EMT-P Question - page 3
I heard a rumor that nurses can sit for the EMT-P exam without going through the course as long as they hold an EMT-B and RN. It's probably different from state to state but does anyone know if... Read More
Dec 29, '04Quote from medic1488I totally agree there! Our ED just implemented paramedics in our department. The ED coordinator is still trying to tweek the total job description, i.e. what they can do, what they can't do. I also heartily agree that RNs should do ride time on the ambulance. I was a medic for 11 years became an RN two three years ago, and then got lazy and let my medic cert go. I don't regret it. I have never looked back at not having to go out in the middle of a dark and stormy night to pick some drunk up off the highway that rolled his car several times. But, that being said, I understand the difference between RNs and medics, as well as the similarities. I am probably the only RN in our ER that has actually intubated a real person, and would feel perfecty comfortable intubating again.I guess I'm just lucky that the hospital based EMS system I work for the nurses and medics have excellent relationships. We respect them, they respect us. They know there limitations, and we know are limitations. And we help each other out whenever possible. (we do provide ED care when not on calls, inlcuding med pushes (only meds within our normal scope of practice), IV's, intubations, and the such. In fact, I'll even help the RN's clean patients and rooms if not engaged in other activities) I dont know if thie level of respect comes from the fact that we are in the ED, willing to help out, and see the other side of patient care, but if it is, maybe more systems should have medics coming into the hospitals and RN's out to the field.
We do have the TNCC course that is supposed to train RNs on skills like extrication on a longboard with a c-collar. Course, when I took it, the first thing I said when going into the scenerio was "is the scene safe?" The nurse in charge said "I hate that phrase." I thought, well honey, if the car is on fire or has a hot electrical cord lying across it, you wouldn't hate that phrase. The course also only teaches you strict by the book head to toe assessment, not stopping to correct something that you find critically wrong before moving onto the next item on the list. Plus the fact that it didn't teach speed of assessment. It was a very frustrating course for me, and my boyfriend was ready to throw me out of the car by the time it was over, because I griped so much about how stupid I thought the course was. Maybe it was just because I had sat through so many EMT and medic practicals as a testor, plus the fact that I was a CPR instructor, it just frustrated me to no end because of how much everything seem to drag out.
I would really kind of like to ride the ambulance again, but there is no way I want to go back through the medic class. I was the last class in our state to be only state certified, now everyone has to be nationally registered and that class is torture, IMHO! Our state doesn't have a prehospital RN so I guess I will just stay in my nice warm, sissy environment and treat the patients that EMS brings in.
Dec 31, '04Quote from EricTAMUCC-BSN...mean anything to you? I've been a paramedic (was the first woman trainee my preceptors had...it was a long time ago... oh Johnny! oh Roy! . I worked as an admitting clerk in an ER for 4.5 years (also a long time ago) and am now in . I don't think anyone was insulting nursing...if anything, it's an insult to paramedics that an RN would think they could waltz in and do a paramedic's job.Frankly I find it very offensive when one profession or another ridicules nursing and tells us what we can and can't do and how our profession should operate.
HAHAHAHAHA!!! You think taking an ACLS class or any of the other alphabet soup classes prepares you to effectively treat a patient experiencing a medical or trauma emergency?
My preceptors kept telling me: you need to be more aggressive; you need to take charge of the scene. That's a very different skill set than you learn in RN school. When you are a paramedic, you are the highest medical authority on the scene; when you are an RN, the physician is (and maybe even the physician-specialist--as I am studying the ACLS manual right now!--they think anesthesiology should be called to intubate; of course, they are also saying combitubes and LMAs may be more preferable in the field.). While there is no doubt in my mind that RNs have a lot of responsibility, there is usually someone there they can consult with--another RN, an MD, pharmacy, respiratory, etc; if you need more hands in an emergency, you can usually get them. A paramedic usually isn't consulting anything, except their own knowledge of assessment and protocol--they have to be able to lead the limited number of people they have on scene to help them, telling them and sometimes ordering them, what to do. And while RNs do put their backs at risk, it's still not anything like lifting a 300# patient down a narrow stairway...
Can RNs learn these skills? Some can, some can't. It's like it has been repeated several times...they are different professions...Not all PMs could be RNs, either...
