RN to Paramedic Bridge Course

hey hherrn,
I wish i had an irrational rant, but sadly...no. I hope you haven't misunderstood my position about bridge courses. For certain people they are fine and as you say, you would certainly be above an entry-level paramedic with your experience.
Just to play devils advocate with the hypothetical scenario: it's not that I was comparing you to an entry level paramedic, I was referring to experience which I think I had mentioned in an earlier post. If not, then I'll explain it now. Everyone needs the "time-in-grade" to see and do as many things as they can, get familiar, etc. So in your scenario the way you state it, I'd rather have you with your experience than someone who is fresh out of school and hasn't seen much of anything yet. But if you make it your 5 years as a nurse with 2 months of paramedic school as opposed to a paramedic with 15+ years of high-acuity experience, that might make a difference. and that's not a slam on you in any way, so please don't take it as such. I'm an RN too and definitely think you should go for your paramedic certification and in my opinion there's no way your cert would be less valid than another new grad, if anything it would be more valid because you have 5 years healthcare experience.
Let me give you an extreme example of something that happened to me: A man was buried in a trench collapse, fairly uncommon EMS call. Took about 10-12 minutes for rescuers to dig him out, my partner (ICU-RN) and myself had prepared a rapid sequence induction for when his upper body was freed. While I was still cleaning dirt and rocks out of his airway my partner pushed the Norcuron. I passed the tube and the patient survived the whole incident, but we had made a 30 minute committment to paralysis without a secure airway. Not something I'd ever experienced, before or since and it happened because he was a little overwhelmed by the whole scenario. It was so intense and the local news crews had gotten there, filming live, etc and he had participated in RSI in the unit but never in a ditch with basically one other person helping, patient half-way buried alive, etc.
I wouldn't want 2 medics there with a total of 1 year experience. They might do a great job and everything turns out fine, but the chances are better when someone there has a lot more under their belt.
Also, ask yourself: what if a paramedic could take a 2 week bridge course and get an RN license? to be honest with you, after taking the NCLEX-RN I knew that I could have walked in there straight off the cuff and passed it without ever having opened a nursing text book or attended any nursing classes. I didn't think it was very hard, but I finished nursing school, got my degree, etc. And even if someone could just "challenge" the nursing exam, they'd be poorly prepared to work as a nurse. someone posted that most medics felt they were equivalent to an ICU nurse in experience and training...I'd have to almost blanketly disagree with that. Some medics are, no doubt about it; but not all. What if a patient has sudden onset frothy sputum, BP 230/140, HR 186, SpO2 57% on NRB? A medic is trained treat acute pulm edema and get that patient to definitive care as rapidly as possible. Just by the nature of paramedicine they're not trained to stand at the bedside for 7 hours while all interventions are failing and basically pre-code someone for that long. I'm still an REMT-P and have had that card for 15+ years, but I've only done things like that as an RN, never as a medic.

I appreciate your perspective. The invite to irrational rants was more towards some of the earlier posts- this thread has some mileage.

My understanding of the bridge course is that they expect you to have at least two years critical/emergency experience, as well as your basic EMT. I would consider anybody new to a paramedic license- I don’t care if it’s a trauma surgeon- to be an entry level medic. If anybody thinks their experience as an RN, plus a bridge course, puts them on par with an experienced medic, they don’t have much respect for the profession, and are in for a rude awakening.

As far as a medic challenging NCLEX? Sure- assuming they have considerable relevant experience. For example, some ER’s use medics as techs. Anybody with a couple of years in an ER wanting to be an ER nurse, I think they would rock. Going from being a truck based medic to a med-surge floor would be a bit more of a stretch.

The example you give, “What if a patient has sudden onset frothy sputum, BP 230/140, HR 186, SpO2 57% on NRB?” would be beyond the ability of any entry level nurse, paramedic background or not.

A whole lot of what I learned in nursing school has little to do with nursing, and nothing to do with ER nursing. Care plans, for example. Or the time spent learning about Lavinia Dock, or Florence whatshername. I think a medic with the right experience would do great in the appropriate setting.

I solicited opinions to try and get an idea of what my reception might be if I were to take the course. If I do, I will be working in an area where at least some of the people know me as having experience in emergency medicine.

Thanks for your input.

hhern

You don't think that an RN w/ a medic background or a medic for that matter would be able to handle that scenario? Or did I not understand what you were saying?

I think that the point rnremt-p was making was that nurses are trained in managing over time, rather than stabilizing short term. The approach is different.

hhern

Very well put. I totally agree.

I think with your level of education, skill and experience a bridge is the perfect option, however I think you have much to learn in regard to pre-hospital operations...PHTLS - Pre-hospital Trauma and Life Support is a big factor in the street.

My thoughts on the bridge in general...Its not a "Joke" however as professionals we need to consider the validity of this option in regard to safety and liability.

This is "Shake and Bake" ... quick and easy, tastes OK too...but not necessarily the best choice...for dinning or pre-hospital care.

I think this is an idea that was drummed up to fill empty paramedic positions...same as the idea of using paramedics in ER to fill the empty RN positions...I am seeing this more and more in my area.

In my opinion there should be a specific qualification profile for an RN to Paramedic bridge...for example critical care experience with ACLS, etc. I think holding a current EMT-B would be a positive attribute as well. In my state one must hold an EMT-I before being considered for EMT-P.

RN vs EMT -- Assessment processes differ. One of the biggest problems I had my first year in nursing school was making the adjustment from SAMPLE to ADPIE. I heard "Think like a nurse" many times.

In the field we have protocols, standing orders and if needed online medical direction. Assessment is focused on treating immediate life threatening situations and transporting to an appropriate facility...no need to call the doc unless you want a lot of morphine.

