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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Chief, 

  That is the notion we hit the ground running with for our latest class.  The difficult part is that it's difficult to see how education applies unless you have experience and see the need for it.  If your students are historically drawn from a knuckle-dragging mook (politically correct, I know) background, where if they can't see the result in the next 10 minutes, it's boring, it can be difficult to impart that wisdom without sounding monotonous in the end.  

 It's also difficult to impart how such education is important when your protocols are written primarily for "lowest common denominator" providers, which, is such the case in Maryland.

That is my challenge right now. It's not an easy challenge to undertake when you still have ER physicians who think that 15-lead ECG's are out of your scope of practice, which, of course, contradicts your whole MO.  To turn the present mentality around will take some time, but we have made long strides in the 16 years I've been in my jurisdiction!  I'm confident it will happen as we get ourselves more organized.  Isn't that how the nurse's did it? 


Skip Kirkwood said:

It sounds like the onus is on the pre-service educators to overcome that notion - to insist on critical thinking and knowledge in addition to skills and procedures.

Where else can a change in the thoughts of the new generation occur?

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. We instructors sometimes take the easy route, in that we use the rote, skip researching the topics we are presenting, perhaps because of time constraints, perhaps because we have taught the topic frequently, etc. I also wonder if we sometimes make the mistake of assuming that since someone is a good clinician or has been a clinician for a long time, that they will be a good instructor, or a good leader or manager for that matter. The approach to preparation for EMS instructors is extremely minimalistic, compared with other professions (I know, a whole other discussion!) I also think that an interesting point is made by Chris, in that most if not all other healthcare professions have little knowledge about what it is that we do and can do. How do we go about educating our healthcare partners about our capabilities? Can we get them involved at a higher level during their education, a little ride time for med students and nursing students? Maybe inservices or presentations at medical or nuirsing staff meetings in our primary receiving hospitals? More, gulp, involvement by our physician medical directors? I do agree that the situation is improving, but slowly.
 
Chris Azevedo said:

Chief, 

  That is the notion we hit the ground running with for our latest class.  The difficult part is that it's difficult to see how education applies unless you have experience and see the need for it.  If your students are historically drawn from a knuckle-dragging mook (politically correct, I know) background, where if they can't see the result in the next 10 minutes, it's boring, it can be difficult to impart that wisdom without sounding monotonous in the end.  

 It's also difficult to impart how such education is important when your protocols are written primarily for "lowest common denominator" providers, which, is such the case in Maryland.

That is my challenge right now. It's not an easy challenge to undertake when you still have ER physicians who think that 15-lead ECG's are out of your scope of practice, which, of course, contradicts your whole MO.  To turn the present mentality around will take some time, but we have made long strides in the 16 years I've been in my jurisdiction!  I'm confident it will happen as we get ourselves more organized.  Isn't that how the nurse's did it? 


Skip Kirkwood said:

It sounds like the onus is on the pre-service educators to overcome that notion - to insist on critical thinking and knowledge in addition to skills and procedures.

Where else can a change in the thoughts of the new generation occur?

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)

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)

Chris Azevedo said:

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


Nor are they public employees, with the ability to get raises by making deals with politicians and threatening voters. If they want more money, they have to work for it.

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!

There are very few people whose job is a "sacrifice" for them.  Most everybody makes the best economic deal that they are able for themselves, even if that means changing professions, venues, etc.  And since involuntary servitude was outlawed, everybody has the freedom to select what they do.  Some people select alternatives that pay less than the max dollar they might otherwise earn, but they do so because they want some other, non-pecuniary benefit.  One of the things that I've always admired about the physician community is their ability to portray themselves as "healers" while still commanding top dollar for their services (in the US at least - maybe not so much elsewhere).

Also, let us not forget that a great deal of EMS is provided by volunteer EMS clinicians who receive little or no renumeration. Regardless of our personal feelings on the benefits or detriments of the volunteer EMS system in our country, we should not forget the original question posed by Skip, that is "what is the take away for EMS"?

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......

I've been hiding in the bushes on this one....binoculars at the ready to see where the conversation was going...

Education Standards seems to be the ultimate problem our discussions arrive at. But from a personal UK stand point we're finding different problems in advancing into community care. We struggle with the question "how do we provide community care but still keep an emergency response.

Studies show us that 90% of our emergency dispatches do not need a conventional ambulance. The majority of patients call for TREATMENT and not TRANSPORT. Hence why we've headed so much to telephone triage and response cars. In the rural area here an ALS crew is on emergency dispatch for only 17% of the week meaning they are idle 83% of the time. Given that the commissioners feel that to tie an EMS resource up for 3 hours on a community care call is an inappropriate use of resources.

So I guess we need EMS leadership to improve and recognise new models of service delivery before we engage in raising education standards.

Some time in the 1970's nurses drew a line in the sand and said you needed an associates degree to be an RN.  I am interested in learning how they dealt with the people who were content with the role of nurses being limited to repeating "yes doctor" over and over at work. 

I do not think it is unreasonable for the scene of every EMS call to be run by someone with at least an associate's degree.  I also think we need to get there before we can safely refer people somewhere other than emergency departments.

I think that you're correct, Bob.  They got to the point, if I recall, where those who wanted a profession outnumbered those who wanted a job, and those who wanted a profession took over the organizations that controlled nursing, and made it happen.

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.

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!

 

 

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