corpsman care on wards

[Perrotfish]

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This is a random question: has anyone here ever seen a corpsman/medic run (no nurses) ward? What do you guys think of the patient care delivered by corpsmen vs our nrusing staff? What care do you think that nurses are capable of providing that corpsmen are not?

I've been surprised in the military how little responsbility the corpsmen seem to be given on the ward relatvie to the nurses. They're often at 1:1 corpsmen : patient ratios, working directly under a nurse (rather than an LCPO) and tend to focus on the simpler patients. Which makes sense, I guess, since it seems like only the most junior corpsmen rotate on the ward, but I'm surprised that there's not an Petty officer/chief role on the ward that has a level of responsibility closer to a nurse. Is that just an MTF thing, or do corpsmen always take a junior role in the ward? Has another system ever been tried?

I'm not saying that the care provided by nurses isn't great, btw, just that I'm surprised that we don't give corpsmen more of an opportunity to grow into positions of more responsibility in an MTF when we give them so many opportunities to practice a wide range of medicine in the fleet.

 

[backrow]

I'm pretty sure that JC would have some serious issues with unlicensed providers supplying that level of care in a hospital on US soil.

Unfortunately the care a corpsman can provide in a hospital setting is basically that of an MA or LVN.

 

[colbgw02]

the care a corpsman can provide in a hospital setting is basically that of an MA or LVN.

This has been my experience, as well - that medics/corpsmen function in lieu of an LPN/LVN and under the supervision of an RN.

 

[corpsman33]

This is a random question: has anyone here ever seen a corpsman/medic run (no nurses) ward? What do you guys think of the patient care delivered by corpsmen vs our nrusing staff? What care do you think that nurses are capable of providing that corpsmen are not?

I've been surprised in the military how little responsbility the corpsmen seem to be given on the ward relatvie to the nurses. They're often at 1:1 corpsmen : patient ratios, working directly under a nurse (rather than an LCPO) and tend to focus on the simpler patients. Which makes sense, I guess, since it seems like only the most junior corpsmen rotate on the ward, but I'm surprised that there's not an Petty officer/chief role on the ward that has a level of responsibility closer to a nurse. Is that just an MTF thing, or do corpsmen always take a junior role in the ward? Has another system ever been tried?

I'm not saying that the care provided by nurses isn't great, btw, just that I'm surprised that we don't give corpsmen more of an opportunity to grow into positions of more responsibility in an MTF when we give them so many opportunities to practice a wide range of medicine in the fleet.

I worked as a Corpsman in a big MTF for 5 years. The most responsibility I was given was when I worked in the PACU. I did the exact same job as the RN's and recovered patients myself. The only thing I couldn't do was push narcotics. Even though I was pretty much on my own, I was still under the license of an RN.

Corpsman "in country" have much greater responsibilities for obvious reasons.

Also, there are Independent Duty Corpsman who function like PAs in MTF, on ships, overseas, etc.

 

[pgg]

This is a random question: has anyone here ever seen a corpsman/medic run (no nurses) ward?

No. Not even deployed.

What do you guys think of the patient care delivered by corpsmen vs our nrusing staff? What care do you think that nurses are capable of providing that corpsmen are not?

I think they do just fine on the whole, but they do different jobs and have different levels of responsibility.

In general I think parking Corpsmen at phones, reception desks, and vital sign stations is a waste and favor getting them clinically involved as much as possible, but they absolutely need supervision. They can "run" certain ward functions just fine (logistics, lab collection, that sort of thing) but these are delegated responsibilities that need followup by the person really responsible.

As with all things in medicine, it's not just the technical ability to learn and perform some skill that matters. The background of an appropriately broad education, experience, autonomy, and accountability are other important elements.

At times I lament the lack of all of these in some nurses, but at least they're nurses. I can't imagine a MTF that would put Corpsmen in those positions.

Also, JCAHO would go absolutely bonkers, and for once I'd be with those rat bastards.

I worked as a Corpsman in a big MTF for 5 years. The most responsibility I was given was when I worked in the PACU. I did the exact same job as the RN's and recovered patients myself. The only thing I couldn't do was push narcotics. Even though I was pretty much on my own, I was still under the license of an RN.

