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Home > Topics > EMS Management
August 14, 2014
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EMS News in Focus
by Arthur Hsieh

Why everyone loses when EMS and nurses clash

Nursing organizations have been battling paramedics for decades, but the turf wars only trivialize shared healthcare goals

By Arthur Hsieh

Turf wars: They tend to break out when one side feels threatened by the other. In California, nursing advocacy organizations have been battling the role that paramedics play in the health care system for decades. The union’s objection to fire departments wanting to start a community paramedicine programs is no exception. Where the fear comes from, I’m unclear about. The lack of training that is cited in the article is  a distraction from the real issue facing health care — shrinking dollars and the demand for better quality at a lower cost. 

The reality is quite simple. In some ways,  evolution is underway and everyone is going to give up something in order to get something. One major roadblock is the  mentality that plagues the provision of health care; the idea that nurses can only do nursing is frankly absurd.

A nurse-medic will tell you how much overlap exists between the two professions in terms of training and capability. One is no better than the other; each is designed to operate in specific environments. This concept is validated by the fact that neither of the  community paramedicine pilot programs requires a change in scope of practice for the medics. It’s an evolving role that is responding to the changing healthcare landscape.

Sadly, comments made by these advocacy organizations do nothing but reinforce the distrust between the two professions. Fortunately, many nurses I know dismiss these comments as rhetoric; they recognize the role EMS plays within the system.

