paramedic nursing - page 7

by mcgill01

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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... Read More


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    Quote from mmutk
    I think I read somewhere that in the above case the paramedic is not nationally registered after doing this. Can you clairify this?
    Florida does not use the NR for Paramedic certification. Instead it has its own state exam. An RN can challenge the state Paramedic exam after they are certified EMT-Bs (NREMT). After that they can receive their Florida Paramedic license.

    If you are a NR Paramedic entering FL, you will also have to take the Florida State exam. I expect more states will be going back to their own Paramedic exams if schools do not want to become accredited in the next couple of years.

    http://www.doh.state.fl.us/mqa/emt-p...s.html#Initial
    Health Professional Licensure - Florida licensed physician, dentist, or nurse may apply for certification as a paramedic and subsequently challenge the paramedic exam, provided he/she holds a Florida EMT certificate which is current and in good standing.
    Here is a link from 2008 about what states allow RNs or other healthcare professionals to challenge or do an abbreviated bridge to Paramedic.

    http://www.nasemso.org/NewsAndPublic...rvey051208.pdf

    In Florida, an RN who does HEMS for scene response will usually take the 2 week EMT class and then challenge the Paramedic. However, the RN will continue to work under the RN license since the Paramedic cert is very limiting especially for critical care IFT. If the helicopter or ambulance does not do scene response, no Paramedic cert is required. This is just an old rule on the books and hopefully it will be updated or replaced by a prehospital nursing credential.

    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.
    This I find that very hard to believe since most Paramedics in Florida do not come into contact with most meds or equipment that RNs do inside of a hospital. A Paramedic is not an independent practitioner so they still must function within their protocols or contact med control. Even in counties that are thought to be fairly progressive, like Lee, and call their protocols "guidelines", they are guidelines in that you don't have to follow the protocol to the letter if you feel something is not necessary. However, even these quidelines also want med control contacted if you deviate.
    Last edit by TraumaSurfer on Oct 6, '10
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    I have no option in Tennessee to get my Paramedic quickly. I am an RN and EMT-I. I was going to go to florida to get it until i learned it would not be NR and transfer to Tennessee.
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    You should consider taking that next step for Paramedic soon or you could be back at EMT or AEMT if TN follows along with the NREMT changes per the National EMS Scope of Practice Model. EMT-I will be eliminated. It shouldn't take that many more hours of training to go from EMT-I to P.

    http://www.nremt.org/nremt/downloads...etter_2009.pdf


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    Yeah TN is eleminating EMT-I, i'm going to take the class to AdvEMT but I really want paramedic. The EMT to AdvEMT is just like a refresher course. Unfortunately paramedic is 2 years.
  5. 0
    Quote from mmutk
    Unfortunately paramedic is 2 years.
    2 YEARS?!!

    Who told you that? Look up just about any college in TN and you will find this:

    The paramedic course is divided into 425 hours of didactic and laboratory training and 600 hours of clinical training. The course is 3 semesters in length spread over 11 months.
    11 months is the longest program I found. A two year degree is NOT required in your state nor any other state except Oregon and I don't believe that degree even has to be related to medicine or science.

    A couple of FDs are doing those 1000 hours in a lot less than 11 months.

    Here's a list of your schools. I pulled up about 6 programs and got the same results each time.

    http://health.state.tn.us/ems/traini...lities.htm#col

    Generally the EMT-I will cover at least one semester of that Paramedic training.

    Of course it is too bad that an RN has to sit through the pathetically over simplified A&P and pharmacology. It is much nicer in the states that have the RN to Paramedic transition that can train the RN at a college level rather than at 10th grade. If the provider already has college A&P you don't need to dumb it down and can actually explain why you are doing something rather than just teach how to read protocols.

    I do admire other countries that take a college degreed (4 year) Paramedic or RN and make them Emergency Care Practitioners with post grad work. The Dutch, Spain and U.K. EMS systems are by far more advanced because they use the RN who can have hospital experience and advanced education knowledge to compliment field treatment. This will never happen in the U.S. because EMS is largely Fire Based and still has numerous volunteer agencies.
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    It would be cool if nurses could practice as nurses (with additional specialized training and education) on ambulances in the U.S.- as their full-time job and not just an avocation in addition to hospital work. I'm sure there are a few nurses in states such as PA or IL who practice as PHRNs full-time on ground ambulances, however, they are the exception to the rule. Seriously, nurses practicing as prehospital providers could do a lot of good because the majority of 911 EMS calls are medical- people who have multiple chronic illnesses and conditions who have acute exacerbations. Nurses have a unique knowledge of illness and disease management that could compliment prehospital training; nurses could use this knowledge to go beyond simply treating and transporting to the hospital- to follow up with patients (especially frequent flyers) in the community so that their medical care and use of resources would be better managed (and that factors which keep them coming back to the ER are effectively managed). It would be so cool if there were formal specialty residencies for nurses who want to practice in EMS- so that they’d not only get ICU and ER experience, but could also participate in prehospital care classes and classes specific to the practice of prehospital nursing (including a mentoring program). I'm not sure this will ever be a reality, though, because municipalities and ambulance services (esp. private providers) would much rather utilize paramedics than nurses- simply because medics aren't paid as much as nurses and most nurses wouldn't be willing to take that much of a pay cut.
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    Doing the initial first aid part is not that difficult to learn. The stabilization is more complex and when you have knowledge of many different tools and medications, you are better equipped for the long haul, literally. The Paramedic education is very limited and they may never even get a chance to see the inside of an ICU in some places unless they are a visitor or a patient. But, somehow they easily get the title of "Critical Care Paramedic" after just a few hours in a seminar.

