Re: medics vs. RN;s

[Guest guest]

In a message dated 4/15/00 1:40:24 PM Pacific Daylight Time,

bbledsoe@... writes:

<< Jerry:

The issue really comes down to education. The Registered Nurse has, at

minimum, a two year degree in nursing. He/She took a year of basics and then

a fairly intensive year and a half of nursing. Many nurses have Bachelor's

degrees in nursing. They start from a different place. They cannot work

until they have finished their education. They go to school and graduate and

go to work Paramedics, on the other hand, work right away after EMT school.

Also, there are still many EMS education programs that are turning medics out

as fast as they can with a minimal number of hours (i.e. 240 hours which

includes rotations). I can see how nurses might have some resentment when

medics want to do the same thing they do in the ED, but there is a difference

of 2,000 or more educational hours in their training.

Things are never going to get better until:

1. The educational programs become college-based and require basic

courses first. The new paramedic curriculum requires considerably more class

room hours.

2. Paramedic programs must stop turning out paramedics as fast as they

can. These graduates work in the system for 2 years or so and go on to other

fields. The big private companies bid their public utility model contracts

based on this. I cannot count on both hands the number of times I have heard

an ambulance service manager say that " all I really want is someone with a

patch and a pulse. " They see the paramedic pool as virtually unlimited.

They do not have problems getting people to work for $7.00 or $8.00 an hour

as field paramedics. My 20 year-old son works at Lowe's Home Improvment

center. With no experience or education, he started at $9.50 per hour and,

after two months, got a raise to $10.00 per hour. There is something wrong

with a society that pays the guy who cuts lumber at Lowe's more than the guy

who comes out and takes care of me when I am acutely ill or injured.

Paramedics are responsible for a $75,000.00 vehicle which contains at least

$50,000.00 worth of equipment. They literally make decisions that affect

life or death on a daily basis. We pay them less than any other aspect of

Allied Health Care. The most complicated thing my son has to worry about is

whether the customer wants treated lumber or regular.

3. EMS must evolve from a job to a profession. I would still be a

paramedic if I had of thought that I could support my family on the wages.

In 1982 I was an experienced paramedic with a Bachelor's degree and making

little more than minimum wage. I was lucky that I had pretty good grades and

was able to get into medical school. But, most people aren't so lucky.

When we look at EMS Week this year.....Let's try and educate the public

about the important role of EMS. Once the general public knows how poorly

paramedics are paid, and how high the turnover rate is, there will hopefully

spring forth a grass roots support to improve the lots of EMTs and paramedics.

Please excuse my ramblings. This wage and turnover issue really gets under

my skin.

Dr. Bledsoe>>

Amen, Dr. , Amen!

[Guest guest]

Jerry:

The issue really comes down to education. The Registered Nurse has, at minimum,

a two year degree in nursing. He/She took a year of basics and then a fairly

intensive year and a half of nursing. Many nurses have Bachelor's degrees in

nursing. They start from a different place. They cannot work until they have

finished their education. They go to school and graduate and go to work

Paramedics, on the other hand, work right away after EMT school. Also, there

are still many EMS education programs that are turning medics out as fast as

they can with a minimal number of hours (i.e. 240 hours which includes

rotations). I can see how nurses might have some resentment when medics want to

do the same thing they do in the ED, but there is a difference of 2,000 or more

educational hours in their training.

Things are never going to get better until:

1. The educational programs become college-based and require basic courses

first. The new paramedic curriculum requires considerably more class room

hours.

2. Paramedic programs must stop turning out paramedics as fast as they can.

These graduates work in the system for 2 years or so and go on to other fields.

The big private companies bid their public utility model contracts based on

this. I cannot count on both hands the number of times I have heard an ambulance

service manager say that " all I really want is someone with a patch and a

pulse. " They see the paramedic pool as virtually unlimited. They do not have

problems getting people to work for $7.00 or $8.00 an hour as field paramedics.