The nursing process is broad and encompasses the patient as a whole...its general in that all systems are assessed and plan of care involves treating the present illness, improving quality of life, preventing future illness, etc.

I think one of the most important aspects of paramedicine is airway management. Paramedics are very aggressive with treatment. Nurses have limited training on airway management as respiratory therapy is used in the units...in the street the medic is respiratory therapy.

I recall reading something about a two week bridge program...I don't think one can learn intubation, breathing treatments and complete enough clinical time in two weeks to become a safe provider.

I consider myself to be competent when it comes to airway management...mainly because I scares the bahjesus out of me. No airway...no patient.

Spinal immobilization is also a huge factor in pre-hospital. I have encountered numerous RNs that cannot apply a C-Collar correctly let alone package a patient for transport. I personally would not want to "practice" immobilization on a live patient with a suspected spinal injury let alone attempt to extricate one.

Consider this...when you are in the unit and a patient goes bad you have resources...get me the crash cart, call respiratory, call the doc. When you're on the street you are the resource...there is no one that can help you...You are it.

I started as an EMT in 1997. I also worked in the ER as a tech and the adjustment was painful for me. I worked in non-emergency transport for 3 months and then got my first assigment with inner city EMS (911). This was a fast paced environment...swoop and scoop all the way. I did what I was trained to do in school...lifting, moving, patient care and transport. Note that of the four descriptors I used only one is acutal patient care.

If I was a patient in the back of an ambulance and had a choice between an RN or a Paramedic for treatment...I'd let them fight it out because either way I think I am in good hands. If I found myself injured somewhere, perhaps in a MVA or some trauma I'd want a paramedic to come and get me.

I am certain that most RNs could complete a bridge program and become a paramedic but I believe the learning curve will place a lot of pressure on the provider. As an RN - Paramedic you will be required to perform, period. Learning basic operations while attempting to provide advanced level care is a recipe for disaster...IMHO.

Another consideration...as a paramedic your partner may be a basic EMT (certified to a lower standard). As a paramedic you are responsible for your partner's actions. If your EMT screws up a treatment you are held liable...just like an RN is held accountable for the actions of an LPN. EMTs are trained to do their job at the basic level and to understand the role of a paramedic as well. Most paramedics come to the table with basic EMT experience. An RN who bridged is at a great disadvantage here as they only know nursing and do not know what to expect from their basic EMT...remember, you have to depend on your partner. You can't depend on your partner if you have no idea what they are capable of or what they are supposed to be doing.

FYI: My cert expired 4 years ago. I recerted as an EMT-I when I started the BSN program. The local medical director recommended that I run through the latter half of the paramedic program before seeking licensure. An RN with ACLS and EMT-I certification can challenge the EMT-P National...Regardless I will still head back to school and run through the program. Short is simply that...short. Short does not mean safe.

Remember "standards" -- If you pass a bridge then you will be held to the same standard as a paramedic that has had 14 months of paramedic training. Drop a patient while extacting from a car, or loading into an ambulance and you will held to the same standard. Break teeth while intubating, same standard...ever apply a traction splint for a femur fx? ... regardless, same standard...Ever use a FROPVD? ... you can blow out someones lungs, regarless, same standard.

No doubt an RN can make the grade in my mind. But in practice will the RN be safe...as safe as a paramedic who trained for 8 months to be an EMT, then worked a year to meet clinical requirements, and then trained for 14 months to be a paramedic?

My 2 cents

All great points.

I have logged a bit of time as a basic EMT. I also ski patrol at a busy mountain. I have boarded and collared people out of MVC's and various wilderness conditions- including our of streams in the winters. I teach pre-hospital assesment and packaging.

The intimidating part is advanced airway management.

hherrn

Believe it or not, some of the biggest problems result from lack of good basic airway management knowledge and technique utilization IMHO.

Truthfully, as long as you never forget the basics of airway management, the advanced stuff really isn't that difficult. You can do more with a BVM and correct technique than you can with any misplaced ET tube. When I went through medic school 16 years ago, intubation was the big thing. Having done it a few hundred times it gets easier the more you do. But the truth is, if you can bag them and keep their sats up, you're much better off...intubation carries with it a slew of problems when done incorrectly, even when done correctly the potential for complications is always there.
If you are wary of this in medic school - I urge you to pay very close attention in class. Much of it you'll know (anatomy and what not) but be prepared as there may be things that you weren't aware of. Also, should you get the chance - get to an OR and intubate patients under the eye of the anesthesiologist. This was a requirement for us - and it was awesome! One doc talked to me for about 45 minutes about cases he'd had, difficult airways, how to solve problems...and told me : "if things get crazy...get back to ABC. Simple as that". I never forgot that.




I would like either one of you to take care of me. I have no bias toward either, but I think that a nurse with your background in "hospital" care who is also taking care of me prehospital has a bit of a "leg up" on the other medic. Just being more familiar with critical care of patients in hospital doesn't necessarily make you better, but it does definitely help, assuming you're not going to freak out when you're the only one in the back with my critical needs.

"Should you get a chance" ???

Please don't tell me there are ANY programs graduating medics without at least a week and ten or fifteen tubes in the OR. That's just to start getting a feel for it! Instruction under the watchful tutelage of an anesthesiologist in controlled conditions is essential to start, and needs to be repeated every year to stay sharp! Where we do yearly rotations, the docs also make sure that we're simply proficient with basic management. Good bagging technique isn't always so simple to accomplish, yet it is the most important of all our skills.

I train on mannikins for scenarios pretty often. It doesn't compare to a real airway. It doesn't look the same and it doesn't feel the same and it doesn't barf the same.

You can take short-cuts on almost any other clinicals (OB is kind of hard to get an idea without 'being there'), but a program that doesn't put students through the OR is irresponsible.

That's my .