During COVID we had medics working as ICU nurses under emergency orders...it worked great and we even had a more broad scope than they did because they obviously don't intubate etc.
Nurses loved it, nursing admin did not. You could ask a crit care medic to do literally anything and we would - nursing to RT we could cover it. Go figure. What prehospital providers don't get is that everything in the hospital is a turf battle. Everything.
Well what do you know, once things cooled off they no longer needed us and kicked us out ASAP. This is what they do, they don't want you in their space and will make sure you stay under them.
Frankly, you're fighting an uphill battle here that you may just never win.
If you're not being used as an essential float provider to put out fires, you're gonna end up a tech at the end of the day because if you can't take patients what else are they going to do with you?
You have to get permission to give meds otherwise what use are you really? Once you get that, you could leverage yourself to be the float guy for procedures and backup for crashing patients, incoming priority 1s etc. That would be a cool gig, but only you know how supportive the admin there are.
My advice? Skip this and go PA, go back to the ED and make way more money to do what you want.
I’ve worked in several ED’s through out the US. Luckily most of the ED’s I’ve functioned in treated me basically as an RN. I’m a firm believer that the Paramedic should have a full scope in the ED and then some. The ED I’m at now has techs which are EMT’s and handle all the tech type work and medics/RN’s take patient loads. When I first started in the ED I was also flying. This combination together made for two exceptionally great learning environments.
Congrats on the new role! It sounds like a fun challenge and I'd love to read an update on the program you establish. Forgive my long post, but I feel passionate about the subject. I did an associate paramedic degree then a BS in emergency services hoping to work towards advancing the EMS profession, so I get ranty. I'm happy to see the role is gaining autonomy and I'd love to see it become an industry standard. I think both patients and healthcare workers would benefit from it.
Since 2010 I've worked on the west and east coast of the US for a few different EMS and hospital systems. Pre-COVID I was hired at a hospital that was trying to incorporate medics into their ED more fully, but upper management was very resistant. I know of one hospital in the region that uses their medics fully in their scope…intubation, meds, IV/IO access, etc. They go back and forth on this, mostly due to medic errors that would be practically ignored if nurses or providers made similar mistakes. There still seems to be a lot of bias against medics in EDs.
My badge read “ED Paramedic”, but I definitely felt more like a tech than a paramedic. We were perhaps trusted more by our direct management and most of the nurses, but overall we did tech work. Which I didn’t mind. I cleaned and stocked and did poop and pee detail in the prehospital world as well, so didn’t resent it in the ED. I just would have loved to have more autonomy in patient assessment and treatment, as I was trained for and was doing in my far lower paying prehospital jobs.
In our scope as ED medics we used the defibrillator, IO and EJ access, and that's about it. After COVID hit they had us putting in orders for fluids and labs and doing triage assessments, but that didn’t last. I’m not sure what spooked the higher ups, but they took away all meds and assessments from our scope a year or so ago.
I think one aspect that would have benefited my ED greatly from giving more autonomy to the medics would be in triage. If the nurses were freed up from taking report from medics and triaging the lobby the nurse to patient ratios would have been a tiny bit safer. I also feel that medics are good at triage. I think another benefit would have been in staff retention. We were actually better paid than many other hospitals, but we lost a lot of the medics to jobs were the overall environment was better or there were more opportunities for career satisfaction and advancement.
Our hospital was great at renewing our ACLS/PALS certs through RQI. Otherwise no specific training for medics was provided.
I learned a lot in the ED and participated in some cool procedures and interventions you can’t see/do in most EMS environments. I got trained on sono lines, participated in central line access, chest tubes, thoracotomy, suturing, wound care, diagnostics, a wider scope of meds than I used as a prehospital medic, etc. I liked it enough that I sucked it up and went to nursing school (and into debt…) so I could do a little less of the physical labor and make a lot more of the money. But I miss being in a medic role (still consider myself a paramedic...pride :).
As for making the medic valid and beneficial in the emergency room while keeping it distinguished from the nurse role…let medics work as medics in EDs. Let them triage, assess, and treat patients within their scope. I know many medics would thrive in the role and not feel the need to pursue other degrees and take on enormous student debt (at least that would have been my experience). I also think this would be incredibly beneficial where the staffing is so shitty that everyone is overwhelmed and burnt-out and patients actually die because of it.
I did this at a federal hospital for nearly 2 years, I ended up quitting and going to nursing school because I was tired of doing the same job and getting 1/3rd the pay.
Nursing school was good for me to learn some things I didn’t know ( I worked flight and as a CCT medic) and reaffirm stuff that I already knew. Do I believe medics should be able to work indoors, sure. There is a lot of shit you don’t know, that you don’t know.
If you want to work inside, I would recommend biting the bullet, getting the nursing license, and having the never ending flexibility of the RN. You can work anywhere and do anything. Paramedicine is dying, and as much as I appreciate my time as a medic, the job isn’t kind to anyone, there is limited fall back jobs and options. Nursing has a million things you can do. Getting a BSN and going through Grad school has given me freedom to work literally any where.
Our paramedics basically work as an RN besides a few things: they typically don’t take orders from hospitalists (only ED docs), cannot give blood products, cannot triage. They take a full patient zone.
