I read an article this morning from my hometown newspaper, about the future of nursing.

It's a quick read.  Anything in there that is applicable to EMS?

http://www.buffalonews.com/life/health-parenting/health/article7344...

What do you think?

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Yep!

Skip Kirkwood said:

Doc - have you missed the dozens of nursing strikes and all the places in hospitals where collective bargaining is alive and well?  Heck, they've even got their own section of the National Labor Relations Act!


I never said nurses didn't sometimes get raises by striking. I said they couldn't get raises by, say, making their contract expire every 4 years, "coincidentally" in the same years as the city's mayoral elections, or outright trading votes-for-contract in a way so noxious as to actually be investigated by one of the worst political hacks to ever be appointed as a federal prosecutor.  :) 

 

There's no doubt, though, that the uniformity (and length) of nursing education has led to less disparity of wages than there are among fire/EMS--the best-paid and worst-paid RNs in this country are closer in wage to each other than the best-paid medics are to the volunteers. As you pointed out, there are RNs who volunteer their time, but no such thing as a "volunteer nurse."

One of the things that I've always admired about the physician community is their ability to portray themselves as "healers"

Funny, because I feel less and less as if we've done so successfully. You're sure this isn't tongue-in-cheek? ;)

Maybe that is the barrier - there are not enough in EMS who want more than a job (and too many who want it to stay a hobby, for such a change to happen.

If it makes you feel any better, Skip, I see higher expectations among a lot of the newer grads. They're frustrated by medicine-by-numbers protocols, low wages, and being bossed around by doctors who often have never spent a day in the field. It should turn around eventually--the only question is when.



dr-exmedic said:

It should turn around eventually--the only question is when.

Probably about the time EMS stops fighting over things that ultimately don't matter (like being called an ambulance driver) and focus it towards things that do (like education and reimbursement issues).

Yes, also a shameless plug.

I am a firm believer in Associates in Paramedics only. No more certificate programs. Ones who argue this; always fall back to the argument that a 10 year Paramedic in a busy service is better clinician that someone without experience who graduated from Paramedic school with an AAS or BS. No one is disagreeing that a seasoned Paramedic may be a better practitioner.

However, the application of collegiate education exposes students to other sudjects which opens their mind. Some may even enhance the practice like A&P, Chemistry, Microbiology, Statistics, Calculus, Pathology, Psychology, Developmental Psychology, Nutrition, Foreign Language, Heath Care Delivery, and others. Some if not most are pre-requisites for Associates and Bachelors level for Paramedics... The fundamental of Basic/Advance Prehospital Care will still be learned but the knowledge will be more well rounded...

There was a time when Nursing and Doctors didn't need an education; not even a HS Diploma. Many Doctors were trained through an apprenticeship. Barbers did surgery. Some farmers who cared for animals care for humans. It was not a respectable profession; it was a trade... Education and education has made the MD a prestigous profession... Same can be said for Nursing; with RN (ASN, BSN, MSN, and PhDN) to NP and DNP to CRNA......

Education can ensure our future as Paramedics will become or stay as a profession; not some trade someone can get into... I hate to say that the Emergency Medical Technician has fallen into that... Of course, what I just did was stirred the pot...

I don't think the onus is necessarily on the instructors.  Instructors who educate past the bare minimum are great, but individual instructors typically have a fairly limited sphere of influence. 

 

The onus should be on the educational institutions, and more globally on those who want to make EMS a true profession to establish programs that are standardized, validated, evidence-based, that require education as well as training, and that requires instructors with educations at least one level above the degree granted to the students.  



Warren E. Shaulis said:

Gentleman, I believe that is a significant point, that our EMS instructors need to raise the bar a bit, not only for the students, but perhaps for themselves as well.

Skip, it happens in the volunteer fire departments and rescue squads as well.   Volunteerism is down tremendously in a lot of places, leading to the demise of many volunteer EMS, rescue, and fire departments.  It might end up being social and demographic changes that have as much effect on morphing EMS (and fire, and rescue) away from the volunteer model.

 

I know several volunteer chiefs who complain that they only have two kinds of members now - those 55 and older who live in their community and the under-25 set who get basic training and a little experience, then move away to an urban career job as soon as they can get hired somewhere else.

 

In those settings, the volunteer agencies are losing experience at an unsustainable rate, and they'll have to either adapt or they'll disappear.

Skip Kirkwood said:

I'm afraid that from my perspective, the whole profession is held back to make standards that are "within reach" of volunteers.