Hopefully these projects will demonstrate their efficacy, as they have in many other states, and help to achieve what we all want anyway: a more effective system that improves the overall health of our communities.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
Comments
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Michael Norris Michael Norris Thursday, August 14, 2014 4:56:30 PM Art, the Nurse vs. Paramedic issue is very old and very tired. The prehospital prejudice on behalf of nurses hurts them far more than they hurt the medics. I can speak from experience after 36 years as a paramedic and 33 years as an RN working in the field and in-house as well.. I have heard all the arguments from less education (which has never been true), to less capability. The education is just different with each set according to context and necessary objectives. The animosity has spread from ground ambulance providers to air ambulances with in-house personnel having attitudes towards both. What the nurses don't want to understand is that the prehospital providers have an integral part in the continuum of patient care. This part is often handled in uncontrolled environments and less than ideal conditions. When they treat EMS poorly, they lose valuable patient admissions and therefore income for their facility as providers will steer patients away towards friendlier facilities whenever possible. It is time they get over it quit providing excuses such as training deficiencies or less knowledge and figure out that adaptation equals sustainability and they better get used to it.
Kathy Robinson Kathy Robinson Thursday, August 14, 2014 7:00:48 PM CNA's opinion should not be construed as representing the opinion of all nurses. In fact, the American Nurses Association has a much more informed view of community paramedics at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards/ANAPrinciples/EssentialPrinciplies-UtilizationCommunityParamedics.pdf.
Cj Ewell Cj Ewell Friday, August 15, 2014 1:57:33 PM I am afraid that paramedicine is headed for heartbreak and disappointment. The fact is that providing ANY trained care provider to look in on people and help them navigate the healthcare system is going to result in improved outcomes. How can I say that with such certainty? Because nursing proved this for decades. Why aren't nurses doing this now? Its not because nurses don't want to. Its because the multitude of third-party payers don't pay for nurses to do this any longer. So now, paramedics are getting grants to run demonstration projects that show home visits improve outcomes. That's a question that was answered long ago. The real question in my mind is who will pay for paramedics to provide this service when the initial grants run out? The ire of nurses is raised, rightly or wrongly, when they see a whole new set of providers providing a service that the nurses are already prepared for taking on this project after advanced training. The question nurses ask is why is that training money being spent in this way, when we could use it to pay nurses to do what they already know how to do?
Adam Rondeau Adam Rondeau Sunday, August 17, 2014 12:37:08 PM As a Paramedic with 27 years in EMS my heart is there first, I have 6 years as an RN. Obviously the training level and jobs are very similar. I believe EMS has much more autonomy, a need for excellent skill development and more dangers. But an RN can make 10 times more money. I would have suffered through EMS pay forever if I didn't have a family. Even with a nursing salary, I live in a 100 year old house and drive old vehicles, nothing fancy at all. I love EMS, but cant afford to work it much. Oh, and the bickering is ridiculous. We need to be a team.
Susan Britt Susan Britt Sunday, August 17, 2014 12:58:33 PM The real reason there is a problem between the 2 groups is the way they speak to each other. Here you have a battle of egos, each group wanting to feel more important than the other. This is a problem in hospitals, clinics and frankly, everywhere else. Nurses tend not to feel like they are part of a team and paras want to be independent. It is really stupid. All provide an important service if they would just get their egos in check. While it is true I was a nurse with Florence Nightingale, the problem existed then too. Everyone wanted to look down on everyone else. Gotta stop.
Lindsey Humphrey Winslett Lindsey Humphrey Winslett Sunday, August 17, 2014 2:14:22 PM Still issue in Virginia
Theresa J Mellen Theresa J Mellen Sunday, August 17, 2014 2:28:23 PM The only problem that I have run into is when on a scene and someone else is there first who is a nurse or higher but is unable to identify the most life threatening injury that the patient suffering from. Or they come over after me and my crew are on scene and say "I'm a nurse, etc", expecting us to just hand over the patient to them. I understand nurses and others are an important part of the entire EMS system, but if a nurse comes up to me on a scene, I say thank you but I have this. There are different levels to nursing from the people that I have talked to. If you are an office nurse who works in a private clinic, please don't stop. If you are a trauma nurse, by all means help me out.
Katie Moon Katie Moon Sunday, August 17, 2014 2:33:45 PM I was a paramedic before I became a nurse. The two professions are complimentary. Always happy to have good medics bring in a patient and give report. There is no point in being adversarial.
Bryce Eden Bryce Eden Sunday, August 17, 2014 2:39:55 PM The problem is they are two very different jobs with just enough overlap fir both sides to think they could do better than the other even though in reality they couldn't. Add to that that despite the hundreds if not thousands of great nurses I have dealt with over the past several years I remember the few that were total idiots far more clearly and Im sure the same is true on their side as well. Factor in politics and the odds of both sides getting along become pretty slim.
Bryce Eden Bryce Eden Sunday, August 17, 2014 2:40:52 PM Also I need to stop posting things from my phone. Sorry for the spelling.
Diane Nieman Senffner Diane Nieman Senffner Sunday, August 17, 2014 3:07:36 PM Nurses should go after the number of providers who no longer hire nurses at all and only hire CNA's to work with their docs in large practices, with maybe a 'token' nurse. That situation is much more troubling to me. The community paramedic program is a winner for public health and all involved.
Bonnie Lee Walker Bonnie Lee Walker Sunday, August 17, 2014 5:50:25 PM In the field defer to the Medic, in the hospital defer to the Nurse. EMS brings them in, reports off and unless asked be free to go. It's easy. Nurses be appreciative of the work and information they have. EMS be appreciative that someone can and will take over and complete what you have started.
