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 organizations opinion, or is there some higher authority that rules on this?
Nancy Brent replies:
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.