Texas ENA position paper against EMS

[triemal04]

I think Triemal made a good post. I'll make some additions:

Average age of a Paramedic: 35
Average age of a RN: 45


>50% of new graduate RNs have a BSN or MSN and this is growing.
>50% of all RNs have a BSN, MSN, or DNP.
Most hospitals are asking for a BSN minimum in order to work in acute care, an increasing trend.
~3% of new nurses enter the profession without a degree, instead completing a 3 year hospital diploma program. Of the total RN population, 10% of all RNs have no nursing degree.

But to have an honest and accurate conversation you really need to leave things like this out. What really matters when comparing professions is what is required at the bottom level to hold that title; while there are plenty of BSN's out there, just as there are a fair amount of paramedics that hold a degree (in something, not neccasarily EMS) what matters is what is required at the base level.

I agree with the generalist training, but family practice + palliative is not quite the closest analogy. The primary aim of most RN programs which is inpatient acute and procedural care. Back in school, 90% of my 1200 hours were critical care/ER/acute/procedural(OR/IR/EP). The other 10% were public/community health.

I was trying to come up with a way of saying "nursing care" without saying "nursing care," and avoiding personal experiences.

 

[triemal04]

~3% of new nurses enter the profession without a degree, instead completing a 3 year hospital diploma program. Of the total RN population, 10% of all RNs have no nursing degree.

That is interesting. I didn't know it was even an option anymore.

 

[Handsome Robb]

Dr.P I don't expect it from you either. Sorry, late night post and didn't add that in. I don't expect it from either of you.

I personally don't get all pissy about them challenging the test however I do personally think that if a Paramedic has an AA/AS/BS with appropriate science courses that we should be able to challenge the NCLEX but that will never happen.

I'd like to know how I've been fooled, Sandpit. Because I understand the limitations of Paramedics? Not only because of our education but also because understand how we practice and am willing to concede to the fact that we do still operate under the orders of a Physician. That we are not individual autonomous practitioners of medicine as we see fit? If that's fooled then cool, but I'm not sure how you're going to argue that.

 

[Carlos Danger]

Nursing is so broad a field and paramedicine such a focused and narrow one that it's hard to really compare them head to head like this.

It's easy to say "let's just compare entry-level to entry-level" - and we can do that, of course - but that doesn't really give an accurate picture of nursing, because entry-level nurses are a small percentage of total nurses. When a full 50% of members of a profession are entering with a 4-year degree (and more are obtaining that degree after entering), and many are doing things like ICU nursing and research and then advanced practice, I think that's an important part of the landscape.

The two look quite similar on the surface, but they really have many more differences than similarities.

 

[Carlos Danger]

You are being intellectually dishonest by claiming that "RNs can't" then when told that they can, you switch your argument to "well, most usually don't" and then insinuate that is tantamount to "can't."

Exactly. That pretty much sums up all of their incoherent and petulant rantings.

 

[triemal04]

**** it. This is a waste of time. Mods, just close this thread, it's worthless.

 

[Summit]

But to have an honest and accurate conversation you really need to leave things like this out. What really matters when comparing professions is what is required at the bottom level to hold that title

Perhaps? But since the genesis of this discussion was the ED, my point was that if a RN wants to work in the ED, the minimum requirements are typically a BSN and 1-2 years acute/emergency/critical care RN experience. That's typical, and for major trauma centers almost universal.

just as there are a fair amount of paramedics that hold a degree (in something, not neccasarily EMS)

That is only relevant if I consider what percent of RNs have a MBA, BS Physics, BA English, etc.

what matters is what is required at the base level.

I think what is typical matters because the base level these days will get a nurse into a nursing home more often than a hospital.

>97% of new RNs have at least an Associates in NURSING
>50% of new/all RNs have at least a Bachelors in NURSING

Most Paramedics do not have a bachelors, and few have any degree in paramedicine.

I was trying to come up with a way of saying "nursing care" without saying "nursing care," and avoiding personal experiences.

