Any other EMS professionals turned nurses having issues!

Nurses General Nursing

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Hi all,

I am an RN also a paramedic, I was a paramedic first. I always dreamed of being a paramedic, since kindergarten to be exact... I will be honest, I went to nursing school really so I could make a better living, and not really because I had a desire to be a nurse. I know I am going to take a beating on here for that statement!!

Just wondering if any other EMS professionals are having problems making a tansition from emt/paramedic to RN... and if so how much time did you give it? (been a nurse for three years now, tried a new area, still love my office on wheels much better).

Any oppinions would be appreciated!

Happy

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I also was a Paramedic for many years before becoming an RN and I did find the transition kind of difficult. As a Medic, I did follow standing orders written not only by the physician but by an entire team including myself who worked long and hard to develop our protocols. As a Nurse, I follow orders written by the Docs, NP's and PA's.:nurse:

*** there are nursing jobs like that. The SICU where I worked full time for years, and still work casual is just like that. We have standing orders and protocals to deal with nearly everything. there are no physicians in the unit except for morning rounds and the PA goes home at 1530. We also respond to the trauma bays when a level I or II trauma comes in. the ER nurses are there to record and take vitals, the SICU nurse is the trauma nurse.

The thing with being a Flight RN, you really need to have a wide range of critical care knowledge and experience. The patient may need a ventilator, VAD or a wide range other other devices and meds. If the OP was having a difficult time during the past 3 years in nursing while working in the ED, the ICU may be even more difficult. Our flight team won't even consider your application until you have done 3 - 5 years full time in the ICUs with a little ED regardless of how long you were a Paramedic.

Of course the exception to that would be joining a FD or county system that has nurses which may have a HEMS program that does no IFT transport.

Even Rapid Response Team members should have some critical care experience. Different meds and devices are initiated for holding in the room until the patient can be moved which an ED RN might not be familiar with. We generally work off the ICU protocols for most responses since that is generally where the patient may end up.

What is this fixation over a couple of skills? Yes, the Paramedic programs in the past had focused on IVs and ETI but now even that is going to the wayside with extraglottic devices and EZ-IOs. Doing ETI is only one skill and there are many other professionals that can perform that skill. When you become an RN you must realize your focus now becomes about organizing many tasks for many different professionals as well as caring for the patient. You have a full plate without doing the skill of intubation. Imagine if RNs focused on just one skill in the ED or ICU and lived only for that skill. Are you really picking a career or where you work based on just who intubates or who does an IO? I find that to be very short sighted considering all the other opportunities that nursing has to offer. Even the RNs that do intubate in the hospital such as in L&D don't just live to do that one skill. The same for RNs in on Specialty and some Flight teams.

If you only are there for the "skills" and not the whole patient care thing, you are missing out on a lot.

Specializes in Peds, School Nurse, clinical instructor.

What is this fixation over a couple of skills? Yes, the Paramedic programs in the past had focused on IVs and ETI but now even that is going to the wayside with extraglottic devices and EZ-IOs. Doing ETI is only one skill and there are many other professionals that can perform that skill. When you become an RN you must realize your focus now becomes about organizing many tasks for many different professionals as well as caring for the patient. You have a full plate without doing the skill of intubation. Imagine if RNs focused on just one skill in the ED or ICU and lived only for that skill. Are you really picking a career or where you work based on just who intubates or who does an IO? I find that to be very short sighted considering all the other opportunities that nursing has to offer. Even the RNs that do intubate in the hospital such as in L&D don't just live to do that one skill. The same for RNs in on Specialty and some Flight teams.

If you only are there for the "skills" and not the whole patient care thing, you are missing out on a lot.

Wow I sure hope this was not aimed at me...I sure didn't see anyone with a "fixation" over a couple of skills... this post is kind of mean

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
The thing with being a Flight RN, you really need to have a wide range of critical care knowledge and experience. The patient may need a ventilator, VAD or a wide range other other devices and meds. If the OP was having a difficult time during the past 3 years in nursing while working in the ED, the ICU may be even more difficult. Our flight team won't even consider your application until you have done 3 - 5 years full time in the ICUs with a little ED regardless of how long you were a Paramedic.