Why is it that this only seems to happen in EMS?  There are volunteer cops, but no different standards.  Teaching, nursing, accounting, and plumbing could all benefit from free labor, but they don't build their professional standards to encourage or support that.  Why do we?

Let the flaming begin......

What particular profession would that be?  Private EMS?  Ironworkers?  UAW members?  Podiatrists?

Or...are you generalizing about some other profession?

Chris Azevedo said:

Chief,

  It's well demonstrated in a particular profession we all here are familiar with that history and tradition is consistently a barrier to progress.  Given that our pool of workers has historically been drawn from a given demographic, the culture change will be substantial only when the demographic and subequently the middle and upper management has changed noticeably.  The nursing paragdigm you give is one such example, and one which demonstrates how such change is possible!

 

 

That doesn't happen in my agency.  We have a very competitive screening process for internal paramedic candidates, with four applicants for every opening the last time we tested.

 

Our pool of workers is drawn from experience EMS providers with no fire background, experienced firefighters with no EMS background, experienced firefighter/paramedics and firefighter/EMTs, and people with no emergency-related experience at all.  Our philosophy is to start by hiring the best people that meet our initial standards, regardless of qualifications.

 

 



Chris Azevedo said:

Don't feel bad!  I'm in the fire service as well and I can tell you that there are EMS clinicians who do NOT want to be EMS clinicians, but are made so as a requirement for getting into the fire department (not the case, though in my department).  The overall thought for those chiefs, and many who think the department should move toward requiring ALS certification to be employed is  "well, you know that being a medic is a requirement for the job, if you don't want to do it, don't apply."

I feel that is flawed logic.  We all have been willing to make sacrifices in our lives to get where we want to go, and "putting up with being a medic for a few years til I can demote," or the like is one that many in a neighboring jurisdiction "make."  So, for all you fire-service based Chiefs out there, here's the great moral (dare I say "business") dilemma:  is having a Paramedic workforce who view getting their EMT-P as a "sacrifice" to get the job indeed a "sacrifice" that you are willing to make?  

1. Does this MO make the best workforce?

2. Will this MO maintain your workforce, or will it burn itself out as the attitudes of those using EMS as a stepping stone influence (and they DO) the attitudes of the new medics?

3.  How much more expensive will this workforce be in terms of law suits, QA issues, patient complaints and department stagnation because you cannot grow EMS leaders from within?

I don't think the nursing workforce as a whole views their jobs as a "sacrifice" at any level, nor as a stepping stone.  


Warren E. Shaulis said:

Oh, and I forgot the other issue brought up by Chris! I hate to say it, but not all people that want to be EMS clinicians should be EMS clinicians! I know, I am speaking heresy, and I can see the pitchfork bearing masses headed to my doorstep led by torch wielding fire chiefs (settle down, I am in the fire service also)



Alexander Woo said:

I am a firm believer in Associates in Paramedics only. No more certificate programs. Ones who argue this; always fall back to the argument that a 10 year Paramedic in a busy service is better clinician that someone without experience who graduated from Paramedic school with an AAS or BS. No one is disagreeing that a seasoned Paramedic may be a better practitioner.

However, the application of collegiate education exposes students to other sudjects which opens their mind. Some may even enhance the practice like A&P, Chemistry, Microbiology, Statistics, Calculus, Pathology, Psychology, Developmental Psychology, Nutrition, Foreign Language, Heath Care Delivery, and others. Some if not most are pre-requisites for Associates and Bachelors level for Paramedics... The fundamental of Basic/Advance Prehospital Care will still be learned but the knowledge will be more well rounded...

There was a time when Nursing and Doctors didn't need an education; not even a HS Diploma. Many Doctors were trained through an apprenticeship. Barbers did surgery. Some farmers who cared for animals care for humans. It was not a respectable profession; it was a trade... Education and education has made the MD a prestigous profession... Same can be said for Nursing; with RN (ASN, BSN, MSN, and PhDN) to NP and DNP to CRNA......

Education can ensure our future as Paramedics will become or stay as a profession; not some trade someone can get into... I hate to say that the Emergency Medical Technician has fallen into that... Of course, what I just did was stirred the pot...
 
