What is a Professional College and what would it change?

At this point in the development of the British Columbia Paramedic Association most will have heard about a goal to make Paramedicine a self regulated health profession in BC. Many have said “that sounds great but what does it mean?” While others have posed the question “Why do we need that when we already have the EMA Licensing branch?” Both are excellent questions with overdue answers.

 

Oxford Living Dictionaries defines a college as “an organized group of professional people with particular aims, duties, and privileges.” Specifically a Professional College seeks to meet said aims, duties, and privileges in a self directed manner. To be self directed is to be “under one’s own control.” Paramedics in the province of BC are in no way under their own control from a professional standpoint. Out of British Columbia’s 26 regulated health professions, Paramedicine (or as it’s referred to “emergency medical assisting”) is the only regulated health profession that has failed to engage in self regulatory practices. Nurses, Physicians, Massage Therapists, Opticians, Dieticians, Pharmacists, Physical Therapists, Midwives, and even Podiatrists all have something in common that Paramedics do not; a self regulating professional college.

 

What have these 25 professions with protected titles realised about themselves that Paramedicine is now learning? These professions have learned that the miss-application of their unique bodies of knowledge poses a risk to the public. Additionally, self-regulated professions understand they are the most qualified to determine what constitutes appropriate versus inappropriate practice within their respective areas of expertise.

 

How did we end up where we are and what does that mean?

 

At the inception of what we now refer to as Paramedicine in BC, the provincial government recognised a need for paramedic practice to be regulated for the safety of the public. No structure for paramedic regulation existed at the time, necessitating the creation of the Emergency Medical Assistant’s Licensing Board. Members of the board are government appointed and have no direct control over the scope/standard of practice to which they hold paramedics accountable. Every paramedic in BC has their scope/standard of practice defined by the Emergency Health Services Act: Emergency Medical Assistants Regulation. What all of this means is that standards of practice enforcement is performed by the government (not paramedics). It also means scope of practice changes meant to better serve the public require an act of legislation via the provincial health minister. Enforcement of paramedic practice standards, changes to practice standards, and enforcement of educational standards, are not left to the subject matter experts (paramedics).

 

How would a self-regulated college of paramedics be different?

 

A self regulated college of paramedics would fall under the Health Professions Act. Professions covered by this act are responsible for protection of the public by, self regulating practice, ensuring professional/ethical conduct with impartial disciplinary processes, setting educational standards, and enforcing continuing competency standards (exact legal wording can be found under Duty and objects of a college within the regulation). The short answer is that Paramedics would be expected to set and enforce their own standards of practice without being directly controlled by other disciplines or legislators (ie. the subject matter experts would be allowed to set the standards to which paramedics are held).

 

Edward Peters

BCPA President

Privilege in Paramedicine

At a glance it may be difficult to see how the life of a Paramedic is one of privilege. Between shift-work, long hours, high stress workspaces, ever changing practice expectations, and remuneration vs. cost of living concerns; being a Paramedic isn’t exactly an occupation that will land you on “Lifestyles of the Rich & Famous.” Statistics regarding work related stress injuries for paramedics are frightening, with suicide data in particular a major cause for concern. Even those of us who retire “healthy” are more likely to suffer from heart disease than the general public. One might ask “What is this Privilege you speak of?”

 

A paramedic’s greatest privilege is trust. Paramedics (alongside firefighters, nurses, and physicians) consistently rank highly as one of the most trusted occupations in Canada. In Australia Paramedics are the most trusted occupation a number of years over. On what may be the worst day of a patient’s entire life; not only do they allow paramedics into their homes, they specifically ask paramedics to lead them through whatever crisis has occurred. Patient’s invite a complete stranger (a paramedic) to take control of their personal crisis out of trust and respect for that strangers occupation alone. This public trust extends through all levels of paramedicine, ranging from the Primary Care Paramedic responding to a simple diabetic call to the Critical Care Paramedic initiating ICU care on behalf of a rural sending facility.

 

With the consistent high degree of trust placed upon paramedics by both the public & other health professionals, it seems unfathomable that paramedics would fail to trust themselves; yet evidence would suggest paramedics do not trust themselves (at least in Canada that is). If paramedics trusted their own judgement as completely as the public seems to, British Columbia would have its own College of Paramedics. A profession that trusts itself has the knowledge, confidence, and maturity to regulate itself for the protection of the public. A profession that trusts itself seeks to build upon the body of knowledge that makes it a unique entity through research and education.

