MagicTyler
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Urgent care on wheels
- Thread starter MagicTyler
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Shishkabob
Forum Chief
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We knew it was going to happen... nurses trying to catch the wave on community paramedicine with the explanation "But we can write prescriptions!"
JPINFV
Gadfly
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"almost like a primary care provider."
Today's SAT analogy...
EMT-Is
aramedics::some mid-levelshysicians.
Today's SAT analogy...
EMT-Is
aramedics::some mid-levelshysicians.
EpiEMS
Forum Deputy Chief
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...my brain...ow. This is a good concept, but I don't like how it was executed. I'd much rather see a community/advanced practice paramedic in a Charger than an ambulance (a la Wake County). Or, failing that, an assistant medical director who's a PA (and can respond to calls on top of doing this community medicine role). Granted, I'm not such a huge fan of the NP over the PA (considering the different training models, varying laws regarding supervision, etc.).
Also...if this anecdote is representative of what the NP is doing: "I'm going to get some vital signs -- I'm going to get some ice back there -- and I'm going to get you something for pain okay? Sound good? Right on."
So, it's a pain med delivery service...? [Update: as per http://www.azsos.gov/public_services/Title_04/4-19.htm#pgfId-36529 and http://www.azbn.gov/documents/advis...iption of Role and Functions rev Jan 2009.pdf NPs in AZ can prescribe up through Schedule II drugs, and they don't have physician chart review)
(By the way, JP, they got rid of analogies on the SAT -- crazy, right?)
Also...if this anecdote is representative of what the NP is doing: "I'm going to get some vital signs -- I'm going to get some ice back there -- and I'm going to get you something for pain okay? Sound good? Right on."
So, it's a pain med delivery service...? [Update: as per http://www.azsos.gov/public_services/Title_04/4-19.htm#pgfId-36529 and http://www.azbn.gov/documents/advis...iption of Role and Functions rev Jan 2009.pdf NPs in AZ can prescribe up through Schedule II drugs, and they don't have physician chart review)
(By the way, JP, they got rid of analogies on the SAT -- crazy, right?)
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JPINFV
Gadfly
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...and my 1240 isn't anything remotely decent anymore either.
EpiEMS
Forum Deputy Chief
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1240/1600 compares to an 1860/2400, ceteris paribus...but a 1240/2400 is just embarrassing
1240/1600 compares to an 1860/2400, ceteris paribus...but a 1240/2400 is just embarrassing
So what? He is still called "doctor."
I don't see this as a bad thing. They're better educated for community / primary care, and the NPs have a level of licensure that allows they to prescribe. If they add value, which presumably they do, it might make the fledgling programs that exist now more sustainable.
It would be great to see Master's degree paramedics running around prescribing, but that's a long way off in a lot of countries. No one's going to give us a 16 hour weekend course, and say, hey, now you can prescribe clarithroymycin.
wanderingmedic
RN, Paramedic
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great idea. only problem I see is nurses having to put up with EMS. I don't know of many nurses who would enjoy working out of a station with EMS or fire.
I think PA's could be a better option. The national average for PA school is ~26 months, and I have heard of PA programs that are willing to take medics who have an AAS and experience. Not to mention having one Medical Director calling the shots for treatment across a system could standardize treatment, instead of NPs who have their own licenses and can do what they want (to an extent). PA's are also less specialized than NP's and are more oriented toward primary care and emergency medicine.
This all goes without saying the ed cost for a PA is more financially prudent since your not paying for a 4 year BS, then ~3-4 year doctorate like NP's need to.
I think PA's could be a better option. The national average for PA school is ~26 months, and I have heard of PA programs that are willing to take medics who have an AAS and experience. Not to mention having one Medical Director calling the shots for treatment across a system could standardize treatment, instead of NPs who have their own licenses and can do what they want (to an extent). PA's are also less specialized than NP's and are more oriented toward primary care and emergency medicine.
