Tuesday, May 13, 2008

An Article Review

I read an article recently from the April 2008 edition of the Journal of Emergency Nursing. The article, "Transitioning Paramedics Into Emergency Nurses: A Unique Population of New Nurses", talks about the impending shortage of nurses. By the year 2020, the estimate is a shortage of 1 million nurses. The gist of the article is that with extra training and attention, a Paramedic could easily transition into a good Emergency Nurse.

On balance, the article was really well written, but it was written by nurses for nurses. Much of the content is a comparison of skills and experiences. There is also a point made about Paramedics who become new nurses being "hazed", or treated with considerable hostility. I can see that happening; many new nurses are treated that way as well. One of my nursing friends refers to this the phenomenon of "eating their young."

In addition, there is a lot made of the skills that medics bring to the table. Many of us already have much of the qualifications and certifications we have that new nurses are expected to get. We have ACLS, PALS, and PHTLS; ED nurses also pick these certifications up as a matter of course. Plus they have some other certifications that most of them are required to get, like the CEN, the CCRN, qualification of some sort in trauma nursing with a course like TNCC, and others that I'm sure I'm missing. Medics, on the other hand, are expected to acquire much of this knowledge beyond ACLS and PALS. Our only real options for further certifications include the FP-C, EMT-T, WEMT, and CCEMT-P. Not that they really matter, of course; they are nice to have, especially from the view of continuing education, but they aren't absolutely necessary for us to do our job. The nature of our job is such that we are taught the skills we need to be able to practice emergency medicine.

As I said, the focus of the article is on the transition. While it was a well-written article, I bristled at the bias. Of course, I have bias myself; I would much rather work as a medic in the setting I work in than the nursing setting. I'm not sure I would have the patience or the ability to juggle multiple patients. Plus, I have the ability to do much more with the standing orders I work under. The nurses in the system I work in don't have that capability. I imagine it's like that in most systems, for that matter, and I know that medics in New Hampshire enjoy a considerable amount of leeway with respect to the orders we work under.

I guess what it boils down to, at least for me, is that if a medic is interested in transitioning to a nursing role, they should. I know a number of nurse/medics that are phenomenal clinicians. On the other hand, there should be much more attention paid to the skill set that medics have going into nursing; it certainly shouldn't be ignored, and in many venues it is.

The other conversation that happens regularly is whether or not medics should be used in-hospital as opposed to pre-hospital. Personally, I believe there is a place for medics in the house as the majority of us are amenable to learning new skills that can be based on the advanced assessment capabilities we already have. I also believe that medics will never take the place of nurses; the nurse is way too important in the hospital venue and a nursing assessment is the "gold standard" of hospital care. But medics can do a lot to relieve the nursing workload and should be allowed to do so.

My own thoughts on this subject. What started as a review turned into a sort of rant. But it is an important issue to consider, and a great deal of attention should be paid to it.

1 comment:

Jen said...

Being familiar with the bias in question, I just wonder how it is that nurses manage to think themselves so superior? Some are great, many are awful. Specific letters behind your name don't make your patient care golden.