Of course the exception to that would be joining a FD or county system that has nurses which may have a HEMS program that does no IFT transport.

Even Rapid Response Team members should have some critical care experience. Different meds and devices are initiated for holding in the room until the patient can be moved which an ED RN might not be familiar with. We generally work off the ICU protocols for most responses since that is generally where the patient may end up.

What is this fixation over a couple of skills? Yes, the Paramedic programs in the past had focused on IVs and ETI but now even that is going to the wayside with extraglottic devices and EZ-IOs. Doing ETI is only one skill and there are many other professionals that can perform that skill. When you become an RN you must realize your focus now becomes about organizing many tasks for many different professionals as well as caring for the patient. You have a full plate without doing the skill of intubation. Imagine if RNs focused on just one skill in the ED or ICU and lived only for that skill. Are you really picking a career or where you work based on just who intubates or who does an IO? I find that to be very short sighted considering all the other opportunities that nursing has to offer. Even the RNs that do intubate in the hospital such as in L&D don't just live to do that one skill. The same for RNs in on Specialty and some Flight teams.

If you only are there for the "skills" and not the whole patient care thing, you are missing out on a lot.

I think the OP is looking for that niche to give her the sense of autonomy and excell in her nursing edeavours. I agree that there is a lot of critical care experence that is required for some flight programs and familiarity in all aspects of critical care and emergency medicine is a must and the bottom line is the patient. I think she just needs to find out it is out there and how to guide her career in the direction that will be most fitting. I have to admit I have always been an adrenaline junkie and probably always will be and I really preferred the office on wheels..............far less political bull to put up with and I have never caged well.

In the ED setting and medic setting their is a different rapport between the MD and the medic and the MD and the nurse. I have witnessed a male medic become a nurse and was outraged over his treatment as a nurse vs medic. Truely......as a medic he was a peer to the MD as a nurse he was the taskmaster......a very different role. Unfair but true.....he said as a medic he felt he collaborated with the MD to make orders and as a nurse he was only to follow the orders given by the MD. I think there are alot of nurses out there that agree. I think the OP will find her niche and the direction of flight nursing just might be it.........;)

In the ED setting and medic setting their is a different rapport between the MD and the medic and the MD and the nurse. I have witnessed a male medic become a nurse and was outraged over his treatment as a nurse vs medic. Truely......as a medic he was a peer to the MD as a nurse he was the taskmaster......a very different role. Unfair but true.....he said as a medic he felt he collaborated with the MD to make orders and as a nurse he was only to follow the orders given by the MD. I think there are alot of nurses out there that agree. I think the OP will find her niche and the direction of flight nursing just might be it.........;)

I think there is a misconception when it seems medics identify with physicians because they do a couple of "physician like skills". Very few medics are actually trained by physicians in their programs and have very little contact with them overall. It is sorta like a guest in your house for a few minutes as they drop off patients which can go very badly or very well between the Paramedic and the physician. Most of the time it is a respect for the FF uniform more than the medical aspect of it. It is also unfortunate when some Paramedics have never met or wouldn't recognize their Medical Director if they appeared on scene or in the ED.

Personally I found working as Paramedic very limiting even though the service was supposed to be one of the more progressive in the state. There is a very limited amount of meds and procedures. The protocols are written in such a way they can be very generic and for doing the least harm. The many mother may I services that are also very prevalent. When I got into the ICU or almost any area of the hospital I was like a kid in a candy store.

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
How mny umbilical lines did you place in the back of an ambulance as an EMT or Paramedic?

You are still counting "skills" and missing the big picture of knowledge and experience. Flight or CCT will also not be a good fit for you unless you start getting the broader picture of nursing and putting some of that education to use.