 

It’s time Paramedicine learned to trust itself. It’s time Paramedics extended their profession the same privilege the public has deemed them worthy of.

 

Paramedic Self-Regulation: Its Importance and The Big Picture of The Paramedic Profession

Paramedic Association of Manatoba Self Regulation FAQ

Leading on the edge: The nature of paramedic leadership at the front line of care

“Leading on the edge: The nature of paramedic leadership at the front line of care”

Few research articles look closely at leadership in Paramedicine specifically. This is one of the few and it just happened to originate right here in Canada!

Development of Active Leadership in Paramedic Practice

What does it mean to be a reluctant leader? Vocabulary.com would describe the word reluctant as “disinclined,” or “unwilling to do something contrary to your custom.” (Vocabulary.com) The same site would define a leader as “a person who rules or guides or inspires others.” (Vocabulary.com, leader) By extension, a reluctant leader is someone who guides or inspires others while being reluctant to do so. As a ten year paramedic the definition of a reluctant leader strikes closer to home than I care to admit.

As paramedics our first samples of true leadership often come minutes to hours after the commencement of our first shift as a licensed/registered paramedic. The safety net of our veteran preceptors has fallen away and we are left to our own madness as thoughts of what our first independent call may be swirl through our fertile imaginations. Will it be a big trauma? Will someone’s mother, father, brother experience a cardiac arrest? Imaginations wander fervently until the phone finally rings or the tones drop. What was your first call?

Every paramedic, no matter their license level, remembers their first independent call. For some it was a simple lift assist; for another it might have been their first opportunity to help bring life into the world. No matter what the call was, it was that paramedic’s first chance to lead another person (the patient) through a trial that exceeded said person’s ability to cope. In that moment a reluctant leader was born. In that moment a paramedic was born.

From the Australasian Journal of Paramedicine, “Three factors: ‘wanting to help people’, ‘exciting career’ and ‘saving lives’, emerged as the most important motivating factors for participants’ to pursue a paramedic career.” (Ross, Hannah, & Van Huizen, 2016) Isn’t it interesting how none of the identified factors included a desire to lead, yet every patient care episode a paramedic participates in involves leading a patient through a trying episode of some variety. Leadership is thrust upon paramedics by the nature of the work. It’s time for paramedics to own the very nature of their role within the healthcare system. It’s time paramedics found comfort in knowing their role is to provide leadership when patients or other health providers have lost control.

How does one transition from the role of reluctant leader to active leader? One definition of active leadership states that, “Active leadership seeks to involve staff in the challenges facing the group and gives them a role in solving those challenges.” (Albers, 2016)  Paramedics can become active leaders by engaging each other as agents of change for their own future. By becoming active leaders, paramedics take ownership of their profession in ways not previously afforded them. Formation of the BC Paramedic Association is one form of active leadership. As active leaders the BCPA will be seek the assistance of all paramedics in facing the challenges before the profession as it continues to grow and develop.

Moving forward the BCPA will ask paramedics to provide Professional Leadership in the areas of Clinical Practice Excellence, Higher Education, and Paramedic Research. Leadership in these areas does not have to come through direct committee involvement. Participation in study data collection, precepting, interdisciplinary communication, and following evidence based standards of practice, are all areas every paramedic can actively display the leadership qualities necessity has breed into the profession.

 

Bibliography

Albers, J. (2016, 02 22). Active vs Passive Leadership. Retrieved 11 07, 2018, from linkedin.com: https://www.linkedin.com/pulse/active-vs-passive-leadership-james-albers

Ross, L., Hannah, J., & Van Huizen, P. (2016). What motivates students to pursue a career in paramedicine. Australasian Journal of Paramedicine, 13(1), 01 to 07.

Vocabulary.com. (n.d.). leader. Retrieved 11 07, 2018, from Vocabulary.com: https://www.vocabulary.com/dictionary/leader

Vocabulary.com. (n.d.). Reluctant. Retrieved 11 07, 2018, from Vocabulary.com: https://www.vocabulary.com/dictionary/reluctant