 
 
Alexander, Thank you for your interest in the discussion, and specifically in my post. I, too, believe in the benefit of the entry level associates degree in EMS for paramedics, However, we as a profession need to be willing to sustain the cost of the additioanl education until such time as the wages "catch up". I am a believer in the diverse education, the "liberal" education if you will of our EMS providers. I would probabaly go so far as to advocate for a minimal entry level of bachelors degree for paramedics, however, the market as it exists would not support it. However, if you (and others concerned) would evaluate objectively, what we are asking paramedics to do, it should be at least a bachelors degree level of education. We ask our providers to provide an assessment at the BSN level (not the general physical assessment of the physical exam class, but the specific exams of the various systems complaints), and to provide interventions based on clinical judgement above the level of an RN acting independently, and at levels of intevention above those designated for entry level RN's (diploma, ADN, or BSN). I still believe that, given the correct situation, this can exist in either a volunteer or career system. Though I am not sure why anyone would tolerate this at the volunteer level of reimbursement. I do believe volunteer paramedics can achieve this level of competence, if they are properly incentivised. The defining factor is not if they are paid or not, but if they are skilled or not. Yes, I understand the implications of volunteer ALS EMS, just putting it out there!



Ben Waller said:

I don't think the onus is necessarily on the instructors.  Instructors who educate past the bare minimum are great, but individual instructors typically have a fairly limited sphere of influence. 

 

The onus should be on the educational institutions, and more globally on those who want to make EMS a true profession to establish programs that are standardized, validated, evidence-based, that require education as well as training, and that requires instructors with educations at least one level above the degree granted to the students.  



Warren E. Shaulis said:

Gentleman, I believe that is a significant point, that our EMS instructors need to raise the bar a bit, not only for the students, but perhaps for themselves as well.

 

Ben. thank you as well for replying to my post, et. al. I spoke from a somewhat mixed skill set. I was acting as a Instructor/Coordinator , as well as acting as the lead instructor. I determined the content of the students academic participation (papers, discussions, etc.) as well as presentations. However, I believe that individual instructors may hold the key to educatinal excellence. I have had good and bad nursing instructors within a good curriculum and good and bad EMS instructors within a, so-so curriculum. I still believe that the individual intstructor plays a pivotal role in the student's educational experience



Ben Waller said:

Skip, it happens in the volunteer fire departments and rescue squads as well.   Volunteerism is down tremendously in a lot of places, leading to the demise of many volunteer EMS, rescue, and fire departments.  It might end up being social and demographic changes that have as much effect on morphing EMS (and fire, and rescue) away from the volunteer model.

 

I know several volunteer chiefs who complain that they only have two kinds of members now - those 55 and older who live in their community and the under-25 set who get basic training and a little experience, then move away to an urban career job as soon as they can get hired somewhere else.

 

In those settings, the volunteer agencies are losing experience at an unsustainable rate, and they'll have to either adapt or they'll disappear.

Skip Kirkwood said:

I'm afraid that from my perspective, the whole profession is held back to make standards that are "within reach" of volunteers.

Why is it that this only seems to happen in EMS?  There are volunteer cops, but no different standards.  Teaching, nursing, accounting, and plumbing could all benefit from free labor, but they don't build their professional standards to encourage or support that.  Why do we?

Let the flaming begin......

 

Ben,

Again thank you for choosing to participate in the discussion, You have a valuable insight into EMS operations. I would however like to discuss your generalization of volunteerism. I certianly appereciate the challenge facing the thousands of volunteer agencies today. However, it is my believe that the lack of volunteer members is not soley the fault of the (volunteer) system. I still maintain that our system rewards dropping the bar, instead, we should be raising it, and in the instance that the volunteer system can't maintain, then another career alternative must be in place as an option. I understand the discussion that no true volunteer nurses, etc. exist. However, I think that in many instances, the volunteer paramedic , exists coexistently in a career somewhere. Is it right, not sure, is it wrong, no more wrong than physicians or nurses who volunteer their time to assist EMS agencies in the US or to volunteer their time outside of the US

Thanks

Warren

Warren, there are examples that fit your description of the situation - I used to be one of those career medics that volunteered for another agency when off duty.   The dependency of that agency on using someone else's paramedics without pay wasn't a sustainable model, and the volunteer EMS agency went out of business long ago, to be replaced by a fully career coutny 3rd service EMS agency.

 

I'm not blaming volunteers or the volunteer system, just commenting that the changes in demographics, changes in societal norms, and the increasing numbers of people who commute long distances to their paying job equal diminishing numbers of volunteer EMS, fire, and rescue providers in a great many places.

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