Trying to constantly compare yourself to a doctor will not get you anywhere either. A Paramedic is not a doctor and that autonomy you talk about comes directly from protocols written by a physician for you to follow sometimes to the letter and number with med control to tell you what to do if it isn't in the protocols. You will not be a flight or CCT RN if you stay focused only on the few skills you had as a Paramedic or the limited procedures and protocols available to you in EMS. If you believe your worth is only measured by a few skills which many different professions can easily be trained to do, you're selling yourself very short. Move on or consider returning to the ambulance as an EMT or Paramedic.

I am not stating that my worth is measured by the amount of skills I know or that I can perform...

In my practice as a medic I don't see A and do B per protocols. Being a paramedic involves A LOT of assessment and judgement and its not about following a cookbook of protocols like you seem to be assuming, and any medic who does that is a bad medic!! In my state, with the exception of Heparin, we do not have to call medical control for anything, and our protocols are pretty generous! The best part of being a paramedic is that I ASSESS A PATIENT AND DECIDE ON A TREATMENT, yes it has to be within the protocols, but I ASSESS THE PATIENT and treat the patient if appropriate and I do not have to say Dr. may I!!

My point is that nursing is a field that seems to be held back and very relient on physicians to do the thinking, and my whole point is I am board in nursing because we are not allowed to do anything, in my oppinion, that is in the least bit mentally challenging!

I have placed no umbilical lines ever, but its nice to know I can do it, if need be, especially since there is no doctor in the back of my ambulance telling me what to do!

Happy

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
I think the OP is looking for that niche to give her the sense of autonomy and excell in her nursing edeavours. I agree that there is a lot of critical care experence that is required for some flight programs and familiarity in all aspects of critical care and emergency medicine is a must and the bottom line is the patient. I think she just needs to find out it is out there and how to guide her career in the direction that will be most fitting. I have to admit I have always been an adrenaline junkie and probably always will be and I really preferred the office on wheels..............far less political bull to put up with and I have never caged well.

In the ED setting and medic setting their is a different rapport between the MD and the medic and the MD and the nurse. I have witnessed a male medic become a nurse and was outraged over his treatment as a nurse vs medic. Truely......as a medic he was a peer to the MD as a nurse he was the taskmaster......a very different role. Unfair but true.....he said as a medic he felt he collaborated with the MD to make orders and as a nurse he was only to follow the orders given by the MD. I think there are alot of nurses out there that agree. I think the OP will find her niche and the direction of flight nursing just might be it.........;)

I agree 100% with you Esme!! I do not want to be a skills junky like some people seem to be implying, which is how I kinda feel working as a nurse... You just dont have to think nearly as much as you do as a medic or as a transport RN!

I love going to someones home, assessing them, and trying to figure out what is going on with them and how to treat it, if I can...

I will be honest I have worked as a medic in an ER and as a nurse, and I agree that doctors treat medics more as an equal! I was treated mroe like an equal by the doctors even as a nurse, but that was becuase they knew of my medic backround! I have seen this first hand, and not just with myself! It has nothing to do with a medic being able to do a couple of "skills" that a doctor can do, it has to do with a medic almost having to think like a doctor! And I do not think as a medic I am a doctor by any means, so don't missinterpret what I am saying!

Happy

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
My point is that nursing is a field that seems to be held back and very relient on physicians to do the thinking, and my whole point is I am board in nursing because we are not allowed to do anything, in my oppinion, that is in the least bit mentally challenging!

*** To me this is like a dermatoligist complaining that they don't get to do any surgery. You chose an area of nursing where there is very little autonomy and are now complaining about it. My question is why did you choose to work in a nursery? Why did you choose not to work in a challenging nursing field?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think there is a misconception when it seems medics identify with physicians because they do a couple of "physician like skills". Very few medics are actually trained by physicians in their programs and have very little contact with them overall. It is sorta like a guest in your house for a few minutes as they drop off patients which can go very badly or very well between the Paramedic and the physician. Most of the time it is a respect for the FF uniform more than the medical aspect of it. It is also unfortunate when some Paramedics have never met or wouldn't recognize their Medical Director if they appeared on scene or in the ED.

Personally I found working as Paramedic very limiting even though the service was supposed to be one of the more progressive in the state. There is a very limited amount of meds and procedures. The protocols are written in such a way they can be very generic and for doing the least harm. The many mother may I services that are also very prevalent. When I got into the ICU or almost any area of the hospital I was like a kid in a candy store.

