What ED nursing functions can be assigned and/or delegated to paramedics?

By | 2022-02-07T18:10:47-05:00 September 2nd, 2008|3 Comments


Dear Nancy,

We have many RN vacancies, and paramedics will be hired to fill some of them to relieve some of the short staffing. I have read position statements from Emergency Nurses Association, state boards of nursing, and ANA/NCSBN regarding the use of unlicensed assistive personnel in the emergency department, and I need to know what nursing functions can be assigned and/or delegated to paramedics.

Our nurse manager says RNs can co-sign their assessments and paramedics can do whatever else they do out-of-hospital. How can the RNs not be held accountable for what the paramedics do, whether or not the task has been delegated to them? Are the paramedics considered licensed when they are working in the ED if that is the organization’s opinion, or is there some higher authority that rules on this?


Nancy Brent replies:

Dear Noreen,

Your question requires a thorough examination of the state nurse practice act and the practice act that licenses and regulates paramedics. In earlier times, paramedics were only licensed/certified to practice “in the field” (e.g., ambulance transport, responding to an accident) and were directed/supervised by a medical director of the ambulance company, state/city ambulance service, etc. In more recent times, paramedics have transitioned into healthcare facilities, especially in the ED. In order to legally authorize such a role, many state practice acts have been amended to allow paramedics to function within an ED.

What the paramedic can or cannot do in the facility is based on the state law allowing them to practice in that setting. Additionally, the state law defines their scope of practice and who is to supervise them while they perform their duties.

If something is delegated to a paramedic by an RN in the ED, there must be authority to do so in the act or rules, and the same principles of good delegation that one uses for delegating to another RN or LPN would hold true for a paramedic, as well. As an example, the RN would need to assess whether the paramedic (or the LPN or another RN) is competent to handle that which is delegated to the paramedic. However, under no circumstances can the RN delegate strictly nursing responsibilities to a paramedic. The performance of a nursing assessment is one such responsibility that only an RN can perform.

Remember that everyone is accountable for his or her own conduct, including his or her own negligent conduct. As a result, if a paramedic performed care in a negligent manner, and the patient sued due to an injury, the paramedic would be the one that would be sued. The RN might also be named in the suit if, as an example, the RN delegated a patient care task to the paramedic and the delegation was done negligently.

It sounds as though a clear and frank discussion about your concerns about the use of paramedics in the ED in your facility needs to occur with your nurse manager and others (e.g., risk manager, CNO). You have already done a lot of work in attempting to sort out this issue (e.g., reading position statement). Sharing your research with those at the meeting, as well as your fellow ED staff nurses, may help clarify some of the issues you have and may help change some of the practices that may not be consistent with what the professional nursing associations’ positions are concerning the use of paramedics in the ED.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.


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  1. Avatar
    Wendi March 13, 2019 at 4:38 am - Reply

    Is discharge teaching within a paramedic’s scope of practice?

  2. Avatar
    Mario Gonzalez March 15, 2019 at 5:19 pm - Reply

    As an EMS supervisor at a Bronx Hospital, the hospital ED tried placing paramedics in the ED to speed up patient preparation and triage. They functioned like patient care technicians, but relied on their paramedic certification. Eventually, the facility had to stop the program for a number of reasons:

    1. The paramedic/EMT certification is only good in the field, outside of a medical facility where people with higher levels of training are available. Paramedics specifically have strict protocols they follow and usually only follow medical orders from a 911 system physician. Once they enter the threshold of a hospital or other medical facility, they must refer the patient to those higher trained individuals. the only time that is not in play is in physician’s practices where the equipment or medications may not be available to treat the patient in an emergency.

    2. Even though they were employed only to perform vitals, start IV and do an ECG and some basic functions, those basic functions were considered nursing functions and they had an issue with the nursing union.

    3. They are not trained in discharge education. That is not within their scope. Normally, the only discharge education they are responsible for is when a patient refuses an ambulance, they are required to tell them that if they don’t see a physician, anything up to death can result regardless of the injury or ailment.

    4. Because of the threshold rule, they can not administer medications, even those they are aptly trained on, in the ED. Once they cross the doorway, they must stop and transfer care to someone of equal or higher training.

  3. Avatar
    Kris August 7, 2020 at 4:53 am - Reply

    Texas does not have a scope of practice. It is a medical director driven state. So, anything that the physician determines could be within their scope if they allow it and taught them.

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