paramedic nursing

GilaRRT · Nov 20, 2008

Do not take such offense. So what, GilaRN thinks one week is not enough education. What does my opinion really change? That is what this site is about? Throwing out our thoughts and opinions. I am an ADN graduate, I am sure people could take issue with my education and entry into practice with an AD.

This does not mean I give somebody over a public forum enough power to take control of my feelings.

Lets debate the topic. Can an RN without any prior EMS experience go through the same program and come out an paramedic type provider with only one week of training? You may be the exception; however, what about all the other RN's? I am looking at the big picture and simply not focusing on you as an individual.

"...produce of it." Don't you just hate spell check. Wish they could make a computer that could interpret what you really mean to say?

APNgonnabe · Nov 20, 2008

point taken

Dr. Tammy, FNP/GNP-C · Dec 2, 2008

I'm a bit thick and don't grasp concepts too well, but what exactly is paramedic nursing? Is that like chiropractic optometry or podiatry endocrinology?

Trauma Columnist · Dec 2, 2008

No Tammy...in some states (IL for one) we have what is called pre-hospital RN. It is an actual license that allows us to practice in the pre-hospital environment. For instance, I'm on a volunteer (rural) fire dept. I'm a pre-hospital RN certified at the ALS (advanced life support) level so I'm "equivalent" to a paramedic.

Dr. Tammy, FNP/GNP-C · Dec 2, 2008

No Tammy...in some states (IL for one) we have what is called pre-hospital RN. It is an actual license that allows us to practice in the pre-hospital environment. For instance, I'm on a volunteer (rural) fire dept. I'm a pre-hospital RN certified at the ALS (advanced life support) level so I'm "equivalent" to a paramedic.

Wow, you live and learn. Never heard of that before. So who regulates--the BON or state EMSA? Just curious, can paramedics there perform ALS within the hospitals?

GilaRRT · Dec 3, 2008

The BON regulates the activities and SOP of nurses.

CraigB-RN, MSN, RN · Dec 3, 2008

The BON regulates the activities and SOP of nurses.

Actually it depends on what state your in. In PA the State Office of EMS regulates what is done pre-hospital.

GilaRRT · Dec 3, 2008

I thought we were talking about a specific state?

mwboswell · Dec 4, 2008

Hi all, I was just re-reading some of the posts on this thread going back earlier this year. At one point someone asked the difference between Paramedics and Nurses; I don't think we ever went down that road. But I was intrigued by this and made me stop to think and I wanted to share my thoughts and see what you all think.

I believe that the [WIKI]Paramedic[/WIKI] (or at least the intent) is just as the name implies "Para-Medicine". I have always considered the P-medic more of a "technician" as evidenced by a high degree of proficiencey required of certain skill sets.

I believe the P-medic (as evidenced by their authority to practice "generally" eminating from some form of "medical control") is more of the medical model of patient care. Also to support this we know that most (if not all) EMS providers have a medical director, OR at the state regulatory level some form of medical directorship exists. You can usually then trace the lineage back to your states' board of medicine. In my thinking, the P-medic is like an "extension" of the medical diretor's arms into the field/pre-hospital; the medic is working in lieu of the physician being on scene.

I also believe (again the technician theory) that the P-Medic is more in their realm to do technical skills/procedures; I refer you to the National Registry exams which include hands on skills testing as well as written...AND most states level renewal requirements will require some re-testing of skill sets.

Finally, in my experience, most cases a P-medic is not a LICENSED practitioner, they are CERTIFIED. Other words, their ability to practice eminates from the LICENSED medical control (IE: Md, DO etc).

Now for RN's.

RN's are LICENSED. Which means that a legislative body (IE Board of Nursing) given authority by the State, issues a right to practice registered nursing. This is different from being CERTIFIED. Certifications are more of your specialty training, not part of your basic licensing requirements.

