Medical Personnel Roles

Hi again -

Well, I'm back after a couple of days off again. Seems like I'm starting to need a few days in between to gather my thoughts. I'd like to go off course a little bit from the health care reform issue today.

I think today I'm going to touch a little bit on medical personnel roles in the health care field - education level, job responsibilities, etc.... Then I want to wrap it up a little bit talking about the so-called nursing shortage - and my views on that. And in the end, I want to pay tribute to someone special who we recently lost, someone who had a calling to take care of others and did so so very well- in our ER.

I'll start with some of the ground level positions and work my way up the so-called ladder. Although, I don't want to imply that any position is any better or worse than any other position. It's important to remember that when a person is in the medical field, they land either where their heart lies or where they can afford to stay for the time being. That's why it's such a dynamic field - you can play where your strengths are and move around until you find what suits you best.

How many different hands-on patient care positions are there? To name a few, there are CNAs, Orderlies, EMTs, MAs, Psych. Techs., LVNs, Paramedics, RNs, PAs and NPs. Of course, these positions aren't all inclusive. There are still Techs in other departments - Radiology, PT, OT, Pharmacy, Cashiers, Clerks, Volunteers, etc... We all need each other to take care of patients.

I'll touch base on a few of these positions and their roles.

I suppose the entry level for many new people to the health care field would be the CNA - Certified Nursing Assistant. This is a very difficult job to do and one that requires a very special kind of person. These are the people who are most in touch with the patients - those who work at the bedside, taking vital signs, feeding, bathing, dressing and toileting patients. Although the hourly educational requirement isn't that high -usually around 75 + hours of classroom and clinical training - interpersonal skills are very important. I remember many a time a CNA saved my butt on the floor - coming to me to alert me that something was wrong with one of my patients.

Orderlies, though few and far between anymore, have similar educational requirements and job responsibilities of the CNA. Because a lot of orderlies are males, they also have the added responsibilities of working with equipment and lifting the patients. Ouch, my aching back.

Next we'll go to the pre-hospital side of the fence, the EMT, Emergency Medical Technician. The EMT certification class is usually around 140 hours of classroom, clinical and field training. EMTs in the field have varying tasks depending on what state you live in, where you work and how rural an area you live in. EMTs in the hospital mostly do task-oriented noninvasive procedures - splint applications, dressings, EKGs, lab draws, etc... EMTs in the field usually ride in the back of the ambulances and take care of the patients or assist the paramedics. Tasks may include splinting, dressing wounds, oxygen administration, spinal immobilization, CPR, etc... Many times, they are firemen or police officers as well. This field is very close to my heart. It's where I started - where the medical bug bit me. One summer I decided to take this class just for the fun of it. I thought it would be a great place to meet guys. True. I didn't even like blood, or couldn't imagine taking care of people, but that sure changed fast. It made me want more.

MAs - Medical Assistants again are an integral part of the health care team. Most vo-tech colleges and some nursing schools have MA classes. They can either go for a year - or two years and earn their Associates Degree. These are the people that usually work in clinics and doctor's offices. They are the ultimate assistant. They answer phones, schedule appointments, assist with billing, put patients in rooms, take vital signs, etc.... They can also do other tasks as long as they have been taught those tasks and the doctor they work for assumes responsibility for those tasks- ie) medication administration, blood draws, assisting with procedures.

Now, let's move over to another specialty field - Pysch. Tech. The educational requirement for these licensed personnel is usually around 1500 hours. This is a parallel field to a LVN/LPN with more emphasis in mental health. These people work in psychiatric facilities, spending time daily with the patients, handing out trays, doing classes and activities with the patients and looking out for the patients' ultimate safety when they're out of control.

Next, we'll move on to the LVN or LPN - Licensed Vocational or Practical Nurse - depending on which state you live in. The LVN actually has a license as well and is ultimately responsible and accountable for their actions. LVN School is usually 14 months long and includes classroom and clinical hours. LVNs have different roles in different states. I personally worked in 4 states as an LVN and each state is very different. In most states, LVNs do bedside nursing, have their own teams and are pretty much independent in their duties. There are some restrictions on medication administration - they can't do initial assessments, care plans, IV push or titratable medications. In California, the LVN role is more limited. LVNs usually work in clinics and doctor's offices as assistants. They usually work along side RNs doing more task oriented skills.
Some hospitals do use them at the bedside. Most patients don't realize there is a difference between LVNs and RNs.