    Flight nurses have already proven they can respond effectively to a trauma at the scene and perform every skill a Paramedic can and more plus utilize their Critical Care experience to stabilize.

    RNs on specialty teams have also proven they can go to just about any location, even other countries, stabilize and transport a critical patient of any age for a long distance transport.

    I doubt if EMS is ready to pay for nurses but RNs would be cheaper than a firefighter and they would be able to offer more services when it comes to medical care or preventitive medicine for the community. And, as long as the FD is in charge of EMS, one will never have to worry about the Paramedic being much more than a few hundred hour certificate.
  8. 0
    Quote from TraumaSurfer
    Doing the initial first aid part is not that difficult to learn. The stabilization is more complex and when you have knowledge of many different tools and medications, you are better equipped for the long haul, literally. The Paramedic education is very limited and they may never even get a chance to see the inside of an ICU in some places unless they are a visitor or a patient. But, somehow they easily get the title of "Critical Care Paramedic" after just a few hours in a seminar.
    Yes, I agree that many prehospital providers don't have the broad knowledge of the diagnostic and treatment process that nurses have, but the majority of paramedics are required to do rotations not only the in the ER, but also in the OR (intubating under the auspices of anesthesia providers) and ICUs. I'm sure training and rotation requirements vary, but that's what I've seen in the states I've lived in (and in the state I am certified as an EMT in). In addition, the CCEMTP (P stands for provider, btw) is definitely more than a few hours long- it's at least a few to several weeks, depending on how sponsoring organization schedules it. Check here for more info: CCEMTP at UMBC


    Quote from TraumaSurfer
    Flight nurses have already proven they can respond effectively to a trauma at the scene and perform every skill a Paramedic can and more plus utilize their Critical Care experience to stabilize.

    RNs on specialty teams have also proven they can go to just about any location, even other countries, stabilize and transport a critical patient of any age for a long distance transport.

    I doubt if EMS is ready to pay for nurses but RNs would be cheaper than a firefighter and they would be able to offer more services when it comes to medical care or preventitive medicine for the community. And, as long as the FD is in charge of EMS, one will never have to worry about the Paramedic being much more than a few hundred hour certificate.
    Again, I don't know what the training requirements are where you live, but many paramedic programs actually require more than a few hundred hours to pass the course- more in the order of >800-1,000 hours (classroom+clinical)- which takes 1-2 years to complete. Still, this course hour requirement pales in comparison with what nurses are required to go through in terms of classroom and clinical time. For example, paramedic textbooks I've seen only have 1-2 chapters dedicated to pharmacology. My BSN program required a 3 credit, semester-long course on the subject. Moreover, many certificate paramedic programs (especially programs that aren't attached to community colleges) don't require the science prerequisites that nursing programs require.

    I don't think nurses should replace paramedics in the EMS system (I'm not sure if you were suggesting that?). I do think that having nurses cross-train into a prehospital role (with 911 ALS services) would definitely benefit the patient in terms of what nurses could bring to the table. I think there are areas that paramedics are not as knowledgeable or adept in (ie- chronic disease management, management of exacerbations, critical care, disease prevention); nurses could take the lead in these situations. Likewise, paramedics are very adept in scene management, initial trauma care, intubation and other areas that are specific to the prehospital environment- areas in which nurses don't get very much (if any) education about in nursing school. From talking to flight nurses, nurse/medic flight teams already compliment each others strengths in the flight arena. We could strengthen prehospital care on the ground if nurses were more widely used in EMS systems.
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    And by cross-training I mean nurses going to paramedic school post nursing school graduation (or most of it) at least the areas that nurses didn't cover in nursing school or their critical care experience. The exception being individual nurses who have extensive experience in the flight/transport arena- in which case they could challenge the exam (it wouldn't make sense to put them through medic school). I think we have to remember that as nurses, we're so used to all the support and resources that hospitals have (RTs, MDs, CNAs, our colleagues); out there on a scene, it's just ourselves, our partners and the patient. Although much of our skill set is similar, the environment and the challenges are quite different.
  10. 0
    Quote from edogs334
    And by cross-training I mean nurses going to paramedic school post nursing school graduation (or most of it) at least the areas that nurses didn't cover in nursing school or their critical care experience. The exception being individual nurses who have extensive experience in the flight/transport arena- in which case they could challenge the exam (it wouldn't make sense to put them through medic school).
    I do not believe a nurse should have to attend a program that is taught at a lesser level of education. The Paramedic is taught with a textbook written barely at the 10th grade level and assumes the student has no other education except for a GED and a 110 hour EMT card. Nor does it assume there to be any type of medical experience. Even without experience, an RN will have over 1000 hours of clinical time and at least 2 to 4 years of college. The Paramedic's total program may be only 1000 hours with the EMT class included as what is done in several FDs.

