What states have a prehospital RN scope of practice?? - page 2

What states currently have RN's working ambulances?... Read More

  1. by   cardiacRN2006
    Quote from mwboswell
    I think we're talking apples and oranges here...

    If you define the purpose of a "Prehospital RN" to be that of a RN who is employed by a free standing (non-hospital-based) State licensed EMS provider; who's primary job responsiblity is to sit in a squad room, waiting for 911 calls, to hop in an ambulance, go to the scene and assess, treat and transport a patient... then the question is "why"?
    No, this isn't apples and oranges, this is what we are talking about!

    Why? Because some of us love EMS, and are RNs. Why go back to paramedic school is there is a way to do it as an RN?

    Quote from mwboswell

    Oh, and during that 2 year degree, they probably aren't going to learn very much about Emergency/Pre-hospital as ASN/ADN programs have barely enough time for basic competency/entry to practice.
    My EMT class was one semester and I learned a ton! The skills and knowledge that I learned remain my foundation for what I do today.

    Many of the Paramedic classes are 9 months out here. Adding it on will be no biggie. Especially if the RN already has an EMT-B or ED experience. (THe link I provided is education in addition to already being licensed as an RN)

    Sooo, there you go.
  2. by   cardiacRN2006
    Quote from chare
    the west virginia office of ems still maintains an emsa-rn certification.

    i hope you find this information helpful.
    thanks for the link! from your link,it listed this as the pre-requisites for initial certification...
    initial certification

    personnel qualify for certification as an emsa-rn, pa, fn by meeting the following requirements:
    • complete the emergency medical services personnel application.
    • attach a copy of current drivers license.
    • attach a copy of current cpr card.
    • be professionally licensed as an rn or pa by the state of wv--copy of license required.
    • be affiliated with a west virginia licensed ems agency.
    • current acls certification--copy of card required.
    • current btls or phtls--copy of card required.
    • current pals certification--copy of card required.
    • current cpr certification--copy of card required.
    • current emt-b certification--copy of card required or:
    • 8 hour ems orientation (from dot emt-p curriculum)
      • prehospital environment (0.5 hours)--signature of squad medical director.

      • roles and responsibilities (0.5 hours)--signature of squad medical director.
      • ems systems (0.5 hours)--signature of squad medical director.
      • medical legal considerations (0.5 hours)--signature of squad medical director.
      • rescue operations (1.0 hours)--signature of squad medical director.
      • major incident response (0.5 hours)--signature of squad medical director.
      • stress management (0.5 hours)--signature of squad medical director.
      • personal hazardous materials (4.0 hours)--signature of squad medical director.
    • 48-hour paramedic refresher course (acls, btls and pals accepted in lieu of all but 16 hours) 48-hour refresher course documentation sheet must be provided.
    • successfully pass state emt-p recertification written and practical exam (practical is not available "on demand", must be taken as part of a scheduled recertification exam)--signature of regional program director and medical director required.
    • 10 completed als perceptual runs--signature of certified emt-p required.
    • 5 completed iv cannulations in prehospital or ed environment--signature of certified emt-p or ed nurse manager.
    • 5 completed advanced airway management education and skills sessions--signature of ems agency medical director or appointed preceptor required.
    • completion of regional requirements, i.e. medical command rotation, protocol exam, etc.--signature of regional program director required.

    Quote from mwboswell
    oh, and during that 2 year degree, they probably aren't going to learn very much about emergency/pre-hospital as asn/adn programs have barely enough time for basic competency/entry to practice.
    as you can see, this isn't a 2-year adn degree that specialized in prehospital rns. we are talking about what to do, in addition to our nursing licenses, to get back into the field.
  3. by   APNgonnabe
    To the OP: Illinois is one of the states has a prehosptial rn (PHRN). When I am using this cert I am functioning on the Illinois EMS act and not overseen by the BON (at least to my knowledge). I have full scope of a paramedic including intubation, chest decompression, surgical and needle cryc (dear God), and of course the range of medications for seizures, resp issues, cardiac events.
    And yes there are some of us our here who are RN's that happen to love the prehospital side of things. I am a member of a volunteer turned paid on call and I also work for a private service. Since I utilize my PHRN working for these I have no additional scope of practice that that other medics have so there is no financial difference other that I'd like to think I bring more to the table in way of critical thinking and advanced concepts learned in the ICU which is where I am an RN. This does not mean that I think my medic counter parts are any less of a provider than I am, although like any profession, there are good and bad providers.
  4. by   airos4
    I can confirm that PA does, called "PH-RN". Essentially you have to be an RN, an EMT-B, and pass the paramedic exam. Currently that's just the written portion, but rumor has is that within the next year they're going to make it the practical as well. With that under your belt you can get a job with any 911 agency in the area as a PH-RN and perform similarly to a paramedic.