The first rule of medicine is.....do no harm. You work in pulmonary and have A LOT of autonomy. I agree you would find being a medic more limiting and you have the MD's ear to make decisions and ...THEY LISTEN TO YOU! You make vent changes and understand principals the confuse the best of us. Your speciality gives you a lot of inout and respect of the MD's. Even in ICU's I have heard MD's demand to speak to the therapist to "get the right story". If you are a good RT or RRT (i can never get the letters right off the top of my head) you have a lot of autonomy so the medic protocol would be frustrating to you.......by the way, not that you ever considered it, don't become a nurse......talk about limitations, especially when youur are first starting! :)

Specializes in Emergency Room.

I would say become a flight nurse, that is what I wanted to do at first.... Yes they allow medics to do so much more in the field because they are no doctors riding around in medic units. Intubation for example they let RT's do it, why in the world can't RN's certified in trauma care intubate? It does not make sense.. I for one would really enjoy doing field work from time to time, but there is no RN to medic courses for me to take I would have to take a full paramedic course.

IYou just dont have to think nearly as much as you do as a medic or as a transport RN!

I love going to someones home, assessing them, and trying to figure out what is going on with them and how to treat it, if I can...

Now that is insulting! Nurses in hospitals don't have to think as much?

An RN on a Flight team, CCT or Specialty team is hired for his/her knowledge and experience in critical care situations. They are expected to function as if they were in the ICU but without the comfort of that environment. You don't get to that level unless you can THINK in the ICUs. Whatever additional skills can easily be taught to someone who is educated, experienced and can think. The reason transport RNs on these teams are so successful is that they are doing what comes naturally from experience. They have the education, knowledge and experience to "think" through any situation which they acquired from working and thinking as a bedside RN.

Yes as a Paramedic you do an assessment for a patient at home but you are also primarily looking for and treating the emergent issues and then only long enough to get them to the ED. If something falls outside of what your protocols are as a Paramedic or you don't know what you are looking and treating for, you call med control for advice. This advice could be "monitor breathing and get to the ED".

A nurse will be caring for that patient during an 8 or 12 hour shift and must pick up subtle changes in a patient's condition. If the RN is not "thinking" or "assessing" something will be missed and then it becomes an "emergency".

Two very different fields for the thought process and treatment. A hospital RN can not just "think" about one thing (or one patient) and for just one moment or one event. An RN must assess not only for the present but the future since all care is connected somehow. It is also the RN who must convince a sleepy attending that the assessment indicates a problem and not just calling an ED or med control to see if they should stay and play longer at scene or rapid transport.

This may sound like a rude post towards Paramedics and I mean no disrespect. But, the medical part of EMS education in the U.S. is what it is. It is meant to be short and to the point since there is not much time in the field to do labs and a thorough assessment of all systems. If is meant to train first responders whose primary job is not always medical. This definitely includes firefighters and in some cases Police Officers where there are still Public Safety Officers. For these reasons, a lot of college prerequisites like Anatomy and Physiology are not required. You treat what you can that needs emergent attention. You don't know what is causing the presenting symptoms. You form a working field diagnosis from your assessment, treat by protocol or call med control and transport quickly. A Paramedic also may have the option of doing very little either through realizing a patient needs rapid transport to the hospital rather than much on scene intervention or the Paramedics just don't want to do much for a variety of reasons.

There are physicians who once were Paramedics and have commented that as a Paramedic the assessments were much simpler (even if they seem complex for the Paramedic doing them) because you didn't know all many differentials that could be associated with certain symptoms. You only know the few that were taught in Paramedic school. I believe this is also true or should be true as you move on in nursing. As you gain more education, knowledge and experience, you realize how complex medicine is. Even going from being an ED RN to working in some progressive ICU can be an awakening.

