Re: working in ER

Mark,

What may be occuring is scope of practice issues. Paramedics are trained and registered as prehospital caregivers. Paramedics operate under established protocol and from medical direction from physcians from the receiving hospital via radio. Another sticking point may concern department of nursing which may feel you are displacing an RN, while you may do alot of nursing duties on transport, the license of an RN gives them greater scope of practice and lattitude.

Another obstacle may come from physcians especially in teaching institutions. On transport, the team does their assessment and interventions as they deem necessary but in house in the ER it is the physican who is in charge and makes the decisions as to what inteventions need to be completed when and by whom. So the poltics of who is in charge and who can complete what is very challenging one to tranport staff who are used to autonomy in the field. So even personalities may play a role. One way around it is for paramedics to also become RN's, then scope of practice issues would not be an issues. Not to mention more latitude in pay advances and oppotunities to work in other areas within the medical field. No easy answers as Paul stated.

Sincerely,

Steve Sittig

>From: "Mark Lewis"

>Reply-To: flightmed@flightweb.com

>To:

>Subject: Re: working in ER

>Date: Thu, 15 Nov 2001 07:06:08 -0600

> This is an interesting topic, which seems to have as many different methods

>of staff utilization as there are programs. I really don't feel qualified to

>comment as to the best answer but do have a question I would like to

>interject into the discussion. For those programs that utilize Paramedics

>on their flight crews and also require the transport crew to assist in the

>sponsoring hospital how are the Paramedics used In-Hospital? I have heard

>some real horror stories about how in the in-hospital enviornment in some

>areas Paramedics are very limited, to the extent of being basically and ER

>Tech. Just curious how other programs are handling this.

>Sincerly,

>Mark Lewis NREMT-P

>----- Original Message -----

>From: "Paul M. Wright, Jr."

>To:

>Sent: Wednesday, November 14, 2001 6:24 PM

>Subject: RE: working in ER

> > I think Rollie has hit the nail on the head with his comment about the

>Holy

> > Grail for transport staffing. I would phrase it as the search for

> > "efficient cost shifting by finding meaningful work capable of being

> > instantly interrupted".

> >

> > However difficult that quest for the Grail appears, I am impressed by the

> > number of times that I have heard of programs that have similar job

> > profiles with respect to non-transport

> > duties but the perceptions of how it's working differ dramatically.

> >

> > Two of the factors that might be involved in this difference are the

>nature

> > of the underlying relationship between the transport program and the

> > sponsoring hospital and the attitudes of the transport team members

> > themselves.

> >

> > I am aware of one hospital-based transport program that was a significant

> > drain on the resources of the sponsoring hospital so the hospital

> > administration's idea of getting everyone on board was to tie the lack of

> > raises for hospital staff that year to the flight program's need for

> > funding. Kind of along the lines of "you can help save our flight program

> > by being good-natured about the lack of a raise". Needless to say, this

>did

> > not make for warm and fuzzy relations between the hospital core staff and

> > the flight program staff.

> >

> > And I could write many chapters of a very long book about the damage done

>by

> > arrogance and pride on the part of transport team members and I could

>write

> > passionately and at length on the profound embarassment I have felt when

> > being professionally associated with some of my colleagues who routinely

> > left anger and ill-will in every situation they touched. Even in this

>forum

> > quite recently, statements have been made suggesting that cockiness and

> > arrogance are a good thing for a flight nurse. I disagree and I wonder

>how

> > often it is that otherwise workable solutions fail solely due to the

> > personality and/or attitudes of the transport members.

> >

> > There are policies and practices that fail because they are bad policies

>and

> > practices but there are also good policies and practices that fail because

> > the underlying relationships are terminally flawed. So part of the search

> > for the Holy Grail of staffing must also include a search for useful

> > relationships between institutions as well a search for useful values at

>the

> > individual level.

> >

> > regards!

> >

> > paul

> >

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> >

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