Transitioning to an in-hosptal role...

[OKparamurse]

Hey guys I'm about to start a new job as a hospital paramedic. It's a small surgical specialty hospital, ~10 bed floor and a few operating suites. Mostly outpatient stuff but abdomens, spines, and a few others stay overnight. I'll be working nightshift and essentially be acting as a tech, however, to be a "hospital," they have to have an ED of course. So basically I'm there since there's no providers after hours in a rare chance something bad comes into the ED or in a code situation. I'm starting nursing school in January and this schedule is much better for school than the 24 on, 48 off rotation my service operates on. I've been in EMS 9 years next month and just turned 28 so honestly, it's really all I've known as a working adult.

So with that little background, I'm just looking for some insight. Did you make the transition to in-hosptal? Was it smooth or a big change? Any advice on my first few weeks starting? Any advice is helpful. As always, thanks a lot guys!

 

[NomadicMedic]

Wow. Sounds like a huge liability to take on. I’m curious how they can justify calling it an ED with only a paramedic on duty.

 

[OKparamurse]

Wow. Sounds like a huge liability to take on. I’m curious how they can justify calling it an ED with only a paramedic on duty.

The hospital itself is part of a large, well-established healthcare conglomerate, so I assume it's all on the up-and-up. And to be fair, that's only how the job was explained to me in my interview, I haven't actually began my OTJ training yet, so who knows. Plus I assume any liability would be on the hospital rather than me as the provider.

Edit: As on the up-and-up as a large, well-established healthcare conglomerate can be. Lol I'm not quite that naive.

 

[NomadicMedic]

Fair enough. I’m interested to hear more about it. Please keep us updated as you progress through the experience. I know several paramedics that have worked in a hospital, but only in the ED. They essentially functioned as techs and filled roles on the rapid response and IV team.

 

[RedBlanketRunner]

Hey guys I'm about to start a new job as a hospital paramedic. It's a small surgical specialty hospital, ~10 bed floor and a few operating suites. Mostly outpatient stuff but abdomens, spines, and a few others stay overnight. I'll be working nightshift and essentially be acting as a tech, however, to be a "hospital," they have to have an ED of course. So basically I'm there since there's no providers after hours in a rare chance something bad comes into the ED or in a code situation. I'm starting nursing school in January and this schedule is much better for school than the 24 on, 48 off rotation my service operates on. I've been in EMS 9 years next month and just turned 28 so honestly, it's really all I've known as a working adult.

So with that little background, I'm just looking for some insight. Did you make the transition to in-hosptal? Was it smooth or a big change? Any advice on my first few weeks starting? Any advice is helpful. As always, thanks a lot guys!

I worked in rural areas where staffing was often short in the ED. EMTs were welcomed. During serious crunch hours we even parked a unit at the hospital and were standby workload crew. So a transition towards in hospital was pretty easy. I took the courses while working ambulance and was running dual, NA and EMT II for a spell.

 

[DrParasite]

So, no nurses? no doctors? Just you? Maybe a few other "techs" but that's it? Assuming that's the case, it sounds like a potential disaster, especially if you do have an admitted patient who crashes on you, or a code that is brought into the ER. yeah, you can stabilize the patient (maybe) but then what? It sounds like an easy job when everyone is sleeping, and you are counting the ceiling tiles, with a huge potential to turn into a disaster, esp if the ED or admitted rooms has a patient who crashes. I'm curious to hear how exactly that will be working

I know a few EMTs that transitioned into in-hospital roles, as well as some paramedics. Many worked as techs (some in the ER, some on the floors), which meant they were the lowest level clinical employee in the hospital. They were over worked, had little downtime, learned a lot, but were often treated as the nurses ***** (anything they didn't want to do or could delegate, they did), and they were assigned as the tech for several nurses. It wasn't a bad job if you were going to nursing school, but it wasn't as "easy" as a shift in EMS (and yes, easy is being used to define how heavy the workload was, not the work itself).

 

[Peak]

Hospitals do not need to have an ED. We have a handful of hospitals in our system that do not have EDs and there are a few others locally that don't either (although they do have physicians in house 24/7 in case a patient decompensates).

I suspect that they are probably licensed as a critical access hospital or otherwise get a financial incentive to keep and ED open.

 

[NomadicMedic]

I know lots of specialty hospitals that do not have an ED. Kindred speciality hospitals come to mind. Big lit up sign that says “NO EMERGENCY SERVICES”

 

[CCCSD]

I can’t understand who is providing hospital level care. A paramedic? That’s it? How do you run a code? Trauma? Fx limb? Obstructed airway? MI? Provide nursing level care?

I hope they have great liability insurance that includes you.

 

[VFlutter]

Personally never heard of a 23hr stay surgical center that has an ED. Most facilities like that staff only a couple RNs (usually PACU or Critical Care experienced) at night and call 911 for emergencies. Honestly not sure what a paramedic on site really adds.... Do they have full protocols for you?

Kindred Hospitals are weird places...In some the charge nurses intubate and do all kinds of stuff they probably shouldn't

 

[NomadicMedic]

Kindred Hospitals are weird places...In some the charge nurses intubate and do all kinds of stuff they probably shouldn't

I learned a lot about vents taking patients in and out of them though

 

[Carlos Danger]

Hey guys I'm about to start a new job as a hospital paramedic. It's a small surgical specialty hospital, ~10 bed floor and a few operating suites. Mostly outpatient stuff but abdomens, spines, and a few others stay overnight. I'll be working nightshift and essentially be acting as a tech, however, to be a "hospital," they have to have an ED of course. So basically I'm there since there's no providers after hours in a rare chance something bad comes into the ED or in a code situation. I'm starting nursing school in January and this schedule is much better for school than the 24 on, 48 off rotation my service operates on. I've been in EMS 9 years next month and just turned 28 so honestly, it's really all I've known as a working adult.

So with that little background, I'm just looking for some insight. Did you make the transition to in-hosptal? Was it smooth or a big change? Any advice on my first few weeks starting? Any advice is helpful. As always, thanks a lot guys!

Sounds like a weird arrangement for sure. Never heard of a facility like that. I don’t see any financial incentive to keep outpatient surgeries for 23 hours post op (usually the goal is to get them gone ASAP), and any true inpatient procedure should by definition be done in a real hospital.

Might be a good opportunity to learn a lot though. Frequent access to anesthesia providers and the OR may be possible from the sounds of it.

 

[GMCmedic]

This sounds like a strange situation? I would think it would have less to do with an ED and more to do with having someone experienced in ACLS on staff.

 

[BobBarker]

Is this a standby ER? They have that license in CA, kind of like catalina island's ER. Not staffed 24hrs a day but the doctor has to be available to come 24hrs a day.
Also, another hospital transitioned from an ER to a 24hr Urgent Care but also has inpatient rooms and a surgery center is Southern California Hospital at Hollywood.
2 similar situations that come to mind. I don't know why they would have an ER other than to get CAH designation and more funds, but if you are only doing procedures, they have to be pre-approved by insurance, so you know what funds come in every month. Something doesn't add up.