Many who chose to go into Nursing or whatever profession from Paramedic may have done so because they realized how limited they were in the field and knew there was more to the patient's story than just the obvious. Labs, CXRs and many, many other diagnostic tests to determine a definitive diagnosis are done to expand upon a working diagnosis. Medicine doesn't stop with the few working diagnoses in the field protocols. I would hope that anyone who has worked 3 years in an ED as the OP stated, but didn't like, could have gotten inspired to look beyond just the obvious or be the least bit curious why a patient is being admitted to the hospital. One thing I've learned through the years is that you can make the most of any situation if you are truly inspired by medicine and patient care. On ambulances too many EMTs and Paramedics waste time not taking advantage of an oppotunity to learn from the patients they see who are "routine" because no cool skills or "thinking" is required. Their focus is purely on an adrenaline rush call. They also forget that those routine patients for nursing home transports may once have been an adrenaline rush call. So much to learn from looking at the patient and skimming through the chart. Another example would be dialysis patients. Ask a Paramedic about them and they will probably refer to them as BS. But, an RN who is getting a dialysis patient as an admit is probably "thinking" about all the associated medical problems, the medicines and what can go wrong easily with this patient. This may not be the most popular patient but also not BS or boring.

The first rule of medicine is.....do no harm. You work in pulmonary and have A LOT of autonomy. I agree you would find being a medic more limiting and you have the MD's ear to make decisions and ...THEY LISTEN TO YOU! You make vent changes and understand principals the confuse the best of us. Your speciality gives you a lot of inout and respect of the MD's. Even in ICU's I have heard MD's demand to speak to the therapist to "get the right story". If you are a good RT or RRT (i can never get the letters right off the top of my head) you have a lot of autonomy so the medic protocol would be frustrating to you.......by the way, not that you ever considered it, don't become a nurse......talk about limitations, especially when youur are first starting! :)

Respiratory Therapists work under a Medical Director just like all the other departments including PT, OT, and Radiology. AND, just like RNs who have protocols in placed signed by the Medical Director of their ICU or floor. Some hospitals have all the P&Ps posted on the intranet for all to see and others still have them in big manuals. Ask the Respiratory Therapists or any of the therapies if you can look at their P&Ps.

For nursing and RT (Respiratory Therapy) they may also have combined protocols such as sepsis, ARDS and sedation vacation.

Each Rapid Response Team and Code Team will also have protocols.

I would say become a flight nurse, that is what I wanted to do at first.... Yes they allow medics to do so much more in the field because they are no doctors riding around in medic units. Intubation for example they let RT's do it, why in the world can't RN's certified in trauma care intubate? It does not make sense.. I for one would really enjoy doing field work from time to time, but there is no RN to medic courses for me to take I would have to take a full paramedic course.

Who is going to start the IVs, push meds and get kits for other procedures setup? Aren't there many, many things that an RN does which is also just as important? Don't write off the RN just because they don't intubate. Without the RN, many intubations couldn't happen very easily.

How would you monitor 200 RNs on their skills and keep them competent in intubation? Paramedics are no longer intubating in the field in some places because that is an issue. There is also the follow through. Just sticking a piece of plastic through the cords is only one part of it.

Outside of NICU, there are only about 20 RRTs who intubate at my current hospital. They must do 10 intubations with a preceptor and then 25 per year. For transport they need at least 100 intubations to apply along with the years of experience and the education requirements.

However, there are many RRTs who do not intubate even though they have 2 or 4 (and 6) years of college specializing in Respiratory. But, that does not make them any less of an RRT. Most are busy getting set up for blood gases, A-lines, the ventilator, Nitric Oxide, heliox and whatever other meds and gases required. They are perfectly content to allow the physician to place the tube and move on with figuring out how to spare the patient's lungs and stabilize them for the long haul.

There is also this one little concept when working in the hospital called "teamwork". You can still be a jack of all trades but it is really great to have those who have serious expertise in their profession.

Abbreviations:

RT - Respiratory Therapy (or also used by Radiology professionals)

Credentials (state licensing may use same titles or sometimes RCP -Respiratory Care Practitioner)

RRT - Registered Respiratory Therapist

CRT - Certified Respiratory Therapist

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