PHRN transfer to EMT-P in other states? - page 2

by RegMurse12 4,693 Views | 19 Comments

Hi everyone, I'm a PICU nurse and volunteer EMT-B in PA and I'm in the process of getting my Prehospital RN here. I'm currently looking at other PICU/NICU/Pedi ED jobs in PA and TX. If I end up moving to Texas, do you know if... Read More


  1. 1
    Quote from DE-ED-RN
    Dear colleague,
    With no disrespect intended, it is obvious that you are unaware of the curriculum of a paramedic course, certificate or associates. i am both a NREMT-P and BSN RN CEN. I can tell you that most medic programs are longer than 6 months, and the ones that are 6 months consist of 5 day per week 8 to 10 days of class room didactic and then 600-1000 hrs of clinical time. The "few extra skills" you write about include intubation, chest decompression, EKG recognition, and in some states central line placement in the field along with other immobilization, extrication, and transportation techniques.
    As someone who completed BOTH programs I can assure you that paramedic school was much more challenging and when completed you are tasked with managing pt care w/o the benefit of yelling out side of the room " I need help in here!" Cause there is no one else to call. With all of this said they are different scopes of practice with different missions and goals for pt care, but both have the best interest of the pt in mind. There are many pre hospital providers with big egos and attitudes that don't understand other practices so in the end don't fall into the same trap and take the position that they are less educated or that you could just " jump" right into a pre hospital provider role. I ASSURE YOU, there is ALOT more to the job than you are recognizing.

    The information is very easy to look up on each state's website.
    Most states in the US require only 600 - 1000 hours total. No FD, which now many areas for Fire based EMS, is going to put their FFs through a 2 year program or the number of hours you suggests.


    Texas is only 600 hours total.
    California is just over 1000 hours total.
    The Carolinas and GA are only 800 - 900 hours total.
    The other states also fall within that range.

    The exceptions are Kansas but then in that state RNs are given special provisions when working or volunteering with an ambulance.

    Oregon always gets mentioned as having a 2 year degree requirement but if you actually read the website, you will find there are many exception and a certified Paramedic can take up to 5 years while working to complete it and there are also options for extensions.

    You also have to consider that the EMT text book is written at the 8th grade level and the Paramedic text is at the 10th grade level. This is common knowledge. The Paramedic program is often taught at a tech school or in the Votech section of a college.

    You also have to consider that the Paramedic programs usually have only the requirement of an EMT cert with a HS or GED diploma. Many of the "hours" you might have in a Paramedic program is spent teaching an overview of A&P. There is no reason an RN should go for an extra 6 - 9 months retaking basic A&P and Pharmacology which is not even considered a college level standard course for other health care professions. Overviews are vastly different in content and hours required for outside learning along with required labs.

    Another point is that many of the clinical situations are actual hours and not necessarily patient contanct. You might spend 400 of a 500 hour rotation sleeping in an ambulance or FD station. The only hours awake might be if you are in an ER rotation. A few states like California might require 40 ALS patient contact but that might just mean sticking a cardiac monitor on and calling it ALS just to get the number for the student. Again, each state is different and each school may be free to interpret training in a different way.

    Another point to consider is that intubations are suggested but not always required in a Paramedic program. Due to the degree of difficulty of finding sites to allow Paramedic students to intubate, many are coming out of programs with just successful manikin intubations. The same for IVs. It is a hit or miss so to speak. Therefore, the Paramedic student is at the same level for actually performing the skills as the RN. But, the RN may have witnessed dozens or even hundreds of intubations before attemption on. The new Paramedic will not have that advantage. The RN who has worked in the ED and ICU will also have the advantage of already have given many,many meds which are not even in a Paramedic's protocols or allowed by the state. Not many states allow for meds used for RSI. But, in states like PA which uses the PHRN, the RN can give the meds not allowed by Paramedics. The RN may also have performed or seen many of the skills which are reserved only for Flight Paramedics (maybe) and some like NG/OG placement will be common place but often not found in many Paramedic protocols.

