theotherphil Posted February 10, 2008 Share Posted February 10, 2008 This is about the only respectable comment in this discussion..at least after it got past the initial comments. As said before..two different jobs and, most of the time, two different types of individuals do them. The bickering never ceases to amaze me.. :roll: Absolutely! The funny thing is, there is no bickering between Paramedics and Nurses at the 3 major hospitals I service. The nurses do a fab job under difficult circumstances and they excel in their own environment. We have a really good working relationship. They never profess to being able to do our job and in fact, many say they wouldn't want it. The same for us, I wouldn't want to work in hospital and certainly don't profess to be able to do the job of a Nurse even if the roles are similar to some degree. Zippy's comments are his own misguided views and are not that of every nurse. Link to comment Share on other sites More sharing options...
zippyRN Posted February 10, 2008 Share Posted February 10, 2008 Zippy talks crap in all forums he frequents. He feels that ferrying around grandma's for routine appointments is "experience in pre-hospital care" :roll: doing 999s and Urgents on support work? i've done One day of PTS for SJA in the last 5 years, i 've done Hundred + shifts of ambulance support and same again or more of event cover ... doing the town centre stuff it;s pure 999 work (or would be if we weren't being used instead of 999 - we are dispatched on the pubwatch/ shopwatch radio system) Here in the UK, nurses may be registered but they are far from autonoumous as Zippy suggests. Almost all clinical interventions/ prescriptions/ administering of meds need to be authorised by the Dr first. wrong ! all initial assesment interventions under taken in the ED or on assessment units are undertaken without being authorised by a doctor first , unless you suggest that the fact the consultants are consulted aobut the standing procedures and the content of PGDs ... the chest pain pathway prior to primary PCI in our locality was entirely Nurse led (now certain patients are sent direct for PCI by paramedics and others are being emergency transferred from the ED for primary PCI) and the Cardiac NPs are all independent prescribers... as are an increasing number of the ENPs ... Outside of Hospital, they can only practice to the level of an EMT (basic)...sure they can start an IV, but they cannot push anything through it without a script. or a PGD, or by virtue of being an independent prescriber ... just like the Nurse background ECPs ... No advanced airway interventions (RN's don't intubate here, that's for Paramedics or Doctors). rubbish , RNs can and do intubate , the numbers who are confident to do so are limited partly because we can't get the theatre time to get the practice to be able to provide a bolam /bolitho proof standard of practice So, at the scene of an RTC, an RN here wouldn't be much use to us other than for taking C-Spine control or applying dressings. To be fair though, there'll be 20+ Firemen that can do that for me so help not needed thanks! Whether Zippy likes it or not, if he gets in the way on scene he can and will be removed. i would remind you of the following statement from the NMC code of professional conduct "1.3 You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional. " i would remind you of the following statement from the HPC's Standards of Performance, Conduct and Ethics "As a health professional, you must protect the health and wellbeing of people who use or need your services in every circumstance. ... 6. act within the limits of your knowledge, skills and experience and, if necessary, refer on to another professional; ... 7. maintain proper and effective communications with patients, clients, users, carers and professionals; You must take all reasonable steps to make sure that you can communicate properly and effectively with your patients, clients and users, and their carers and family. You must also communicate effectively, co-operate, and share your knowledge and expertise with professional colleagues for the benefit of patients, clients and users." Paramedics here are fully autonomous and work under their own licence. They can practice even when they are not on duty - and, indeed, would be expected to if needed. Nurses here are fully autonomous and work under their own licence. They can practice even when they are not on duty - and, indeed, would be expected to if needed. once again those claiming to be UK paramedics have demonstrated an inaccurate and incorrect understanding of thescope ofpractice of the Registered Nurses, based it seems on the assumption that the core skills of the registered Nurse on registration are the only skills they have and that Nurses some how need the permission of Doctors to do anything ... the only 'permission' that a ( none- prescriber) Nurse 'needs' from a doctor is to administer prescription only medicines not covered by PGDs or other arrangements... virtually everything other intervention is either a matter for the employing body or general professional standards this is why the term 'orders' is not recognised in the UK in relation to the plan of care suggested by a doctor ... Link to comment Share on other sites More sharing options...
theotherphil Posted February 10, 2008 Share Posted February 10, 2008 Zippy, being an independant prescriber means nothing pre-hospital. You cannot operate to that level in the pre-hospital environment. all initial assesment interventions under taken in the ED or on assessment units are undertaken without being authorised by a doctor first Then you walk round to the Dr and say sign this....authorising your interventions. Sure, it's not the right way to do things but that's what happens....I know this as my partner works in A&E in a major hospital. Extended skills nurses are few and far between. In fact, they can't even afford standard nurses and are employing Associate Practitioners....cheaper nurses in all but registration. Isn't it right that you've been moved from the ED to a general medical admissions ward? I'm sure you'll find some way to big that up and make it sound like a promotion. i would remind you of the following statement from the NMC code of professional conduct blah, blah, blah In the pre-hospital environment, you are not a statutory responder and you have no rights on scene. If you get in the way, you will be removed...simple. You can wave your arms and shout as much as you want about NMC this and HPC that but it'll get you nowhere fast. Sorry, but if you turn up on scene, I don't know you from Adam and I couldn't care less what you can or can't do. You'll be there as my guest or not at all. the only 'permission' that a ( none- prescriber) Nurse 'needs' from a doctor is to administer prescription only medicines not covered by PGDs or other arrangements... Those arrangements only extend to the hospital environment and when you are during working hours. Pre-hospital, you cannot do anything more than a EMT. That's all I have to say on the matter, I won't be drawn into petty squabbling with you. Link to comment Share on other sites More sharing options...
