The "Nursing Officer" Merged Thread

[starlight_745]

I'm just stirring the pot here but is it time to subdivide the Med Tech trade?  In the US army their 91W can get the M6 skill identifier which involves going through LPN training.  That way you could have a certain percentage of Med Techs with the nursing skills of an LPN to work in the BMS etc.  The Med Tech trade is so broad now I think most people are going to be hard pressed to maintain all their skills at any given time.  It could be a separate branch off at the QL5 level similar to P Med Tech etc.  This certainly wouldn't replace NO's but it could bring some additional nursing skills into a medical platoon.

 

[Armymedic]

Reg Force trade 737 is too short of pers right now to even attempt that, but I am sure there are as many people who would disagree with that concept as there is who agree. NTM it would threaten the NO role again....

 

[starlight_745]

Just a crazy idea I had, not really all that feasible. 

 

[Fraser.g]

Giving the Med Tec an LPN role would not threaten the RN (NO) role any more than LPNs threaten the RN role in acute care facilities on civi street.
The difference in the roles is the critical thinking skills and medical knowledge that is provided in a BSN as opposed to a LPN course.
There are some areas on civi street that hands on treatment is at the RN level and Paramedic level only. This is due to the level of acuity. On military terms it would mean that in critical care or ER environments the hands on care would be provided by NOs and at least 6A Regular force members. Once they are less than critical then the lower skill sets are more appropriate. In that environment the NO becomes a supervisor, clinical resource and instructor to ensure that a high standard of care are provided.

This would also serve to ensure that there is a transferablility of slills between the military and civi life on retirement.


Grant

 

[Armymedic]

Only one problem with that:

On military terms it would mean that in critical care or ER environments the hands on care would be provided by NOs and at least 6A Regular force members. Once they are less than critical then the lower skill sets are more appropriate. In that environment the NO becomes a supervisor, clinical resource and instructor to ensure that a high standard of care are provided.

Is that the current Reg force 6a does not teach any medical skills, only admin and management, until they change it AGAIN.

Unfortunately, IMHO, it was the nurses (or former nurses who are now HSO's) who have directed the Med Tech training solely toward prehospital care and away from LPN skills. (but of course I could be wrong...then again whom had the most to gain)

 

[Fraser.g]

There may be some faint validity to the last posts statement but I believe that the move towards Prehospital training is more likely to be one of simplicity, ease in training and less legality when it comes to bridging. Remember that we lost NDMC in the last decade and with it the last DNDfully funded facilty that we could train in.
If we moved to the model that I submitted earlier with a Nurse Educatior teaching the med tecs and Med As we would have a more rounded medic at the end. Also ask yourself where we are most often used? Prehospital or in a clinic environment and which skill set would be more benificial to eiter or both.

Grant

 

[Armymedic]

Thats just the bitter med tech in me coming out..

There may be some faint validity to the last posts statement but I believe that the move towards Prehospital training is more likely to be one of simplicity, ease in training and less legality when it comes to bridging. Remember that we lost NDMC in the last decade and with it the last DND fully funded facilty that we could train in.

Actually, I believe its simplicity and also the desire for CFMG to be able to justify the granting of spec pay to Med Techs from Cpl to Sgt. To be able to do that, I am told approx 75 % of Med Tech must hold some civilian equivilency, and seeing there is no other national stardard other then PCP....

To add on three months of nursing skills would make the QL 3 course a bit long.

How'd  we get soo far of topic anyway?

 

[Fraser.g]

Does anyone out there have any information about the role of a military nurse (esp Army)?  ie/what sort of clinical stuff do they do? is it mostly managerial work? how likely is it that they'd go overseas? where could one be posted? etc.

Drawing from the orroriginalst I think that we are still on topic. The ref as to what is the NO scope of practice, what can and should the medtec do in their role as well as discussing fututre possilbilties for the medical trades seems bang on.