    And yes, I have seen and worked both sides for a long time. That is why I am an advocate for higher education standards for Paramedics across the board rather than just one exceptional FD or ambulance company. I prefer not to bury my head in the sand and ignor existing problems in EMS which are well published if you care to do a simple search. They have the topic in the national level of politics for awhile since reimbursement has been an issue. The sooner you realize not all is rosy in EMS the sooner you can get on board to support Paramedics.
    SummitRN likes this.
  2. 1
    Quote from DE-ED-RN
    Dear colleague,
    some states central line placement in the field
    I do have to ask one thing and I don't mean to distract from the original question, but, why in the year 2013 would any Paramedic do a central line in the field when IOs are so readily available or even doing an EJ? Also, this is where an RN would be of value to give an insight on risks vs benefit for central lines since that has been a hot issue in hospitals now for over 10 years. Actually, it has been longer than that since PA catheters formerly known as Swan Ganz catheters decreased in use about 15 years ago. Any EMS agency still bragging about inserting central lines in the field is about 20 years behind. That was a thing of the 70s and 80s. Even prehospital intubation can now be in despute about risks vs benefits and increased survival by not intubating in the field. Skills should be about best practice for patient outcome and not bragging rights to stroke egos.

    The RN would bring to the table vast knowledge of infection control and have an understanding about what hospitals and what is expected by those who monitor them for accreditation and reimbursement.

    This differs from the EMS beliefs that hospitals pull lines and tubes just so they can charge for another or just to pick on Paramedics.


    I think the PHRN would raise the standard in EMS especially with new concepts and evidence based medicine as well as education. I really hope more states start to realize the value.
    SummitRN likes this.
  3. 2
    In Wisconsin you would be allowed to practice at the level of the EMT on the ambulance with you. I don't recall ANY provisions in the EMS laws for PHRN.

    ***rant about EMS education follows***

    As someone who is leaving EMS right now and coming into Nursing, I have to agree that Paramedic education needs an overhaul and needs to stop being dumbed down to the volunteer level for the people who don't want to get AT LEAST a 2-year degree to be a Paramedic. Oh yea, and Paramedics should leave EMTs (and AEMTs) in the dust when it comes to education; worry about your own job.

    Associates Degree minimum
    REAL A&P, Micro, Pharm

    Me?
    A.A.S. Paramedic Technician (SO much more useful than relying on my Paramedic course's half made-up explanations of the body)
    TraumaSurfer and SummitRN like this.
  4. 0
    You will have to go through some form of paramedic education program. The one at Brookhaven College in Dallas is 12 credit hours and you must have at least 2 years of experience in your nursing field prior to enrolling. That site was last updated in 2010 so I wonder if they even offer it anymore but it is worth checking if you're interested. According to that site, only three programs even exist in the state.

    You would be better off contacting your own state and finding out requirements for paramedic bridge programs. That way, if your state is a NR state, you will just be able to transfer your NR cert to a Texas medic license (provided you have either a Associate's in EMS or a BS in any field) or certification as a medic in Texas through reciprocity with the NR.
  5. 0
    Quote from TraumaSurfer
    I hope nobody takes any information on that forum seriously. Most of those commenting on education have only a 3 - 6 month certificate as a Paramedic and no college. Not even an Associates. They regularly bash anyone with education and are very outspoken against RNs, NPs and PAs. Strange how someone with a 6 month cert from a medic mill can criticize a nurse with a Masters or Doctorate. Unless you have actually taken college level A&P and Pharmacology courses, you will probably not know how little you do know. It is also no surprise that most instructors for EMTs and Paramedics do not hold an Associates degree. There will always be a bias against those with education.