My 20 year-old son works at Lowe's Home Improvment center. With no experience

or education, he started at $9.50 per hour and, after two months, got a raise to

$10.00 per hour. There is something wrong with a society that pays the guy who

cuts lumber at Lowe's more than the guy who comes out and takes care of me when

I am acutely ill or injured. Paramedics are responsible for a $75,000.00

vehicle which contains at least $50,000.00 worth of equipment. They literally

make decisions that affect life or death on a daily basis. We pay them less

than any other aspect of Allied Health Care. The most complicated thing my son

has to worry about is whether the customer wants treated lumber or regular.

3. EMS must evolve from a job to a profession. I would still be a paramedic

if I had of thought that I could support my family on the wages. In 1982 I was

an experienced paramedic with a Bachelor's degree and making little more than

minimum wage. I was lucky that I had pretty good grades and was able to get

into medical school. But, most people aren't so lucky.

When we look at EMS Week this year.....Let's try and educate the public about

the important role of EMS. Once the general public knows how poorly paramedics

are paid, and how high the turnover rate is, there will hopefully spring forth a

grass roots support to improve the lots of EMTs and paramedics.

Please excuse my ramblings. This wage and turnover issue really gets under my

skin.

Dr. Bledsoe

" Jerry S. Woods " wrote:

> Folks. I no longer practice in health care. One of the many reasons is this

insipid argument of " medics vs.RN's " . I have been sitting in front of this

screen for several hours trying to come up with some " problem solving " solution

to this mess. But I just can't. Primarily because EMS in general won't let go

of its " better than you 'cause we work the streets " mentality, and because ER

nurses just (generally) think they're " better " and because they (RN's) have a

better lobbying group in Austin. ER nurses need to get their act together and

realize that EMS provides an unbelieveably important part of health care,

and,quite often, make their job much easier. But, EMS needs to realize that

they are only the very beginning of the " health care continuom " that begins with

EMS, but only ends when the patient is discharged from the ER/hospital. For you

RN's out here,I suggest you listen carefully to the EMS people that bring folks

to your ER, and build your nursing care plan on that info. To EMS, I suggest

you go into great detail about your transport (and put same on paper), and if

the triage nurse seems not interested, ask for another nurse, or the charge

nurse. People! Work together! When you get down to basics, isn't our only job

good patient care? Thanks to all. Jerry S. Woods,EMT-P.

>

>

[Guest guest]

Jerry S. Woods wrote:

>

>

>

>

[Guest guest]

Dr.Bledsoe. Thanks for your reply. I did not want to get into the

" education " thing, because I felt many EMS persons would think I was getting

into a " better thn you " thing. But, the darn thing of it is, that the more

you know,the better off you are to perform. I graduated from nursing school

in 1970, and even then, my textbook on " pediatric nursing " was 20 pages more

than my EMT basic book in 1988. Point is, EMS needs, no should demand, that

they are more educated, not just for their " job " , but to be a better

inclusive part of heath care. If EMT's want to be just emergency medical

TECHNICIANS, then, fine. But, I feel EMS can be so much better.Thanks.

Jerry S.Woods,EMT-P(L)

Re: medics vs. RN;s

>Jerry:

>

>The issue really comes down to education. The Registered Nurse has, at

minimum, a two year degree in nursing. He/She took a year of basics and

then a fairly intensive year and a half of nursing. Many nurses have

Bachelor's degrees in nursing. They start from a different place. They

cannot work until they have finished their education. They go to school and

graduate and go to work Paramedics, on the other hand, work right away

after EMT school. Also, there are still many EMS education programs that

are turning medics out as fast as they can with a minimal number of hours

(i.e. 240 hours which includes rotations). I can see how nurses might have

some resentment when medics want to do the same thing they do in the ED, but

there is a difference of 2,000 or more educational hours in their training.

>

>Things are never going to get better until:

> 1. The educational programs become college-based and require basic

courses first. The new paramedic curriculum requires considerably more

class room hours.