Now, can't we all just get along?
NurseFirstLast edit by NurseFirst on Dec 31, '04
Jan 1, '05Quote from EricTAMUCC-BSNFrom my perspective in EMS, I have seen that nurses have had quite a hand (at the state and national regulatory level) in telling EMT's and Paramedics what they can and can't do (and how they should operate in general).Frankly I find it very offensive when one profession or another ridicules nursing and tells us what we can and can't do and how our profession should operate.
Jan 2, '05From my perspective in EMS, I have seen that nurses have had quite a hand (at the state and national regulatory level) in telling EMT's and Paramedics what they can and can't do (and how they should operate in general).
I am a firefighter/paramedic and currently attending . I have absolutely no question that nurses can perform the assessment, skills, and apply the medical knowledge required for the job. Some skills not usually performed by nurses may need practice (intubation, RSI, pericardiocentesis, retrograde intubation, etc.). I would think that a 2 week course for paramedicine would not adequately prepare anyone to be comfortable with these procedures without some sort of clinical component to practice these skills.
My biggest concern is with the safety factor, not the patient care aspect (I believe nurses can do an extraordinarily good job). There are many situations out there "in the field" that will kill you or kill your partner. I am NOT saying that nurses cannot handle the situation, but does a 2 week (or abbreviated) course cover these situations adequately. Sometimes you will be the first to arrive onscene and must assess the situation: electrical hazards, natural gas, HAZMAT scenes, people with guns, knives - basically trying to injure you also, MVAs - airbag deployment while you are in the vehicle, WMD (remember the 'white powder' calls), etc.
I'm not sure how much of those safety items are covered. Nurses can do a good scene safety assessment and take control of the situation - I just hope a quick course like that can give them enough knowledge & instill the tools they need so they don't get hurt.
This is my opinion and concern. This is not a "knock" on nurses by any means, heck - I'm trying to become one. My question would be: Are they taught the safety measures needed so they can remain safe. There are a large number of firefighters, police officers and paramedics that are injured or killed on scenes (especially MVAs) - it would be disheartening to see nurses also added to that list.
Jan 2, '05Quote from EricTAMUCC-BSNIt is just plain arrogant to think that you are the only one capable of intubating or stabilizing a patient in different environments especially when talking to highly skilled and well educated professionals.
I've worked both sides of the stretcher for a more than two decades now and I can tell you that it takes a lot more than an ACLS/PHTLS class for an RN to function effectively in the field. It also takes more than a couple nursing classes for a EMTP to work in an ED with any success. There are similarities to both jobs, but each are a seperate link in the chain of survival. It's a merely a matter of focus. RN's and Medics arrive at the same destination but take different paths.
Back to the original topic. In PA you have to take a special dedicated Pre-Hospital RN class which involves, the EMT class, extrication, ACLS, PHTLS and maybe some others for an RN to become a PHRN. I did from the other end. I was a Paramedic who went to nursing school, once I held both licenses I was granted the PHRN status.
Jan 2, '05I do both the RN and Medic thing. Even being an RN in the ER, which some have said would be a great jumping off point to being a Medic, requires a completely different mind-set than working in the ambulance.
The ambulance requires me to be THE go-to guy. More often than not, my partner will be an EMT and, if there are first responders there, they'll be BLS too. I need to complete an assessment, make a transportation decision, and treat the patient.
In the ER, I treat the patient and act as more of a facilitator of care (did the xray get done? what about the CT? etc., etc.). It's a different mind set.
Jan 2, '05Quote from Medic946RNWhat does PHRN stand for?Back to the original topic. In PA you have to take a special dedicated Pre-Hospital RN class which involves, the EMT class, extrication, ACLS, PHTLS and maybe some others for an RN to become a PHRN. I did from the other end. I was a Paramedic who went to nursing school, once I held both licenses I was granted the PHRN status.