The problem with the NO scope and role is that they are not utilized to their full potential as I have said in preveious posts. Now the question is where can the assembled masses here see as a future role both at the basic and at the advanced clinical level.

 

[Armymedic]

At OP Ceelbration there was alot of discussion of the Nurse Practitioner taking alot of the in garrison care in the new CDU concept. This would be a realitively new role for Nursing Officers in the military.

What do you think about here role, RN PRN, Brad, and Starlight?

 

[Fraser.g]

Depending on the position they could be covered by an RN with their TNCC, ACLS with PALS for deployment. The only time the requirement would be for a MN in advanced practice is if they are out functioning beyond communication with medical authority.
Advance practice nurses are in increasing demand throughout Canada. The CF would be hard pressed to recruit into those positions.
One way would be to assist reserve RNs to take their advance practice course and then employ them on class C or B positions. This way the Regular force gets their clinical specialists at a cheaper cost and only has to pay when they are using them. come to think of it they could do the same for the rest of the reserve medics (like the Air Reserve). Pay for their school or subsidise it, then use it when needed. All the while the reservists are keeping their skills up and sharp without the federal government having to pay a cent.
Hey the regular force MOs do it why not the rest??
But I digress from topic,
Yes there should be consideration for a wider scope of practice for Nurses in the CF and one way is implementing in the new CDU system. If anyone knows more about this proposition please let me know.

Grant Fraser

 

[starlight_745]

I agree with RN PRN, however I think while we're deciding the role of the NO in the CF we also have to clearly define the role of the med tech.  In my opinion, the med tech field is too broad and we are sacrificing being excellent at a couple things for being fair at most things.  I believe there has been general agreement on here that medtechs need more realistic, focused training however the main stumbling block is a lack of people (i.e. can't get away on courses etc).  My proposal is that medtechs become the SME's on prehospital and tactical medicine.  The CF is not going to start sending its limited numbers of MO/NO far forward anytime soon the Med Techs might as well hone this skill set as they'll be the ones doing it.  I am not super familiar with the new CDU concept however my initial understanding is that a core cadre of staff with provide care freeing up other medical stuff to deploy take courses etc.  Feel free to correct me if I'm wrong. 
My proposal would be to take medtechs and instead of doing a ton of clinical work, have them do the med coverage/field type stuff but then spend the remainder of the time on civilian EMS ride alongs, trauma rotations, BTLS, physical fitness, marksmanship & soldier skills.  Use the CDU in garrison and free up people for things like the new combat casualty care course etc.  I've worked with all kinds of medical staff who spent their life in a clinic and practically forgot how to handle a C-7, never mind maintain a decent level of physical fitness, but I guess this is the sign of a peace time army.

 

[Fraser.g]

Sarlight I think you have hit the nail on the head,

If I can I would like to expand on your last post a bit.
Since the problem is that we do not have enough members in the regular force to send on course and maintain our commitments to either the rest of the military or our allies we need to have more with less.

Here is what I propose:
We create a separate clinical trade within the regular force. It would be a re-muster trade somewhat like premedtec or the engineer heavy equipment operator.
Regular force medics would have to spend their first three year hitch as a combat medtec and then they could re-muster to clinical medic if they wanted to or had to because of a change in medical category. The pre-rec for the combat medic would be the same as for the â Å“0â ? trades such as infantry or engineer.
The combat medtec trade would be responsible for all pre-hospital and combat trauma from the FEBA to two tactical bounds behind. Supervision at that level could be accomplished by a PA or TNCC trained RN in the limited treatment facilities. Experience for the combat medic could be attained by having them do Ambulance and ER practicums in any major center in Canada.
From three bounds and further to the rear would be the responsibility of the newly created clinical medic. Their training would be more clinically advanced then that of the Combat Medtec but in a safer environment. This would be at the FSH or field hospital back to national hospital. The scope if practice would be at the LPN/ RN bedside level. Supervision could be conducted by RNs on each ward.

