RN or paramedic

SuesquatchRN, BSN, RN · Apr 30, 2008

Paramedic seems to mean something different in Canada. RN is a hgiher/different level of licensure here, although goodness knows in an emergent situation get me a medic!

thegoose · Apr 30, 2008

I used to consider paramedicine too. i though it would be more exciting, more intense. And I know in alot of cases (shotings, traffic accidents) it is.

I am an RN and I ended up working in a busy inner city ER (so I have lots of contact with paramedics) and this is soley my observation and opinion:

as a nurse I work in a semi controled environment, I have mulitple staff members and security if a problem ever arises. I work in a climate controlled building. Although it is difficult to get all our breaks in most days, we do have time to physcially get away and have a coffee/lunch/etc.

We see medical cases through(more so than a paramedic), we have a greater scope of pracitce and we interact with many different health care team mebers, social work, MD's physio etc. When a pt. gets brought in at 5 min to shift change, I know the next shift (who's usually there to get report) will take on the patient.

As a paramedic you work in the field, are you comfortable going into stranger's houses? Picking somone up off the floor who has been there for 3 days? Dealing with intoxicated and drugged people? Working in the rain, in the snow? In my estimation most calls are not all that exciting, as in my expereince most patients comming into the ER are mostly chronic medical conditions and patients from nursing homes (as opposed to the more exciting arrests, traumas etc).

Where I work, the paramedics dont' routinely get thier breaks and eat their lunch in the truck. If a call comes in at 10 min to shift change, they have to go out on it so they often don't get home on time.

There is the sense of autonomy of being in the field, however paramedics are mostly bound by medical directive for some treatments which negates the need for personal and professional judgement (nurses have some of those too in the hospital).

Nurses also do 4 year degrees, and as far as I'm aware (correct me if I'm wrong) paramedics are a 12 month college program.

I think you have much more flexibility with Nursing as a career, as you said you can go lots of places with it and you can also get soem more schooling and do the nurse practitioner program.

but that's just what I think based on my expreiences.

S.T.A.C.E.Y, LPN · May 1, 2008

I know where you're coming from 'cause I was in a similar place myself. This is how I saw it. In Ontario, having the paramedicine degree does nothing more for you as a medic other than MAYBE helping you eventually get into management.....is this something you see yourself doing? As a BScN prepared RN you have a degree, can EASILY switch specialties anytime you want and can go just about anywhere. As a medic, well, you can maybe eventually do flight or teach. Thats about it.....not too much leeway if you decide the job's not for you. Or god forbid you get hurt.....can't do too much as a medic if you blow out your back. RN degree is so much more versatile. And as other posters said, working as an RN you get to see alot more of that exciting stuff through to the end. EMS runs into the resus bay with an acute stroke, gives you report, then thats it for them. You work them up, bring them to CT, see the scans, give the meds, assess the return of the neurologic function, interact with the family, bring the patient up to the ICU, etc. ALSO, take a look at the job situation for medics in Ontario. There are literally THOUSANDS of unemployed medics in the province. Ask anyone who has recently applied for a PCP job through centralized testing. Thousands of applicants for very few jobs. I know MANY medics who are either unemployed or still only able to work part time hours after several years of trying as there are just too many people for the number of jobs available. For nursing, I was guaranteed a job before I even finished school. Actually multiple job offers before I even applied! New graduate guarantee program in Ontario, now guarantees that every RN grad gets a job right out of school! Plus, so many places are willing to pay for extra schooling. My employer pays for new grads to attend college programs in their specialty as part of their orientation.

Also, if you do your nursing degree in Ontario you can work towards completing your EMCA by just doing ride-time hours. I've included the link here. I know at least one nurse who is doing this now, and I plan to start this myself in the next year. So RN degree can still put you in the same place as the Paramedic degree/diploma.

http://www.health.gov.on.ca/english/public/program/ehs/edu/equiv_qa.html#5

codeblue20 · May 6, 2008

thanks for the info guys, great responses...

my instinct is leaning towards RN... so I think I just gotta go check out the job a bit before I commit to my decision..

stacey: i am interested in doing the RN - PCP thing in the future, good to hear it is possible because I have either been told its NOT possible (even though its on that website), or I havent run into anyone who's actually done it

fenders · May 12, 2008

My brother, I was in the same shoes as you in the beginning. I ended up doing a little volunteer fire and decided to do nursing as I worked full time in a hospital for 10 years and was influenced by staff. I finsihed my degree and it was the better decision. Paramedic growth is flat, where do you go after paramedicine??

Not only that, it's an unregulated profesion (which bugs me) and the traingin is only 1 year. I also disagree with using paramedics on flight care as int he states they use properly trained critical care nurses with years of experience. If you work in the states and go for flight they will give you some paramedicine training. RN's in both the states and here are at a level higher than the paramedics. You would have a better chance of getting into med school as a degree rn than a paramedic. You need to have a degree first and they will laugh at you here if you apply to med school as a paramedic.

