Supporters of Community Paramedic programs are having a difficult time grasping the concept that some nurses and their organizations are reticent to jump on the bandwagon.
May I present exhibit A.
Now, how does that make you paramedics feel?
I think that about sums things up.
I think this kind of thing is both good and bad.
Pros: Nurses getting out of their comfort zone, learning new skills, keeping old skill sharp.
Cons: Gives the public the idea that if they call 911 that will get nurses to respond. EMS gets so little respect from the medical community as it is that this just seems like stepping on toes.
My question is this: are they going to have to call for orders to put patient on oxygen? Paramedics have the training and knowledge to work without having to call for everything that needs to be done; however, nurses do not unless they are/were paramedics. Even then, nurses have to call for orders!
A paramedic gives O2 using off line medical direction, protocol. They do not have the authorization to independently dispense oxygen without it (it is a prescription drug). Standing orders, protocol, works the same way for RNs. As both a well educated, experienced paramedic and RN, it works the same. No worries.
First off, I’m a medic, but who do you think writes our protocols? In the counties I’ve worked they have all been written by physicians. Nurses have degrees in medicine, we do not. They are are far more knowledgeable about medicine. This whole ” have to ask doctors for orders” argument is not a sustainable argument. We follow “orders”/protocols written by physicians.
What this is all coming down to is Money!!! These ambulance company’s are all about money. Think about it. A CCT transport will cost you around $2500.00 and these greedy company know they can bill that amount and insurances will pay that amount because it’s a nurse transport. But the average ALS transport is billed at $1200.00 and after billed they receive 700-900 out of the 1200.00. Leave the nurses in the hospital and the paramedics in the field.
In the netherlands all ambulances are staffed with Atls/phtls trained nurses.
doesn’t matter who staffs what as long as something gets done properly.
I’m an RN/RRT. I work in critical care transport. We operate on protocol all the time. It’s really not much of a stretch as long as we get proper training on scene response. That being said, we are intra hospital only. We all have to take PHTLS though.
I welcome any nurse who can start a line laying one your back in an upside down car on a back country road holding a flash light with your teeth. Oh yeah , wearing bunker gear and havering the patient and their drunk friends curse at you the entire time. We all have our strengths and our place in the system. We need to recognize that and build on that.
My question is, what dept or private company has the $$$ to staff these ambulances with nurses? I don’t know any nurse, with an AA,BSN or PHD that would do that job, or does already, for a Paramedic/ EMT’s wage, benefits or lack of retirement
Haha, well I guess you could take that “staffed by nurses” statement as as either a warning or selling point. The thought that paramedics are somehow more adept at providing independent care isn’t well founded. Nurses can function off standing orders just like paramedics. Nurses have been providing pre-hospital care in the HEMS and CCT environment for some quite some time now. The skill sets are not interchangeable but with the correct training a nurse is more than capable to function in a pre-hospital setting. Paramedics are also more than capable of functioning outside the “band-aid box.” The focus should be on the patient care not the cat fight between who needs to “stay in the kitchen.”
Nurses have degrees and paramedics do not? This statement and lack of knowledge is why paramedics do not get the credit they deserve. Both RN and paramedics can obtain Associates and Bachelor degrees. Here in Texas, paramedics work in ERs and have the same duties as nurses. With proper training each can do each others job.
I’ve heard many EMS workers complain about the new “extended care services” that may be coming at us. A few have said, “I will leave EMS if that happens.” Now they’re complaining about Nurses doing it? I’m about serving the community we live in, not just the adrenaline rush. Yes, the pay sucks, and Medics should be compensated if required to function in that capacity, but … If EMS doesn’t do it, then someone has to. Nurses are trained to change foley’s and help with meds and do wound care. They don’t need the “added training.” They should leave the Emergency Care to Paramedics though; if not for any other reason, but respect. Sadly, politics and greed don’t operate with that mindset. Times are changing, people need to change to stay in the game or they may find themselves unexpectedly on the sidelines. As a medic student 2 months away from graduation, and 18 years in the field of EMS, seeing this photo stirs ambivalence within.
Nurses through the years have shown that they can function remarkably well in combat zones, disasters, and epidemics. Like first responder doctors, which are routinely used in some countries, having an RN on board means providing a higher level of clinical care for the patient. Paramedics who are not RNs would hate the idea as it encroaches upon their exclusive domain. But in the final analysis it’s about patient care, not who owns bragging rights to the arena. Having been a soldier, EMT and RN, I think RNs in the field would be just fine.
Notice the company name: Stat TRANSFERS. Trying to insinuate that I’m insulted because nurses are doing horizontal taxi runs is specious at best.
And for the record, the hole being filled by CP programs is a hole that nursing created. Tough shit if they feel threatened.
Reading these comments makes me laugh and be angry both. The rig you see pictured, is not used as a 911 ambulance. This rig is used for RN and CCT transfers. I work for this company, and yes we do have RNs that fill street shifts on the paramedic ambulances. When in these trucks there role is the exact same as any other paramedic that would fill that spot. They all have to take the PHRN course, and can then practice at the level of a IL licensed paramedic, therefore the comment about how much can be charged to the insurance or patient is irrelevant because it is no different from a paramedic or an RN filling that truck.
Maybe i’m missing something, but what does a transfer truck have to do with community paramedicine? Regardless, i’m in Canada and there have been a number of successful projects here using blended RN/Paramedic staffing to fill physician shortages in rural communities, as well as both using both NP’s and Paramedics to deliver hospital grade care inhome. The great thing about the NP’s is they can prescribe meds, often antibiotics, inhome. Also, at least where I am, we all get paid the same, so thats not part of the equation to the same degree.
Let us not forget who started this whole EMS / medic thing; Clara Barton, RN “Angel of the Battlefield” who founded the American Red Cross. My point is, this has always been a collaboration through the years. Only due to nursing shortages and the frequency of injury on our “highways and bi-ways” there was a need to fill out on the “streets; which EMT’s and Paramedics have done admirably and will continue to do. There is a role for both EMT/Medic and RN’s in pre and post hospital care.
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