    For a nurse to transition to a certificate level course it should not be that difficult. A few new skills and additional algorithms are not that big of a deal if you have a strong foundation. Experience, past, present and future should be considered. This should be no different than an RN training another area of the hospital be it HBO, CCU, ECMO, ER, PICU, NICU, Onocology etc. We could also include those who intubate in the delivery room or do US. There is a transition period with educaiton and training but there is also respect for the education and experience as an RN. You also don't have to change your profession and can still be an RN.

    In a perfect world, no RN should ever have to change their profession or totally give up their identity as an RN to work as a "Paramedic". Cardiovascular RNs don't give up their identity to work in a position where there are also CV Technologists.

    Each state should have a prehospital credential and path for RNs who have the education and experience. No RN who has the experience and knowledge to make a flight team should ever have to sit through 8th grade A&P again. Other specialty teams like Peds, Neo and Organ Procurement teach advanced skills (including performing Bronchoscopies) to RNs and don't require the RNs to get another license unless it is a cert pertaining to nursing. It just makes it easier to answer to one professional board and not worrying if you do something with a Paramedic license that could be out of scope because you always did it as an RN. This is especially true with meds.

    Someday EMS will drop its egos and see other professions as team members in health care rather then these ******* contests. Those in EMS who say they can do much more than a BSN RN and it only takes them 3 months to master everything need to go away with the lights and siren whackers.

    Back to the topic, it seems there are some colleges which take the RNs education and experience into account and will allow you to take just what you need. This should not be a big deal since Texas only requires 600 hours including classroom and field clinicals to be a Paramedic.
    And while you make some good points, your post and your attitude make you part of the problem and not the solution. While it is true that skills are key to being successful as a paramedic, assessment goes hand in hand with that so that we can determine what to do and when to do it. I don't have the benefit of yelling for someone else when I'm 30 miles from my destination hospital and things go from bad to worse - it's all me. If you think it only takes three months to master your skills then you are purely speculating and are not at all familiar with what happens in real life.

    No one is asking you to give up your profession to become something else. Having education as a paramedic will only serve to supplement the education you already have and will provide a depth of focus in areas that your nursing skills and experience might not have.

    And in Texas, every transport program that I have knowledge of requires RNs to become NREMT Ps regardless of how much education they have as an RN.

    One day we'll all be above the whole "I can do this and you can't, nanny nanny boo boo" stuff that permeates forums like this and others. Just because you're critical of those who do it doesn't mean you aren't guilty of doing the exact same thing, as evidence by your post, which, to me, is quite hostile toward paramedics. If you aren't a paramedic, at least find out what it involves before you go deriding those who are. Many paramedic programs across the country now are college or university based (like mine) and the minimum requirement is rapidly changing to the BS degree. My degree program alone had me in externship or clinicals for 1000 hours prior to graduation, and that was 20 years ago. To use your own quote, someday nursing will drop it's ego and realize that we are all on the same team, with the same goal...just a slightly different focus.
  6. 1
    Quote from vamedic4
    And in Texas, every transport program that I have knowledge of requires RNs to become NREMT Ps regardless of how much education they have as an RN.
    That is incorrect and does not take into account for all of the transport teams in TX. Specialty transport teams do not require an RN to be a Paramedic. Being a Paramedic would have very little to do with the care of a neonate, pediatric or ECMO patient or most other critical care transport patients.

    CCT RNs are also not always required to be Paramedics. They do need extensively critical care experience. In California, many of the CCT-RNs are MICNs.

    You can also look at the Flight nurse job boards and see not every RN job requires them to be a Paramedic.