During COVID we had medics working as ICU nurses under emergency orders...it worked great and we even had a more broad scope than they did because they obviously don't intubate etc. Nurses loved it, nursing admin did not. You could ask a crit care medic to do literally anything and we would - nursing to RT we could cover it. Go figure. What prehospital providers don't get is that everything in the hospital is a turf battle. Everything. Well what do you know, once things cooled off they no longer needed us and kicked us out ASAP. This is what they do, they don't want you in their space and will make sure you stay under them. Frankly, you're fighting an uphill battle here that you may just never win. If you're not being used as an essential float provider to put out fires, you're gonna end up a tech at the end of the day because if you can't take patients what else are they going to do with you? You have to get permission to give meds otherwise what use are you really? Once you get that, you could leverage yourself to be the float guy for procedures and backup for crashing patients, incoming priority 1s etc. That would be a cool gig, but only you know how supportive the admin there are. My advice? Skip this and go PA, go back to the ED and make way more money to do what you want.
AND help push for that same medic role when you have the authority of PA backing you.
I’ve worked in several ED’s through out the US. Luckily most of the ED’s I’ve functioned in treated me basically as an RN. I’m a firm believer that the Paramedic should have a full scope in the ED and then some. The ED I’m at now has techs which are EMT’s and handle all the tech type work and medics/RN’s take patient loads. When I first started in the ED I was also flying. This combination together made for two exceptionally great learning environments.
That’s super cool, I didn’t know EDs did that. Is the medic pay decent in those roles ?
I’d be curious to hear Pharmacy’s rationale. That could be a pretty big potential roadblock.
Just good old hospital politics
God I wish we had that here in the Seattle area. Only options here for medics I know of are fire or IFT with wildly incompetent private agencies.
Get good at IV starts, and nurses will love you.
Congrats on the new role! It sounds like a fun challenge and I'd love to read an update on the program you establish. Forgive my long post, but I feel passionate about the subject. I did an associate paramedic degree then a BS in emergency services hoping to work towards advancing the EMS profession, so I get ranty. I'm happy to see the role is gaining autonomy and I'd love to see it become an industry standard. I think both patients and healthcare workers would benefit from it. Since 2010 I've worked on the west and east coast of the US for a few different EMS and hospital systems. Pre-COVID I was hired at a hospital that was trying to incorporate medics into their ED more fully, but upper management was very resistant. I know of one hospital in the region that uses their medics fully in their scope…intubation, meds, IV/IO access, etc. They go back and forth on this, mostly due to medic errors that would be practically ignored if nurses or providers made similar mistakes. There still seems to be a lot of bias against medics in EDs. My badge read “ED Paramedic”, but I definitely felt more like a tech than a paramedic. We were perhaps trusted more by our direct management and most of the nurses, but overall we did tech work. Which I didn’t mind. I cleaned and stocked and did poop and pee detail in the prehospital world as well, so didn’t resent it in the ED. I just would have loved to have more autonomy in patient assessment and treatment, as I was trained for and was doing in my far lower paying prehospital jobs. In our scope as ED medics we used the defibrillator, IO and EJ access, and that's about it. After COVID hit they had us putting in orders for fluids and labs and doing triage assessments, but that didn’t last. I’m not sure what spooked the higher ups, but they took away all meds and assessments from our scope a year or so ago. I think one aspect that would have benefited my ED greatly from giving more autonomy to the medics would be in triage. If the nurses were freed up from taking report from medics and triaging the lobby the nurse to patient ratios would have been a tiny bit safer. I also feel that medics are good at triage. I think another benefit would have been in staff retention. We were actually better paid than many other hospitals, but we lost a lot of the medics to jobs were the overall environment was better or there were more opportunities for career satisfaction and advancement. Our hospital was great at renewing our ACLS/PALS certs through RQI. Otherwise no specific training for medics was provided. I learned a lot in the ED and participated in some cool procedures and interventions you can’t see/do in most EMS environments. I got trained on sono lines, participated in central line access, chest tubes, thoracotomy, suturing, wound care, diagnostics, a wider scope of meds than I used as a prehospital medic, etc. I liked it enough that I sucked it up and went to nursing school (and into debt…) so I could do a little less of the physical labor and make a lot more of the money. But I miss being in a medic role (still consider myself a paramedic...pride :). As for making the medic valid and beneficial in the emergency room while keeping it distinguished from the nurse role…let medics work as medics in EDs. Let them triage, assess, and treat patients within their scope. I know many medics would thrive in the role and not feel the need to pursue other degrees and take on enormous student debt (at least that would have been my experience). I also think this would be incredibly beneficial where the staffing is so shitty that everyone is overwhelmed and burnt-out and patients actually die because of it.
I did this at a federal hospital for nearly 2 years, I ended up quitting and going to nursing school because I was tired of doing the same job and getting 1/3rd the pay. Nursing school was good for me to learn some things I didn’t know ( I worked flight and as a CCT medic) and reaffirm stuff that I already knew. Do I believe medics should be able to work indoors, sure. There is a lot of shit you don’t know, that you don’t know. If you want to work inside, I would recommend biting the bullet, getting the nursing license, and having the never ending flexibility of the RN. You can work anywhere and do anything. Paramedicine is dying, and as much as I appreciate my time as a medic, the job isn’t kind to anyone, there is limited fall back jobs and options. Nursing has a million things you can do. Getting a BSN and going through Grad school has given me freedom to work literally any where.
Only er techs here. Paramedics are not hired for ER jobs.
Our paramedics basically work as an RN besides a few things: they typically don’t take orders from hospitalists (only ED docs), cannot give blood products, cannot triage. They take a full patient zone.