Fair enough. Avoiding, personal experience, the majority of RNs do work in the hospital, so I disagreed with the "family practice" analogy which implies outpatient/ambulatory/sub-acute.

Depending where you look, about >60% are in the hospital. The biggest groups there are:
1. Acute care (Med/Surg/Tele/Onc/OB etc)
2. Procedural Care (OR/PACU/EP/CCL/IR/GI/L&D etc)
3. ICU
4. ED

<30% of nurses provide care out of the hospital: transport, public/community/home health, nursing homes, ambulatory/rehab
~10% are in non-direct-care positions like education, research, management, informatics, case review, policy etc.

 

[Carlos Danger]

**** it. This is a waste of time. Mods, just close this thread, it's worthless.

I'm sorry things aren't as simple as you'd like them to be.

 

[SandpitMedic]

Nurses coming out strong - super strong - for their positions! No wonder they make so much more money - never give up and make counter accusations all day without compromise!
Wish more paramedics would post up.

Summit- nurse
Remi - nurse
Robb - nurse hopeful

Hmmmm?
Nurselife.com? Perhaps.

This is rediculous.... Like fer'real.

 

[Carlos Danger]

Nurses coming out strong for their positions! Wish more paramedics would.

Summit- nurse
Remi - nurse
Robb - nurse hopeful

Hmmmm?
Nurselife.com? Perhaps.

This is rediculous.... Like fer'real.

Summit - EMT
Remi - paramedic
Robb - paramedic

I'm not sure what your point is.....

 

[SandpitMedic]

Don't you understand? Remi is never wrong. The nurses are never wrong.

A nurse will do whatever they want. ****, a nurse is going to be the first person on Mars. WITH a degree!

C'mon... You can't just compare entry level nurses to paramedics... Because nurses are so freaking amazing... New grads and all.
Even those SNF nurses...

......
Nurselife.com
......
#Remi2016!

 

[Carlos Danger]

Don't you understand? Remi is never wrong. The nurses are never wrong.

Oh I definitely understand. Your panties are all wadded up because everyone isn't constantly blowing rainbows at you about how paramedics are the awesomest thing ever.

 

[SandpitMedic]

Run for office bro. Please.
You're good at the politics game.
I don't have enough tact or patients for it. I'm a realist.

But you... You're a politician.

You should run for office; congress, school board or something.

 

[SeeNoMore]

No matter what paramedics think we will always be regarded as below nurses until we mandate similar education and excercise similar professional advocacy. The name calling is silly. We all know great nurses and medics and weak ones. All the rest of the medical world sees when paramedics claim they are more autonomous or independent than nurses "who just follow orders" is childish boasting from a position of weakness.

 

[DrParasite]

Sandpit, Dr P, seriously, stop. Your attitudes and arrogance reflect extremely poorly on EMS. So does your double standard.

double standard? Because I say in an emergency situation, a paramedic can assess, create a treatment plan, and begin interventions prior to seeing or speaking to a doctor using protocols where they can decide, using their education and experience, how they should be followed, while a nurse can't begin a treatment plan or most serious interventions before a doctor sees the patient?

I am standing up for my profession when it is being accused of being inferior to another healthcare profession, because someone who is using inaccurate information decided to slam it.

You are being intellectually dishonest by claiming that "RNs can't" then when told that they can, you switch your argument to "well, most usually don't" and then insinuate that is tantamount to "can't."

when you can do something in theory, but you can't do it in reality, that is tantamount to can't. In theory, a paramedic can do a C-section in the field, assuming they get permission from their medical control base to perform the procedure (because as long as the doctor is ok with it, you can do a lot of things). In reality, those paramedics who did that are no longer paramedics. See, that's the difference between a theory (a concept that is theoretically possible) and reality (what actually happens).

And I would drop the topic if anyone could name one health care facility where a nurse can administer a narcotic med to a patient prior to being seen by a doctor. But alas, even the all knowing CRNA couldn't provide one.

you know what? I give up.