This all goes without saying the ed cost for a PA is more financially prudent since your not paying for a 4 year BS, then ~3-4 year doctorate like NP's need to.
That is not entirely true.
NPs do have specialty programs but many are geared for family practice and for community health. The NPs in community health have been prominent in many cities and rural areas for the past 40 years.
NPs also have the advantage of more often than not having at least 2 years of experience working in a healthcare setting as an RN prior to entering NP school.
PAs definitely have their place also in community health.
But, if you present this purely on economics and start pushing for someone with just an Associates degree and limited experience primarily in emergent situations rather than someone with a Masters level education, , is the public better served? This is like saying the 3 month medic mill is better than the 1 year medic certificate or the 2 year degree if you can mass produce for the cheap.
There are several states, including Texas and Virginia, which have had success with NPs in community health units which provide care in mobile units. The reason some in EMS may not have noticed is that they primarily serve those who are poor and without insurance which does not sound very exciting to EMS or this population is just written off as calls which waste time. The preventative or overall health aspect is missed since that is not the focus of EMS. These community vans will also rarely have a need to call an ambulance since they may have their own connections for transport since they have access to Social Workers to work with them. Working with others in healthcare rather than against them is key to success for any system. Some in EMS waste more time disregarding others in health care as being unprofessional and unnecessary rather than embracing a team concept. One could say EMS is attempting to fragment other systems just as it has its own.
Fire departments are a good option for providing the transport and space since their facilities and vehicles are tax supported. It can give patients a stationary "clinic" with easy access in most neighborhoods. Most FDs also have CMS billing ability.
Nurses have been involved in community medicine for over a century. They have helped with clinics, mobile and stationary, and even have been involved in mobile military units for many wars. Nurses have increased their education to meet the demands of the community. The community Paramedic concept had been trialed a couple of decades ago and failed because of the disconnect between EMS and preventative medicine or as some would say the chronics. I doubt if a 100 hour course in addition to the current Paramedic cert is going to change the mindset for those who entered EMS for the emergencies and not to be glorified snot or butt wipers in a mobile van. The privilege of writing prescriptions for NPs also comes with remembering how to be a nurse in many situations especially when it comes to working the streets. This does not mean scoop and transport but establishing a care plan for many visits and being good enough to educate for compliance or know the resources which can. But this again means relying on others for a team effort rather than trying to have a penis measuring contest at the expense of the community.
mycrofft
Still crazy but elsewhere
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I worked as a primary care nurse conducting my own sick call using a 500 plus page standardized procedures manual. I was a former EMT and a baccalaureate prepared licensed RN with such experience in the field (military). I had good access to a MD at all times. At times, I would see fifty patients in eight hrs (yes), mostly just wanting some Advil or a Rx renewal.
Worked well with me. We had trouble with other RN's overreaching (inventing their own standardized proceduresw) or not being able to make enough decisions and turfing ALL the pts to the MD.
But without those standardized procedures (MD orders) I would have been virtually motionless. As it was, each successive review made the scope narrower and narrower until we couldn't order sudafed, tinactin, or normal saline eye drops.
Withbout an MD's orders, as protocol or SP or whatever, the nurse cannot do this.
Worked well with me. We had trouble with other RN's overreaching (inventing their own standardized proceduresw) or not being able to make enough decisions and turfing ALL the pts to the MD.
But without those standardized procedures (MD orders) I would have been virtually motionless. As it was, each successive review made the scope narrower and narrower until we couldn't order sudafed, tinactin, or normal saline eye drops.
Withbout an MD's orders, as protocol or SP or whatever, the nurse cannot do this.
If Paramedics are educated like NPs and PAs in community medicine at the Masters level and working solely in community medicine, would you consider them to be the same as the EMS Paramedics? What if they only get manikin intubation experience and no longer run 911 calls? Except for the name would they be the same?