Now back to the pre-hospital field. Paramedics, again, have different roles in different states. Some work in doctor's offices doing cardiac tests, some work in ERs or out of ERs as first response personnel. In big cities, paramedics usually run with the fire departments or private ambulance companies. Their course which includes classroom and clinical training varies from state to state again - usually anywhere from 600 - 1500 hours. Their skill levels are somewhere between a LVN and a RN - they can pretty much do everything a LVN is licensed to do, some things a RN is licensed to do, plus they can do advanced emergency procedures, airway management, intubation, needle decompressions, etc.. These people are usually the true adrenaline junkies. There is a high rate of burn out in this field due to all the tragedies they see.

OK, back to home base for me again. On to the RN - Registered Nurse. Now this is probably one of the most diversely educated and employed career of the bunch. RN's work everywhere - public health systems, schools, clinics, doctor's office, psychiatric facilities, hospitals, skilled nursing facilities, home health agencies; they work for private home care companies, private ambulance companies, air transport companies, the American Heart Assn., the American Red Cross, the military, the Motion Picture industry, private employers, etc.... There are so many endless possibilities out there for RNs. The education levels vary as well. You can go through a Diploma program, get your 2 year Associates degree, 4 year Bachelors degree - actually you can also have your Masters or Doctorate in nursing as well. One of the really nice things about nursing is you can find your own little niche, you can move around until you find what you really like, what fits you best. RNs have their own license and a lot of responsibility and accountability for their actions. They are the bedside nurse, the educator, the task oriented person, the assistant to the doctor. They often do research work or even work for the insurance companies. They are the telephone triage nurses. You see them, well, us, everywhere.

And when you want to move further up the ladder, you can - you can become a Nurse Practitioner, a Physician's Assistant or move into Administration or Education with your Master's or Doctorate Degree.

I think that sums up the roles and educational requirements. I hope I didn't put everyone to sleep - at least not yet.

Now, I want to talk about the nursing shortage - or what they call one anyway. Weigh in with me - do you really think there is a nursing shortage. I just listed all these positions - how can there be so many different positions -and be such a nursing shortage.

Well I may be wrong, but I have never really thought there was truly a nursing shortage. I've worked in 4 different states. They're all cranking out many, many classes of new graduate nurses. And nursing is a long career - well potentially anyway. You can be a nurse for 40 years at least - if you want. I've always felt like there are a lot of nurses and ancillary medical personnel. I just don't believe that we all stay in the field. I think we come and go as our lives change so that we can live our lives around that career. It's one that's easy to go in and out of. The pay is good. The hours are fairly flexible. I also am of the belief that facilities just can't afford to hire - or choose not to hire as much staff as they need. We've all worked in facilities where our ratios are ridiculous. I hope the days are gone on the floors where you're 7 - 10 - 15 patients to 1 nurse. It's not safe and I don't believe that it's that way too many places anymore. We all work short for one reason or the other - sick calls, vacations, budgetary restraints. And because of this, we lose a lot of nurses because they're just too overworked, stressed out and just plain tired. They feel under appreciated and choose to change careers. Such a shame we can't covet what we need the most - caring, trained and diligent patient care personnel. People taking care of people.

So they say we're in big trouble as time goes on, as we baby boomers become old - and as the nursing schools don't have enough funding or teachers. So what do you guys think? Is there a shortage - for real - or is it all just a figment of the countries imaginations?

And lastly, I just want to say nurses are not just numbers, we can't easily be replaced with the next one, any one - sometimes contrary to some people's beliefs. Once you find one or two or as many as you can find, you need to nurture them, connect positively with them, shower them with respect, listen to their concerns, and yes, complaints. You need to encourage them with positive reinforcement to get them to the next step. And sometimes, you need to pick them up off the floor and give them a hug and a kind word when things get tough. It's what keeps us here. It's what we need to keep going in such a highly charged emotional and stressful field.

And one more thing, we need to take care of ourselves first - before we can take care of our families, friends or patients. When our bodies are so tired and stressed, we sometimes get sick - physically or mentally - and we just can't go on without recharging. We can't minimize this - we must listen to what our bodies are telling us - and we must look out for each other and encourage self-care first. I fear we let one of our down recently - she just pushed herself too far - further than her body could handle. So to you Trisha, may you rest in peace. You had truly found your calling, your niche - you were a great person, a great ER nurse - good to your patients and co-workers alike. You'll be truly missed.

More on health care reform coming up. I've got to get back to reading that bill - next thing you know, there will be another out.