RN-Paramedic

[Guest guest]

In reply to Wayne, I would add the following:

Not all RNs are created equal. It is the RNs with heavy emergency department

experience who are wanting this, and, by and large, they're extremely well

qualified with the caveat that they probably need to do the Basic EMT course

to learn about all the bells and whistles they don't know about unless

they've been riding out as a first responder or something. I think usually

will need to ride out with a paramedic preceptor for a sufficient amount of

time to demonstrate that they have the street skills, critical thinking and

problem solving abilities that street medics have to have and to gain the

experience in doing street skills. These are not necessarily those of the ER

nurse, no matter how much Level 1 experience s/he has. Doing it in the ditch

is different from doing it in the ER. Everybody's got to be able to do it in

the ditch, in the dark, in the rain, the snow, and with wild animals and

unruly crowds surrounding.

Now, on the subject of the BNE. They have never for ONE MINUTE considered

even a Licensed Paramedic with an AAS to be on their level, and I don't see

any evidence of change. Further, BNE is controlled NOT by emergency nurses

or even ICU nurses (who generally DO have a clue) but by dinosaurs that still

think in terms of the traditional role of the nurse and are committed to the

protection of their major constituency of nurses not involved in acute care.

In fact, many of them have no idea what acute care is all about. It's not of

interest to them. It's not a part of the curriculum in nursing programs.

It's somehow a little soiled and tawdry when compared to the wonderful

calling of the nurse to attend to the long-term needs of their " clients. "

Notice that nursing has used the word " client " rather than patient for the

last decade or more. I thought attorneys and accountants had " clients. "

The arrogance level at the BNE is on FL 41, the same as a LearJet flies, and

until they seriously consider granting us some sort of reasonable

reciprocity, then I'm absolutely and intractably opposed to letting them

challenge paramedicine without us having full and complete knowledge that

they're able to perform in ALL prehospital arenas, not just the helo. That

means getting coded beached whales out of the bathtub or the recliner with

only one partner to help and conducting a code on a patient who insists on

staying in ventricular fibrillation and subject to resuscitation in the back

of a rapidly moving truck by one's self for at least a 25 mile transport.

Before GETAC jumps in and recommends any concessions to the nurses, we need

to have a concurrent, reciprical position statement from BNE that it supports

equal opportunity for LPs to challenge the RN program. Until we receive that

from BNE, we ought not ever give ONE INCH.

I know this will offend some good nurses out there who are, without a single

doubt, eligible and entitled to get their paramedic certs. But nursing, not

paramedicine, is the discipline that's maintained the turf battles and shows

no signs of reform. Nursing is the profession that's looked down it's nose

at everybody else for way too long.

EMSAT, by the way, has taken the position that RNs should not be granted

automatic equivalency rights.

I urge all the nurses who are interested in Paramedic certs to make their

wishes known to the BNE, and to let the BNE know that it's going to work both

ways or not at all. Until the BNE decides that it's in the best interests of

its constituents to agree to some reasonable reciprocity rules, then I for

one, oppose granting challenge rights to RNs without stringent but fair

requirements for demonstration of competencies prior to testing.

I do not for one millisecond think that I could do the job of a nurse in many

of their areas of practice, and I would not even think of wanting to

challenge their professional standards until mine were up to the required

level. That's all I ask of the nurses.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

Greetings,

First, sorry for any duplicate posts. In setting through the joint EMS and

Education Committee meeting on Thursday, several things were talked about in

regard to the RN to Paramedic process. I would like to commit on a few

things.

1) If an RN is going to apply for paramedic certification, they should have

to take and complete the ENTIRE EMT-Basic program first; then based on

critical care experience in ICU/ER/CCU and use that to determine what parts

of that experience could be applied toward paramedic training to see what

area needed to be covered or completed. However, if the RN has no critical

care experience, they should be REQUIRED to complete the ENTIRE paramedic

program. In either case, both should be required to complete the ambulance

time and certain parts of the clinical time, especially if they have no

critical care experience. Both should also be REQUIRED to pass ALL skills

associated with paramedic training.

2) It was brought up that certain course work should not be repeated, i.e.

A & P. Most colleges require that after a certain period of time, certain

courses have to be taken over. This should apply to RN's seeking paramedic

training through a college. If it has been past the 5-7 yr limit, certain

course should be completed again, no exception.

3) Bridge courses are going to vary depending on the individual, so why

bother with such a program unless it is going to be uniform across the board

and not have 50 different courses. By each program having something

different, it would be more work on the coordinator by having each person at

a different level of training.

I know that GETAC is only working on the RN portion for now, because of the

interest at that level. However, I do tend to agree with Henry and his view

point. Most, if not all of this was brought about by the air medical

providers wanting an easy was for their RN's certified as medics. As

pointed out before on the list server, the state is bowing down to a small

group of people in order to satisfy those providers. Jeff Jarvis and other

posted about this matter also.

Many in EMS have expressed their opinions on this and most all are against

the challenge process. Many feel that RN's are not earning this

certification, but having it handed to them. We all earned ours and many if

not all thin k that RN's should have to earn theirs also.

Provider rule changes were talked about for the air medical group. But, if

you change one rule to satisfy one particular group, before long other will

come back and want the rule changed to satisfy them, thus becoming a never

ending process.

The other thing that was touched on was the use of EMTs and Paramedics in

the ER. As pointed out, this has always been a touch subject for years and

will continue to be I'm sure.

The biggest problem here in most all cases is who should supervise the EMTs

and paramedics, and under what department should they be placed, nursing or

under the ER Medical Director.

Under BNE rules, an RN cannot delegate to a paramedic, not even a licensed

paramedic any invasive procedures, i.e., IVs, meds, etc. BNE has refused to

recognize the LP as " licensed personnel " even thought they are issued a

license by a state regulatory agency. According to the Secretary of States

Office, if a Texas regulatory agency issues a license to a person, it should

be recognized by ALL other state agencies. However, the BNE seems to be

exempt and has refused to recognized such license. Even in talking with the

BNE, they have not plans on changing their rules to recognize license

paramedics as " licensed personnel " or licensed professionals. Therefore,

until the BNE recognizes LP's in the hospital setting as licensed personnel,

they and other EMS personnel remain nothing more that certified/licensed

CNA's, bed pan totters and other " scud " work the nursing staff does not want

to do.

