Latest Comments by AnnieOaklyRN

AnnieOaklyRN, BSN, RN, EMT-P 24,367 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'Previously ER RN, 17 years in EMS (yes, I still love it) , IV RN 8 months!' year(s) of experience and specializes in 'IV RN, (911) Paramedic'. Posts: 2,054 (33% Liked) Likes: 2,373

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  • 0

    Quote from PeakRN
    As someone who has taught paramedic students, both in the hospital and in the classroom, I will back up the statement that the classes are not hard. There is very little that is taught in P school that a competent ED nurse doesn't already know, intubation and 12 lead interpretation are the biggest things that pop into my mind but a good ED nurse should already have a good grasp on that.

    P school ultimately teaches someone how to be a technician and follow protocol orders, the rest is developed through experience and self motivated study.

    The biggest hurdle is to learn to think in an ems mentality, which is more difficult than most people think. Most nurses that I know that went to P school for whatever reason still think like nurses anyway, and as a result their scene management is poor to say the least.

    A large amount of all of this boils down to goals. Many states either allow RNs to challenge their state exam, can practice in the field without additional licensure (but still with additional training), or have some form of prehospital nurse qualification. A volunteer group is normally happy with this, most career groups actually want to see that emt-p credential.
    This is where you are wrong, it isn't simply see A do B, even when you get out of school, that is why you do ride time and work with a more senior medic! Having been an ER RN as well as a paramedic I can tell you they are not even remotely close, as there is MUCH more autonomy as a paramedic!!

    A paramedic is NOT a technician who simply follows protocols, and maybe if you actually spent some time as a pre-hospital provider you would know that.
    ** IT'S NOT ABOUT THE SKILLS OR THE MEDICATIONS, IT'S ABOUT KNOWING WHEN TO USE THEM!!! ********* It requires critical thinking. Do you think physicians just see A and do B? Probably not since they would kill a few people, neither do we!!! Here's an example: I brought a patent in who was in a fib with a rapid ventricular rate to the ER. The patient's HR was about 130ish, but he was also tachypneic and hypoxic prior to oxygen therapy. He was working hard to breath and was also febrile. The ER nurse immediately asked if I gave him Diltiazem, (this was after I told her he was most likely septic and had a pneumonia) for his "rapid a fib". Imagine if I had just saw A and did B, the patient who had a history of Afib and who was tachycardic because he was compensating for the hypoxia and sepsis, and not because of his rhythm would have become hypotensive and in worse condition! So please, don't ever say paramedics are "just technicians" because we are far from that. We think more critically than most nurses and we do not do cook book medicine. I work in a state where my only medical control option medication is Heparin for STEMI, oh and thats the 12 lead ekg I INTERPRET, not a physician, not a computer, me.

    Yet another person, who to my knowledge, has not done both jobs and should not be giving their opinion on paramedic education or how paramedics function in the field. You are also not a student you are teaching, that is a different ball game. Did I think paramedic school was difficult, no, but that was probably because I did the associates degree so it was spread over two years. Paramedics have to be an expert in everything, ER nurses have to also be an expert at the nursing level at everything, but nurses have a doctor to make the actual judgement on how to treat the patient if needed, so please don't ever say an ER nurse is equivalent to a paramedic, not even close!!!

    I am done arguing with people on here about this topic, especially nurses who have never even set foot in an ambulance!!!

    To those considering transferring into the EMS field I advise you not to bridge, that is bad medicine in my opinion and I wouldn't want you coming to my family members house!! I can guarantee if I took 10 ER nurses out of the ER and stuck them on an ambulance 8 of them would run way or wouldn't have any idea what to do (I worked in an ER for 8 years)!!!!


  • 5
    Mavrick, elizzyRN, prmenrs, and 2 others like this.

    I just allow the blood to flow until the vacuum stops, which is what I would assume to be the preferred amount of blood in that tube. It also probably depends on how many tests they are performing on a particular tube.

    Sometimes you just can't get enough blood so that nurse may have just put a little in each tube.


  • 0

    Quote from amzyRN
    That would be a step back though, less pay, less scope of practice. Do what you love though if you'd like it more than being an RN, by all means, go for it. Someone mentioned flight or CCT as an RN and I think those are great ideas. Good luck!

    Actually as a paramedic I can do more than most RNs when you compare hospital RNs to pre-hospital paramedics!