> 2. Paramedic programs must stop turning out paramedics as fast as they

can. These graduates work in the system for 2 years or so and go on to

other fields. The big private companies bid their public utility model

contracts based on this. I cannot count on both hands the number of times I

have heard an ambulance service manager say that " all I really want is

someone with a patch and a pulse. " They see the paramedic pool as virtually

unlimited. They do not have problems getting people to work for $7.00 or

$8.00 an hour as field paramedics. My 20 year-old son works at Lowe's Home

Improvment center. With no experience or education, he started at $9.50 per

hour and, after two months, got a raise to $10.00 per hour. There is

something wrong with a society that pays the guy who cuts lumber at Lowe's

more than the guy who comes out and takes care of me when I am acutely ill

or injured. Paramedics are responsible for a $75,000.00 vehicle which

contains at least $50,000.00 worth of equipment. They literally make

decisions that affect life or death on a daily basis. We pay them less than

any other aspect of Allied Health Care. The most complicated thing my son

has to worry about is whether the customer wants treated lumber or regular.

> 3. EMS must evolve from a job to a profession. I would still be a

paramedic if I had of thought that I could support my family on the wages.

In 1982 I was an experienced paramedic with a Bachelor's degree and making

little more than minimum wage. I was lucky that I had pretty good grades

and was able to get into medical school. But, most people aren't so lucky.

>

>When we look at EMS Week this year.....Let's try and educate the public

about the important role of EMS. Once the general public knows how poorly

paramedics are paid, and how high the turnover rate is, there will hopefully

spring forth a grass roots support to improve the lots of EMTs and

paramedics.

>

>Please excuse my ramblings. This wage and turnover issue really gets under

my skin.

>

>Dr. Bledsoe

>

>

> " Jerry S. Woods " wrote:

>

>> Folks. I no longer practice in health care. One of the many reasons is

this insipid argument of " medics vs.RN's " . I have been sitting in front of

this screen for several hours trying to come up with some " problem solving "

solution to this mess. But I just can't. Primarily because EMS in general

won't let go of its " better than you 'cause we work the streets " mentality,

and because ER nurses just (generally) think they're " better " and because

they (RN's) have a better lobbying group in Austin. ER nurses need to get

their act together and realize that EMS provides an unbelieveably important

part of health care, and,quite often, make their job much easier. But, EMS

needs to realize that they are only the very beginning of the " health care

continuom " that begins with EMS, but only ends when the patient is

discharged from the ER/hospital. For you RN's out here,I suggest you listen

carefully to the EMS people that bring folks to your ER, and build your

nursing care plan on that info. To EMS, I suggest you go into great detail

about your transport (and put same on paper), and if the triage nurse seems

not interested, ask for another nurse, or the charge nurse. People! Work

together! When you get down to basics, isn't our only job good patient

care? Thanks to all. Jerry S. Woods,EMT-P.

>>

>>

[Guest guest]

,

I'd like to add a few things to this topic:

1. With the BBA of 97 that will be phased in from 2001 through 2004 for

medicare reimbursement to EMS Providers will cause many providers to be

reluctant in paying higher salaries. Many will have to down grade the

level of service to BLS. There are to many unknowns from HCFA for the

EMS Provider to make any dramatic moves in there budgets at this time.

For those that receive more for their base rate and mileage will still

lose in the loss of reimbursement for supplies, increase in cost of

vehicles, O & M,equip.ect.

2. The Medicaid program in Texas had reimbursement for EMS Providers

FROZEN since 1993 until last legislative session. The freeze was broken

only to see about a 1% increase in reimbursement. That equaled a $1.43

per call in my area. They only pay for BLS ambulance service. If the

many physician, hospital, NH, and other health care groups would help us

with the legislature perhaps we could be reimbursed properly and pay

properly.

3. Ambulance services can't be reimbursed by the Indigent Health Care

Program, but all other medical providers are. If the legislature would

at least change this to reimbursement of the provider at the medicaid

rate this would be a huge boost to the EMS Providers. Once again the

many physician, hospital, NH, nursing, ect. groups could help us get the

legislature change this. Then we may have the money to improve salaries,

and education.

4. Dr's. Hospitals, Nursing Homes, ect. treat health care as a business,

and until EMS does the same by ALL PROVIDERS the reimbursement will be

low and so salaries will stay low with, or without education.