Many ER's will allow the EMT or paramedic to draw blood, but not start a hep

lock or IV. It would seem logical to draw blood as the IV is being started

rather than stick the pt twice. Along with blood draws, most places will

allow them to place foley's and in some places NG-Tubes. The question

remains, under who's directive should EMT and Paramedics be placed? It

would seem logical to place them under the ER physician using standing

orders just as one would in use in the field, because nurses cannot delegate

to EMTs/Paramedics/LPs.

There are some hospitals in the state that will allow paramedics to start

IVs and push meds on a regular basis. However, most cases only in an MCI

situation, but not always. Some hospitals have had to change policy or job

descriptions for EMTs and Paramedics because of the nursing associations in

Texas throwing a fit about EMTs/Paramedics/LPs using their training in the

ER. This is why some have placed them under the ER medical director.

It was pointed out sometime back, that TDH should not be involved or have a

position on EMTs and Paramedics in the ER. It was suggested that this be

left up to each hospital to decided on how personnel should be used and not

TDH. TDH may offer suggestions, but leave it to the hospital on what skills

they will allow.

Also it was pointed out that EMTs and Paramedics don't have a scope of

practice that we fall under like that of other nursing and other healthcare

professionals so. Maybe this is something that should be looked at.

Since I was not able to stay for the main GETAC meeting on Friday, I'm not

sure what was suggested or recommended on the RN-Paramedic or the TDH

position paper, maybe someone could enlighten me.

Changes to need to be made, but EMS should not be the only one doing ot

offering to change rules to satisfy certain groups, those groups or agencies

should also be willing to change rules also, especially nursing.

Just my thoughts.

Wayne Dennis, EMT-P

_________________________________________________________________

Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp

[Guest guest]

Melody,

Yes, I know you did. And thanks. We've got to be tough on this issue. The

emergency nurses are our friends, as we know, but the BNE is in NO WAY a

friend of Paramedics. I urge all of us to hold tight and make the BNE at

least recognize us before we let nurses challenge our licensure/certification

without their letting us do the same to nursing.

It's great that GETAC is willing to accommodate the nurses by even

considering access to certification/licensure without completing the entire

curriculum for paramedics. Where is the BNE on this? Nowhere! They won't

even acknowledge our existence. Tell me ONE THING that the BNE has ever done

to ease the way for Paramedics to become nurses. Tell me ONE THING that the

BNE has ever done to ease the way for Paramedics to work in hospitals. Tell

me ONE WAY that the BNE has offered to cooperate with us at any level.

So, until the BNE changes its stance, I'm not going to change mine. Let's be

real here. The nurses are asking us for a privilege they're not willing to

grant to us. And unfortunately, the nurses that are asking us for this are

probably embarrassed by the BNE, as they should be.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

I thought that all the points had been made, and that I shouldn't speak. I

didn't want to appear to be against the progress that I thought was being

made. I have the reputation of speaking out too much, so that's why I didn't.

gg

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

RN-Paramedic

I agree w/ Wayne!

On the other side of this issue is a Paramedic to RN bridge program, such as

the LVN to RN bridge program. As the old saying goes " Turn about is fair

play " . My thoughts also.

Shiplet, A.A.S., L. P.

EMS Coordinator

City of Whitewright

[Guest guest]

I brought this exact issue up at the joint committee meeting. Dr. Racht

requested that the new three-person

" Bridge " subcomittee look at it also. This subcommittee includes a nurse, a

doctor and Neil Coker, an EMS

educator.

No matter how you feel about it, NOW is the time to send in your suggestions,

not after months of work is

completed.

Melody Malouf, JD, LP, NREMT-P

Education Committee

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

> Subject: RN-Paramedic

>

>

>

> I agree w/ Wayne!

>

> On the other side of this issue is a Paramedic to RN bridge program, such as

> the LVN to RN bridge program. As the old saying goes " Turn about is fair

> play " . My thoughts also.

>

> Shiplet, A.A.S., L. P.

> EMS Coordinator

> City of Whitewri

[Guest guest]

Gene:

There were only three public comments and they were rather mild. You guys

were there--why didn't you stand up

and voice your opinion if you feel that strongly about it?

Melod

[Guest guest]

On Tue, 28 Aug 2001 00:22:18 EDT wegandy@... writes:

> We've got to be tough on this issue. The

> emergency nurses are our friends, as we know, but the BNE is in NO

> WAY a friend of Paramedics. I urge all of us to hold tight and make

the

> BNE at least recognize us before we let nurses challenge our

> licensure/certification without their letting us do the same to

nursing.

Giving the reciprocity chip away is the equivalent of letting the

" critter-on-scene " swing the chain first because you at least took a

shower this morning. In my collection of alpha-bits, you would see some

of each. I stand with EMSAT on this one.

Both nursing and EMS are evolving to a more community health based

service system. If the nurses without " situational awareness " insist on a

" dog in the manger " approach, then they are creating more self fulfilling

prophesy. Let me leave you with no doubt; they want this to continue

building a power base. They are trying to equate " RN shortage " with

" nursing shortage " . THEY are NOT the same thing!

I don't think a mom who needs school shots for their kiddos gives a

flying fig WHO gives their child the shot, as long as it is done well and

with a minimum trauma to their child.

This attitude is directly proportional the further you get away from the

" mega health systems " . Rural /Frontier health care requires a blend of

both nursing and EMS; both professions should be working together. Not

fossils of any ilk building walls.

" Leadership is action, not position "

Larry RN LP CEN CFRN NREMTP... all earned!

________________________________________________________________

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[Guest guest]

Mike, there have been several inquiry's made to the BNE by myself and friends

of mine lately. They should be legally bound to recognize it as a license,

however, the answers you get from them are either a vague rant with no clear

anser, or an absolute NO, they won't honor it. It's stupd, and I have no

idea why they aren't being forced to honor it. As for an AG opinion, I have

no idea.

CB

[Guest guest]

Well I said my piece at the meeting. However, Cheek and I were both

on the same wave length in regards to this issue. I felt that it would

not even be an issue if it had not been for the flight services wanting

a quick easy fix to allow nurses to fly on a TDH licensed provider

helicopter.( I would question in 90% of the flights if a quality

paramedic could not ride the call and provide the service. Is it

necessary or are we in the case of the hospital based flight services

saying that a nurse is the higher level of care and the need for a

paramedic certification is just incidental.)