For those of you who want to believe the lies and half truths spoken by a nurse about paramedics, do it.

for those of you who think nurses can do so much more than paramedics in an emergency situation, do it.

for those of you who like spin more than actual facts, than feel free to believe everything Remi says.

I don't care about the differences between paramedics and nurses. I know there are many. But the topic was supposed to be about a letter written by a chapter president of the ENA, saying how paramedics were inferior for various reason. You want to continue thinking that, more power to you.

I'm done.

 

[Summit]

double standard?
...
In reality, those paramedics who did that are no longer paramedics.
...
And I would drop the topic if anyone could name one health care facility where a nurse can administer a narcotic med to a patient prior to being seen by a doctor.

Let me try one last time. RNs can do what paramedics can do if they work on a helicopter. I don't know every hospital's RN protocols...

Let let's just assume that the answer is NONE.

How many TX health care facilities can Paramedics do this?
Also None

What would it take to allow a RN to do the things mentioned?
MD and facility write a protocol, policy, and training.

What would it take to allow a paramedic to do the thigns in a hospital?
MD and facility write a protocol, policy, and training... AND A NEW LAW.

I say double standard because you are using exactly the disingenuous method that you are accusing the ENA of.

So explain to me why there should be a new law?

Paramedics can do all the things they do in the prehospital environment with the current training requirements they have because our society has, for some stupid reason, decided that we don't want to pay more. So you need a broad skillset provider at, sadly, a low cost who implements skills that are primarily either low risk/high gain or high risk/high gain with thresholds for implementation where the consequences of inaction are nearly as high. And to get enough of these providers to work for cheap enough, you have to settle for low education standards so the barrier to entry is low enough . That is how the healthcare system is designed to screw EMS in the US, vs how it is done in say Canada, NZ, AU etc with high compensation and education... or other countries where they use RNs or MDs.

And EMS providers in the US don't like it the low pay, but they do like the rather autonomous protocols. So someone decided the solution is to work in the ED, but imagine it would be a good idea to keep the liberal field protocols?

The reason that RNs don't have more liberal universal standing orders is because MDs and hospitals don't want them to because there isn't a huge need for it. NOT BECAUSE THEY CAN'T. In order to provide better patient care and achieve more autonomy in the hospital where MD/PA/NP/CRNA are close at hand, RNs raised their educational standards so that 2 year degree RNs can barely find a hospital job and the ED/ICU wants years of experience. Now why would the hospital want to bring in paramedics to do what they could have their RNs do with the same policy/protocol change and without a new law? One reason: Paramedics are cheaper because their training is less expensive and faster. So after the RNs fought for higher educational standards, there is a proposed law change to allow providers who may only have one year of technician training in to supplant them with more autonomy... yea... I bet they are frothing at the mouth just like you are in this thread. How does that make sense?

The other question is do the ED physicians really want paramedics in the ED with more autonomy than their RNs? Or is this a push by hospital corps? Or is this a push by EMS associations?

 

[SandpitMedic]

Let me try one last time. RNs can do what paramedics can do if they work on a helicopter. ..

I LOVE LAMP!
Are you a brick wall or a human being?
This debate has been about emergency room RNs and prehospital field paramedics.
Why are you bringing up HEMS?!

Irrelevant.

The reason that RNs don't have more liberal universal standing orders is because MDs and hospitals don't want them to because .....

STOP!


Just stop. That is quite an astounding assumption. Also, that's the dumbest thing I've ever heard.

You're the Palin equivalent for Remi.

#REMI.SUMMIT2016!

The other question is do the ED physicians really want paramedics in the ED with more autonomy than their RNs? Or is this a push by hospital corps? Or is this a push by EMS associations?

This is actually a fantastic question.

 

[RocketMedic]

I fully support the Texas nurses and ENA. Paramedics are not educated enough to be able to perform the same tasks as nurses in facilities as a standard, we lack the professional development mechanisms to improve most of our entry-level personnel and we fiercely defend our islands of ignorance.