5. As an administrator I have also heard " I don't care as long as they

have a patch and a pulse " . I can assure you most EMS Providers don't

feel that way. Although we make the comment out of frustration of not

being reimbursed properly to pay our personnel, and other costs.

6. I'm a government provider. I've read many comments criticizing

private providers on this list. The fact is most private providers are

paying more than government providers, and heavy with a benefit package.

At the same time they do not enjoy the tax exempt, immunities, tobacco

funds ect. that I receive. Don't take this wrong, since many government

providers pay well also.

7. There are many volunteer services, and first responder groups that we

all know work for free. They are a god send to the community and many

EMS services. With that said the fact remains as long as EMS personnel

will do the job for free, unlike Dr's, nurses, hospitals, nursing homes,

home health, Pa's, then what's the incentive to pay anyone more. I have

a well paid full time paid staff that volunteers here and elsewhere off

duty. I know they have their reasons, but why would I want to pay them

more if they will do it off duty for free? I do want to pay them more,

but it's hard for me to sell when they volunteer for other EMS services

off duty for free. I bring the issue up to raise salaries, and some of

the thinking is " why should we pay them more here when they work in the

next county for free " , " why don't they ask for money from the city/

county they work for free " . We also see many that work here, and will

work for another provider off duty for 1/2 the salary, when they could

work a overtime shift at 5 times the rate. Why? They can pick and choose

their hours,and days? Less control as a medic? I'm sure each one has

their own reason, but all will tell you it's to help the community, or

it's only PRN. Who can argue with that? Not me!!!! Does it help increase

salaries?

8. I feel until ALL of EMS is forced to treat their service like a

business you will find it hard to see salaries raised in Texas or any

other state.

9. I feel that all EMS providers need to be educated on how to run EMS

as a business. This would benefit, ALL providers. The volunteers,

probably wouldn't have to do as many Bar B Q 's. The best place to

start is a special track at the EMS conference. Other places would be in

the EMS class room at every level of training. This is one area sorely

missing in the College arena on EMS education.

10. I feel all the colleges should collectively put together a distant

learning program through computers, and other methods. At the current

time they do a great job for there own college with what they

have.Imagine if they combined their resources, equipment, and efforts.

This could be accomplished with a small amount of funding from the

legislature set for that purpose only. The educators seem to be chopping

at the bits to do this. So let's empower them to do so.

11. The physician groups want to drag out the pass/fail, C.E. ,rules in

Austin. They want us to come up with a QI,QA program that suits them,

before they will let the evaluation, or pass/fail issue go. It's already

in place in the EMS Provider License. Why won't they put that kind of

effort in distant education? Believe me it's been 8 years of effort on

the physicians to go Austin to insist on the pass/fail. I never see any

of them make one trip to promote, and help provide/pay for education.

They will endorse it, but no effort. They will demand more hours, but

never look at the financial impact, or how to pay for it. They can ask

for things all day long, but so did my kids when they were younger. If

you agree perhaps you could help persuade your colleagues to help the

providers get better reimbursement, fund distant education, ect. The

ones that scream the loudest are paid the most. I guess it's to feel

like they earned their money. I know a few do it, because they feel it's

best for patient care. They problem is they can't get the funds locally

so they try to force a bad rule, so they can go back and force the local

officials to given them the money. This a bad course to reach that goal.

It only sets up a conflict, that ends up back in Austin.

12. What went wrong with the Licensed Paramedic and Pay? As usual we do

things knee jerk and backwards. If we would have pushed this issue for

EMT's and increased their salaries, then the others would have had to

gone up across the state as a whole. Now we have a few and I mean few

services paying from $250 to $3,000 extra for licensed paramedics. If

the provider was going to pay for a degree they would have done it

without a rule. Some just need a new title (patch) to justify an

increase for them in their budgets. They already had the paramedics with

a degree, they just needed the rule to get another patch. If we create

another patch for the EMT maybe we can do the same for the few with a

degree. Will this really take us where these folks are paid properly?