Ok I got the snotty part out of the way. In reality we are dealing with

a small special interest group. I think we would be better off

addressing the issue of the flight aircraft and if it really should be

classified as a ambulance and thus fall under the provider rule. If not,

I would be willing to bet my boat that the nurse challenge would go

away. I bet its about money. Certainly its not about patient care. If

the flight services can afford to put that much money into having flight

services, then the small amount of money time and effort it would take

to send the nurses through a paramedic school would be cost effective.

Its really about shortcuts. The 10,000 paramedics and licensed

paramedics did not have the opportunity to take shortcuts. TDH made sure

that they followed the rules. TDH also keeps bringing the nursing

challenge back to the table. It appears to me that TDH should be out

there protecting the paramedics in this state. (Sorry Kathy, this is not

a personal shot. Just my opinion.)

I feel that TDH as our regulatory agency has the obligation to protect

our (paramedics) interest. Some will make the statement that TDH is

there to protect the patient. I fully agree, as are the Paramedics in

TEXAS.

I have nothing but respect for nurses and other professionals. However,

I feel they will bend over backwards to protect their profession. They

do so by a strong voice and the BNE. Their regulatory agency works for

them. At this point and due to our own inability to come together as a

group, TDH is our only hope for profession protection.

Do I think we need as a EMS Committee member move forward with

addressing the nursing challenge? No I don't. I will however continue to

voice my opinion at the meetings (stay in the hunt) Do I think this

issue if moved forward with will affect EMS in the long run? No I don't.

This is due to trying to appease a small special interest group that was

as happy as punch as long as TDH was circumventing the existing rule.

(Thank you so much Jeff Jarvis for stirring this pot then clamming up.)

I guess in closing this jumbled rant of thoughts, I would say to you

that not every issue brought to TDH or the Committees or GETAC needs to

be addressed. Not every rule needs to be re-looked at. Its like drugs,

sometimes you just have to say NO!

Henry

wegandy@... wrote:

> I thought that all the points had been made, and that I shouldn't

> speak. I

> didn't want to appear to be against the progress that I thought was

> being

> made. I have the reputation of speaking out too much, so that's why I

> didn't.

>

> gg

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

>

[Guest guest]

Gene and others:

I disagree. Numbers DO count and it gives others courage to speak. Kathy

stated that there were only three

responses during the open comments period for the last rule change. TDH

considered that a success. The time to

shape and mold policy is best done at the beginning and during committee

meetings, especially before so much

time, talent and resources are invested.

After a certain point the more time that is invested on an issue, the more

people tend to feel it MUST go forward and

pass. Everyone involved would appreciate knowing sooner than later what the

level of support or disagreement is

before so much time and money is invested. We want to work toward a consenus

and can't do that if we don't know

where everyone stands on an issue. Your feedback is welcome.

If you are not able to make the meetings then send an email or letter. Correct

me if I am wrong, but speaking out on

this list service does not necessarily count. You can simply " cc " it to the

person or department that you want to

hear it.

Melody Malouf, JD, LP, NREMT-P

Education Committee

> I thought that all the points had been made, and that I shouldn't speak. I

> didn't want to appear to be against the progress that I thought was being

> made. I have the reputation of speaking out too much, so that's why I didn't.

>

> gg

>

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

> [Non-text portions of this message have been

[Guest guest]

How is it that the BNE is allowed to not recognize a paramedic license issued by

an agency of the State?

Has anyone challenged this or received an AG opinion on it? If it's a state

license, I thought they were *required by law* to see it as such?

Mike

Re: Re: RN-Paramedic

Melody,

Yes, I know you did. And thanks. We've got to be tough on this issue. The

emergency nurses are our friends, as we know, but the BNE is in NO WAY a

friend of Paramedics. I urge all of us to hold tight and make the BNE at

least recognize us before we let nurses challenge our licensure/certification

without their letting us do the same to nursing.

It's great that GETAC is willing to accommodate the nurses by even

considering access to certification/licensure without completing the entire

curriculum for paramedics. Where is the BNE on this? Nowhere! They won't

even acknowledge our existence. Tell me ONE THING that the BNE has ever done

to ease the way for Paramedics to become nurses. Tell me ONE THING that the

BNE has ever done to ease the way for Paramedics to work in hospitals. Tell

me ONE WAY that the BNE has offered to cooperate with us at any level.

So, until the BNE changes its stance, I'm not going to change mine. Let's be

real here. The nurses are asking us for a privilege they're not willing to

grant to us. And unfortunately, the nurses that are asking us for this are

probably embarrassed by the BNE, as they should be.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

I echo Melody.....also BNE was there at the meeting, i believe, and he spoke up.

Once again we are willing to speak

up on the listserver but not in the public meeting, hmmmmmmm.

Tim

malouf@... wrote:

> Gene:

>

> There were only three public comments and they were rather mild. You guys

were there--why didn't you stand up

> and voice your opinion if you feel that strongly about it?

>

> Melod

>

>

>

>

>

[Guest guest]

The man who spoke is a lawyer for the Texas Nurses Association, NOT the BNE.

To my knowledge there was nobody from BNE there, nor would it have been

appropriate for them to have sent one to speak without invitation. The man

who spoke is a lobbyiest.

gg

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

People did send Emails!

The TDH received somewhere around 35 Emails, all in opposition, however these

never quite made it to the committees. They were replied to with " the

comment period on this rule is past. " While I agree that the comment period

for the initial rule submitted to the BOH had passed, this was a NEW issue

being brought up for discussion and it seems that the input and opinions from

EMS people were dismissed due to a technicality. I, as well as 30 something

other people are *VERY* disappointed that the comments were not forwarded to

the committees where this was debated. This sent a message in itself to a

lot of EMS people who took the time and effort to attempt to make their

opinions known. Ya know, the ENA didn't have any trouble getting their

letter requesting this action distributed by the THD to the committee

members! These two actions speak volumes to me.

I applaud the efforts and courage displayed by some of the committee members.

It was very refreshing to hear some of the questions they posed. EMS people

can be proud of the representation they are receiving from some of the

members of the EMS, Education and GETAC committees. Unfortunately, they may

be outnumbered.

As far as expecting the BNE or the ENA to be flexible or to give something in

return, we better do a little history research. I have been told that in the

beginning (before my time) when the EMS act was passed, there was a deal made

then. The deal was to allow RN's easily become paramedics, and they would

allow paramedics to easily become RNs. As someone else put it, EMS vica-ed

but the RNs didn't versa! Do any of you Old Timers remember this?

