medic v/s RN

[Guest guest]

In a recent post Eib wrote: " there are a lot

of nurses out there that

think that they are superior to all Paramedics

and think that they should

just be able to work on an ambulance without

any further education."

Mr. Eib made the common mistake of generalizing

the thoughts and opinions of the few for the majority. It is my experience

that there are many more nurses who think that the paramedic has a unique

position and would not like to be in that position for anything in the

world. Many nurses respect the position and the job the paramedic

performs and admire it. Very few in fact feel that they could step

into the role as paramedic and function as an experienced paramedic can.

Admittedly there are some who feel they could do just as good a job as

the paramedic, just as there are a few paramedics who feel they could step

into a nurses role and perform up to standard. They both are wrong!!!

Being both an experienced paramedic with municipal

911 service experience and an RN with Level 1 Trauma experience I know

of what I speak of. Both would be the proverbial fish out of water.

"Correct me if I'm wrong, but I think

that Paramedics are able to do and do every

skill that an RN does with the added skills

of endotracheal intubation,

external jugular IVs, intraosous IVs,

and in some places subclavian IVs."

Ok, I will. Nurses who participate in ACLS

are trained in endotracheal intubations, nurses who participate in PALS

are trained in intraosseous infusions, and nurses trained in peripheral

IVs also know how to start an EJ. Their constraints are the same

as that of the paramedic. Those institutions that allow their employees

to perform these invasive techniques are experienced to do so and those

that are not, are not. Many of your rural ERs depend upon the nurses

to perform these skills. Take for example the small town ER manned

on the weekend by the moonlighting podiatrist or optomatrist. Their

skill experience is very limited and if not for the paramedic or the nurse,

procedures would go undone. "

Paramedics are able to do and do every skill that an RN does ".

How many paramedics are experienced in ng tubes, foley catheters, swan

ganz catheters, ICP monitering, etc...? Probably very few.

Watch what you THINK is the skill level of a profession you have no experience

in.

"Also, are Paramedics allowed to take a course

other than the full nursing

courses and become an RN, probably not."

Lets remember the difference between the educational

approach to the paramedic as opposed to the nurse. The paramedic's

education emphasizes HOW whereas the nurses education emphasizes WHY.

I think we would all agree that it takes longer to teach why than it does

to teach how. The incorrect insinuation that is made is that a RN

can simply pay a fee and sit for the paramedic exam. If you would

review the TDH web page for RN to paramedic you can realize there is more

to it than that. An Rn is exempt from much of the paramedic course,

but is still required to attend an extrication class, perform EMS clinical

rotations and perform an intubation in the OR, just like a paramedic does.

Also, the RN must pay and pass the basic EMT test befor being allowed to

pay for and take the Paramedic exam. Do the nurses who do challenge

the exams become just as certified (or licensed) yes. Do the majority

of them feel that they would be comfortable in that role? No. Many

receive their certification as a means of understanding the other

side and some receive bonus pay for their certification as an ER nurse

because of their expanded knowledge. (much like CEN or CCRN certifications.)

" Has

anyone thought that if the nursing community becomes over saturated

(and it is) will these EMS nurses want to start running on

an ambulance".

It is highly unlikely that any RN will sacrifice

an average income of 36K/year for a paramedic position for an average of

20-24K/year. Granted some salaries are higher and some are lower

for both professions, but the likelihood of nurses taking over the EMS

profession is minimal at best. Your job is safe, at least from a

nurses stand point. "How many people will

have to suffer further injury or death because of incompetent nurses

in the ambulances." Once again, don't worry!

Please don't make the mistake of thinking that

I am pro nurse and negative paramedic. I am probably the most pro

paramedic nurse anywhere! I have on many occassions defended paramedics

from the fury of the few nurses that Mr. Eib has generalized about.

As a training nurse for the San Fire Department and riding on the

ambulances in the capacity as both an RN and a paramedic I can say that,

while I disagree with his assessment of the nursing profession as a whole,

and his broad generalization of nurse bad-paramedic good, he does attempt

to address a common problem. That being an unending animosity between

nurses and paramedics. And his comments do nothing to cure the problem,

but rather only add fuel to the fire. We all must realize that we

are not individual entities when it comes to patient care, but rather members

of an elite team of professional that must work together for the sake of

patient care. It does the patient no good if the paramedic and nurse

don't communicate on a professional basis because he or she as a bone to

pick because of an attitude or history of lack or respect for each other's

profession.

The University of Texas Health Science at San

's Department of EMT has taken a major step towards bridging this

gap between ER nurses and paramedics. We are offering a continuing

education program for ER nurses, good for 10 hours of type I credits for

nurses who ride with a training officer(RN/Paramedic) aboard the SAFD MICU

ambulances for (3) eight hour shifts. Thus far in the program's overall

concensus has been a very positive one. The nurses are able to see

the other side of the picture,. are able to communicate with the paramedics

and the two professions get a better understanding of eaches roles and

responsibilities. The result is a better rapport between the two

and a decrease in the biggest barrier between them, a lack of knowledge

of the other side of the picture. Maybe we should consider in the

future a continuing education program for the paramedic that allows him

or her to walk in the shoes of an ER nurse, with the first invitation going

to Mr. Eib.

Thanks,

Wayne L. Kierce, RN,BSN,CEN,CCRN,EMT/P,CTO