13. Yes EMT's go to work then go and get their paramedic. So do many

Lvn's work and then go and get their RN.

14. You see many EMS services attached to fire departments, hospitals,

police departments, sheriff departments,etc. You never see it the other

way around where they are attached to EMS. If EMS by itself could

provide two services for the price of one with the same personnel, then

ems would be worth more.

15. When we look at EMS it is looked at much differently than nursing.

EMS contact with a patient is for a very, very short term compared to

the time the nurse will deal with the same patient. The same with the

Dr. and hospital. Who is the patient going to remember the most? Who's

going to provide the most care in the long run? All of the above will

more so than EMS. Many times the patients total contact with EMS is 30

minutes more or less, and they get a bill.

16. When it comes to ambulances what does the majority of the public

want? Do they care what name is on the vehicle? Who's in the vehicle?

Usually they just want to see those sirens, and red lights coming fast

to get me to the hospital in one piece fast. It's like water. It's taken

for granted until someone cuts the water off.

..

Yes education is the key. It must start with educating physician's,

nurses,elected officials, TML, TAC,Rac's, hospitals, nursing homes, and

Doe citizen about all of the components of EMS as well as the

difficulties the industry is facing. Maybe this should be the number one

priority of the Rac's to educate the public about EMS salaries,

reimbursement,education needs,ect. The public health would be greatly

improved once the public is involved in EMS in general, and not just at

the local level.

I appreciate your comments ,and you are a big advocate for the

field medic in every way. Your status in the EMS community is large. I

think if you, the other physicians understood (I'm sure you do) what it

cost to put EMS on the streets, and help the state ems associations get

the funding we need for the provider the rest will fall in place.

I could ramble more, but I guess it's time to get off the soap box.

These opinions are my own and not of anyone, my employer, associations,

or other group!!

Thanks

" Bledsoe, DO, EMT-P " wrote:

> Jerry:

>

> The issue really comes down to education. The Registered Nurse has,

> at minimum, a two year degree in nursing. He/She took a year of

> basics and then a fairly intensive year and a half of nursing. Many

> nurses have Bachelor's degrees in nursing. They start from a

> different place. They cannot work until they have finished their

> education. They go to school and graduate and go to work Paramedics,

> on the other hand, work right away after EMT school. Also, there are

> still many EMS education programs that are turning medics out as fast

> as they can with a minimal number of hours (i.e. 240 hours which

> includes rotations). I can see how nurses might have some resentment

> when medics want to do the same thing they do in the ED, but there is

> a difference of 2,000 or more educational hours in their training.

>

> Things are never going to get better until:

> 1. The educational programs become college-based and require basic

> courses first. The new paramedic curriculum requires considerably

> more class room hours.

> 2. Paramedic programs must stop turning out paramedics as fast as

> they can. These graduates work in the system for 2 years or so and go

> on to other fields. The big private companies bid their public utility

> model contracts based on this. I cannot count on both hands the number

> of times I have heard an ambulance service manager say that " all I

> really want is someone with a patch and a pulse. " They see the

> paramedic pool as virtually unlimited. They do not have problems

> getting people to work for $7.00 or $8.00 an hour as field

> paramedics. My 20 year-old son works at Lowe's Home Improvment

> center. With no experience or education, he started at $9.50 per hour

> and, after two months, got a raise to $10.00 per hour. There is

> something wrong with a society that pays the guy who cuts lumber at

> Lowe's more than the guy who comes out and takes care of me when I am

> acutely ill or injured. Paramedics are responsible for a $75,000.00

> vehicle which contains at least $50,000.00 worth of equipment. They

> literally make decisions that affect life or death on a daily basis.

> We pay them less than any other aspect of Allied Health Care. The most

> complicated thing my son has to worry about is whether the customer

> wants treated lumber or regular.

> 3. EMS must evolve from a job to a profession. I would still be a

> paramedic if I had of thought that I could support my family on the

> wages. In 1982 I was an experienced paramedic with a Bachelor's

> degree and making little more than minimum wage. I was lucky that I

> had pretty good grades and was able to get into medical school. But,

> most people aren't so lucky.