The Board of Nursing can only authorize a licensed nurse to practice Nursing as defined in your BON documents. There are certain acts/skills that are "delegate" to nursing that are medical-like in nature; however, the focus of the nursing set is still nursing, not medical.

When an RN is working Pre-hospital (MICN, HEMS) or in the field, they "may" be working under medical control, but that is for medical care only. Their nursing care is not regulated or directed by a medical director. for the most part, the RN (after having demonstrated competency in certain medical like skills) is given "policy and procedure" coverage by medical control to perform (IE: Intubation, needle deomp, central access etc)...Just like demonstrating ACLS competency and medical directorship authorzing the "use of a medical device" (IE defibrillator) to perform a medical act (defibrillation) ...legalistically both of which require a physician "prescription" (IE: order) to perform....

I could probably go on comparing and contrasting a lot more, but I think it's understandable so far.

So what then is the REAL difference?

Some would say money.... a medic costs less than a nurse (generally) to keep on staff.

(IE: Costs less to put medics in ambulances than two RNs), but a counterpoint here; there are more HEMS services going to dual RN crews (and a majority of them are dual RN/EMTs)....

Some would say level of care...

Odds are if it's a dedicated Neonatal/Peds Non emergent transfer (HEMS or ground) you're more likely to see RN's involved.

Odds are if it's a scene call/trauma; there is a Medic involved.

Some would say regulatory influences...

Especially for Hospital Owned HEMS, the same JCAHO standards apply in as much as requiring some involvement of "professional nursing" care for the pt (IE: RN)

When it comes down to the patient care I can only make one set of statements on the differences....

I think the Medics are great at the technical skills and things that are procedural driven.

I think the RNs are good a managing the total patient.

-this does NOT mean that I think medics can't/dont give high quality pt care,

-nor does it mean that I think the RNs give BETTER pt care

-It means I think the two work TOGETHER for the best outcomes;

I have taught in both nursing and paramedic programs and have noticed differences as well there...but that's another discussion altogether.

Everyone feel free to reply/respond with YOUR thoughts, I'm interested to hear any counterpoints based on experience and knowledge.

Oh By the way, my background...

9 years first responder/fire department

6 years "street medic"

1 year flight/transport nurse/medic

3 years ICU/CCU/MICU

7 years ER Staff RN (Certified)

8 years ER Nurse practitioner

...and STILL working as Part time medic "on the street" in my spare time

-Be safe everyone!

-Mark

bat3fingers · Mar 5, 2009

I'm a nurse, soon to be paramedic. My nursing degree took me around the world. I am hoping that having both will get me flying. I think being both is great, the 2 compliment each other and have different mind sets to bring to any situation.