In a message dated 8/28/01 11:10:35 AM Central Daylight Time, malouf@...

writes:

>

>

> If you are not able to make the meetings then send an email or letter.

> Correct me if I am wrong, but speaking out on

> this list service does not necessarily count. You can simply " cc " it to

> the person or department that you want to

> hear it.

>

>

[Guest guest]

Henry and others,

I had to reply and say, very well put. If it were not for the flight

programs wanting this, it would have never came up.

I do think that TDH should support EMS in Texas and take the same stance

that the BNE has against paramedics.

We should not be able to allow ANYONE obtain a EMT or Paramedic

certification without taking the ENTIRE program. As you said, there were no

shortcuts for us. If we are going to allow shortcuts for one group, them

why not let everyone take the shortcut to paramedic training.

And yes, where is Jeff now that we need him.

Wayne

>

>Reply-To:

>To:

>Subject: Re: Re: RN-Paramedic

>Date: Tue, 28 Aug 2001 09:02:31 -0500

>

>Well I said my piece at the meeting. However, Cheek and I were both

>on the same wave length in regards to this issue. I felt that it would

>not even be an issue if it had not been for the flight services wanting

>a quick easy fix to allow nurses to fly on a TDH licensed provider

>helicopter.( I would question in 90% of the flights if a quality

>paramedic could not ride the call and provide the service. Is it

>necessary or are we in the case of the hospital based flight services

>saying that a nurse is the higher level of care and the need for a

>paramedic certification is just incidental.)

>

>Ok I got the snotty part out of the way. In reality we are dealing with

>a small special interest group. I think we would be better off

>addressing the issue of the flight aircraft and if it really should be

>classified as a ambulance and thus fall under the provider rule. If not,

>I would be willing to bet my boat that the nurse challenge would go

>away. I bet its about money. Certainly its not about patient care. If

>the flight services can afford to put that much money into having flight

>services, then the small amount of money time and effort it would take

>to send the nurses through a paramedic school would be cost effective.

>Its really about shortcuts. The 10,000 paramedics and licensed

>paramedics did not have the opportunity to take shortcuts. TDH made sure

>that they followed the rules. TDH also keeps bringing the nursing

>challenge back to the table. It appears to me that TDH should be out

>there protecting the paramedics in this state. (Sorry Kathy, this is not

>a personal shot. Just my opinion.)

>

>I feel that TDH as our regulatory agency has the obligation to protect

>our (paramedics) interest. Some will make the statement that TDH is

>there to protect the patient. I fully agree, as are the Paramedics in

>TEXAS.

>

>I have nothing but respect for nurses and other professionals. However,

>I feel they will bend over backwards to protect their profession. They

>do so by a strong voice and the BNE. Their regulatory agency works for

>them. At this point and due to our own inability to come together as a

>group, TDH is our only hope for profession protection.

>

>Do I think we need as a EMS Committee member move forward with

>addressing the nursing challenge? No I don't. I will however continue to

>voice my opinion at the meetings (stay in the hunt) Do I think this

>issue if moved forward with will affect EMS in the long run? No I don't.

>This is due to trying to appease a small special interest group that was

>as happy as punch as long as TDH was circumventing the existing rule.

>(Thank you so much Jeff Jarvis for stirring this pot then clamming up.)

>

>I guess in closing this jumbled rant of thoughts, I would say to you

>that not every issue brought to TDH or the Committees or GETAC needs to

>be addressed. Not every rule needs to be re-looked at. Its like drugs,

>sometimes you just have to say NO!

>

>Henry

>

>wegandy@... wrote:

>

> > I thought that all the points had been made, and that I shouldn't

> > speak. I

> > didn't want to appear to be against the progress that I thought was

> > being

> > made. I have the reputation of speaking out too much, so that's why I

> > didn't.

> >

> > gg

> >

> > E. Gandy, JD, LP

> > EMS Professions Program

> > Tyler Junior College

> > Tyler, TX

> >

> >

> >

[Guest guest]

In thought that was a Rep from the Texas Nursing Association, which is

totally different fron the Board of Nursing Examiners, unless I hear him

wrong.

What I posted was things that I thought of after the meeting, so I posted

them to the list. Plus I wanted to check some other notes that I did not

have with me.

Wayne

>

>Reply-To:

>To:

>Subject: Re: Re: RN-Paramedic

>Date: Tue, 28 Aug 2001 11:37:58 -0500

>

>I echo Melody.....also BNE was there at the meeting, i believe, and he

>spoke up. Once again we are willing to speak

>up on the listserver but not in the public meeting, hmmmmmmm.

>

>Tim

>

>malouf@... wrote:

>

> > Gene:

> >

> > There were only three public comments and they were rather mild. You

>guys were there--why didn't you stand up

> > and voice your opinion if you feel that strongly about it?

> >

> > Melod

> >

> >

> >

> >

> >

[Guest guest]

Thank you Gene...Until BNE offers something in return, we should not give

anything.

We recognize a RN with a ASN, BSN, MSN or PhD, but BNE will not recognize a

licensed paramedic with the same degrees.

Also, let me point out that BNE, like other state agencies including the

BOH, have members that are appointed by the Governor and they do have GP

members on the board. Maybe we in EMS should apply for appointment to these

positions.

Wayne

>From: wegandy@...

>Reply-To:

>To:

>Subject: Re: RN-Paramedic

>Date: Mon, 27 Aug 2001 23:06:08 EDT

>

>In reply to Wayne, I would add the following:

>

>Not all RNs are created equal. It is the RNs with heavy emergency

>department

>experience who are wanting this, and, by and large, they're extremely well

>qualified with the caveat that they probably need to do the Basic EMT

>course

>to learn about all the bells and whistles they don't know about unless

>they've been riding out as a first responder or something. I think usually

>will need to ride out with a paramedic preceptor for a sufficient amount of

>time to demonstrate that they have the street skills, critical thinking and

>problem solving abilities that street medics have to have and to gain the

>experience in doing street skills. These are not necessarily those of the

>ER

>nurse, no matter how much Level 1 experience s/he has. Doing it in the

>ditch

>is different from doing it in the ER. Everybody's got to be able to do it

>in

>the ditch, in the dark, in the rain, the snow, and with wild animals and

>unruly crowds surrounding.

