employment Law, so we wouldn't so easily be bullied by our employers.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[wtbcrna, MSN, DNP, CRNA]

I deleted my response since it was off topic.

[James Huffman]

Except the Physical Therapists who open up the "free standing" Physical Therapy Centers, and bringing in a six figure salary as Independant Contractor. If nurses went to a BSN as entry practice, their would be more time in their program to include business classes on opening up your own practice, working as an Independant Contractor, learning how to work on legislative matters, to impact and pressure the legislative to favor nurses (which would help nurses learn how to impact our elected officials to mantain control over our practice. They could offer classes on Employment Law, and Administrative Law. We don't have to hand over our practice to UAP's, and nursing techs. We have the power to prevent it, we just don't use it.

In other words, we would have the knowledge to positively impact the nursing profession, and take it back. We would have knowledge of Employment Law, so we wouldn't so easily be bullied by our employers.

Lindarn, RN, BSN, CCRN

Spokane, Washington

1. I would argue that it's probably not appropriate for nursing schools to use instructional time to teach these issues. Most schools don't have enough time to do all the clinical and theoretical instruction needed; this stuff (while very important) is not germane to a basic nursing curriculum.

2. I'm not familiar with how PTs do it, but most MDs learn practice management basics from seminars offered by insurance companies.

3. Independent contracting has been available for RNs for years; it's just that most folks I know don't want to do it. While it can be lucrative, it can also be risky, and having the ability to stomach that risk -- and deal with the peaks and valleys independent contracting inevitably brings -- is crucial.

4. I think the problem for nurses who are bulled by their employers is not a lack of knowledge, but an inability to stand up to the bullies. Someone who is afraid to stand up for their position as a nurse, afraid to stand up for their clients, or afraid to call the bluff of a bully will not be helped by a class.

Jim Huffman, RN

[caroladybelle, BSN, RN]

I must have missed something. How is going to all BSNs for entry into nursing going to give nursing education more time to talk about business/law etc. ?

As a matter of note, you didn't miss anything because it wasn't there. The thread is supposed to be about paramedics and their qualifications.

It would be nice if people do not turn every discussion on this BB into the "BSN should be the only entry level" or "Nurses must unionize" threads. Especially the threads that have only minimal connections to those issues addressed in the thread. There are plenty (plenty!) of threads to cover those issues, IMHO.

[rn/writer, RN]

It's really unfortunate that a thread like this one, with some really intriguing possibilities, has to degenerate into yet another US vs. THEM spewing contest.

Having been involved in both nursing and EMS for many years, I can see either side of this debate. We don't have to be adversarial or even territorial. We can and should cherish our own perspective yet be willing to learn and employ the knowledge and skills other disciplines have to offer.

Nursing and EMS have many overlapping skills, with paramedic level training actually exceeding that of nursing in some areas. Paramedics tend to have many more hours of exposure to certain aspects of patient care, in part, because their training is concentrated and more focused on critical care issues. Nurses tend to have less depth but more breadth, with their schooling covering areas that paramedic training either does not spend much time on or doesn't include at all. This isn't politics, one-upsmanship, or a pi$$ing contest. It's a basic reality and rather than carping at each other about supposed deficiencies, it would be nice if we could give each other credit for knowledge already acquired and go from there.

Beyond the technical skills, there is a difference in perspective that can and should be addressed by any bridge or accelerated program. Again, these differences don't have to be--indeed, should NOT be--perceived as flaws. They are a starting point and not a permanently limited state of mind.

Sayings things like, "Paramedics save 'em; nurses bathe 'em," or, "A paramedic thinks of coding a patient; an RN tries to prevent it," doesn't serve either side well. The truth is, our training DOES teach different approaches and priorities. So what? The other mindset can be learned. And both perspectives can be coordinated to give excellent patient care.

Nurses have just as much of a challenge becoming paramedics as the reverse. Why? Because the two jobs are different. Not better. Not more professional. Not more important. Just different. Those differences ask the individual to set aside that which was taught to them as gospel and take in something new. This is hard, no matter which side you're coming from. But it's also energizing and enlarging and, if done well, can get the practitioner to see a bigger picture than they might have been capable of seeing before.

Scope of practice issues as determined by state licensing boards and facility policies are another matter altogether. These usually end up being heavily influenced by politics and personalities. The do NOT need to be made worse by all of us being willing to tear each other down and trash each other's credentials. We SHOULD work to come up with clear guidelines for what each role ought to encompass, but any finsihed product that doesn't recognize some overlap won't be realistic.

We do need to insist that people from either discipline desiring to enter the other be willing to set aside their original theory and principles long enough to learn and incorporate the new thinking. And they need to be absolutely consistent about which license they're working under when functioning in either role.

At the same time, there is so much to be gained from all of us working together, that it's worth putting some of this misdirected energy into getting past the distrust and antagonism.

We really do have so much to offer each other. At the top of the list should be respect.

[rn/writer, RN]

As a matter of note, you didn't miss anything because it wasn't there. The thread is supposed to be about paramedics and their qualifications.

It would be nice if people do not turn every discussion on this BB into the "BSN should be the only entry level" or "Nurses must unionize" threads. Especially the threads that have only minimal connections to those issues addressed in the thread. There are plenty (plenty!) of threads to cover those issues, IMHO.

Further references to "BSN as entry level" or any other off-topic subjects will be deleted or moved.

[ZASHAGALKA, RN]

Further references to "BSN as entry level" or any other off-topic subjects will be deleted or moved.

The issue at hand is alternative stategies for the supply of nurses: it's in the title: paramedics to be used for the 'nursing shortage'.

