Re: Paramedics in the ER

[Guest guest]

With all due respect to the person who posted information from the Texas

Board of Nurse Examiners, unfortunately I believe that the waters may have

been muddied despite your obvious good intentions. While the issue of

" licensed verses unlicensed paramedic " may or may not have any relevance to

the issue of paramedics working in the hospital, it distracts from the far

more important point that was made: The statutes regarding the practice of

nursing have NO relevance on anyone except nurses!

Paramedics are not nurses. Physicians are not nurses. For example, physicians

cannot perform nursing assessments, because we are not nurses! If the state

or the Joint Commission requires that the patient receive a nursing

assessment, the doctor is not able to perform one.

On the other hand, a paramedic functioning under the laws allowing physician

delegation cannot be delegated nursing care, because physicians do not

delegate nursing care, physicians delegate MEDICAL care. Under the laws of

this state, a paramedic can never be delegated the responsibility to do a

nursing assessment in the ED; but he/she CAN be delegated the responsibility

to do a PATIENT assessment! The nursing profession has made this distinction

very clear: only nurses can do nursing. But everything that goes on inside

of a hospital is NOT nursing! Again, it's a matter of how the hospital has

defined the practice.

Yes, it's confusing. Why? Well, because realistically, some tasks are so

similar that you practically need to be a lawyer to understand how you can

split hairs about how they are technically different. Like many things in

this life, arbitrary definitions define what the perspective is, and what

rules apply. In this case, however, as I said before, it is up to the

HOSPITAL. The hospital can choose to have in-hospital use of medics defined

as a nursing function or as a medical function. If the hospital arbitrarily

defines it as nursing, the Nurse Practice Act is applicable and the medic is

severely restricted in function. If, however, the hospital arbitrarily

defines the medics function under the auspices of the medical staff, then the

physicians can define paramedic hospital practice in a way that resembles

field practice.

I pray for the day that all health care professionals can live and work

together without the constant struggles that have lead to the need for this

clarification. Perhaps paramedic licensure will help develop a more

functional working relationship between nursing and paramedicine. In the

meantime, the laws of the State of Texas allow a licensed physician from

delegating MEDICAL tasks to appropriately trained people (including certified

paramedics), and do not allow nurses to delegate NURSING tasks to non-nurses.

Hope this made the water clear again. Bob Suter, DO, MHA