Emergency room jobs for paramedics

[Arizonaffcep]

I am FT with University Medical Center in Tucson AZ. Most hospitals in the Tucson area do hire medics in the ED, also it's kinda cool here 'cause we are the only true teaching hospital in AZ, and also the only level 1 trauma center in Southern Arizona. The only places we can't work is in triage, or on the telemetry (orders for field medics via radio). My personal fav. place to work is in the trauma bays.

[AZCEP]

UMC is the only university affiliated "teaching hospital" in AZ. There are several others that are contracted sites for numerous residency programs.

[TJZ]

Many of the hospitals have paramedic jobs in WI ERs. I have been eyeing them

[StrchrFetchr]

You are right, JCAHO does not have a problem, they consider Paramedics as strictly technicians the same as an LPN in ER or critical care area. EMTALA only allows RN's to perform triage for MSE, and usually most areas only allow RN's to perform initial assessment.

Unfortunately, due to vast differences in educational levels provided by EMS education and training, it is hard to invest in Paramedics in the ER. When I was an ER manager, I attempted to employ Paramedics to be used to assist and use their license within their scope of training. Unfortunately, I have seen many ER's get burned and stop using Paramedics due to hiring Paramedics that lacked education, or attempted to perform skills outside their scope in the ER, the most response I heard of was due to poor professionalism.

It is a shame, but usually the worst enemy is definitely not nursing associations, boards, JCAHO, but ourselves. Think about it, in comparison how many Paramedics do you know of could actually be able to function at an ER level?

R/r 911

Funny you mention all of this, R/r, because [for me] it's all true.

I work FT in a relatively small suburban ER, with a grand total of about 18 beds. During the daytime, the Paramedic is banished to Triage for the day, where we have 2 expectations: Vital Signs on all triage patients, and IV access and blood draws for what the nurse orders. [Yes, what the Nurse orders...Ugh...].. And that's it. Occasionally, we'll meander inside to start IV access and assist in other CNA/ PCT duties, and transport patients. That's it.

My ER Manager states consistently that EMT-P's are unable to actually perform the triage, because of JACHO. [Maybe she means EMTALA, or doesn't know herself, HA!] She also informs us that we're unable to 'care for' a patient, as in have an assignment, for the same reason.

Above this, Paramedics are unable to administer medications to patients on the basis that due to State Nursing Regulations [Massachusetts], only Nurses are able to administer medications inside a hospital. [Which I am unable to find any documentation or verification of this for or against] What's somewhat laughable, is there's another sister hospital only 12 miles away where the Paramedics are allowed to practice at the state's EMS Protocols.

And, something I don't think I'll ever understand, Paramedics are unable to transport a monitored patient without a nurse present. Not a tremendously huge deal...But if the nurse doesn't bring a code box with her to transport the patient, why do you need a nurse? Paramedics are allowed to transport monitored patients in the other hospital, with another staff member who is not required to be a nurse.

So, we're quite limited at what we can do. That's it. It's weird, though...If there's an ICU or OR patient that Critical Care/ Anesthesia/ ER Doc can't intubate, we get the call to go do it... But only after the Nursing Supervisor Okays it.

((And sometimes, it's nursing [theory/ practice] that is the biggest hindrance to patient care...But that's another story))

Now, why? Are nurse's afraid? No. Intimidated? Some, yeah. I've had one nurse tell me she hates working with me because I intimidate her 'because you're so booksmart'. Legal Liability? Sure, in a hospital everyone deserves to have a state licensed RN to hold their hand. And knowledge? That's my guess. It's a small hospital that lives in the shadow merely minutes from, debatedly, some of the best hospitals in the world. Simply put: We don't get sick people. All sick people [e.g. Trauma, MI, Stroke, all pedi, etc etc] go to town. Our population is typically geriatric, and a good percentage nursing homes. We do sepsis better than many. It's what we do. But all this ER eveer sees EMT-P's do is Longboarding, splinting, and an occasional IV and/ or neb. In 7 months of FT employment, I can honestly say I've not seen nor heard of any ALS Ambulance transporting a patient to this ER and administering anything more than Oxygen, Albuterol, Atrovent, or a few cc's of Normal Saline.

/shrug

Sorry for the ranting. Maybe not so educational as it is cathartic, but it is something that exists somewhere... Hope you don't get to see it. ;-)

[ceejay2005]

Students who graduate from Paramedic Schools can find jobs in hospitals, fire departments, ambulance services and even police departments. In addition, Paramedics can also choose to work for private companies or city municipalities. Because of the intensity and the length of training, most aspiring paramedics do not take volunteer jobs.