Jan 2, '05without a doubt some of the knowlegde and skills of rn's and medics cross over, but not enough to qualify one profession to perfrom the duties of the other. i've been a medic for ten years, my wife, an rn for the same amount of time. the one thing i know to be true is this, rn's go to school for two years (aas), to learn how to provide care to all types of pt's from the onset of illness until death (years), medics go to school for a year (not counting emt or prerequisite experience), learn how to best manage pt's from the time of injury or exacerbation of illess utill delivery at an ed(minutes.). medics are far better prepared to accomplish thier tasks than are rn's. a medic, without going though an entire rn program could not hope to accomplish all of an rn's duties and the reverse is true as well. the rn that thinks they can be a good medic after taking a few courses, acls,pals,pepp, whatever is profoundly fooling themselves
(written by bonemarrowrn's husband)
Jan 2, '05Quote from bonemarrowrnPHRN = PreHosptial RNWhat does PHRN stand for?
it is a designation given by some states, a title given to a RN with EMS who has demonstrated skills in the prehospital setting.
Jan 2, '05I remember the days, back in the very early 70's, when Paramedics were the butt of many jokes and would never be taken serious by any doctor. I lived those days and it was sometimes down right embarrassing to come into a ED with a patient. A tremendous change in the EMS as we see it today was something I really couldn't see some 30 years ago. I really thought being a paramedic was a go no where job and finally settle on nursing as a profession. I really can see the difference between field work and hospital work. There really is no comparison. Alot of nurses, with a few years under their belt, can take care of themselves adequately in the field but are far from being proficient in patient care outside of the hospital. Hospitals seem to give them a sense of security because they are always surrounded by others who will help them in their decisions. On the other hand Paramedics are the eyes and ears of the ER doc and without proper identification of the problem, everything could go wrong. I agree with other posters that nurses and paramedics all work towards the same goal of caring for the patients. I do think their jobs are really as different as night and day and just because you are an RN doesn't mean you are qualified to perform out in the field. I have been away from the profession for a very long time and when I do come across an accident and stop to help, I always relinquish control over to the Paramedic or Firefighter/paramedic when they come on scene, they know what's best for the patient. I know alot of guys want to go the RN to Paramedic because deep down once you get the sound of sirens, red lights a flashing and racing down the freeway at breakneck speeds, it's something you don't easily forget. Mike
Jan 4, '05Quote from Traumamama59hehehe...Memories! In my EMT-B class, we knew the answer when arriving on scene was 1-Scene Safety and then 2-gloves!!!! We joked about it all the time. -AndreaWe do have the TNCC course that is supposed to train RNs on skills like extrication on a longboard with a c-collar. Course, when I took it, the first thing I said when going into the scenerio was "is the scene safe?" The nurse in charge said "I hate that phrase." I thought, well honey, if the car is on fire or has a hot electrical cord lying across it, you wouldn't hate that phrase.
Mar 6, '05Apples and Oranges...I agree...I am both an ER RN and a PH-RN....being an ER nurse did nothing to prepare me for working as a medic EXCEPT...I knew where stuff in the body was, I could already start an IV, and I knew my drugs...thats it....Knew nothing about vehicle rescue...PROPER spinal immobilization...how to needle a chest...how to intubate (doing it in ACLS doesn't count)...Its a different ballgame..trust me..I was the biggest skeptic out there...I can't tell you how many times my boyfriend and I would go around about how hard could it be?? I can speak from experience...it is different...My Ph-RN class was 9 weeks long...I wish it would have been longer, because even some of the things they teach in that class doesn't cover what you need to do on the street....I still take every pre-hosp course coming down the line just to better help me with my decision making and skill competency...I definitely think that their should be some sort of bridge program where it is an abbreviated class...I don't think you need to do the whole thing as their are alot of similarities in both fields...HOWEVER...if you go in with the mindset that being an ER nurse and taking a couple classes and a test makes you a paramedic...you are not only doing yourself a diservice...you are also doing a diservice to your patients...This class has definitely broadened my horizons...it has also made me a better nurse!
Mar 14, '05Quote from chris_at_lucas_RNMost EMT courses are at least 6 months long. Most Paramedic Programs are AAS. In NY an RN can take a bridge course to be a Paramedic if they have ER/ICU experience, and have been an EMT for a year. The bridge course is 6 months, and still includes ALL the same field clinical experience the full course contains.Someone can become certified as an EMT cold off the street in a matter of months?
(Am I the only one that finds that just a little bit scarey?)