Putting paramedics at full scope into EDs is a shortcut for education that only appeals to the lazy, semi-literate and arrogant among us- explaining why Sandpit is so vehemently for it.

 

[Summit]

This debate has been about emergency room RNs and prehospital field paramedics. Why are you bringing up HEMS?!

Why do you think RNs have liberal universal standing orders in HEMS?

Just stop. That is quite an astounding assumption. Also, that's the dumbest thing I've ever heard.

Why do you think RNs do not have liberal universal standing orders in the ED?

 

[Carlos Danger]

First, I really don't understand the fixation with morphine on standing orders. Even as a mere example, it's a stupid way to try to define autonomy, for numerous reasons.

Second, it's important to understand that paramedics have liberal protocols based on necessity, not because they possess some superior clinical judgment. It's impractical to call for orders for everything that happens in the field. On the other hand, in the hospital, doctors are everywhere, and it's generally not hard to get orders when you need them, hence less reliance on written protocols. It has nothing to do with autonomy, and everything to do with practice environment and the availability of physicians. The same exact is true of invasive skills - paramedics don't intubate and cardiovert because they are better at it than everyone else; they do it because there are no physicians around to do it.

The real proof that the level of autonomy has much less to do with licensure than with practice environment rests in the simple fact that when they are placed in the same environment, RN's and paramedics typically have very similar levels of autonomy. For instance, flight and CCT nurses generally follow the same if not more liberal protocols (yes, I can give several examples) as flight or CCT paramedics. Paramedics who work in the hospital, on the other hand, are generally not going around running trauma alerts and running codes and ordering meds and dropping tubes all by themselves; they are usually working at a level similar to an RN, if not as a PCT.

I thought the whole thing was so dumb, in fact, that I wasn't going to bother taking the time to respond to it. Eventually, though, you've worn me down. So I thought I'd take a quick look and address these inane demands, just to put them to rest and prove that you don't know what you are talking about.

In regards to the administration of Morphine... Are you suggesting, that via standing order, on a first encounter with a patient in an ER or urgent care, that an RN can just administer morphine if they deem it appropriate? Prior to that patient seeing a provider or mid-level provider? Yes or no?

The answer is no.

Prove me wrong with fact, or stop.

double standard?
And I would drop the topic if anyone could name ONE health care facility where a nurse can administer a narcotic med to a patient prior to being seen by a doctor. But alas, even the all knowing CRNA couldn't provide one.

sure.... give me ONE example. that's all I want. where a RN (not an NP or anything, a new grad RN) in an ER or urgent care setting can do it <administer morphine on standing order, and I will gladly accept it as true.

​

It took me less than 5 minutes to find several examples of "proof" that in some places, RN's do in fact give morphine in the ED, on standing order, prior to the patient being seen by a physician. I googled a couple terms, and the search engine suggested "emergency department triage nurse initiated pain management". I clicked on that and quickly looked at the first few hits.

The third search result was this article, which is about a study done at Chula Vista Medical Center in San Diego, on the way that their nurse initiated pain protocol affects time-to-analgesia and patient satisfaction. The protocol "is based on the patient's pain score and ranges from Tylenol for mild pain to morphine for severe pain", says the article.

So there you go. There's your one example. And it's not at some teeny-tiny shack of an ED out in the middle of nowhere.

I wouldn't have looked any further, but the fifth hit caught my eye because it was from Medscape Anesthesiology - one of my favorite references. It is an article in which a physician promotes the practice of RN-initiated opioid pain management, based on several studies that are cited. You can't study something that doesn't happen, can you?

This is only two examples, but that's twice what you demanded, and it literally took less than 5 minutes to find. Even though most ED's don't bother publishing their nursing protocols online, I have no doubt that I could find many more examples if I cared enough to really rub your nose in it.

See, I told you so.

-----------------------------------

And with that......I'm out. Apologies to everyone about the way this discussion slid from reasonable debate to silly arguing. I'm honestly a bit embarrassed at how long it dragged out.