    Quote from vamedic4
    One day we'll all be above the whole "I can do this and you can't, nanny nanny boo boo" stuff that permeates forums like this and others. Just because you're critical of those who do it doesn't mean you aren't guilty of doing the exact same thing, as evidence by your post, which, to me, is quite hostile toward paramedics. If you aren't a paramedic, at least find out what it involves before you go deriding those who are. Many paramedic programs across the country now are college or university based (like mine) and the minimum requirement is rapidly changing to the BS degree. My degree program alone had me in externship or clinicals for 1000 hours prior to graduation, and that was 20 years ago. To use your own quote, someday nursing will drop it's ego and realize that we are all on the same team, with the same goal...just a slightly different focus.
    Yes there are several Paramedic programs at colleges but most are just certificate based with a degree option. You still can not disagree that only about 20% of the certified Paramedics in this country only have a degree, including an Associates. And, most are degrees in another profession such as nursing rather than EMS. Even at the instructor level for Paramedic, degrees are not required. You can also easliy look up the state requirements for every state and find that 800 - 1200 hours total is the norm for Paramedic programsl. Look up TX and see it is only 634 hours and at one time TEEX boasted its ability to get someone through its program in 3 months. Across the US there are many votechs, private and public, which can get students through in 6 months average. But, don't take my word for this. You can find a listing of each state's Paramedic programs and see which are votechs and which are college. Again, if you look at the college programs you wil find they offer a certificate with the degree as an option.

    If Virginia is your state, here is the requirements for EMT, EMT-I and Paramedic. It says nothing about a degree being mandatory nor does the EMT-I to Paramedic require 1000 hours.
    EMS Training Programs Summary

    Here is a summary of VA:
    EMT-E
    102 hours of instruction plus a minimum of 48 hours devoted to clinical rotations in the Emergency Department and in the field

    EMT-I
    minimum of 272 hours of instruction with a minimum of 68 hours devoted to extensive clinical rotations in specialty units

    Paramedic
    minimum of 781 hours of instruction. Of these hours, a minimum of 136 hours is devoted to extensive clinical rotations in specialty critical care units.

    For RN to Paramedic bridge:
    minimum of 120 hours of didactic instruction and an additional 136 hours minimum devoted to extensive clinical rotations acquiring specific competencies.


    I could agree with you that 20 - 30 years ago our programs were a little longer but we also did a lot of things which have since been deemed to be unnecessary in the field such as subclavian central lines, chest tube insertion and pericardiocentesis.

    As far as being hostile towards Paramedics, I am only to those who believe the Paramedic education is perfect in the US as it is. Having only a handful of "educated" Paramedics is not enough. Get past your own ego and do a little research on the education of US Paramedic. Even the new standards are pathetic at best and very little has changed when it comes to increasing educational standards. If you are truly as educated as you say, I am surprised you have not heard this before. Aren't you involved in any EMS organizations to support improved EMS standards for education and safety?
    SummitRN likes this.
  7. 1
    My ego is well in check. I would simply point out that the National Standards for Paramedic Education are minimum standards set by the DOT, and that most college based programs and many certificate programs, exceed those standards. I know you're only advocating for more education and I don't disagree - especially when one speaks of working in the hospital. You are absolutely correct that more education is warranted, because the environment of care outside of the hospital is completely different than the one you and I see on a daily basis inside the hospital.
    As for my misinformation, you are correct, specialty care teams do not require a nurse to become a paramedic. And you addressed part of the problems with the education topic in your post above - much of EMS anymore is fire department based. If there were any holdup to further educating paramedics - that is the main culprit. I have no idea why but many fire departments across the country hire fire fighters and put them through the minimum training to make them paramedics instead of doing it the other way around. This does not allow for the kind of education you receive when you attend a college or university based nursing or medic program.
    My apologies to you, TraumaSurfer, if I touched a nerve or offended you. It was not my intention.

    To the OP, my only suggestion to you remains: Find an RN to paramedic program near you and take it. That way, if you wanted to go anywhere, you could, provided you have your NREMT P. There are a few states that don't, but most states offer reciprocity with the National Registry.
    TraumaSurfer likes this.
  8. 1
    Quote from vamedic4
    My ego is well in check. I would simply point out that the National Standards for Paramedic Education are minimum standards set by the DOT, and that most college based programs and many certificate programs, exceed those standards.
    *****************

    As for my misinformation, you are correct, specialty care teams do not require a nurse to become a paramedic. And you addressed part of the problems with the education topic in your post above - much of EMS anymore is fire department based. If there were any holdup to further educating paramedics - that is the main culprit. I have no idea why but many fire departments across the country hire fire fighters and put them through the minimum training to make them paramedics instead of doing it the other way around.