zippyRN Posted February 10, 2008 Share Posted February 10, 2008 Zippy, being an independant prescriber means nothing pre-hospital. You cannot operate to that level in the pre-hospital environment. says who ? an independent prescriber can prescribe in any situation, can issue private scripts, can order drugs for their own use i nthe same way docs can... all initial assesment interventions under taken in the ED or on assessment units are undertaken without being authorised by a doctor first Then you walk round to the Dr and say sign this ....authorising your interventions. Sure, it's not the right way to do things but that's what happens....I know this as my partner works in A&E in a major hospital. Link to comment Share on other sites More sharing options...
chbare Posted February 10, 2008 Share Posted February 10, 2008 Ok, then. Is this really a global problem? Are EMS providers constantly having to remove nurses from the scene? It seems that only in medicine do we have to debate this problem. If somebodies car brakes down on the side of the road, you do not see off duty mechanics fighting with the wrecker crew over how to take care of the problem. Nor do I see off duty garbage men or hamburger cooks fighting over how to provide me with their services. Yes, I see what I do as a service. When I am off duty, I am not a nurse. It is that simple. I am more than happy to let somebody else deal with the emergency. I have stopped a couple of times in my career to provide BLS care, then promptly left when help arrived. It seems that we are getting carried away over something that in my mind should not be a problem. Take care, chbare. Link to comment Share on other sites More sharing options...
zippyRN Posted February 10, 2008 Share Posted February 10, 2008 <snip> When I am off duty, I am not a nurse. It is that simple. I am more than happy to let somebody else deal with the emergency. I have stopped a couple of times in my career to provide BLS care, then promptly left when help arrived. It seems that we are getting carried away over something that in my mind should not be a problem. Take care, chbare. one ofthe problems in rightpondia at least is that a nurse will be held to his /her own scope of practice regardless of off duty or on, the only real get out is lack of equipment ... also in rightpondia no health professional can 'order' any other health professional to do anything ... also if a paramedic doesn't turn up to scene the nurse will be held accountable for the patient's care until they reach hospital, regalrdess of whether they travel or not, as it can be held that the nurse delegated care to non-Health Professional provider especially if the Nurse in question has demonstrable emergency care skills, knowledge and experience... Link to comment Share on other sites More sharing options...
theotherphil Posted February 10, 2008 Share Posted February 10, 2008 Ok, then. Is this really a global problem? Are EMS providers constantly having to remove nurses from the scene? Take care, chbare. Nope, we are quite happy to have the help of any person who is competent. I have never ordered anybody off scene but if somebody turned up with the attitude that Zippy displays, I'd be more than happy to. We have a new law over here, the Emergency Workers Obstruction Act which pretty much gives us the right to have any person removed from scene who is not acting on the behalf of Fire and Rescue, the crown or a statutory Ambulance service. Turning up off duty saying you're a nurse/ doctor/ whatever means nothing if you're getting in our way. The NHS Ambulance service is the statutory provider of pre-hospital care. 1 Obstructing or hindering certain emergency workers responding to emergency circumstances (1) A person who without reasonable excuse obstructs or hinders another while that other person is, in a capacity mentioned in subsection (2) below, responding to emergency circumstances, commits an offence. (2) The capacity referred to in subsection (1) above is— (a) that of a person employed by a fire and rescue authority in England and Wales; ( in relation to England and Wales, that of a person (other than a person falling within paragraph (a)) whose duties as an employee or as a servant of the Crown involve— (i) extinguishing fires; or (ii) protecting life and property in the event of a fire; © that of a person employed by a relevant NHS body in the provision of ambulance services (including air ambulance services), or of a person providing such services pursuant to arrangements made by, or at the request of, a relevant NHS body; (d) that of a person providing services for the transport of organs, blood, equipment or personnel pursuant to arrangements made by, or at the request of, a relevant NHS body; (e) that of a member of Her Majesty’s Coastguard; (f) that of a member of the crew of a vessel operated by— (i) the Royal National Lifeboat Institution, or (ii) any other person or organisation operating a vessel for the purpose of providing a rescue service, or a person who musters the crew of such a vessel or attends to its launch or recovery. Link to comment Share on other sites More sharing options...
zippyRN Posted February 10, 2008 Share Posted February 10, 2008 note my emboldening also note that should someone happen to be there when contracted to an NHS organisation... it doesn't apply also you need to consider the situation where the person you claim is 'obstructing' you is already on scene and by virtue of that already has a legally ( and professionally ) established duty of care Link to comment Share on other sites More sharing options...
JPINFV Posted February 10, 2008 Share Posted February 10, 2008 Wow, this thread is still going, complete with the ad hominem attacks... Link to comment Share on other sites More sharing options...
scott33 Posted February 10, 2008 Share Posted February 10, 2008 I work on an Assessment Unit which takes all the medical admissions other than those who go direct to CCU and a significant proportion of the general and vascular surgical admissions, the unit also provides the clinical decisions unit beds on the site i work at ( it doesn't on the other site the ED staffs them - i helped set it up - one ofthe reasons i was asked to move to the assessment unit ) and the grossly mis named (at present ) 'short stay unit' - which had been being used as a bit of a dumping ground ... thanks to the inabiliy of social services to 'do what it says on the tin' Sounds very familiar. Though over here in "Rightpondia" we would call you a Holding Nurse! All the "not-really-an-emergency" emergencies, referrals for admission from PMDs, and crap you cannot fast track and D/C in under an hour. Call me Mr Picky, but I think I would rather stick to emergency nursing Link to comment Share on other sites More sharing options...
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