😱 Corpsmen should never, ever, ever be covering patients independently in a PACU. This is not something I would ever allow in any PACU that I had control over. This is far outside the standard of care. I can't imagine any anesthesiologist or CRNA giving report and turning over a patient to a Corpsman.

Even awake/stable patients who bypass Phase I recovery and go direct to Phase II (but physically in the same space a the PACU) need turnover to a responsible RN. That RN certainly doesn't need to be continuously present, but has to be the responsible person.

 

[corpsman33]

No. Not even deployed.



I think they do just fine on the whole, but they do different jobs and have different levels of responsibility.

In general I think parking Corpsmen at phones, reception desks, and vital sign stations is a waste and favor getting them clinically involved as much as possible, but they absolutely need supervision. They can "run" certain ward functions just fine (logistics, lab collection, that sort of thing) but these are delegated responsibilities that need followup by the person really responsible.

As with all things in medicine, it's not just the technical ability to learn and perform some skill that matters. The background of an appropriately broad education, experience, autonomy, and accountability are other important elements.

At times I lament the lack of all of these in some nurses, but at least they're nurses. I can't imagine a MTF that would put Corpsmen in those positions.

Also, JCAHO would go absolutely bonkers, and for once I'd be with those rat bastards.




😱 Corpsmen should never, ever, ever be covering patients independently in a PACU. This is not something I would ever allow in any PACU that I had control over. This is far outside the standard of care. I can't imagine any anesthesiologist or CRNA giving report and turning over a patient to a Corpsman.

Even awake/stable patients who bypass Phase I recovery and go direct to Phase II (but physically in the same space a the PACU) need turnover to a responsible RN. That RN certainly doesn't need to be continuously present, but has to be the responsible person.

Well I worked at one of the "big 3" naval MTF and anesthesia would give report directly to Corpsman with nurses "listening" within earshot. However, if you were a seasoned Corpsman and the nurses and anesthesia staff trusted you then often times the nurse would be across the floor taking care of their own patient while listening 😉. This didn't happen with every Corpsman, but I was an ACLS instructor for 4 years, lots of experience, etc. and so they trusted me and a few others. However, all Corpsman were expected to recover patients, but if their skills were lacking then the nursing staff would hang all medications, and hover fairly close, etc.

Once a Corpsman has worked on the floor for a year they are eligible to challenge the LVN/LPN test because they are considered equivalents.

I didn't create the rules, I just played by them. But I was very grateful for the opportunities to learn and grow. I feel that several of the Corpsman I worked with were significantly more competent than about half of the nursing staff. However, I know that it is not about competence, but rather the nursing license, which is why "technically" these patients were signed off by the nursing staff.

On the flip side there were many Corpsman who were definitely lacking in competence and it scared me that they were forced to take care of patients (it was these Corpsman where the nurses were forced to do most of the work). There were also a few nurses (not many but a few) who scared me to death. I refused to work with these nurses, because I was scared they would push an inappropriate med, or do something else foolish on a patient I was caring for leading to some kind of sentinel event.

 

[pgg]

However, if you were a seasoned Corpsman and the nurses and anesthesia staff trusted you then often times the nurse would be across the floor taking care of their own patient while listening 😉.

If the 😉 means the nurse was there in name only, and wasn't really listening, that ain't right. I would never turn over a patient to just a Corpsman, no matter how seasoned. It's not even fair to the Corpsman.

If the nurse really was listening, then the nurse was still there and responsible, and aware, and choosing to delegate to you and supervise from nearby, which is a completely different situation. There are patients where this is appropriate.

 

[corpsman33]

If the 😉 means the nurse was there in name only, and wasn't really listening, that ain't right. I would never turn over a patient to just a Corpsman, no matter how seasoned. It's not even fair to the Corpsman.

If the nurse really was listening, then the nurse was still there and responsible, and aware, and choosing to delegate to you and supervise from nearby, which is a completely different situation. There are patients where this is appropriate.

