Re: Flight Nurse vs Flight Paramedic
Howdy. I don't fly, but am curious as to why a few would consider the RN title to be most superior in the out of hospital environment? Considering a flight team that consists of both a associate degreed paramedic paired with an associate degreed nurse, as is often the case in flight crews, I can't really view either as superior to the other.
On the contrary, I have always felt the out of hospital environment as the paramedic's turf, and when looking at it from an educational perspective, the academics are very different from one another. Where as an RN with a comparable degree may have a better grasp on disease process through education in such things as microbiology, and be well educated in topics such as sterility - the paramedic's program will have focused on subjects more specific to this environment such as extrication, staging, and field operations in addition to the usual A&P and sociology.
With that said, there is no disputing that there are far more BSN prepared nurses than paramedics who are trained to the Bachelors' level in EMS. Nursing has been around a while and well established, but I see EMS as a very young and still evolving field but limited in opportunity for advancement. I read recently that the National Registry (their version of the NCLEX) will no longer be accepting non-accredited colleges offering diplomas at some point in the future, and I say good for them. I see EMS as being very progressive in elevating their educational standards and think we'll one day see less professional inequality among all healthcare providers as the continuity of care becomes less divisioned.
As for experience, I work ER. We are high volume, and it is often me against the world in triage. At times I thought it was the most challenging and down right irritating job until I was able to ride out with a EMS crew not very long ago. That brings me to my next point, experience in the field. I was so out of my element. I thought it would be just like triage, but with just one patient at a time for me to focus my attention on. But there were so many variables to consider about each scene, safety of self and coworker, the patient, their treatment, and transport. It was an emotionally charged environment and decisions had to be made without hesitation, by someone capable of being a leader. One thing I noticed is that most of the patients were in considerably more distress than the ones that typically walked into the ER, making assessments far more difficult to preform. There were no safety nets and those guys preformed incredibly under stress in what is an often under appreciated not very well understood job. Each one cared for the patient professionally and authentically, being a master at his skills while still getting them safely to definitive care at a breakneck clip. I'll take my triage, 40+ deep and alone over approaching another backyard swimming pool and seeing a lifeless little body floating at the bottom, and then bearing all the responsibility of getting them out myself, getting them back, and getting them to the ER in front of their hysterical loved ones. It was definitely an eye opener and because of that I have a better understanding and deeper appreciation of what is done by paramedics.
But back on topic, while it seems I have nothing but great things to say about our local EMS, I'm not trying to diminish the nursing role in out of hospital care. This is an even younger entity in our line of work, and I appreciate the differences between our two professions and see both providers as having equal value and knowledge, albeit different, in ways of thinking to get us to our one familiar goal, and that is doing what is in the best interest of the patient. These people are the most vulnerable of our society and deserve the best damn care available to them. Paramedic/RN crews in a tug of war over who's going to play captain of the ship are useless to the patient and dangerous to the employer. This is a partnership and you might not always look large and in charge, but you can always do your job well.
. But, I never have an issue with any paramedic I work with - and you can also bet that if I am in the medic seat for a shift (and doing all the fancy airway stuff), I am not inferior to my co-worker that occupies the RN seat. Actually, I think of all my co-workers as different, but - EQUAL. 
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