GilaRRT · Mar 5, 2009

Hi all, I was just re-reading some of the posts on this thread going back earlier this year. At one point someone asked the difference between Paramedics and Nurses; I don't think we ever went down that road. But I was intrigued by this and made me stop to think and I wanted to share my thoughts and see what you all think.
I believe that the [WIKI]Paramedic[/WIKI] (or at least the intent) is just as the name implies "Para-Medicine". I have always considered the P-medic more of a "technician" as evidenced by a high degree of proficiencey required of certain skill sets.
I believe the P-medic (as evidenced by their authority to practice "generally" eminating from some form of "medical control") is more of the medical model of patient care. Also to support this we know that most (if not all) EMS providers have a medical director, OR at the state regulatory level some form of medical directorship exists. You can usually then trace the lineage back to your states' board of medicine. In my thinking, the P-medic is like an "extension" of the medical diretor's arms into the field/pre-hospital; the medic is working in lieu of the physician being on scene.
I also believe (again the technician theory) that the P-Medic is more in their realm to do technical skills/procedures; I refer you to the National Registry exams which include hands on skills testing as well as written...AND most states level renewal requirements will require some re-testing of skill sets.
Finally, in my experience, most cases a P-medic is not a LICENSED practitioner, they are CERTIFIED. Other words, their ability to practice eminates from the LICENSED medical control (IE: Md, DO etc).
Now for RN's.
RN's are LICENSED. Which means that a legislative body (IE Board of Nursing) given authority by the State, issues a right to practice registered nursing. This is different from being CERTIFIED. Certifications are more of your specialty training, not part of your basic licensing requirements.
The Board of Nursing can only authorize a licensed nurse to practice Nursing as defined in your BON documents. There are certain acts/skills that are "delegate" to nursing that are medical-like in nature; however, the focus of the nursing set is still nursing, not medical.
When an RN is working Pre-hospital (MICN, HEMS) or in the field, they "may" be working under medical control, but that is for medical care only. Their nursing care is not regulated or directed by a medical director. for the most part, the RN (after having demonstrated competency in certain medical like skills) is given "policy and procedure" coverage by medical control to perform (IE: Intubation, needle deomp, central access etc)...Just like demonstrating ACLS competency and medical directorship authorzing the "use of a medical device" (IE defibrillator) to perform a medical act (defibrillation) ...legalistically both of which require a physician "prescription" (IE: order) to perform....
I could probably go on comparing and contrasting a lot more, but I think it's understandable so far.
So what then is the REAL difference?
Some would say money.... a medic costs less than a nurse (generally) to keep on staff.
(IE: Costs less to put medics in ambulances than two RNs), but a counterpoint here; there are more HEMS services going to dual RN crews (and a majority of them are dual RN/EMTs)....
Some would say level of care...
Odds are if it's a dedicated Neonatal/Peds Non emergent transfer (HEMS or ground) you're more likely to see RN's involved.
Odds are if it's a scene call/trauma; there is a Medic involved.
Some would say regulatory influences...
Especially for Hospital Owned HEMS, the same JCAHO standards apply in as much as requiring some involvement of "professional nursing" care for the pt (IE: RN)
When it comes down to the patient care I can only make one set of statements on the differences....
I think the Medics are great at the technical skills and things that are procedural driven.
I think the RNs are good a managing the total patient.
-this does NOT mean that I think medics can't/dont give high quality pt care,
-nor does it mean that I think the RNs give BETTER pt care
-It means I think the two work TOGETHER for the best outcomes;
I have taught in both nursing and paramedic programs and have noticed differences as well there...but that's another discussion altogether.
Everyone feel free to reply/respond with YOUR thoughts, I'm interested to hear any counterpoints based on experience and knowledge.
Oh By the way, my background...
9 years first responder/fire department
6 years "street medic"
1 year flight/transport nurse/medic
3 years ICU/CCU/MICU
7 years ER Staff RN (Certified)
8 years ER Nurse practitioner
...and STILL working as Part time medic "on the street" in my spare time
-Be safe everyone!
-Mark

However, the definition of "paramedic" in the United States is changing. The Nationsl Scope of Practice is being instituted over the next few years and a paramedic will no longer be considered a technician. In addition, the NREMT will be changing the testing procedures to reflect these changes. EMT and AEMT are considered technicinas, while a paramedic will be considered a paramedic. In addition, changes will require a paramedic to graduate from an "accredited" program. Hopefully, we will get to the point where all paramedics graduate from two year program as required for entry into practice.

Of course, this will begin to deflate all of the "nursing" arguments against paramedic presence in the hospital. This could force us to take a look at our educational standards and push for changes. Win, win situation, hopefully.

CraigB-RN, MSN, RN · Mar 9, 2009

No chance of improving anything. EMS is just repeating the same mistakes nursing made. No has yet proved that ALS actually makes a difference. we know that there are a few specific areas and problems that benifit from ALS care, but on the whole, who knows.

I was a medic for over 20 years. I've worked in places were Paramedics only had 500 hours of training and in places were they had 2000. Each had it's own good medica and each had it's bad one. I'm all for accredidation and closing the paramedic mills, but how exactly is having a 2 year degree going to change how EMS providers are percieved in a hospital setting. They are still being tought the exact same thing. I'ts just going to take 2-3 years to get there now.