  • 0


    I was in EMS long before I did the nursing thing, and I think EMS is a far better career (yes them money is less), but not really since you can easily work overtime since you aren't stressed out of your mind like you would be as a nurse (I am only speaking from my own experience).

    Please do not even consider bridging, as EMS and nursing are two TOTALLY different ball games with different ways of thinking, and no short cuts should be taken ever in these fields. It is important that you become an EMT first to learn the basics and extrication etc before you become a paramedic. Remember you will be responsible for assessing an treating patients appropriately without a doctor there to make those decisions. You may also work in a system, as I do, where you are the ONLY medic on a call and are working with basic or advanced EMTs, which means there isn't someone else to ask if you aren't sure about something. You of course have medical control; however it isn't the same as being in person. You are telling them your findings and your working diagnosis, they are going by what you see, and not what they see.

    To those that say you will be poor and broke working in EMS, you won't be. You will be less stressed and not short staffed and those families and patients who are needing and hitting your last nerve will only be yours for minutes instead of hours or days. I make 92K a year working full time as a medic (60 hours a week, which isn't as bad as it sounds. 24 hour shifts or 12 if you like, and I spend most of it chilling on the couch or walking laps) and per diem as a nurse (5 hours a week). I also live in the northeast where the cost of living is very high, so depending on where you live you may work less. Honestly you could even split the EMS and nursing half and half.

    I worked full time as a nurse for about a year in the ER before getting totally burnt out, then I split medic time and nursing time in half, and I realized the nursing just isn't worth the stress. It sucked actually in my opinion. I went back to EMS full time and haven't looked back. I am happy to have the nursing as a back up plan for when I can't physically do EMS, or I get burnt out (19 years and still going).

    One thing to remember with EMS is it can be physically demanding and it causes a lot of wear and tear on your back and joints. I am not sure how old you are, but that is defiantly something to consider. I feel it and I am only 39.

    Did I take a pay cut yes, but ultimately to me what matters is my health and stress level. If my health and happiness are suffering, then the money isn't worth it, as long as the bills can still get paid!

    If you have any more questions feel free to ask. I did the Paramedic thing before doing nursing if that helps.


  • 1
    JQuam likes this.

    Quote from SummitRN
    Are you excited about a massive paycut? EMT is not much more than minimum wage with Paramedic typically being only slightly better unless you work for a Fire Department.

    You will feel exceedingly limited as an EMT in your scope.

    However, EMS is fun. The courses aren't hard.

    The "courses" aren't hard? Are you a paramedic and have you been to paramedic school? I am just wondering how you formed an opinion about paramedic school not being hard if you are an EMT-B.


  • 0


    You may want to look into whether it is actually the gloves you are wearing. My sister had this issue and realized it was the nitrile gloves and not the hand washing.

    Go to your employee health and speak to them about supplying you with non nitrile gloves.


  • 2
    DTWriter and sallyrnrrt like this.


    As the others have said nursing is no easy feat, and doing both and keeping a good GPA would be extremely difficult! Also as far as student loans go I doubt that you would be able to get loans or government backed money for both at the same time.

    As the others have said wait until you finish your bio degree and then either do an accelerated BSN or MSN, as you would have to go back for your BSN if you get an ASN.


  • 2
    nehneh14 and OrganizedChaos like this.

    It's called professionalism and maturity.


  • 1
    BostonRN29 likes this.


    The job market in Boston is very tough, as there are many many nurses looking for jobs, and not that many to go around.

    Keep trying, at least you are getting interviews!


  • 29
    h00tyh00t, Heylove, CocoaDreamer, and 26 others like this.


    I am going to be blunt. Your husband sounds like a selfish jack@$$ who is afraid of letting you out into the world to gain some independence. Maybe he thinks you won't "need" him anymore.

    In my opinion I would go get your education, but skip the LVN and go right for the RN if you aren't paying for it, as LVN in my opinion is a waste of time and money if your end goal is RN. Get your associates RN and then you can do your BSN at some point. Don't settle for anything less than what YOU want to do, as you are the one that has to actually do the job, not him. He is afraid of you gaining financial independence!

    Talk with your husband, and unless there is a financial reason like you are going to be totally poor if you go to school tell him you are going! The sooner you are financially stable with your own career the sooner you can leave him if this is the treatment you receive all the time, otherwise as others have said seek counseling!


  • 0

    Thanks for the info Klone!

    I am just wondering though, as all the resources I have read stated that IM Pit was contraindicated for a retained placenta and an IV infusion would be indicated instead?


