Sunday, November 30, 2008

Battle for the ERs

"The funniest thing I ever heard a nurse say was that Paramedics don't belong in triage. "

I am not anti-nurse, but I would like to explore the subject of Paramedics in the ER. Why do nurses run the ER? What is an ER? Emergency Rooms are used to assess newly arriving patients and determine if they need to be admitted to the hospital, or can be treated and sent home. Emergency Room Doctors are equipped to handle a myriad of diseases and trauma, temporarily, until proper long term care can be established. An ER is not meant to be a long term care facility. The idea is get them in and get them out, or admit them. Everybody knows the saying, "Greet them, Treat them, Street them." What is a nurse? The very definition of nursing is to care for in a long term manner, as in to nurse back to health. That is why you see nurses in Hospice and NURSING HOMES!!! What is a Paramedic? A paramedic was created to provide short term care to sick and injured people until they could be cared for, long term, by a doctor or nurse. They specialize in triage and transport. So I ask again, why are nurses running the ERs?

Paramedics have taken over the role of the house-calling doctor. No, I'm not calling us doctors, but we do go to people's houses and treat what we can while we transport to the hospital. We work under an extension of a Medical Directors license as put forth by the Medical Control Office's Protocols. Where I am from, we do not need to call online medical direction for anything, unless we just need advice. I am seeing more and more Paramedics being utilized in the ERs around here, but only under the descretion of the nurses. They are treated as techs. Nurses cannot intubate, do surgical airways, or many other things that Paramedics can do, so why are we taking a role that limits our abilities? Wouldn't it make more sense to place Paramedics in the nurses place, to work alongside of the ER doctors and actually help them treat and care for the patients seen in the ER? I know nurses do that same thing, but not like a Paramedic would be able to. Regardless of how you feel about Paramedics and nurses, the end result should be to the patients benefit, and by having a person who can intubate and do many other things that a nurse cannot, the patient would definately benefit. I'm not saying that nurses need to leave the hospital, but they should have a bigger role on the floors, where long term care is needed. There is a nursing shortage ater all, that would help alleviate the nursing shortage, as well as the Paramedic shortage. Paramedics working in the ERs would get paid much more than street medics (they traditionally have), which would lure more people to the field. It would be a trickle efect.

So why isn't this going to happen? Nursing Union! They have been here longer, took control of the ER long ago, and won't give it up, even if it means that the patient doesn't get the benefit. I'm not saying there aren't nurses out there that cannot intubate, do sugical airways, and whatever else, but they aren't trained that way. They have to take extra classes and whatnot to get the experience. Paramedics are trained that way from the go, and we specialize in short term medical care, like TRIAGE!! When was the last time a nurse intubated as opposed to a Paramedic? When was the last time nurses were put in charge of Triage at a mass casualty incident? I am sure there will be nurses that say, I have, or I do, or I do all the time. They are the exceptions, not the norm. The only way Paramedics will start to win the Battle for the Ers is with higher education. Everything with us starts with more education. I advise all the medics out there to look into higher education and go get your Baccalaureate.

Paramedics need to look into the ERs and explore what could be.

I mean no malice or harm to any nurses reading this. I am not against nursing, I just don't understand this trend we have going in the ERs. This is just the tip of the ice-burg and I could go on, but I don't want to monopolize the blog. PLease let me know what you think. Thank you



MedicThree said...

SO many hospitals round here use Medics as "nurse extenders" like PA's are Doctor Extenders.

Lots of smaller hospitals love using medics as they often have more freedom based on their standing order basis.

That being said--a GOOD ER nurse knows WAY more about the physiology of the myriad of illnesses that they see in the ED. I treat symptoms, but rarely understand the overlying conditions(though I'm really trying to learn). Good nurses are supposed to know the whole reason before doing anything. Not that this is the case.

Zumstin said...

Thank you for your reply, unfortunately I'm not sure exactly what your stance is. I mean no disrespect, but you really didn't say anything.Yeah "GOOD ER nurses know WAY more about the physiology," but the same is said about a GOOD Paramedic or GOOD ER Doctor. I think you will see that most ERs are turning to Paramedics because of their freedom to do things based on their standing orders and skill level, but my concern is moving Paramedics away from the "Nurse Extenders" into a secondary care giver in the ER, not a tertiary or even a quaternary one. Why do ERs pay Paramedics MORE money to do LESS work? It's ridiculous!

I would hope that ALL medics, nurses, doctors, or anyone else in a patient caring profession knows what they hell they are treating. This is why I keep after the notion of higher education for our profession, as a requirement!


Chris T. said...

I'm a nurse. I'm not offended by what you said simply because you know not of what you speek.Nurses can intubate and do surgical airways, amongst a myriad of other procedures in the ER. I've been trained and done intubation, surgical airways and placed subclavians in the ER when the Dr. was having a hard time getting access or busy with something else.Nurses run the ER because we are trained in HOSPITAL care,you are trained in PRE-hospital care. there is a large crossover in this skill set in the ER but a lot of ER isn't simple treat 'em and street 'em. Much of it is also surgery, tele, ICU, etc prep and treatment and a lot of this would be a bit alien to the EMT-P just as field trauma is alien to an ER nurse. I've always wondered why there is such animosity/feud like competition between the 2 fields. Each job is equally important and vital to the well-being of the patients.

Zumstin said...

You assume I know not what I am talking about. I am by no means the voice of paramedics, but to say I don't know what I am talking about is a big leap. Yes, some nurses can intubate and start subclavians and whatnot, but that is not what they are trained for. At least not around here. You said,"Much of it is also surgery, tele, ICU, etc " Yeah, on the floor, not in the ER. That is my point. Nurses are better trained and equipped to run the floors, not the ERs. Well, maybe they are right now because they have been doing it for so long, but paramedics are trained for emergency care. Yes there are emergency care nurses, but the nursing field is geared towards long term care, not short term like pre-hospital and ER. When I send my paramedic students to the hospital to learn about pt. care and treatments, they get stuck doing the grunt work of the nurses, not rewal pt. care. Not blaming you or the majority of nurses, but you wonder where the animosity comes from, this is a good example. There are always exception to the rule, and I'm sure you will claim that status for yourself, as you have already done. I am talking about the status norm, not the special nurses that go the extra mile.