>

>Now, on the subject of the BNE. They have never for ONE MINUTE considered

>even a Licensed Paramedic with an AAS to be on their level, and I don't see

>any evidence of change. Further, BNE is controlled NOT by emergency

>nurses

>or even ICU nurses (who generally DO have a clue) but by dinosaurs that

>still

>think in terms of the traditional role of the nurse and are committed to

>the

>protection of their major constituency of nurses not involved in acute

>care.

>In fact, many of them have no idea what acute care is all about. It's not

>of

>interest to them. It's not a part of the curriculum in nursing programs.

>It's somehow a little soiled and tawdry when compared to the wonderful

>calling of the nurse to attend to the long-term needs of their " clients. "

>Notice that nursing has used the word " client " rather than patient for the

>last decade or more. I thought attorneys and accountants had " clients. "

>

>

>The arrogance level at the BNE is on FL 41, the same as a LearJet flies,

>and

>until they seriously consider granting us some sort of reasonable

>reciprocity, then I'm absolutely and intractably opposed to letting them

>challenge paramedicine without us having full and complete knowledge that

>they're able to perform in ALL prehospital arenas, not just the helo. That

>means getting coded beached whales out of the bathtub or the recliner with

>only one partner to help and conducting a code on a patient who insists on

>staying in ventricular fibrillation and subject to resuscitation in the

>back

>of a rapidly moving truck by one's self for at least a 25 mile transport.

>

>Before GETAC jumps in and recommends any concessions to the nurses, we need

>to have a concurrent, reciprical position statement from BNE that it

>supports

>equal opportunity for LPs to challenge the RN program. Until we receive

>that

>from BNE, we ought not ever give ONE INCH.

>

>I know this will offend some good nurses out there who are, without a

>single

>doubt, eligible and entitled to get their paramedic certs. But nursing,

>not

>paramedicine, is the discipline that's maintained the turf battles and

>shows

>no signs of reform. Nursing is the profession that's looked down it's nose

>at everybody else for way too long.

>

>EMSAT, by the way, has taken the position that RNs should not be granted

>automatic equivalency rights.

>

>I urge all the nurses who are interested in Paramedic certs to make their

>wishes known to the BNE, and to let the BNE know that it's going to work

>both

>ways or not at all. Until the BNE decides that it's in the best interests

>of

>its constituents to agree to some reasonable reciprocity rules, then I for

>one, oppose granting challenge rights to RNs without stringent but fair

>requirements for demonstration of competencies prior to testing.

>

>I do not for one millisecond think that I could do the job of a nurse in

>many

>of their areas of practice, and I would not even think of wanting to

>challenge their professional standards until mine were up to the required

>level. That's all I ask of the nurses.

>

>GG

>

> E. Gandy, JD, LP

>EMS Professions Program

>Tyler Junior College

>Tyler, TX

>

>

>

[Guest guest]

I would be interested to know what the RN's that are working for the EMS

division of TDH think, and are they doing anything to actively support the

integrity of EMS or are they just standing by?

Please dont blast me for this, its just a question and I dont know the answer

!!!!!!

[Guest guest]

The reply that I got from the BNE is that they have no plans in changing

their rules, and this was back in April of this year. They still hold their

ground that a Licensed Paramedic is " unlicensed personnel " . I'm sure that

it could be set as an agenda item for their meetings, but I'm sure that it

would get no where.

Wayne

>From: CBlum26666@...

>Reply-To:

>To:

>Subject: Re: Re: RN-Paramedic

>Date: Tue, 28 Aug 2001 12:39:12 EDT

>

>Mike, there have been several inquiry's made to the BNE by myself and

>friends

>of mine lately. They should be legally bound to recognize it as a license,

>however, the answers you get from them are either a vague rant with no

>clear

>anser, or an absolute NO, they won't honor it. It's stupd, and I have no

>idea why they aren't being forced to honor it. As for an AG opinion, I

>have

>no idea.

>

>CB

>

>

>

[Guest guest]

I have been criticized for not speaking out at the EMS SubCommittee meeting

on Thursday in Austin regarding my position that the BNE ought to at least

recognize Licensed Paramedics before we grant RNs the right to challenge the

Paramedic Exam with minimum preparation.

Let me try to explain. First, I had not had lots of time to explore the

issue prior to the meeting. I wanted to hear what all the speakers said and

wanted the opportunity to engage them in conversation and draw them out

before I spoke. I simply did not feel that I had nailed down my position at

that time and therefore hoped not to confirm the suspicians of many that I

am a fool by proving it beyond a reasonable doubt by my public statements.

Melody, I think that, in retrospect you'll agree with me, although I

understand that you would like to have had me speak.

I shall make my comments known to Ms. Perkins and Mr. Arnold, as well as the

members of GETAC, by direct email, and I trust that this form of

communication has now achieved sufficient status that it will be recognized

and taken into consideration.

My position is this:

1. TDH should not allow RNs nor LVNs to challenge the Paramedic

Certification or Licensure Examination without first requiring them to have

completed an approved EMT-B course, and without having satisfied the

requirements of a transition program designed to insure that they possess and

can deliver the skills and knowledge of a paramedic in the pre-hospital

setting. This evaluation must be carried out by a Coordinator affiliated

with at least a community college. Coordinators in freestanding Paramedic

programs ought not have this power because they are not subject to the

requirements of the Texas Higher Education Coordinating Board nor are they

granted accreditation by the Southern Association of Colleges, which is the

accrediting organization of all community colleges. Any free-standing

program that has national accreditation would be an exception to this.

2. Unless and until the BNE agrees to recognize Licenced Paramedics as being

duly licensed medical personnel, and grant them recognition as such, there

should be NO opportunity for RNs or LVNs to challenge the Paramedic

examinations.

3. The BNE must agree to a parallel challenge pathway for Licensed

Paramedics to become Registered Nurses before there is any pathway for nurses

to transition to Paramedic.

4. The BNE must agree to meet with GETAC and develop a fair and equal

program for RN-Paramedic transition and Paramedic-RN transition, which

program must be implemented within no more than 2 years from now.

5. Unless BNE agrees to recognize LPs as licensed personnel, give up their

policy that nurses are above and superior to paramedics, and do so in clear

writing, there should be NO opportunities for RNs to transition to Paramedic

without completing the entire paramedic curriculum. BNE must recognize the

skills that may be performed in ANY setting by Paramedics, and abandon its

stance that nurses rule paramedics.

