Nurses: Not So Different From Us After All

One of the most ludicrous assertions in the endless Nursing vs EMS debate is that paramedics are somehow more skilled than nurses. It's simply not true, and just as insulting to the nursing profession as it is to us when some snurse calls us ambulance drivers.

I've lamented before on the skills-centric thinking endemic in EMS, and how it holds us back. Go read that post, and come back.

The truth is, nursing is much farther along the path to independent practice than EMS, and we'll never draw abreast of them unless we increase our educational requirements and start producing medics who can not only do things, but understand why they do them.

Sadly, that does not describe the majority of paramedics I know. They can recite the indications, contraindications and dosing of, say, lidocaine, but damned few of them will be able to articulate how lidocaine suppresses ventricular ectopy, and why it might be a bad idea to give a dose of it to their patient with left bundle branch block and frequent PVCs.

In many states, mine included, registered nurses can do every skill in the paramedic arsenal. The fact that they don't is a function of hospital policy and protocol, not scope of practice.

They can intubate, and even administer sedatives and paralytics to facilitate it. 

They can needle chests.

Cardiovert or pace.

Even do a needle cricothyrotomy.

And yes, they can even do these things without a direct physician order…

… if written protocols allow it.

Paramedics often fail to recognize that, even though they may not have to call and say "Mother, may I?" to employ some of those skills, they are not doing them independently. They do them under off-line medical control in the form of written protocols. Nurses can operate under the same type of arrangement.

Question is, are those written protocols necessarily a good thing?

Today, I am somewhat saddened by the current state of the nursing profession. Don’t get me wrong: I love what I do. I am so thankful for the opportunities set before me.

But whatever happened to “nursing judgment.” Or “nursing decision.”

I can’t tell you how much recently I’ve heard the phrase, “It is hospital policy that…” “You can’t do that, it is protocol that…”

Read the whole thing. Insert "paramedic" wherever it says "nurse," and it could easily be one of Rogue Medic's rants on absentee medical directors and restrictive protocols.

Well, without the sarcasm and meticulous annotation, that is.

If you've ever worked in one of those systems where the protocols leave you feeling as if you're practicing with one hand tied behind your back, then you should be able to sympathize with that nusing home nurse that our profession enjoys ridiculing so much.

When the default policy decision to every problem is "Call the doctor," or "call the ambulance to take them to the hospital," you can either get out of that environment, or stay in it and become accustomed to the fact that your superiors don't trust you to think for yourself.

And after a while, you stop thinking for yourself, because after all, if your superiors don't think it's necessary, why should you? If you've ever been tempted to not even ask for orders because you already know what the answer will be, then are you so different from that nursing home RN who just calls the ambulance instead of giving a Tylenol to their febrile patient?

Nurses chafe at the same silly restrictions on their patient care and decision-making that we do. Maybe they're not so different from us after all.