    New Jersey also has a program called MICN. RN, EMT-B, and it's a more formal program that requires a sponsoring hospital and about 200 hours of truck time including skills, tubes, etc. Once you have that card it's similar to the PHRN as far as being able to practice as a medic.

    The reason that you would see RNs on 911 jobs is used more heavily by NJ. Several systems (including UMDNJ in Newark, RWJ in New Brunswick, and Capital Health in Trenton) run what they consider "Hybrid" units. These are staffed with a medic and an MICN, and can respond to critical care transport runs as well as operate as backup 911 ALS jobs. In New Jersey, all 911 ALS jobs require two paramedics on the ALS unit, so if you have an MICN and a medic you're good to go.
  5. by   edogs334
    Quote from mwboswell
    I think we're talking apples and oranges here...

    What unique, "RN-only" job skills are being brought to the table here?
    How does this improve patient outcomes?

    So I think the bigger question is what I said above which is "why?"....
    ...and from a consumer/tax payer standpoint; if I knew that it was going to cose more to staff pre-hospital 911 services w/RN's - I would say how do we justify the expense (which also includes at least a 2 year degree)....
    Wake Co. EMS (in Raleigh, NC) utilizes what they call "Advanced Practice Paramedics." Here are the three main objectives for their program


    The APP program has 3 main objectives:

    1. Reduce the occurrence of, or minimize, medical crises for persons with specific medical conditions known to benefit from close medical monitoring. Increasing the overall well being of the patient can prevent the need for EMS response and decrease the time and money spent by patients and other taxpayers for emergency room visits and hospital stays.

    Studies show that diabetics, high blood pressure patients with congestive heart failure, those with increased risk of falls (such as people over 65 years of age), some substance abusers, and children with asthma may all significantly benefit by home visits from medical care providers like our Advanced Practice Paramedics.

    2. Facilitate care for people with mental health or substance abuse crises at facilities other than the emergency room when no other medical emergency exists. APPs may evaluate a patient along with paramedics from a responding ambulance to help determine if the patient would benefit by treatment at another facility. For appropriate patients, the APP will determine the best alternative treatment location and arrange for the patient’s transportation and admission. Ambulance transport to the emergency room is always an option if our patients request other medical evaluation or treatment.

    3. Assure that an additional experienced paramedic is available on critical level calls by responding alongside paramedic ambulances. While some EMS systems use a “paramedic chase car” to provide the lone paramedic responding to assist a basic ambulance, our approach brings APPs to provide a supplemental paramedic with a high frequency of critical patient care encounters to augment the care being provided by our outstanding ambulance-based EMS providers and fire service first responders.

    The first objective sounds a lot like what nurses do in community health or home care settings- ie- preventive and follow-up home visits. In terms of the second objective, it sounds a bit like nursing case management, except on an urgent/acute basis. Although the third objective would naturally be more of a paramedic's purview, nurses could perform the function of the experienced provider given the right amount of training and ED/ICU/prehospital experience. Why would it be beneficial to have nurses doing something similar in other cities? Because nurses (especially at the BSN level) already have basic education in preventive and community health as part of their initial education. Nurses also know more about preventive and longer-term care as well as chronic disease management. Moreover, if such a nursing position (with similar duties to the above objectives) was created, then we would save significant funds by providing less expensive preventive and urgent care in the community; as opposed to thousands of dollars in non-reimbursed ambulance trips, ER visits and ICU admissions. I mention ICU admissions because it seems as though many of my patients could have avoided their ICU admission if they had the means to better manage their chronic conditions (or their overall health). Seriously, it seems ridiculous sometimes. An ER visit can cost a few hundred-few thousand at least, while ICU care can easily be in the thousands of dollars per day- all unreimbursed if the patient doesn't have insurance. But I digress....