So the next question would be â Å“what about the reserves?â ?
Due to the limited amount of training time and restricted budget it is not feasible to train reservists as both combat medics and clinical ones. In most centers that there is a reserve field ambulance there are several hospitals. We could set up a supervised clinical practicum in those hospital wards for the reservists. If we specifically train them for the clinical environment from BMS to ward it would free up regular force medics to continue on with their pre-hospital training and trauma. The resrvists could then work in the base clinics and MIRs across Canada leaving the regular force to concentrate on the initial trauma care from a modern battle field.
There is little difference between the hospital load in a large urban center and those casualties from a modern battle field once treatment has been initiated and their condition somewhat stabilized. The only big difference would be age.
I am confident that if DND were to approach the nursing managers on several Surgical and medicine wards they would be more than happy to have extra hands to do the day to day care on the patients including assessment and dressing changes. We would have to work out something for the medication administration etc but that is doable.

 

[starlight_745]

An interesting proposal and similar to the one I presented above for an LPN like trade.  I agree with many of the things that you have said, however I disagree about using the reserves as a clinical manpower pool.  There are slowly growing numbers of prehospital professionals coming into the reserves and your proposal would effectively negate some of the most experienced prehospital providers in the military.  Also, I think having a mix of personnel is advantageous.  If you look at the TO&E for a US Army Main Support Medical Company, there are positions for medics as well as MO/NO but the holding squad also has positions for LPN trained pers.  Instead of making it an all or nothing issue, I would train the reserves as the conventional prehospital medic and then provide a bursary (with conditions) to attend LPN school.  Now you have LPN trained staff who are in the reserves and can go out and get a civilian health care job to maintain their skills.  I have seen many many medics in the reserves go to LPN or nursing school so I think this would be a hit.  The key is you need to start having some terms of service.

 

[Brad Sallows]

By "tactical bound" do you mean lines of support, or echelons?  A tactical bound is just an expression of distance which is dependent on the terrain and the nature of the mobility of the unit doing the "bounding".

 

[Fraser.g]

Once again we come down to the issue of money. The problem with training Reserves to the pre-hospital medic level is that the military is unwilling/unable to invest the amount of money to bring the reserves up to the PCP level without some kind of commitment after the investment. If members are comming into the reserves with the pre-hospital skill set or get that training on their own I see no problem with using them to that level. What I am proposing is what to do with the rest of the army reserve medical corps. Those who we recruit out of high school and then only train to the BTLS and AMFR2 level.
We would get more bang for our buck if we went the pseudo LPN route.


I would love it if DND approached each civi training accdamy that teaches the PCP course and pre-booked two spots per rotation for reservists. I can not see this happening any time in the near future.

 

[Fraser.g]

I was thinking of the acual distance away from the FEBA but we could just as well talk about echelons.

 

[Donut]

Hey Grant,

Another approach to the CF's understandable reluctance to fund reserves on PCP's would be to identify all the Reserve medics on Cl B/A for, oh lets pick a number, 2 years or more. 

Since we write the job descriptions for the competition, and most are already ranked Cpl/MCpl or MCpl/Sgt, this becomes a double retention bonus:  You can't even apply for the job until you've had some time in and demonstrated some degree of commitment, and it lets you save the other CL B education benefits for something else you want to do, or

As part of that two year contract, they spend 16 weeks on the PCP.  The course could come at the start of the contract, if that was what was required by the job, or at the end, as a "thanks for coming out".  You could then have a relatively constant flow of PCP qualified reserves to do all the taskings the reg  force is too understrength to complete.  He**, why not make it a three-year contract with the last year in a deployable holding pool; the CF has had you for two years, you should meet trade specs and be dentally fit to deploy, not a admin nightmare, etc...

You could then hold these pers to their contracts on a "early withdrawal" clause requiring them to pay back the course tuition and expenses if they terminate their contracts.  I suspect the majority of the pers who did this would then persue at least part-time prehospital employment and maintain a license for some period.  When it expires, the mbr goes back to the AFMR2 mocomp stuff, by which time they are a clinical leader and can manage pers who hold the licenses and have the specialist skills.

