Nurses working in EMS system?

[rangermedic]

well i do have to admit the fresh backed cookies were nice.

[WelshMedic]

What is that with EMS and low-pay? It really is the same the world over. It's no different here either. I get paid less than my ER colleaugue even though I've been through the same post-graduate courses + I have my EMS qualification. He/she also doesn't have anything like the same responsibility, there's always a doctor on hand to run to. There really must be something about working on the streets that we let this happen globally

Interesting - shall we have a ballot for a world wide strike?

WM

[VentMedic]

What is that with EMS and low-pay? It really is the same the world over. It's no different here either. I get paid less than my ER colleaugue even though I've been through the same post-graduate courses + I have my EMS qualification. He/she also doesn't have anything like the same responsibility, there's always a doctor on hand to run to. There really must be something about working on the streets that we let this happen globally

Interesting - shall we have a ballot for a world wide strike?

WM

Reasons for Nurses to make more money:

1. In the U.S., no set minimum educational standard or consistent licensure for Paramedics.

2. Many more patients for 1 nurse to be responsible for continously for 8 or 12 hours.

The number can range from 2 in ICU to 15 on a med-surg floor. In nursing homes, one RN may be responsible for 25 patients at one time. There are some paramedics that will not see that many patients in one month. EMS: for the majority of the time it is still 1:1.

3. Continous work for 8 or 12 hours with an occasional chance for a break and definitely no sleep on the night shift (unless you are a California nurse).

There are some very busy EMS stations and then there are some that may only run 1 or 2 calls and you will hear people still complain that is too many.

4. A Nurse must deal with the same obnoxious and/or violent patient (or 2 or 3) the entire shift. EMS unloads those patients quickly and disappears. The nurses will also get the family and all of their problems for the enitire shift. This will be in addition to the families of his/her other patients all demanding time NOW.

5. Nurses must endure constant scrutiny of their behavior and skills in the hospital by administration, peers, patients and their family members. QA/QC of everything they write, say and do. No matter how perfectly they have performed, there will always be some criticism.

6. Nurses learned long ago they were mighty in numbers and unity was the best way to get things accomplished. More important then unions are the professional organizations that represent them at local, State and National levels.

7. Myth: There's always a doctor around.

Many nurses and other health care professionals work under protocols. There are times when a doctor is not able to be reached by telephone. ER doctors may or may not help out. ER doctors rarely set foot in the ICU areas if they can avoid it. The ER is their responsibility and they must stay available there if at all possible. The hospitals now have Rapid Response Teams (RN/RT) to act quickly under protocols to get a patient through a crisis before something worst happens. ICU and ER nurses can be very impressive in an emergency situation. Those that don't know what RNs can be capable of have not been around many critical care settings. Critical Care RNs and RTs don't wait for a doctor to get the life-saving started.

8. For anybody that doesn't think nursing and total patient/family care for 8 or 12 hours, I can try to get some input from the 3 of the 5 paramedics who just quit nursing school. The remaining 2 EMT-Ps are looking pretty discouraged also. They are in a bridge program with LVNs who all 10 for 10 are still around.

[BEorP]

What is that with EMS and low-pay? It really is the same the world over. It's no different here either. I get paid less than my ER colleaugue even though I've been through the same post-graduate courses + I have my EMS qualification. He/she also doesn't have anything like the same responsibility, there's always a doctor on hand to run to. There really must be something about working on the streets that we let this happen globally

In Ontario, Primary Care Paramedics (BLS) are typically paid more than Nurses.

[frontcrawl]

WelshMedic is a nurse, working as a nurse. Dutch ambulances are staffed with a nurse and a driver. Now, can we take that into account?

[ksbparagod]

This is a very interesting topic to me as I am both a Paramedic and a nurse. In my opinion I feel that all nurses (especially those that work in the ER) should be required to do some ride time with the ambulances so that they can see what we have to deal with in the field sometimes. This way when you bring a pt into them they won't sit there and go what did you do that for or why did you bring him here and not take the pt to a different facility.

[VentMedic]

This is a very interesting topic to me as I am both a Paramedic and a nurse. In my opinion I feel that all nurses (especially those that work in the ER) should be required to do some ride time with the ambulances so that they can see what we have to deal with in the field sometimes. This way when you bring a pt into them they won't sit there and go what did you do that for or why did you bring him here and not take the pt to a different facility.

Then as a nurse you probably know many times the nurses may have a valid point. Example; Why did you bring them to that facility?

This is true especially in the city where there are many hospitals of many different specialties. In many areas, it was decided to allow paramedics to make their own decisions on appropriate facilities. Cardiac to cardiac centers, CVA to stroke centers and trauma to trauma centers. Yet, in many cases we have ambulances bringing everything but the above to the appropriate centers and an AMI gets dumped at little General less than a half mile from a cath lab. Then a NURSE from that ER has to get into another ambulance, leaving that ER short staffed, to transport the patient to the cath lab.