    I do admit, I would love to have a job doing what APP's do in Wake Co. (except as a nurse). I also think that if such a nursing position was instituted in our EMS systems, it would give paramedics an incentive to get more education and would create a new level of field provider in the EMS career ladder. Who knows, maybe having that step in the career ladder would prevent some of EMS's best and brightest from leaving the field entirely. I'm not questioning the overall intelligence of paramedics- I've worked with a lot whose professional expertise I highly respect. It just that, over the years, I've noticed that people who want to advance their careers get out of EMS because, once you're a paramedic, there's really no other field provider position to move up to (in terms of money and practice level)- unless you count field supervisors.
    Last edit by edogs334 on Jun 4, '10
  6. by   MBRN4
    I am a PHRN. I studied very hard and took the exam. Pennsylvania requires it even for interfacility transports and non-EMS. In the Commonwealth of PA requires any and all ambulances to stop at an accident scene therefore all ambulances must have an EMT/EMT-P or PHRN. To be considered a critical care transport team one must have a nurse therefore a PHRN is needed in PA. It can widen your scope of practice in your area if you have medical command. However, limitations and extensions of your scope of practice are set by your medical command.
  7. by   emt123277
    PA requirements for PHRN as per EMS of NEPA:
    RN License
    EMT Certification
    1 yr critical care exp

    Submit all to the DOH, they issue an authorization to test for the NREMT-P.
    Then all you have to do is pass your NREMT-P.

    That's the offical version from BEMS at the DOH in Harrisburg. Eastern EMS states they require you to attend an accredited PHRN program. The PA EMS guidelines DO NOT require you to attend ANY program to gain PHRN certification. It just so happens that Eastern EMS has it's head so far up LVH's back-end that it is mandating you attend they're overly expensive class. If you want to sit through EMI's PHRN class, you may as well just go to a pramedic program and pay the same $ and have independant certifications.
  8. by   edogs334
    Someone in a previous post stated that "people line up to volly" as EMS providers in some states- which would negate the need to have RNs in the prehospital field. I can tell you that's definitely not true where I live- we don't have enough people to staff the ambulance 24/7 at my volunteer fire company- let alone enough paramedics or ALS providers to staff the ambulance at the ALS level all the time.
  9. by   FF-PHRN
    I took full advantage of my Ill PHRN by getting on a paid fire service. Better money, better hours, and better benefits than the local hospitals as a RN. EMS is more "fun" to me. I believe Iowa has a PHRN, atleast they did at one time.

    It opened alot of doors for me, including a flight job.
  10. by   JMurse89
    Sorry to bump an old thread up, but does anyone have any updated info on any of this? I just renewed my EMT license for the 3rd time and am about a year away from my RN/BSN. I did it for this exact reason- I'm told RN's can challenge the NREMT-P and upon successful completion, earn their -P credential. But how would we learn to intubate and crich? I believe Creighton university in Omaha, NE has a 2 week RN to Medic program that teaches these skills and a current EMT-B is required.

    Any additional info would be helpful!!

  11. by   GilaRRT
    Challenge NREMT? I'm an RN, RRT and NREMT-I/85 and I've just been notified by the NREMT that I must take the entire NREMT exam over in addition to taking a transition class just to maintain AEMT credentials. If not, I loose and will be demoted to EMT regardless of my other credentials. Your state may have an approved bridge programme that will allow for NREMT eligibility however. I've heard good things about Creighton, but I'm always skepticle about taking the path of least resistance. I didn't "pull rank" with my RN when I looked at respiratory school and I do not intend to do so regarding EMS. Your personal mileage may vary however and I'm not here to pass judgement.

    Edit: Also, pay close attention to the pre-requirements for the Creighton programme. You will need at least two years of experience & ACLS before you can apply.
    Last edit by GilaRRT on Feb 10, '12