Wim Breeman Wim Breeman Sunday, August 17, 2014 11:24:59 PM Interesting discussion! In the Netherlands there are no paramedics at all. We have ambulancenurses, they all must be ICU / ER nurse to enter ambulance nursing training program. So the discussion doesn't exist here.
Cher Kandra Williams Smith Cher Kandra Williams Smith Sunday, August 17, 2014 11:37:28 PM I'm a nurse. If I come upon an accident, I help until the Medics get there, at which point I report off, then get out of the way. They know their job in the field better than I do. Once at the hospital, they report off, or if we need them, they stay and help/support, but let us do OUR jobs. I'm sorry, but we are all working for the same thing.....the good of the patient. I don't want my support system on the defensive side. I would rather work ALONG with someone who has a bit more info than I do cause they got to the patient in the field, then try to pull turf shit and make a mistake. We all need to support each other, not fight over who does what, where the lines are, etc. That's nuts.
Scott Best Scott Best Monday, August 18, 2014 4:19:23 AM I don't even see the RN vs. paramedic issue as relevant. The grant projects are redundant as we know community care works. It's just that no one (insurers) want to pay for it...which is another selling point for single payer. In the pre-hospital environment, EMS is in charge of patient care. In the ED, the ED provider is in charge of directing care. Nurses provide nursing care in various roles and nursing involvement is mandated in facilities subject to JCAHO. In other centers that are not subject to JCAHO, the physician determines who provides what care and they accept the responsibility for whomever that is. This might include nurses, but often includes CNAs, medical assistants, or various technicians. Everyone has their place in the system. Rather than perpetuating pointless conflicts, everyone should focus on their place in the system and strive to do their best in their respective roles as team players dedicated to providing patients with the best possible care.
Patrick Gomer Roberson Patrick Gomer Roberson Monday, August 18, 2014 4:46:27 AM As an EMT/Paramedic, of nearly 25 years, I have seen both sides of the coin many time. I worked the truck for 15 years and had many great nurses who were thankful for the care and report given. Then there were some who seemed to care less. After leaving the truck to work in an Emergency Department, I have found a great team to provide patient care. As EMS brings patients to the ED, we often get great reports and our nursing staff can almost triage the patient according to the report given. The rift come in when EMS personal or nurses for that matter fail to adequately perform patient assessment and fail to communicate their findings to the next level of care. I have personally seen EMS providers and nurses, make up vitals out of thin air and never touch the patient. After receiving patients which have not been properly evaluated, then the other profession quickly labels that provider as incompetent. The bottom line is, as we treat patients, we treat all patients the same and provide the best care possible, no matter how many times we see the same patient as eventually their complaint will be for real. If a provider is getting to the point that their job is just a paycheck and they care about nothing else, it is time to get out of the business.
Kevin Storm Kevin Storm Monday, August 18, 2014 11:07:56 AM Ah the nurse vs medic issue. Nursing feels threatened and therefore lashes out at medics as being undertrained Neanderthals on the healthcare spectrum. Nursing as a whole is better organized from decades of fighting to gain acceptance, become more formal in education standards, and pushes to elevate themselves, which they have largely been very successful. EMS on the other hand has been at times sluggish to embrace and copy the model that nursing has used to move our profession ahead. We are still not a professionally licensed field, and that will forever hold us back. Think about it, the person who cuts your hair has professional license, shouldn’t the person who has to try to resuscitate your heart have one? It also doesn’t help that much of EMS is linked to Fire Departments that traditionally not had a great interest in EMS related issues. How many Fire Chiefs are huge advocated for EMT’s and Paramedic’s having Degrees? It would mean having to pay them more, more than what some of their line officers make? Possibly. And no city wants to hear that they have to pay extra if it is not required. As long as we are fractured between those who will do it for free, and those who do it for a living, do not demand to be professionally licensed, do not demand higher education on a national level EMS will always be treated as a the bastard child of health care services.
Terry Songer Terry Songer Monday, August 18, 2014 11:56:17 AM The role of paramedics and nurses are two different roles, please keep in mind that all health care professionals number one concern should be patient care. I have been a paramedic for many years now, and I enjoy my career and would never give it up. The emergency room nurses in the region I work in are an amazing bunch of folks. The hatred and undermining stems from poor patient care from most skilled nursing facilities. There is nothing more frustrating than running code 3 for a respiratory arrest and their staff has done nothing but watch that patient circle the drain...and I mean even putting the pt on o2, or sitting them up instead of watching them drown in their own pulmonary edema, I have personally went to two different codes that were supposed to be CPR in progress and the staff had look outs for fire and ems....walk in and dead is dead.....saying it was a witnessed arrest and pt was in full rigor and lividity. It only takes one idiot to make everyone look dumb abd that is the same for all professions. The same in paramedicine, egos the size of God...PITIFUL. everyone is on the same team. I agree with the post below....medics vs nurse is old dried up issue....grow up
Terry Songer Terry Songer Monday, August 18, 2014 11:58:10 AM I had a nurse run to my ambulance and tell me that she was going to drop a tube, she got pushed out of my truck.... That's not scope of practice
Shane M. Comstock Shane M. Comstock Monday, August 18, 2014 6:50:05 PM Medics can do more. Nurses know more.
Iquana Jackson Iquana Jackson Tuesday, August 19, 2014 6:55:32 AM Starting to see an increase of paramedics in the ER's.
Gregory Carr Gregory Carr Friday, August 22, 2014 7:00:39 AM Opinions from nurses who do not carry an EMT-P certification are not valid. It's that simple. I am not an RN, therefore I have no right to judge their capabilities. The shoe fits the other foot as well. If CNA want's their objections to be taken seriously, they will need to assemble a committee of people who carry both certs and let them weigh in on the issue. Anything less will be full of prejudice and puffery.

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