I've had some pretty scarey experiences with paramedics, both personal and professionally. My mom fell and had almost passed out and when the paramedics arrived I told them what had happened, assessed her myself and had told them that she needs to go to the hospital and get xrayed as i think there may be afracture. the guys were appareantly experienced and told my mom to ly on the couch and asked her to flexion with th eknee bent both legs. Then they determined from that that she had no fracture. I was furious that they made a diagnosis ont he spot. they are there to treat and transport. They ended up not taking her, nothing was signed, i grabbed my mom and took her to the hospital I worked at, sure enough was a right hip fracture requiring surguery and a partial hip replacement.

Anyhow buddy, nursing is great, takes many years to get the experience, dont expect to be all ready to go from school. Nurses are very skilled at what they do and in directing the phycians decisions (if they listen lol)

I had paramedics in my degree program who were getting into nursing cause they were bored and had no where else to go.

cheers

manchmedic · May 28, 2008

okay - first time poster in this (or any) forum.

i feel sort of compelled to comment on this post, so bear with me:

i've had some pretty scarey experiences with paramedics, both personal and professionally. my mom fell and had almost passed out and when the paramedics arrived i told them what had happened, assessed her myself and had told them that she needs to go to the hospital and get xrayed as i think there may be afracture. the guys were appareantly experienced and told my mom to ly on the couch and asked her to flexion with th eknee bent both legs. then they determined from that that she had no fracture. i was furious that they made a diagnosis ont he spot. they are there to treat and transport. they ended up not taking her, nothing was signed, i grabbed my mom and took her to the hospital i worked at, sure enough was a right hip fracture requiring surguery and a partial hip replacement.

it appears, just based on what you say here, that you had an ems crew that either didn't know what they were doing, or they didn't care. in either case, stuff like that makes the rest of us look bad. and this type of care is simply bad medicine. i hope your mom is doing better after this experience, and i am sorry for what happened to her.

i've been an ems provider for 14 years, and i know that if i ever did anything like what you describe, a couple of things would happen to me. first, there is no doubt in my mind that i would be terminated from my job. second, i would likely be the target of a lawsuit.

not only that, it's an unregulated profesion (which bugs me) and the traingin is only 1 year. i also disagree with using paramedics on flight care as int he states they use properly trained critical care nurses with years of experience. if you work in the states and go for flight they will give you some paramedicine training. rn's in both the states and here are at a level higher than the paramedics. you would have a better chance of getting into med school as a degree rn than a paramedic. you need to have a degree first and they will laugh at you here if you apply to med school as a paramedic.

while i will agree with you that rn's are indeed the higher level of care (i am happily married to an rn that has nearly 30 years in the field, and she and i have this discussion regularly), i take exception to the statement you make about ems being non-regulated. in this case, i will respectfully say to you that you are wrong. emt's and paramedics in the u.s., anyway, are indeed regulated at multiple levels. since i am not licensed or certified anywhere outside of the u.s., i can't speak to that. i don't know what canada's requirements and regulations are, and frankly, i don't need to know them unless i intend to work there.

at the federal level we're regulated by the u.s. department of transportation, and the standards of training and education for all levels of ems originate from there. in fact, any educational or academic institution in the united states that offers ems programs has to, by law, conform to the different curriculum standards for each level of care. they are set by year; for example, emt-b's at trained using the dot 1994 curriculum, emt-i's at either the 1985 or 1998 curriculum (depending on the state where the emt-i is licensed) and medics are at the 1998 curriculum. it is also my understanding that the dot is currently working on updating the curriculum at all levels, and anyone trained with an earlier curriculum will have to bridge up to the new level of training within a window of time. i don't think any of that has been made public yet.

also, 38 of the 50 states as well as guam, puerto rico, and the u.s. territories in the pacific utilize the national registry of emergency medical technicians for testing and certification. if you work as an ems provider for the federal government (and this includes military personnel) you are required to be nationally registered. the testing process is nothing to joke about, and i can promise you that if you are a nurse and try to go through the process without any bridge training or anything like that, you will fail.

finally, each state regulates ems and how providers are licensed, how continuing education requirements are fulfilled, disciplinary issues are handled, and all of the same stuff that nurses deal with in terms of their licensing. contrary to what you say, we are not an unregulated bunch. i am licensed in three states (nh, massachusetts, and maine), and while the patient care protocols differ in all of the places i work, the regulations are all very similar, and they all have teeth. we are required to do things right where i work. we are also required to be professionals, and to be any less would result in loss of privileges to practice and, in some cases, loss of license.