  • 0


    I just have a question.

    I work on the ambulance as a medic and one of our crews got called for a woman in labor (it was a planned home birth).

    On their arrival it was just the mom and father, and the baby had already been delivered. The midwife arrived shortly after we did and immediately gave the patient IM oxytocin and then repeated it a few minutes later. I cannot comment on how much bleeding there was unfortunately as I was not there. They were actually called because the placenta still had not delivered and transported for that reason.

    My question is wouldn't giving Pit cause the uterus to clamp down and trap the placenta? Or would it increase the chance of the uterus contracting and the placenta delivering?

    It is in our protocol to administer IM Pit after vaginal birth, but only after the placenta is delivered.



  • 1
    brownbook likes this.

    1) if you are not a DNR and have no signs of prolonged death (lividity, rigor mortis, significant trauma and presenting in traumatic cardiac arrest etc) we are obligated to start resuscitation, no matter your age or quality of life.

    2) I have only had two patients survive to discharge with an intact brain after pre-hospital cardiac arrest in my 19 years in EMS. One was 22 and the other was in his 60s, both had wives, girlfriends, kids, parents, siblings, and maybe even grandkids to return too, and the potential for decades more to spend with those loved ones, making the other 498 that didn't survive worth taking the chance on.

    3) Consider the 80% practice, so that 20% will live as we become more proficient.

    4) Do you play the lottery? you should because there is a small chance you may win, there is a bigger chance you may loose, but you still play because even a small chance of becoming rich is worth the risk and effort. Consider cardiac arrest resuscitation as playing the lottery, except the prize is far better in that someone may win a second chance at life and a family wins more time with their loved one. The gamble is that sometimes you loose, but you cannot predict that.

    5) We cannot truly predict who will live and who will die, or how long they may hang on, or whether their brain will be intact, thus we cannot pick and choose who we resuscitate (the exception is rule #1) .

    6) As a healthcare provider you may secretly wish you don't get that 80 or 90 year old back because you know the chance of them ever coming off a vent and walking out the hospital is just about zero, and the only thing that is gained is a body that is traumatized, more suffering if you get them back even if it's brief, and a family who gets their grief prolonged, and lets not forget the financial burden, but you do it because you have too (see #1).

    7) You will loose more than you save, but those two people I spoke of in #2 are real. The 22 year old went into cardiac arrest while at work after drinking numerous energy drinks throughout the morning, which put him in V-Fib arrest. We shocked him 3-4 times, gave him epi, Amiodarone, intubated him, and 30 minutes of CPR all on the side of the road, before putting him in the ambulance after ROSC was obtained. In our ambulance he was unresponsive with posturing so I really didn't think he would walk out of the hospital, but after several days of induced hypothermia he woke up neurologically intact. He now has a normal life and is healthy, and with the exception of his implantable defibrillator he is like any other 24 year old ( this was two years ago). I have never met him, but I knew his name of course so I "checked" on him on FB and I see the value our work and cannot imagine not attempting to resuscitate in appropriate cases, as I see him going to a baseball game with his GF or spending the day with his family.

    To answer your question, you are running for the 100% of cardiac arrests that occur on your watch, since you cannot predict who will be part of the 8% of cardiac arrest patients who do survive to discharge and go home will be.


  • 1
    hopefulRN'17 likes this.

    Hi there,

    I am in the same area of the US and I recommend you continue looking for a job and start your RN-BSN. MA is a very tough job market, but you may have some luck with your associates.

    I am not sure where in MA you are, but I HIGHLY recommend Rivier University in Nashua, NH for your BSN, as they offer a flexible schedule and they offer both online and hybrid classes. They are also reasonably priced even though it is a private college and the faculty are wonderful too! You can easily work full time and do your BSN, so I wouldn't worry.

    If you have any questions feel free to respond on her or send a PM. Good luck!


  • 1
    Esme12 likes this.

    I would NOT do a nursing diploma program because even with your other degrees you will have a VERY hard time finding a job, especially as a new grad!!

    Hospitals want and ADN at the minimum and most prefer BSN candidates, especially in Boston. If you apply as a diploma grad and your competition has an ADN or BSN , guess who will get the job! Hospitals don't seem to care much if you have non nursing degrees.

    This advise is especially true if you are in Massachusetts, as there are few new grad jobs and LOTS of new grads looking.

    Good luck