Not a lot of time to draw this out , but here it is.

DF

 

[Armymedic]

I just lost the rant I was trying to type up...
So here is the highlights....
The reasons why your proposals are not good are:
1. Good reg force med techs must learn more then first aid,  BTLS trauma, and basic cardiac care skills (really all PCP learn is it not?) because clinical assessment skills are required to work in the first line role.
2. Good reg force med techs are ideally striving to become PA's, and without daily patient contact the accelerated PA program in Borden wll just chew up the army medics.
3. Good reg force med techs have to work in Air force and navy enviroments as well as in the field,
4. With no clinical 6a then basic assessment skills need to be taught asap, if all PA prerequisite skills are being taught on QL 5, then basic assessment has to be taught to QL 3 (and was prior to JI programs),
5. When do the med techs learn those other skills required for first line role like putting on a cast, sizing crutches, giving SQ, IM or ID injections, and doing eye chart and hearing tests, which are so important in a CDU/UMS daily operation?
6. With the limited scope of expertise, how do we learn to make do with no support and protracted evac times when the goose gets it....

You absolutely CAN NOT seperate the Med Tech trade in the way you discuss as much as it would make sence to do it. If we were to then the division would be the Med Techs who fast track to WO PA, beginning at the MCpl level, and the remainder Med Techs stay as PCP qualified and learn admin and man management crap and never go past Sgt....

Get more PA's and we can be rid of those Nurse practitioners who can't (or better said, CFMG won't) deploy anyway.

 

[Fraser.g]

You absolutely CAN NOT seperate the Med Tech trade in the way you discuss as much as it would make sence to do it. If we were to then the division would be the Med Techs who fast track to WO PA, beginning at the MCpl level, and the remainder Med Techs stay as PCP qualified and learn admin and man management crap and never go past Sgt....

Get more PA's and we can be rid of those Nurse practitioners who can't (or better said, CFMG won't) deploy anyway.

I believe you answered your own question or statement with the above quote. I am not stating that the medtec would stay stagnant at the PCP level but move upward to ICP and ACP levels. Once there the next step would be the PA. No fast track just progression.
As for casting there is no need to cast that close to the FEBA in the first place. If a member is casted then they are not combat effective and require time to preserve the manpower that is our mandate. A splint would be sufficient until the wounded individual is evacuated back to a facility that has the x-ray and other requirements to do the job properly.

Now on to your last point. Why is it that CFMG cant or wont deploy NPs into the field or on ship for that matter? Go into any northern health station in this country and you will find NPs not PAs. The major difference between the two is that NPs operate on their own licence as opposed to PAs who work under a Physicians. It is the last letter of the title that says it all. Practitioner versus Assistant.

It is great to teach skills to members but if they are not used they are gone. It is time to look at how we can maintain the skill sets we are teaching and not just do scenarios and mockups. Practice is nice and an essential part of learning but it is just makebelieve until you are actualy doing it. Now I have to get back to actualy doing it my brake is up and I have a level 2 trauma comming in.

It is time to critically think of a solution to the situation we are in by considering things outside the normal scope as opposed to bashing our heads against the old stereotypes.

GF

 

[Armymedic]

My point is Med Tech must fill all roles of first line care, not just those on a army field of Battle. IMOand many others is the reliance of PCP and civy paramedic style training keyholes us to a narrow scope of practice which limits our effectiveness in the broader scope of our employment. It is easier to refresh a skill lost then to learn it brand new at the moment it is needed.

Ref NP's, their current role is restricted to the CDU's in garrison, and so far there is no plans to have them work else where, leaving operational and deployable positions to Military MO's and PA's. PA s are now recognized by CMA and will be licenced in the next 2 yrs...And currently, niether a NP nor PA can work totally independent of a real Doctor.