as for training and the length of programs, there are minimum requirements for each level: basic and intermediates are each at 140 hours of training, and paramedics are at approximately 1500 hours. in most places, that is didactic only, not including internships, clinical rotations, and field practice. i went for just over 18 months before i had everything completed. that includes working at a full-time job in addition to all of the time commitments for school. additionally, there are 4-year ems programs out there, and i know three people that graduated from two of them: the one at george washington university and the one at the university of maryland. both fine programs, both of which produce excellent basically-trained paramedics.

as for medical school, one of the people that graduated from umbc's program just got accepted to dartmouth medical school. and to my knowledge, he didn't get laughed at when he went for his oral interview.

i apologize for the length of this post. however, i felt a strong need to set the record straight. i am not a nurse; i am a paramedic. while i have the greatest respect for the nurses i work with and for what they know and what they do, i am very proud of what i do, and i take offense when my profession is slammed in any way.

Fiona59 · May 28, 2008

Great first post BUT the question is related to Canada, what works in the US doesn't apply to us up here in the Great White North, an independent country.

manchmedic · May 28, 2008

I forgot to mention that Flight Medics are a whole different breed of Paramedic. While they have all of the same skills and experience as the rest of us, they go through further schooling and have to be qualified as flight paramedics in most places. I know this because I went through such a program last fall. The program I went through was run and taught by nurses, medics, and physicians. It was an excellent educational experience.

manchmedic · May 28, 2008

Great first post BUT the question is related to Canada, what works in the US doesn't apply to us up here in the Great White North, an independent country.

Okay - no offense intended.... I was simply making a point about regulation, nothing more. As I said, I have no clue how EMS is regulated in Canada. I imagine there are similarities, but I don't know that.

fenders · May 31, 2008

Machmedic, I was referring to Canada. I have heard great things about some of the U.S paramedic programs. I didn't mean by saying laughing as an insult but the universities up here want you to have a degree before you apply to med school. I have quite a few paramedic friends here who are quite knowledgable and good at what they do and I think the problem is that there is no regulatory body (meaning , a body that governs the profession to protect the public). But if you already have a degree then it really helps being a paramedic, that's what I was told by Mc Masters in Canada.

In my case when I complained to the EMS chiefs here, they did nothing to address the issue to the paramedics in question. If it was a nursing complaint they would probably call you down to the nursing college for an interview with your license at risk. Someone has to be accountable for their actions. In nursing if you abandon care of a pt you could lose your license.

Another incident occured when I saw a person jump off a bridge and the person was still alive but the paramedics walked slowly to the scene and had just assumed that the person was dead already because they had jumped. This was a MH patient at the hospital I had worked at and I was furious because they didn't even try to help this individual. I realize this person may have died anyways but sometimes we don't know this. Should I have back boarded this patient myself and took him back to my ER?

I have read some studies showing that gang members in some areas have a higher survival rate from GSW or stabbings because they drive themselves to the hospital (Golden hour). I'm not sure how statistically significant these findings are, plus therre are numerous factors involved but I find it interesting. Also heard that if you have a heart attack, you have a better chance of survival in a well equipped casino then in a hospital. Maybe we should put casinos in hospitals.

Unfortunatly my buddies told me there's a lot of unhappy paramedics here because they are under the garbage colection union which treats the garbage collectors alot better then they do.

I remember working in the emerg during a major outbreak and having paramedics calling asking what they should do next as they may have been exposed. The organiation did nothing to address their employees with their concerns. I felt really bad for them but we helped them out the best we could. So it would be nice if they had some protection as well for themselves, such as an association.

:up:

manchmedic · Jun 1, 2008

I have to admit something.

First, when I read the thread, I jumped in without taking a closer look at who the audience was. I shouldn't go off half-cocked when I'm talking about a totally different system and environment than the one I work in. For that, I apologize.

With respect to regulation in Canada, I think you and I are on the same page, Fenders. Regulation is paramount if the system is to work the way it is intended to, and if there is none up your way, then I can understand your (and medics who are worth their salt) frustration.

An issue we run into down here in a lot of local EMS systems is that there is no unionization. Because of this, pre-hospital providers get hosed when it comes down to pay, benefits, etc. And that's a problem. Personally, I'm pretty fortunate in that I work for an agency that it ultimately owned by a hospital, and they do an above average job of taking care of us and what we need.

With respect to the jumper: that sounds like an awful situation. As far as getting to where the patient was, I can't speak for the actions of the EMS crew that was on scene, but unless there was a compelling reason for them to go that slowly (things that come to mind are whether or not there was access to where the patient landed, if the area was safe, anything like that) they should have been more proactive in getting to where the patient was. And as far as I'm concerned, patient isn't dead until confirmed dead.

Thanks for putting up with my posting. This is a great thread - worth the time of conversation, in my opinion....

:typing