    Good discussion vamedic4.


    I did not mean to come across as FDs being the root cause. There are several private ambulance companies which also put their employees through the medic mills and some have their own mills. AMR has one of the nation's largest private votech (NCTI) to mass produce their Paramedics. They only require their own abbreviated week long A&P course.

    The FD firefighters also take the same Paramedic course as many other city and county EMS employees. Many FDs will not hire someone unless they already have the Paramedic cert. There is also very little demand for EMT level since the market is flooded with them due to the short and easy certifying requirements. Many will be in a rush to get the Paramedic cert just to get hired by someone. Everytime there is a new EMS/Fire TV show you see more "Zero to Hero" ads and some are recruitment posters for private ambulances. FDs rarely have to put FFs through the training themselves unless they have recently taken over EMS. But the same is true for private ambulances which want to expand quickly into an area or who want to do CCT and mass produce CCEMT-Ps quickly just for the higher reimbursement rate.

    But, the real culprit is the minimum education requirements to be a Paramedic instructor. Most have less education or the same as those they have been instructing. There are very few role models who have even an Associates degree. The stats still remain that only 20% have any type of college degree.

    For RNs, once they have acheived their degree (ADN - 3 years or BSN - 4 years), their education and training for specialties are often longer than the entire Paramedic program starting from scratch. Those who want to work in critical care can't just take a 2 week course and call themselves a CCRN. But, NCTI and a few other votechs will include the CCEMT-P/CCEMTP in with their programs for the new grads who have no experience just to make their school more attractive in a competitive market. Colleges will also offer their certificate programs in votech still or call them academies in order to stay competitive. The A&P in the Paramedic track even in the college programs are often just an overview. You can also request the data on those graduating from a cert program at a college vs their AS degree and you will find it very disheartening.

    I also believe Paramedic programs could learn a lot of valuable lessons from nursing and many other health care professions, some of which are alot younger than EMS but have achieved professional status through education.

    I definitely believe if more RNs were to get involved in EMS, educational stanards for the Paramedic might start to rise when it is seen what a contribution it can be along with the skills.
    SummitRN likes this.
  9. 0
    I find CCEMT-P to be a misnomer in how it is written. It is as if the bearer wants people to think of their EMT-P post-nominal title, Emergency Medical Technician - Paramedic, and read it as Critical Care Emergency Medical Technician - Paramedic. However, it is a 100 hour class also open to RNs and RTs that actually stands for Critical Care Emergency Medical TRANSPORT PROGRAM.
  10. 1
    Quote from SummitRN
    I find CCEMT-P to be a misnomer in how it is written. It is as if the bearer wants people to think of their EMT-P post-nominal title, Emergency Medical Technician - Paramedic, and read it as Critical Care Emergency Medical Technician - Paramedic. However, it is a 100 hour class also open to RNs and RTs that actually stands for Critical Care Emergency Medical TRANSPORT PROGRAM.
    The UMBC might be responsible for that with the patches they sell.

    CCEMTP at UMBC

    It is misleading if the state does not have a certification or title for CCEMT-P. It leads people to believe this title is much more than it actually is. Any company which wants to bill for the higher rate could offer as little as a 2 hour CCT class and give their Paramedics that title. Some rely just on the material taught in the UMBC class which can vary according to the location and quality of instructors.

    I do know the BON for a couple of states are checking into the use of the CCT-RN title. RN itself is the official title. Any certs outside of that can be listed separately and should not be mistaken for the actual licensed title. MICN and PHRN are recognized in some states as a title along with RN. Certification titles like CEN, CCRN and CFRN are given out by agencies other than the state and should be differientiated from. Paramedics will often forget the difference between a weekend cert and what the state sees as their legal title.
    SummitRN likes this.


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