In fairness, I discussed the above in passing and abstractly as a look at how supply and demand effects this issue (I didn't mean to turn the debate in that direction). But any proposal that changes the balance of supply and demand of nurses is going to DIRECTLY affect the alternatives to nurses that hospitals consider - and the pressure that allows hospitals to push through the regulatory changes to adopt those alternatives.

And I think its fair to look at exactly how this very issue affected Physical Therapists - who are now by and large managers of the UAPs/techs that NOW do THEIR former job.

Whether and how much paramedics take on 'in-house' roles that encroach upon 'nursing' is a supply/demand issue. And those supply/demand issues are directly related to the topic. I have great respect for paramedics and I'm all for them making some 'in-roads' into 'in-house' care. But let's be clear: the thrust of such a move - while beneficial to paramedics by giving them more job opportunities - the thrust is off-setting the cost of nurses. I'm not making any comment about the quality of either nurses or paramedics - economics tends to deal with quantities and not qualities. And there are simply more paramedics (relative to current job opportunities) than there are nurses.

If hospitals can have paramedics do a good deal of what nurses now do, the result is to decrease the demand and therefore, the cost of nurses. My complaints about paramedics encroaching into nursing isn't about appropriate 'skill-set'. I agree that those can be learned. No, it's about protection of the relative rarity of nurses that sets my salary.

I'm all for paramedics making some limited gains that allow them to expand their opportunities: but not at a pace and clip that curtails my opportunities as a result.

~faith,

Timothy.

[rn/writer, RN]

The issue at hand is alternative stategies for the supply of nurses: it's in the title: paramedics to be used for the 'nursing shortage'.

In fairness, I discussed the above in passing and abstractly as a look at how supply and demand effects this issue (I didn't mean to turn the debate in that direction). But any proposal that changes the balance of supply and demand of nurses is going to DIRECTLY affect the alternatives to nurses that hospitals consider - and the pressure that allows hospitals to push through the regulatory changes to adopt those alternatives.

And I think its fair to look at exactly how this very issue affected Physical Therapists - who are now by and large managers of the UAPs/techs that NOW do THEIR former job.

Whether and how much paramedics take on 'in-house' roles that encroach upon 'nursing' is a supply/demand issue. And those supply/demand issues are directly related to the topic. I have great respect for paramedics and I'm all for them making some 'in-roads' into 'in-house' care. But let's be clear: the thrust of such a move - while beneficial to paramedics by giving them more job opportunities - the thrust is off-setting the cost of nurses. I'm not making any comment about the quality of either nurses or paramedics - economics tends to deal with quantities and not qualities. And there are simply more paramedics (relative to current job opportunities) than there are nurses.

If hospitals can have paramedics do a good deal of what nurses now do, the result is to decrease the demand and therefore, the cost of nurses. My complaints about paramedics encroaching into nursing isn't about appropriate 'skill-set'. No, it's about protection of the relative rarity of nurses that sets my salary.

~faith,

Timothy.

There is a big difference between mentioning something in context and changing the subject entirely.

We can discuss supply-and-demand and whether or not using ancillary staff poses a threat to nursing. What is not okay is to convert this thread into a "BSN as entry level" discussion. There are plenty of other threads that have covered that topic to the nth degree. And we have more than enough subject matter to talk about here.

One of the things I wonder about is where the balancing point is between finding and empoloying enough ancillary staff to keep nurses from imploding and hanging up their stethoscopes AND getting so much outside help that we see the nursing shortage evaporate and our paychecks dry up accordingly.

I think that is part of what you're talking about when you refer to the economics of all this, and it's a valid consideration.

It's to the bean-counters' advantage to have us all at each other's throats. Siege mentality gets us to do their dirty work for them. Then, when we're walking around weakened and demoralized, we have nothing left to resist changes that place foolish economy over decent and sensible care.

[Victoriakem]

Where I work, paramedics are being used to function as equals to RNs and over LPNs. Their duties include but are not limited to: Taking verbal and telephone orders, administering medications, treatments and a wide variety of other duties. They are being paid $1 an hour more than RNs. They often let us nurses know that "Paramedics save 'em, nurses bath 'em". I feel that because our administrator once drove an ambulance might be one reason why so many signatures are now ending with "EMT-P" as opposed to LPN or RN.

Well, that remark about nurses bathing & paramedics saving really burns me up! No it pisses me off. I dislike anybody thinking they are doing more for the patient. I thought we all were a team here. Where is your hospital & remind me NOT to apply there?! :angryfire

[ZASHAGALKA, RN]

One of the things I wonder about is where the balancing point is between finding and empoloying enough ancillary staff to keep nurses from imploding and hanging up their stethoscopes AND getting so much outside help that we see the nursing shortage evaporate and our paychecks dry up accordingly.

And this above comment is the crux of the debate: not some useless argument about 'skill-sets' or, as you say, a return to that debate.

But it's not just about how the issue affects nurses. I'm not opposed to the idea that paramedics be allowed to expand their opportunities. Both sides of the debate have to be balanced.

And it IS true that paramedics are grossly underpaid and having more 'in-house' opportunities could address that positively - for all paramedics whether they work 'in-house' or not. But. As you say: at what point is this more a boon for paramedics, and it what point is it more a disadvantage for nurses.

Because, in the end, the whole purpose - from the bean counter's perspective - of this exercise is DECREASING the value of nurses. To the extent that paramedics gain from such in-roads, the design is that nurses pay the cost of that gain by decreasing demand and, as a direct result, stagnated salaries.

To put it bluntly: this is an economic issue. As you point out, some in-roads for paramedics could have advantages for nurse, reducing the stress that is driving our peers away in droves. But too many in-roads would be the wrong medicine, devaluing nurses to the relative economic advantage of paramedics. My concern is that the bean-counters pushing this have 'too many in-roads' in mind.

~faith,

Timothy.