6. While a shortage of nurses apparently exists, it is clear that many of

the functions of the RN can be performed by Paramedics in the emergency

setting. Therefore there is NO justification nor reason for the BNE to

oppose full practice privileges for Paramedics in the hospital setting.

7. When the BNE recognizes Licensed Paramedics as being medical

professionals, then and then only, should the Paramedic community address the

transition of RNs to Paramedic without completing the full Paramedic

curriculum.

8. While I recognize that there are nurses who could perform paramedic

skills adequately because of their experience, particularly in the area of

helicoptor EMS, it is not appropriate that a nurse be allowed special

considerations in challenging the paramedic license unless and until

paramedics are granted the same special considerations in challenging the

nursing license.

9. Whereas the BNE is formulated for and dedicated to the nursing

profession, TDH has no such mandate to represent EMS. I recommend that

either a separate, free-standing agency be created by the legislature to

govern EMS at the same level that the BNE governs nursing, or that TDH be

given a clear mandate by the Legislature to represent the interests of EMS in

such a way as to promote the profession and insure the survival of EMS

professionals.

10. If budget cuts in TDH continue at the present level, it will be

impossible for the Bureau to carry out its mandate to govern EMS, much less

to promote it. One wonders who and what the forces are that continue to

decimate TDH's budget and ability to carry out it's mandated functions to

supervise EMS. Promotion of EMS is clearly falling by the wayside, if for no

other reason than the remaining people at TDH BEM are stretched so far that

they cannot be expected to perform even the minimum functions that we expect

from them.

11. Flight nurses have a valid argument that they ought to be granted

special privileges; however, they need to use their power and influence to

force the BNE into a rational policy regarding Paramedics. Unfortunately,

war is hell, and we as Paramedics are in a war with the BNE. We have nobody

to stand up for us, so we must stand on our own. We must vehemently oppose

any plan which would give nurses an advantage over Paramedics in the

workplace until the BNE agrees to recognize us and grant us full and equal

opportunities to challenge the nursing licensure procedure.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

To all:

As a paramedic first, and then a RN second (both professionally and

chronilogically), I have some interest in this discussion for obvious

reasons and only partially because of some questions that I have been

asked by the nurses that I work with on my side job. I am not a

flight nurse, and have no desire to ever become a flight nurse (I do

critical care), so hopefully I can generate a fairly unbiased

opinion. I have pulled some of the statements from Wayne's post as

part of my reply:

> 1) If an RN is going to apply for paramedic certification, they

should have to take and complete the ENTIRE EMT-Basic program first;

then based on critical care experience in ICU/ER/CCU and use that to

determine what parts of that experience could be applied toward

paramedic training to see what area needed to be covered or

completed. However, if the RN has no critical care experience, they

should be REQUIRED to complete the ENTIRE paramedic program. In

either case, both should be required to complete the ambulance time

and certain parts of the clinical time, especially if they have no

critical care experience. Both should also be REQUIRED to pass ALL

skills associated with paramedic training.

>

This is a very reasonable comprimise to the situation. The only

things that should be optional are the hospital clinical time

(depending upon experience and training) and the portions of the

didactic classroom that is covered in nursing school (pharmacology,

A & P etc.). Anything that deals with the prehospital environment

should be included (most of the important stuff there is covered in

EMT-B classes).

> 3) Bridge courses are going to vary depending on the individual, so

why bother with such a program unless it is going to be uniform

across the board and not have 50 different courses. By each program

having something different, it would be more work on the coordinator

by having each person at a different level of training.

>

With the changes going on in education in EMS and the push towards

college based programs, the curriculum that has been developed should

allow for those nurses to take those classes that would be required

to make up the deficiences in background. This could range from very

little (an intubation/pulmonary class and ambulance time) to

everything. There should not be a single bridge program - that would

not meet the needs of either the nurse who is wants to be a paramedic

or TDHEMS.

>Most, if not all of this was brought about by the air medical

providers wanting an easy was for their RN's certified as medics. As

pointed out before on the list server, the state is bowing down to a

small group of people in order to satisfy those providers.

>

I'm sure this happens more often than just this time. What should be

different about this time. The question should be - Is this a change

that is being made to increase the availability of paramedics and

nurses for aeromedical units and does this improve the patient care

provided on these units? (this is a rhetorical question, no need to

answer it).

> The other thing that was touched on was the use of EMTs and

Paramedics in the ER. As pointed out, this has always been a touch

subject for years and will continue to be I'm sure.

The biggest problem here in most all cases is who should supervise

the EMTs and paramedics, and under what department should they be

placed, nursing or under the ER Medical Director.

>

Who do you think runs hospitals? The doctors? Are you kidding????

Of course they don't, nurses do. And the business bums that have

absolutely no idea what they are doing to health care. The use of

paramedics and EMT's in the hospitals is at the mercy of the

administration of the facility. They don't have to hire any EMT's or

paramedics. However, the facility does determine the scope of

practice to a certain extent and paramedics can function somewhat

independently under protocols set forth by the ER medical director.

> Under BNE rules, an RN cannot delegate to a paramedic, not even a

licensed paramedic any invasive procedures, i.e., IVs, meds, etc.

BNE has refused to recognize the LP as " licensed personnel " even

thought they are issued a license by a state regulatory agency.

According to the Secretary of States Office, if a Texas regulatory

agency issues a license to a person, it should be recognized by ALL

other state agencies. However, the BNE seems to be exempt and has

refused to recognized such license.

>

The rules of the BNE refer to licensed personnel specifically

refering to RN's and MD's and they specifically exclude LVN's, also.

RN's cannot delegate certain actions to LVN's, either, specifically

assessments and certain invasive procedures. By the argument above,

if the BNE recognized all licenses regulated by the state, a lawyer

would be able to do invasive procedures (I also recognize this is the

reducto ad absurdum argument, but go with it).

> Also it was pointed out that EMTs and Paramedics don't have a

scope of practice that we fall under like that of other nursing and

other healthcare professionals so. Maybe this is something that

should be looked at.

>

There is an important point that is often missed when RN and

Paramedic scope of practice are discussed. As Paramedics, we are

trained (educated) in the medical model - that is the disease/cure

approach. The strength of this approach is that we have in depth

knowledge of medical problems and how to deal with those problems in

the pre- or inter-hospital environment.

