paramedic nursing

Specialties Flight

Published

Hi, I'm a 2nd year nursing student and have an interest in paramedic nursing. Is there anybody involved in this area of nursing and would like to share some related information?

For example what would be the expected requirements to enter this field?

Thanks,

Lynda

...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.

Simple, the "typical paramedic is an uneducated UAP" argument will no longer be valid. In fact, the PM would have the same degree for entry into practice as an RN. Nurses can no longer use the education argument to keep PM's out of the hospital.

I disagree, the same things are not being taught. You can go through a "shake and bake" school, rush through the required 1,000 total hours, and pop out a medic. These providers have little exposure to A&P (other than the chapter integrated into their medic classes), little exposure to English and compesition skills, little exposure to biological studies, little exposure to math, and little exposure to any humanities or social science courses such as psychology. While you can argue these courses are trivial, they in fact provide the student with a solid foundation of knowledge that can be used to build their house of paramedic studies upon.

You could most likely condense the "core" nursing courses of an AD program into a few months as well without all of the pre-requisite and co-requisite material; however, you stand the good chance of having an impotent provider who has no real understanding of their profession because they lack the foundational knowledge that allows them to understand and utilize the knowledge of their profession.

As far as the ALS argument, this depends on your definition of ALS does it not? You see, when somebody gives lifesaving IV dextrose to a diabetic with a critically low blood sugar, I call that ALS. However, many people call that BLS or ILS. The later may simply be a basic with a few hours of IV training who is told to push an amp of D50 if the sugar is below "x." Providing interventions without adequate education is potentially harmful IMHO. Even educated" providers can screw this up. Just look at the six million dollar arm judgment for that proof. Or perhaps we cold go to the pain argument? Sure, a limited amount of data supports improved outcomes between BLS and ALS in trauma patients. However, if your femur is sticking out of your foot, you would most likely want somebody to manage your pain? Not going to happen at the BLS level. Of course the ultimate outcome may be the same; however, at that moment, how important is having an ALS provider capable of safely and effectively managing your pain? Again, it comes dow to your definition of a "positive" outcome.

Specializes in Critical Care, Emergency, Education, Informatics.

First I want to make it very clear that I am very pro education, and that education is never wasted. What I was trying to point out is that just makeing the associate degree the solution to all EMS problems is way to simplistic, and it's not going to solve any problems. The problem is way to complex for that. There are many factors that have to be addresses and untill they are, you could have a PhD and still not looked at as anything but an ambulance driver. There are many factors, political, econonim, ego's and perception that have to be addresed first.

I'll get the biggest hurdle out of the way first, Ego's. You know as well as I do that the nursing community isn't going to care, what the degree is, if it's not nursing, then it's not the same and can't do the job as well. Now I know for a fact that a good paramedic, can do the job of an RN in a busy setting. I work in an ER that see's 122k pt's a year, some night, I"m to busy to be anything but a technician.

The second biggest hurdle is economic. How are you going to change the reimbursment patterns? Again I have to go back to nursing as an example. No matter how hard nursing tried to change the perception of the hand maiden to the MD, as long as everything we do is included in the basic room rate, the perception is never going to change. Untill reimbursment changes, it will be hard to break out of the ambulance driver pidgenhole.

State practice acts have to change. Now this prob had the potential to change the fastest, sur to the way that some of the state EMS acts are worded. But there are way to many fingers in the pot, and if you've ever sat in on a board of ems meeting, thre are some docs in postitions of power that don't think the average paramedic can fing the toilet papper inteh AM without a step by step protocol. Then you have the hospital board. Most people don't know, that it isnt'e the EMS board that says paramedics can't work in hospital environments, it's the hospital licensing boards in a number of cases.

Fire deparments. As long as Paramedics are attacheed to fire departments, it's going to be to easy to remember the Jonny and Roy days of Emergency. Being part of the Fire dept also froces EMS into an strange situation, were there is to many Paramedics. Having one in every station, spreads the calles out. Politically gret for patients, but not so good for proffesional development. I know medics that have never dropped a tube in a crisis situation. Not to spend to much time on the old days, because they had their problems, but back when there was only a few medic untis in every city, we were over worked and dangerous in that sense, but I'd drop a tube or two every day. In 1987, i actualy dropped exactly 365 tubes. that averaged 1 a day. That's how you get good at something. This falls into the same catagory as limiting intern and resident hours though, there is good and bad to both sides of the argument. Telling a community that is used to having a paramedic no more than a few blocks away that they dont' need them there. Not a political move many politicians are going to make. (Do you know of any stats on how many paramedics work for companies that actually do 911 calls, vs transport? I haven't had time to look, and don't know. If so I'ld like to see them)

My statement about ALS wasn't meant to be so generalized. Yes there is some invasive interventions that do save lives, but a two year education vs a certification isn't going to make that much difference. Just look at that errors and maltpractive against CRNA's. Look at how many medicaion errors have been made by 4 year nurses.

I have to end this with Ego's again. As long as statements made out of frustration are made, like "they will have to take us seriously" it's always going to look like ego. It's not about patient care, it's about me. Look at the fights going in the medical and nursing community now about the Doctorate of Nursing practice. After the fist 5 min of discusion, is stops being about providing the best care possible to a patient population, and becomes a battle of egos.

EMS has come a long way over the years. I can rember the first time I heard a medical command call in Sacramento, with a nurse telling the EMT-I to give one amp of the blue box, I just about died. There are places that are have fantastic protocols now that let EMS workers do what they do best. But it is always someone else directing what they are doing.