I never said it was right, but it was just the system we were forced to work in. I think this was partly due to staffing. We had a PACU where we would routinely see 50-60 patients a day and it was impossible for the nurses to handle this on their own. It was also impossible for the DOD (or seemed impossible) to send us more staffing (we were trying unbelievably hard to get more staffing). If the patient was ASA 1 or 2 then it was policy that the Corpsman could take the patient, but if he/she was and ASA 3 or 4 then only a nurse could take the patient. However, even with the ASA 1 and 2s technically a nurse was supposed to supervise, but supervise can be a loosely interpretted concept with a wide variety of meanings (again, I am not saying it was right, but it was just the system we were dealt).

If this disturbs you then I would definitely try and avoid the West Coast (and I am being sincere, not sarcastic) if you catch my drift.

 

[Perrotfish]

So I guess my question is, why do we only have nurse officers, and not nurse petty officers/CPOs? Every CPO needs a college degree, we have CPOs in what is essentially a PA/Physicians role when they work as IDCs, and we've estabilies a clear pathwathway for junir enlisted to become LVNs/LPNs. Have we ever tried an enlisted pathway to becoming licensed RNs, so we could have a CPO RN? If not why not?.

 

[corpsman33]

So I guess my question is, why do we only have nurse officers, and not nurse petty officers/CPOs? Every CPO needs a college degree, we have CPOs in what is essentially a PA/Physicians role when they work as IDCs, and we've estabilies a clear pathwathway for junir enlisted to become LVNs/LPNs. Have we ever tried an enlisted pathway to becoming licensed RNs, so we could have a CPO RN? If not why not?.

You aren't required to have a degree to become a CPO. Although it definitely makes you more competitive. Most CPO's I know are degreeless (or may have their AA, etc.).

There are two programs available that allow enlisted to become RNs: MECP and Sta-21 where enlisted Sailors can become commissioned/licensed RNs.

Also, the PA program evolved from Corpsman (not the other way around). Very skilled Corpsman were coming back from Vietnam and they didn't know quite what to do with them in the civilian world, hence the origination of PA's:

http://www.aapa.org/the_pa_profession/history.aspx (hisory of the PA).

IDC's have to undergo an additional year of training than standard Corpsman (somewhat similar to what PA's go through, only PAs do 2 years). There is a fast track system where IDCs can take some extra college classes and convert to PA's. Also, just because you are an IDC does not mean you are chief. There are 2nd class IDC's through Master Chief IDC's.

 

[vellnueve]

So I guess my question is, why do we only have nurse officers, and not nurse petty officers/CPOs? Every CPO needs a college degree, we have CPOs in what is essentially a PA/Physicians role when they work as IDCs, and we've estabilies a clear pathwathway for junir enlisted to become LVNs/LPNs. Have we ever tried an enlisted pathway to becoming licensed RNs, so we could have a CPO RN? If not why not?.

There are quite a few CPOs who do not have degrees, while there are plenty of enlisted personnel who do. I have four IDCs at my clinic right now (billeted for five plus a chief IDC, but the other billets are gapped right now) and they handle the vast majority of patient care here - All of them are HM1s. Granted, this clinic is technically outpatient only. We have a flight surgeon and a FM doc who handle the flight stuff, any civilians, and emergencies, and two nurses who pretty much only do admin work and emergencies.

I've heard of a few RNs who enlisted, not knowing what they were doing when they came in, but this is rare. As noted before, we have a lot of current nurses who became nurses through the MECP program (in fact my clinic has one who did that program and his predecessor did so as well - and one of my guys is working hard to get selected this coming cycle). The reason why all Navy nurses should be officers is pretty simple - they get paid more as officers and will all have access to educational and leadership opportunities as officers.

Think about it, why would an enlisted servicemember (not all MECP applicants are corpsmen - one of the guys I know was an ST) with who knows how many years of service go through the same education and training in a nursing program, only to be paid less and have fewer opportunities for career advancement than some fresh, naive 22 year old recent nursing school graduate who has never seen water?

 

[Perrotfish]

nvm

 

[d2305]

There is no fast track from IDC to PA. IDC used to be a prerequisite for PA school, but now a welder can go if all of the courses are done.