Diversion is another topic that gets Paramedics upset. If the ER is full, its full and the staff is maxed. Why make the patient suffer in an overcrowded ER when again in the city there is another ER just a few blocks away. Yelling and complaining to nurses is not going to make the system work any better. In rural areas, the little hospitals have no choice. The nurses will be stuck more patients than they can safely watch for all 8 or 12 hours and the EMS crew leaves.

And, the "short of breath thing" when the patient is talking and on room air gets old as a reason to take to the closest facility. I have even pulled this one a couple of times as a Paramedic for a quick unload, although, I did make sure the patient was wearing oxygen when I entered the ER.

Of course, maybe hospital workers might pick on the next crew that comes along because the other crew members were total wastes as far as paitent care. Too often the standards and expectations get set at the lowest level and those who do excel at patient care get the brunt of the criticisms.

Now, as far as comparing U.S. Paramedics to the Paramedics in other countries; apples and oranges. The U.S. does not have set minimums in place to adequately form a comparison. The 46 certifications that make up different State EMS programs are a good example of that.

To the dually credentialed RN/EMT-Ps, if you have it so rough in the field, why not work for more money and what you believe to be better conditions in the hospital?

I crossed over for the money and better hours after 20 years in EMS. I also enjoy keeping most of my "Paramedic" skills in the hospital while acquiring more knowledge and other advanced skills. I did spend a few years working both jobs just to get a comfort level established for a career change.

[anchormedic]

Interesting topic. I can not help giving my two cents worth when I read about nursing practitioners working in the pre-hospital setting. First the good - It is great to hear that nurses are allowed / required to work in the pre-hospital emergency medical field. Even more so when it is happening in developed countries. Now the bad - extricating baby Jessy Brown from the tangled wreck that used to be Mr. Browns car is a job for a qualified Advance Life Support Paramedic and the extrication team working under his command. If - and this is a BIIIG if - ambulances where only required to perform paliative care and no acute emergencies then I will be the first to promote Nursing sisters working on an Ambulance.

[VentMedic]

Interesting topic. I can not help giving my two cents worth when I read about nursing practitioners working in the pre-hospital setting. First the good - It is great to hear that nurses are allowed / required to work in the pre-hospital emergency medical field. Even more so when it is happening in developed countries. Now the bad - extricating baby Jessy Brown from the tangled wreck that used to be Mr. Browns car is a job for a qualified Advance Life Support Paramedic and the extrication team working under his command. If - and this is a BIIIG if - ambulances where only required to perform paliative care and no acute emergencies then I will be the first to promote Nursing sisters working on an Ambulance.

Your post assumes paramedics are male and nurses are female.

Extrication skills can be easily taught and used by nurses or just about anyone else in the emergency field. We've seen volunteers (EMS and FD), EMTs and Paramedics do this with minimal education or hands on training. The medic factories proved this point. Nurses in ICUs/EDs/CCT/Specialty Transport Teams practice Advanced Life Support on all ages very well without a paramedic's assistance and at times outside of the hospital on ambulances. Nurses and a variety of other providers work outside of the hospital in ambulances in many roles in the U.S. Nurses have been in various aspects of the emergency field for several decades. HEMS nurses direct ground extrication crews with no problem. You might be surprised to see it is RNs that are the directors of many Paramedic education programs in the U.S. Nurses have also been on ambulances in other countries for several decades. Nurses have been a vital part of developing pre-hospital care in under-developed and developed countries including the U.S. And, let us not forget our "sister nurses" serving in the armed forces in a variety of roles.

If EMTs and Paramedics don't want to push for some standards in education and professionalism or even agree on what their profession is, then maybe the nurses are the best to pave the way to push EMS into the future.

[WelshMedic]

I really was a man the last time I checked, my wife and kids may be able to confim this.....

But seriously, education is the way forward. We went through the same struggle in the 70's and 80's. Before then we were seen as doctor's handmaidens. I started in the early eighties and I distinctly remember being told by a fossil of an RN that she thought there was something wrong about men in nursing. It just wasn't right! We weren't compassionate enough. To which I replied: "How come the first "nurses" were Benedictine monks then?"

One of the misunderstandings is that people tend to have certain images and expectations of a particular profession. Nurses=white uniform/female/hospital based. But like many things in health care today, these boundaries are blurring. I happen to work in an EMS system where it is nurse based, we never had the military history that spawned modern-day paramedicine. But I do exactly the same job, I stand in a ditch at 3 am cannulating someone. I tell the firefairies how we are going to do things with an extrication (although often this is a question is teamwork).

I think it's time to stop judging a whole profession on whether or not they're suited to EMS and start judging the individual on their skills and competencies. I carry the title RN, but I still do the same job as a medic. The only thing that matters is whether I do it well.

WM