Technical Assistance
Document
June 1996
ISSUE: With the shortage of professional
healthcare personnel,
particularly in the rural setting; the healthcare industry is
having to
rely on specially trained technicians to assist in direct care
delivery.
Since certified Emergency Medical Technicians (EMTs) and
paramedics study
a curriculum which has a firm foundation in anatomy, physiology,
and patient
assessment, they are prepared to make a natural transition into
service
within the hospital emergency department (ED) or IV team, as
long as a
job description exists and is consistent with their level of
training.
PROBLEMS: There are a few problems that have developed
within
some facilities that have employed EMS personnel. Awareness of
these concerns,
will allow planners to anticipate reactions and avoid conflict.
A. Disagreements have arisen over to whom the EMT should
report.
These discussions have led to clashes between the medical and
nurse practice
acts. A paramedic must work under a physician's license when
working invasive
procedures. The RN can't delegate invasive procedures but can
supervise
them.
B. EMS personnel are trained specifically for prehospital
roles.
Clearly there is some overlapping. If job description calls for
procedures
beyond EMS training, they must be trained and evaluated on that
procedure
prior to including it in their work assignment.
C. The EMS Act refers to medical supervision which means
physicians.
An RN may supervise as long as a physician has agreed to be
medical director
for the paramedic.
D. Traditionally, there have been professional clashes
between
some nurses and some paramedics. Where this exists, good
orientation to
increase awareness of each other's functions and background
might level
the playing field. If the nurses in question are given an
opportunity
to participate in planning for the new hires, there should be
less antagonism.
E. There has been a turf issue with nurses fearing that
they will
be supplanted. EMS personnel should not be hired to supplant
nurses, but
to enrich the team and work in collaborative partnership with
the nurse.
The following guidelines are suggested when the goal is to
employ prehospital
personnel for the "in-house" setting.
The following guidelines are suggested when the goal is to
employ prehospital
personnel for the "in-house" setting.
PREPLANNING
1. Study the guidelines, which the Board of Medical
Examiners and
the Board of Nurse Examiners promulgate regarding delegation of
tasks
to EMTs. The Texas Nurses Association (TNA) has recently passed a
resolution
on Unlicensed Assistive Personnel (UAP). They advocate that in
all settings,
UAPs who assist the RN or who perform delegated functions or
tasks must:
a. meet uniform screening requirements.
b. complete training programs that are standardized in length,
content
and competencies and skills; and
c. be subject to regulation and discipline.
The TNA advocates that healthcare facilities employ only those
UAPs who
have met these standards requirements. (NOTE: EMS personnel meet
these
requirements.)
2. Acquire prior approval of the accrediting agency, if
you do
not have JCAHO accreditation. JCAHO states, "certified EMTs
should have
their duties and their responsibilities to physicians and nurses
providing
care within the Emergency Services area defined in writing." The
job description
needs to be clearly defined and based on department need and the
delegated
tasks, which delineate lines of authority. The job description
should
assign a name for the job and establish a pay scale commensurate
with
training level.
3. If IVs/medications are to be part of the job
description, specific
delegation should be specifies by the medical staff and outline
in a written
policy/procedure/standing order.
DEVELOPMENT OF POSITION
A. Interview as for any other position.
B. Check credentials to assure that the applicant is
educationally
prepared at the appropriate level and that he/she has EMS
certification.
C. Work with the director of the ED, the medical
director, and
the new employee to set out protocols for supervision.
D. Provide for any inservice education that may be
necessary to
orient the new employee to the hospital setting and his/her new
job responsibilities.
Appropriate documentation should be maintained in the employee's
file
regarding any training that is given to the employee.
Bureau of Emergency Management
June, 1996