Summit
Critical Crazy
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I don't know many nurses who want to work with paramedics on critical care transports and helicopters... oh wait... there bunches of em. :rofl:
Suffice to say, I don't see a PA vs NP problem here for the role. Both are suited and will self-select according to interest and practice limitations of their locale.
Sign me up (for the helicopter or the ambulance if I become a midlevel).
Most PA schools in most of the US are MS programs and most PA students have a BS. Most NP programs are MSN programs who accept only BSN RNs and are also 26 months long. DNP programs are optional extensions offered by a great many NP schools.
1240/1600 compares to an 1860/2400, ceteris paribus...but a 1240/2400 is just embarrassing
If it is just a straight 3:2 ratio, can I cash in my old 1510 for a 2265? Does that get me a front row seat for my MCAT? :wacko:
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Summit
Critical Crazy
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Echoing Clipper's last two posts, the provider role under discussion has long been the realm of the community health RN/NP. In fact, it bears very little resemblance to EMS and paramedicine. Community medicine really doesn't resemble emergency medicine AS EMS SEES IT (as opposed to how the ED is forced to deal with it). As Clipper points out, the role of a community health whatever is very far from the role EMS providers typically believe they fill (and train for).
In the military you probably would have a younger population and many of the pre-existing conditions requiring intensive followups would not be accepted in the military.
It seems you don't like RNs from this and just reading a few of your recent posts. An EMT also must turn their patients over to MDs. Your ego as an EMT might get you into trouble if you believe you can do it all without referring to a doctor. The original discussion concerns NPs and PAs. NPs are RNs who continue their education to a BSN and then a Masters level. Unless you have an understanding of the education and scope of practice for other professionals, it is really not appropriate for you to make such comments just in an attempt to make RNs look stupid.
EMTs and Paramedics also can not do anything without protocols from a doctor. If you compare RNs to Paramedics you will find the RN's scope of practice can easily be expanded. But still the discussion is about NPs and PAs in the community. That doesn't mean there are not RNs and many other HCWs involved in the needs of patients outside of the hospital
The distinction between what prehospital care as EMS sees it and what out of hospital care actually consists of. Not everything is an emergency. But, that does not mean not everything will be within a Paramedic's ability to diagnose and treat for a treat and release program. Only a few things are acute and obvious. Most disease process will require an advanced practitioner. There is also nothing wrong with referring to a doctor and even one who is a specialist. Doctors also refer to each other and do consults. NPs and PAs do have the knowledge to know when they are in over their abilities. Some with lessor training believe they can do it all because they don't know how much they don't know.
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JPINFV
Gadfly
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...because an EMT transferring care to a physician and a mid-level transferring care to a physician is completely the same thing. At the current situation, one is expected to be competent at treating and releasing within a certain population of patients. The other isn't. Where's the efficiency if the mid-level is going to triage a significant number of patients to a physician anyways? So we get to pay for a trip to the mid-level AND a trip to the physician? After all, fiscal efficiency is the only reason mid-levels exist.
wanderingmedic
RN, Paramedic
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Nursing is moving towards a DNP as the standard for nurse practitioners. The MSN programs for NP's are bring phased out and any current MS NP's are being grandfathered in.
Amberlamps916
Droog
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Dude, I thought my 1210/1600 was nothing to get excited about. I farted around during and after high school anyway so I never took advantage of that score. Now I'll end up being a transfer student from a jc. Still debating if I should follow my grandparent's footsteps (they were both general surgeons and my grandfather taught at The Royal College of Surgeons of Edinburgh, Scotland) and take the plunge into medical school or take the much maligned PA route. Decisions, decisions.
Summit
Critical Crazy
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This rumor is most persistent... usually it is accompanied with the "DNP entry by 2015" canard. That is what some want to see, it is a trend but it is NOT what is happening with any speed.
Once nursing academia adds universally stipulates that the DNP expansion has to have more clinically meaningful content, it will gain traction. That is only the case in some programs, thus plenty of schools and students continue to pass on it.