Nurses are educated (trained?) in a different model, the nursing

model. This is much more of a psychological/holistic approach to

healthcare and its strength is looking at patients as more than just

a current health problem - much of the classroom portion of nursing

school focuses on a continuity of care thoroughout the lifetime.

There is nothing better in either approach, they are just different

and therein lies the problem of crossing fields.

What it all comes back down to is education. Unless we reform our

educational process in EMS and take our place as a true profession,

we will always have a problem when it comes to the BNE and nursing

associations. They fought this fight 30 years ago and unless we

learn from that, we are doomed to languish for that long a period of

time or, God forbid, die as a profession.

JMHO,

Marc Meyer, MS, LP, RN

Engineer/Operator-Paramedic, Houston Fire Department

Staff Nurse, St. Luke's Episcopal Hospital

[Guest guest]

Although I am not a Paramedic, well said, Gene.

Jay

Re: RN-Paramedic

I have been criticized for not speaking out at the EMS SubCommittee meeting

on Thursday in Austin regarding my position that the BNE ought to at least

recognize Licensed Paramedics before we grant RNs the right to challenge the

Paramedic Exam with minimum preparation.

Let me try to explain. First, I had not had lots of time to explore the

issue prior to the meeting. I wanted to hear what all the speakers said and

wanted the opportunity to engage them in conversation and draw them out

before I spoke. I simply did not feel that I had nailed down my position at

that time and therefore hoped not to confirm the suspicians of many that I

am a fool by proving it beyond a reasonable doubt by my public statements.

Melody, I think that, in retrospect you'll agree with me, although I

understand that you would like to have had me speak.

I shall make my comments known to Ms. Perkins and Mr. Arnold, as well as the

members of GETAC, by direct email, and I trust that this form of

communication has now achieved sufficient status that it will be recognized

and taken into consideration.

My position is this:

1. TDH should not allow RNs nor LVNs to challenge the Paramedic

Certification or Licensure Examination without first requiring them to have

completed an approved EMT-B course, and without having satisfied the

requirements of a transition program designed to insure that they possess and

can deliver the skills and knowledge of a paramedic in the pre-hospital

setting. This evaluation must be carried out by a Coordinator affiliated

with at least a community college. Coordinators in freestanding Paramedic

programs ought not have this power because they are not subject to the

requirements of the Texas Higher Education Coordinating Board nor are they

granted accreditation by the Southern Association of Colleges, which is the

accrediting organization of all community colleges. Any free-standing

program that has national accreditation would be an exception to this.

2. Unless and until the BNE agrees to recognize Licenced Paramedics as being

duly licensed medical personnel, and grant them recognition as such, there

should be NO opportunity for RNs or LVNs to challenge the Paramedic

examinations.

3. The BNE must agree to a parallel challenge pathway for Licensed

Paramedics to become Registered Nurses before there is any pathway for nurses

to transition to Paramedic.

4. The BNE must agree to meet with GETAC and develop a fair and equal

program for RN-Paramedic transition and Paramedic-RN transition, which

program must be implemented within no more than 2 years from now.

5. Unless BNE agrees to recognize LPs as licensed personnel, give up their

policy that nurses are above and superior to paramedics, and do so in clear

writing, there should be NO opportunities for RNs to transition to Paramedic

without completing the entire paramedic curriculum. BNE must recognize the

skills that may be performed in ANY setting by Paramedics, and abandon its

stance that nurses rule paramedics.

6. While a shortage of nurses apparently exists, it is clear that many of

the functions of the RN can be performed by Paramedics in the emergency

setting. Therefore there is NO justification nor reason for the BNE to

oppose full practice privileges for Paramedics in the hospital setting.

7. When the BNE recognizes Licensed Paramedics as being medical

professionals, then and then only, should the Paramedic community address the

transition of RNs to Paramedic without completing the full Paramedic

curriculum.

8. While I recognize that there are nurses who could perform paramedic

skills adequately because of their experience, particularly in the area of

helicoptor EMS, it is not appropriate that a nurse be allowed special

considerations in challenging the paramedic license unless and until

paramedics are granted the same special considerations in challenging the

nursing license.

9. Whereas the BNE is formulated for and dedicated to the nursing

profession, TDH has no such mandate to represent EMS. I recommend that

either a separate, free-standing agency be created by the legislature to

govern EMS at the same level that the BNE governs nursing, or that TDH be

given a clear mandate by the Legislature to represent the interests of EMS in

such a way as to promote the profession and insure the survival of EMS

professionals.

10. If budget cuts in TDH continue at the present level, it will be

impossible for the Bureau to carry out its mandate to govern EMS, much less

to promote it. One wonders who and what the forces are that continue to

decimate TDH's budget and ability to carry out it's mandated functions to

supervise EMS. Promotion of EMS is clearly falling by the wayside, if for no

other reason than the remaining people at TDH BEM are stretched so far that

they cannot be expected to perform even the minimum functions that we expect

from them.

11. Flight nurses have a valid argument that they ought to be granted

special privileges; however, they need to use their power and influence to

force the BNE into a rational policy regarding Paramedics. Unfortunately,

war is hell, and we as Paramedics are in a war with the BNE. We have nobody

to stand up for us, so we must stand on our own. We must vehemently oppose

any plan which would give nurses an advantage over Paramedics in the

workplace until the BNE agrees to recognize us and grant us full and equal

opportunities to challenge the nursing licensure procedure.

GG

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

Gene,

You've done it again! Your position is very well stated and are my thoughts

exactly. May I quote you when I write my state representative. Thanks in

advance.

Shiplet, A.A.S., L.P.

EMS Coordinator

City of

Whitewright

-------------------------------------------------------------------

This message was sent using MailMan from http://mailman.texoma.net.

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[Guest guest]

Thank you, Mike, for a very well written and very sensible e-mail on the

subject.

, BS, LP

In a message dated Wed, 29 Aug 2001 11:05:58 AM Eastern Daylight Time, "

W. , LP " writes:

> Jay, you bring up an interesting point... the MINORITY of EMS personnel in

Texas are Paramedics (I'm spelling that with a capital letter from now on!),

even fewer are Licensed Paramedics. Why should EMT-B's, EMT-I's and certified

EMT-P's care about a transition program? Personally, I don't want to be a

nurse. I could care less about getting an RN license. BUT:

>

> Simply allowing RN's to " test in " to a Paramedic role inherently lowers the

value of Paramedics. If " any nurse can be a Paramedic, " that naturally makes

Paramedicine subservient to Nursing. As many will tell you, they are parallel

fields - practitioners at roughly the same level with a different focus... but I

digress.