Shotting for the moon is important! If you set you sights to low, you might just get what your aiming at, even if it just mediocraty. But somewhere, people have to be reilistic. What will bring EMS out of the dark ages, not a piece of paper from you local community college. It will be politically active community, a research and evidence based community, and a community that has solidarity.

Personally, I'd like to see the Paramedic become a nurse position, with specialized training and certification. Might add to the oportunities for prehospital providers, when they become to old or fat to fit into what passes for aircraft around here. But that is another topic and I forgot to put on my fireproof underwear this AM.

Accredidation is the first step and it's an important one, but its only the first step.

Ok now that I've completly hijacked this topic.

Interesting post. You correctly identified one area - reimbursement. However, in my opinion, the problem isn't reimbursement but what we are reimbursing for. In EMS you are reimbursed if you transport the patient. You are not reimbursed if you don't. Therefore the impetus is to transport.

In the UK they are experimenting with another model which for a lack of better terms they are calling advanced paramedic practitioner. Its outlined here:

http://www.jephc.com/uploads/Woollard990156.pdf

The key to this is the ability to triage and treat the patient in the field. They are authorized to treat minor issues such as lacerations in the field. They also have the ability to triage and decide that the patient does not need to go to the ER (A&E there) but instead can follow up with their PCP in the morning. If you consider how much this would unburden the US system its rather amazing. The issue here is that since its a national health system there is no reimbursement pressure to transport. Instead there is pressure not to transfer since it saves the system money.

David Carpenter, PA-C

Specializes in Critical Care, Emergency, Education, Informatics.

Again David takes my posts and makes them clearer. And I was so hoping that Grad school would help he state my thoughts clearer. :)

Specializes in ED, Flight.

David, in the Maritimes in Canada (don't recall where) a 'paramedic practitioner' like you describe has successfully been in place for a while. They practice on islands where transport to hospital for routine calls can be delayed and expensive.

Specializes in Critical Care, Emergency, Education, Informatics.

There are many models to choose from in developing programs like that. Just about every military organization in the world has a program to teach their medics how to handle those kind of situations. The hard part is deciding were it's appropirate. One of the white papers from a few years back, talked about doing that in inner cities, to help with ER over crowding. Like David pointed out, we have to change our reimbursment structure. I fear that making that kind of change would just move the problem from one jursitiction to another.

There has been a lot in the news about the need for health care reform, I hope that the powers that be, (The Obama administration) remember to include out of hosptial/unscheduled care in the discusion andthe reform.

Specializes in Pediatric Intensive Care, Long Term care.

I have nothing to add to this blog because I am actually just starting nursing school, however, I must say that I greatly enjoyed reading this. It has taught me about the differences between a medic and a nurse and the need for reform in this field. My goal is to becaome a critical care nurse but I am also interested in becoming a medic as well. Thanks guys:yeah:

Hi,

I'm just curious, does anybody know what it takes to be a paramedic in IIlinois? I'm also an RN, just want to know what will I need to be one. Thanks

Specializes in Med/Surg ICU.

Gavins Dad,

If you want to be a Paramedic in Illinois then I believe you must take a Paramedic class and testing. In Illinois there is what is call a Prehospital RN (PHRN) and they typically function at the level of a paramedic on ambulances. Here is what the state says about them http://www.ilga.gov/commission/jcar/admincode/077/077005150E07300R.html

If you would like to PM me and give me your location I may have some contacts for you.

J

I have been a nurse for almost 3 years and I just started working as an EMT last year but I am having a hard time trying to land a job in the E.R I just dont understand it

We'd probably all agree that the AVERAGE RN is not qualified to work as an EMS professional. But most of us who are looking into this are NOT average. We've grown up in ALS services as EMT's, become RN's and spent a lot of time in critical care / ER while still continuing to work and volunteer as EMT's. Now, we're wanting to extend our experience and skill to being ALS providers. In my regional EMS system, they will let me practice above the level of a Paramedic as a PHRN. The main difference being the ability to take critical care drugs on transfers that are above paramedic level. So, my medical director obviously does not have a problem with experienced RN's providing ALS care and above, so neither should you.

Now for the purposes of "having the certification" I would like to get my NREMT, since it looks good on a resume. I already can perform every paramedic skill. I would simply like the letters behind my name to make that more marketable. So, from the previous posts, I see that California, North Carolina, Florida, and Pennsylvania all have some sort of way for an RN to challenge the state EMT-P license exam? I've also looked into the Creighton program.

Did I miss any states?

Specializes in Emergency Dept, ICU.
here in florida an rn can challenge the state paramedic exam......i believe they have to have their emt basic. a paramedic (at my nursing school) can opt to clep one semester of the rn program.....of which i chose not to even try.

as far as skills go, paramedics are only limited to what medical control allows. where i work, the sky is the limit as to what you want to do, you just need the courage to try or ask. we have it much more liberal than rn's in the hospital or er's, at least in my area.

i have worked in 2 other states, and they each were different with some rules, but neither allowed any clep for the rn to paramedic..., but they both did vice versa.

after working as a paramedic 13 years i cannot imagine why a nurse would want to do my job.....maybe some can't figure out why i want to be a nurse either.

I think I read somewhere that in the above case the paramedic is not nationally registered after doing this. Can you clairify this?

+ Add a Comment