>

> When we look at EMS Week this year.....Let's try and educate the

> public about the important role of EMS. Once the general public knows

> how poorly paramedics are paid, and how high the turnover rate is,

> there will hopefully spring forth a grass roots support to improve the

> lots of EMTs and paramedics.

>

> Please excuse my ramblings. This wage and turnover issue really gets

> under my skin.

>

> Dr. Bledsoe

>

>

> " Jerry S. Woods " wrote:

>

> > Folks. I no longer practice in health care. One of the many

> reasons is this insipid argument of " medics vs.RN's " . I have been

> sitting in front of this screen for several hours trying to come up

> with some " problem solving " solution to this mess. But I just can't.

> Primarily because EMS in general won't let go of its " better than you

> 'cause we work the streets " mentality, and because ER nurses just

> (generally) think they're " better " and because they (RN's) have a

> better lobbying group in Austin. ER nurses need to get their act

> together and realize that EMS provides an unbelieveably important part

> of health care, and,quite often, make their job much easier. But, EMS

> needs to realize that they are only the very beginning of the " health

> care continuom " that begins with EMS, but only ends when the patient

> is discharged from the ER/hospital. For you RN's out here,I suggest

> you listen carefully to the EMS people that bring folks to your ER,

> and build your nursing care plan on that info. To EMS, I suggest you

> go into great detail about your transport (and put same on paper), and

> if the triage nurse seems not interested, ask for another nurse, or

> the charge nurse. People! Work together! When you get down to

> basics, isn't our only job good patient care? Thanks to all. Jerry S.

> Woods,EMT-P.

> >

> >

[Guest guest]

14. You see many EMS services attached to fire departments, hospitals,

police departments, sheriff departments,etc. You never see it the other

way around where they are attached to EMS. If EMS by itself could

provide two services for the price of one with the same personnel, then

ems would be worth more.

That's something I've been wondering for a while. Not many people

understand that most services revolve around EMS calls, not the other way

around. In some areas, DPS organizations exist that provide police and EMS,

in many locations the EMS agency also fights fires, and gets called a fire

department. Are there many services out there (especially the volunteers,

who fill an unfilled role in their community, but also the other first-line

911 services) that are running EMS/Resuce departments, and let FD handle

supression alone?

Mike

[Guest guest]

> department. Are there many services out there (especially the volunteers,

> who fill an unfilled role in their community, but also the other first-line

> 911 services) that are running EMS/Resuce departments, and let FD handle

> supression alone?

Yes there are many of such departments in NC where I live, however

because of

the need for a charged handline at all vehicle extrications, most EMS

agencies

are giving up the extrication side of things rather than spend the big

bucks for

a pumper. Also the continuing education requirements for EMT-P and ERT

(emergency rescue tech), have many departments giving extrication up.

Dwayne

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[Guest guest]

This is such a good point, I've stayed out of the whole thing untill now,

but I remember from my " vollie " day's that even in my fire dept. that there

were the " medic's " and there were the " firemen " ....but we were still known

as the Fire Dept. ...

Goodman EMT-P

>

>Reply-To: egroups

>To: <egroups>

>Subject: Re: medics vs. RN;s

>Date: Sun, 16 Apr 2000 19:47:21 -0500

>

>14. You see many EMS services attached to fire departments, hospitals,

>police departments, sheriff departments,etc. You never see it the other

>way around where they are attached to EMS. If EMS by itself could

>provide two services for the price of one with the same personnel, then

>ems would be worth more.

>

>That's something I've been wondering for a while. Not many people

>understand that most services revolve around EMS calls, not the other way

>around. In some areas, DPS organizations exist that provide police and

>EMS,

>in many locations the EMS agency also fights fires, and gets called a fire

>department. Are there many services out there (especially the volunteers,

>who fill an unfilled role in their community, but also the other first-line

>911 services) that are running EMS/Resuce departments, and let FD handle

>supression alone?

>

>Mike

>

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