    but the majority of paramedics are required to do rotations not only the in the ER, but also in the OR (intubating under the auspices of anesthesia providers) and ICUs.
    Not necessarily true. Many hospitals no longer allow Paramedics to do rotations in their ER, OR and definitely not in the peds or neo ICU and L&D after some hideous incidents. The doctors at my hospital were appalled that the students had absolutely no preparation on how to intubate and thought they were there just to see if they could get the plastic tube through the hole and that was the whole process. Needless to say we no long allow Paramedic students to intubate or rotate anywhere but in the ED. We do allow RT students and Flight RNs to get their intubations. All IVs attempted by a Paramedic student will be monitored by a staff RN.

    There is also no guarantee as to how many patient contacts will be made during the clinicals. There can be much time wasted do very little at the ambulance stations and even in the EDs. There are usually no assignment preceptors or instructors following the students so it is an honor system. Some may get someone to sign their paper who is too busy to notice what it is and then skip out for the rest of the day. Others may do 24 hour shifts on an ALS engine that may only do one call which gets turned over to an ambulance service to transport. However, one state, California, does require 40 ALS patient contacts but that could just be starting an IV for the heck of it or placing 3 EKG patches on someone and hitting the start button. Other states just list "hours" on an ambulance or in the ED. There is also not always a guarantee you'll get to practice IVs and intubations on humans. The Paramedic checkoffs may all be done on manikins. There are working Paramedics who still have not done one endotrachel intubation and may never since several departments not use King or CombiTubes. Most Flight and Specialty team RNs will get at least 10 live intubations and probably more like 25 before they are checked off by their medical director. Some Paramedics may never meet their medical director.

    A nurse already has a solid education foundation. Good flight and specialty transport teams realize this and build upon their existing education and experience to get the RNs ready to handle critical patients with just one other partner.

    I think we have to remember that as nurses, we're so used to all the support and resources that hospitals have (RTs, MDs, CNAs, our colleagues);
    Paramedics aren't much different and often they have more help than the hospital RN. For almost any given call there will be at least 2 and probably 3 - 6 Paramedics and a few EMTs on scene. Almost all FFs are required to have at least EMT and in many parts of the country they are required to have the Paramedic before applying to a FD or get it within 1 year of hire which may be right after the Fire Academy. It usually only takes about 3 - 6 months in some areas. So you also don't actually need to have an interest in medicine or patient care to get a Paramedic cert. Getting stuck in one of these classes when you are an experienced and educated patient care provider already can be a real bummer. For this reason I believe degreed and experienced health care professionals should have their own advanced level training such as what is done for some Flight and Specialty programs.

    Again, I don't know what the training requirements are where you live, but many paramedic programs actually require more than a few hundred hours to pass the course- more in the order of >800-1,000 hours (classroom+clinical)- which takes 1-2 years to complete.
    As I stated somewhere, Paramedic programs run anywhere from 600 - 1200 hours. RN programs and any other health care professional will have at least 1000 hours of just clinicals. If it takes a Paramedic 2 years to finish 800 hours they must be taking the very slow route which some volunteer organizations offer to take in account the student may only be able to "donate" one evening a week for the class. They may also take up to a year to finish a 110 hour EMT class by just "donating" 2 hours per week to class time.

    CCEMTP (P stands for provider, btw) is definitely more than a few hours long- it's at least a few to several weeks,
    The UMBC program is about 2 weeks (80 hours) and it stands for Critical Care Emergency Transport Program. It is a very, very general overview of an overview of critical care medicine. It is open to several different healthcare providers without any prior experience but I would not advise it for critical care RNs. I also would NEVER advise any Paramedic who takes this course to consider themselves Critical Care ready as most have never had any hands on experience with any of the concepts discussed in the course.

    In other countries, the Critical Care Paramedic requires another year's worth of training AND actual ICU experience after they have completed a 3 or 4 year degree.

    For Flight and Specialty programs that handle mostly critical care patients, the RN/RN or RN/RRT combo is much better prepared than the RN/Paramedic. They have the ICU experience and knowledge to compliment the skills.

    It is much easier to train skills and have them adapt to different environments if the person has a solid education background and clinical experience.

    I also don't believe RNs would be necessary on all EMS calls but they would be better in the fly cars to assist with hanging drips on major calls, RSI, determining appropriate destination (like for psych or certain medical) and community health calls.
    Last edit by TraumaSurfer on Oct 11, '10


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