With irregular work hours, paramedics can be called out at anytime, but reports have shown that most of them find their jobs interesting, and of course, challenging. Salaries vary depending on the level of training, the organization and the geographic location. Usually, they begin at approximately $25,000.

In some places, critical care departments and emergency units hire paramedics. They treat patients in pre-hospital settings with their advanced skills and knowledge in handling emergency cases. Experienced paramedics are also employed as medical providers in far-flung industrial sites like offshore oilrigs. With their expertise, abilities and resourcefulness, they have made noble contributions towards society and are in great demand.

[VentMedic]

And, something I don't think I'll ever understand, Paramedics are unable to transport a monitored patient without a nurse present. Not a tremendously huge deal...But if the nurse doesn't bring a code box with her to transport the patient, why do you need a nurse? Paramedics are allowed to transport monitored patients in the other hospital, with another staff member who is not required to be a nurse.

This is one of the reasons why a nurse or other licensed staff member who is familiar with a hospital goes with you. It seems you are not familiar with the workings of a hospital, Nurses know there are code carts easily within reach almost everywhere. All he/she has to do is identify a problem. There is no need to carry the equivalent of an ambulance with you from the ED to the ICU. The code team can also stabilize to the protocols of the hospital which may include many more pressors or whatever drugs that a Paramedic may not be familiar with. The team's protocols are written by their medical director who is usually a Critical Care Medicine physician.

In the hospital, and in the field, the Paramedic is essentially a tech. Period. The certification does not carry enough weight with the minimal education standards to meet the requirements of a licensed professional.

Now, why? Are nurse's afraid? No. Intimidated? Some, yeah. I've had one nurse tell me she hates working with me because I intimidate her 'because you're so booksmart'. Legal Liability? Sure, in a hospital everyone deserves to have a state licensed RN to hold their hand. And knowledge? That's my guess. It's a small hospital that lives in the shadow merely minutes from, debatedly, some of the best hospitals in the world. Simply put: We don't get sick people. All sick people [e.g. Trauma, MI, Stroke, all pedi, etc etc] go to town. Our population is typically geriatric, and a good percentage nursing homes. We do sepsis better than many. It's what we do. But all this ER eveer sees EMT-P's do is Longboarding, splinting, and an occasional IV and/ or neb. In 7 months of FT employment, I can honestly say I've not seen nor heard of any ALS Ambulance transporting a patient to this ER and administering anything more than Oxygen, Albuterol, Atrovent, or a few cc's of Normal Saline.

/shrug

Sorry for the ranting. Maybe not so educational as it is cathartic, but it is something that exists somewhere... Hope you don't get to see it. ;-)

You don't consider sepsis "sick"? Do you know how many patients die from sepsis? Geriatric? Do you not believe any patient that lives in a nursing home has a legitimate "sickness" or can be really, really sick?

There is a huge part of assessment and medicine missing in your education. If you were booksmart you would recognize this. The nurse who said you were so booksmart was probably being flirty or kind as not to know how to not offend you. Or, maybe you impressed her by reciting your protocols like memorized poetry.

As long as you continue to only list skills, nurses have nothing to fear. It is the assessment portion that makes them very valuable. Paramedics are not taught the full assessment and needs of a patient inside the hospital. Your assessment in the field is to identify immediate problems.

My advice to you is to learn how the hospital environment functions. It is a poor excuse to just say "they afraid of us". Know your own limitations within your own state EMS statutes. Often the way EMS wrote they statutes they use the terms prehospital only. Know the regulations required of your hospital by their accreditation agencies. Understand the professional reimbursement scales and where the hospital may be left out if an unrecognized tech performs certain skills. Learn what their liability is if their allow certain techs perform these skills.

For assessment, look at the RNs paperwork. Note some of the things that were not taught in Paramedic school. Pull out the nurses P&P manual which should be at least two large volumes or an extensive list online.

I would bet those Paramedics in the other hospital still function under the supervision of a nurse. Prehospital protocols do not supercede those of the hospital within the walls of a hospital. Just because you are allowed to push a certain med for something outside of the hospital does not mean that will be the appropriate pathway inside the hospital. You must understand some of the differences between prehospital and in the hospital. In the hospital you are working with known values so there would be no defense if you did as you normally do in prehospital especially if that known value would prevent you from causing harm.