>

> Basics, Intermediates and Certified Paramedics alike need to show, voice and

scream their full support for limited transition from RN to Paramedic, and full

recognition of Paramedic status by the BNE. Why? EMS will *never* be

considered a medical specialty, just " another Allied Health certification. " If

bringing Paramedics, even just the Licensed ones, up to par with RN's begins to

achieve the goal of having EMS recognized as a medical profession, a field of

practice, then it by default elevates the status of everyone " below " them on the

certification ladder (and no, I'm *not* trying to start the arguement that

Licensed Paramedics are " above " certified Paramedics, but in the eyes of the

*law*, having a license is a different status from being certified, and this is

a *legal* issue as it relates to scope of practice, etc.).

>

> Basics, Intermediates and EMT-P's alike can *all* benefit from the elevation

of any tier of EMS to a more professional status. Basics, Intermediates and

everyone need to ACTIVELY voice this to ALL of their representatives, and to

TDH, and NEED TO JOIN EMSAT, their ONLY collective voice.

>

> Mike

> Re: RN-Paramedic

>

>

> I have been criticized for not speaking out at the EMS SubCommittee

meeting

> on Thursday in Austin regarding my position that the BNE ought to at least

> recognize Licensed Paramedics before we grant RNs the right to challenge

the

> Paramedic Exam with minimum preparation.

>

> Let me try to explain. First, I had not had lots of time to explore the

> issue prior to the meeting. I wanted to hear what all the speakers said

and

> wanted the opportunity to engage them in conversation and draw them out

> before I spoke. I simply did not feel that I had nailed down my position

at

> that time and therefore hoped not to confirm the suspicians of many that

I

> am a fool by proving it beyond a reasonable doubt by my public statements.

>

> Melody, I think that, in retrospect you'll agree with me, although I

> understand that you would like to have had me speak.

>

> I shall make my comments known to Ms. Perkins and Mr. Arnold, as well as

the

> members of GETAC, by direct email, and I trust that this form of

> communication has now achieved sufficient status that it will be

recognized

> and taken into consideration.

>

> My position is this:

>

> 1. TDH should not allow RNs nor LVNs to challenge the Paramedic

> Certification or Licensure Examination without first requiring them to

have

> completed an approved EMT-B course, and without having satisfied the

> requirements of a transition program designed to insure that they possess

and

> can deliver the skills and knowledge of a paramedic in the pre-hospital

> setting. This evaluation must be carried out by a Coordinator affiliated

> with at least a community college. Coordinators in freestanding Paramedic

> programs ought not have this power because they are not subject to the

> requirements of the Texas Higher Education Coordinating Board nor are they

> granted accreditation by the Southern Association of Colleges, which is

the

> accrediting organization of all community colleges. Any free-standing

> program that has national accreditation would be an exception to this.

>

> 2. Unless and until the BNE agrees to recognize Licenced Paramedics as

being

> duly licensed medical personnel, and grant them recognition as such, there

> should be NO opportunity for RNs or LVNs to challenge the Paramedic

> examinations.

>

> 3. The BNE must agree to a parallel challenge pathway for Licensed

> Paramedics to become Registered Nurses before there is any pathway for

nurses

> to transition to Paramedic.

>

> 4. The BNE must agree to meet with GETAC and develop a fair and equal

> program for RN-Paramedic transition and Paramedic-RN transition, which

> program must be implemented within no more than 2 years from now.

>

> 5. Unless BNE agrees to recognize LPs as licensed personnel, give up

their

> policy that nurses are above and superior to paramedics, and do so in

clear

> writing, there should be NO opportunities for RNs to transition to

Paramedic

> without completing the entire paramedic curriculum. BNE must recognize

the

> skills that may be performed in ANY setting by Paramedics, and abandon its

> stance that nurses rule paramedics.

>

> 6. While a shortage of nurses apparently exists, it is clear that many of

> the functions of the RN can be performed by Paramedics in the emergency

> setting. Therefore there is NO justification nor reason for the BNE to

> oppose full practice privileges for Paramedics in the hospital setting.

>

> 7. When the BNE recognizes Licensed Paramedics as being medical

> professionals, then and then only, should the Paramedic community address

the

> transition of RNs to Paramedic without completing the full Paramedic

> curriculum.

>

> 8. While I recognize that there are nurses who could perform paramedic

> skills adequately because of their experience, particularly in the area of

> helicoptor EMS, it is not appropriate that a nurse be allowed special

> considerations in challenging the paramedic license unless and until

> paramedics are granted the same special considerations in challenging the

> nursing license.

>

> 9. Whereas the BNE is formulated for and dedicated to the nursing

> profession, TDH has no such mandate to represent EMS. I recommend that

> either a separate, free-standing agency be created by the legislature to

> govern EMS at the same level that the BNE governs nursing, or that TDH be

> given a clear mandate by the Legislature to represent the interests of EMS

in

> such a way as to promote the profession and insure the survival of EMS

> professionals.

>

> 10. If budget cuts in TDH continue at the present level, it will be

> impossible for the Bureau to carry out its mandate to govern EMS, much

less

> to promote it. One wonders who and what the forces are that continue to

> decimate TDH's budget and ability to carry out it's mandated functions to

> supervise EMS. Promotion of EMS is clearly falling by the wayside, if for

no

> other reason than the remaining people at TDH BEM are stretched so far

that

> they cannot be expected to perform even the minimum functions that we

expect

> from them.

>

> 11. Flight nurses have a valid argument that they ought to be granted

> special privileges; however, they need to use their power and influence to

> force the BNE into a rational policy regarding Paramedics. Unfortunately,

> war is hell, and we as Paramedics are in a war with the BNE. We have

nobody

> to stand up for us, so we must stand on our own. We must vehemently

oppose

> any plan which would give nurses an advantage over Paramedics in the

> workplace until the BNE agrees to recognize us and grant us full and equal

> opportunities to challenge the nursing licensure procedure.

>

> GG

> E. Gandy, JD, LP

> EMS Professions Program

> Tyler Junior College

> Tyler, TX

>

>

>