Allowing Corpsman to Become Nurses

[Asystole RN]

Watching the Presidential debate tonight and a statement by Obama made my head turn. He was relating a story when a corpsman was stating that he has treated wounded soldiers but when he became a civilian he could not use his training or experience to count towards becoming a nurse (unknown which kind). The corpsman was upset that he had to start his education/training from the beginning.

Obama stated that the requirements to be a nurse (assumed licensure/NCLEX requirements) should be changed to allow corpsman to become nurses (did not state which kind).

Any thoughts?

[jeckrn, BSN, RN]

I was lucky. After 4 years of humping it with the infantry I got to work in a hospital. I knew I wanted to challenge the LPN so I took the requirments to my commander and asked it could be arranged that I work in all the setting required. She was very understanding and arranged for me to work in different areas.

I am curious if you shopped around with different nursing schools? I found a wide variety of what they would accept.

There are a few jobs in nursing that would give you similar autonomy like you had as a corpsman. My job as RRT for example allows me to order any sort of diagnostic test from an EKG to an chest CT to R/O PE. I can administer a wide variety of medications on standing orders and protocols. For example when the post CABG patient goes into rapid a-fib with RVR I can order the EKG and BMP. I can administer Lopressor IV and even amioderone drip all on my judgement and based off a protocol. No physician is ever involved. For respiratory cases I can do everything from give them a little O2 or an albuterol neb to intubate them. I am in the curious position of not only being able to order tests, labs, etc, but also preforme them myself. i can draw my own ABGs, get my own EKGs, etc. That is why my hospital has found that time between when a problem is noticed and when it is effectivly dealt with has been cut dramaticaly with the RRT RNs vs a resident ordering things, then waiting around for the lab people to come and draw.

My old job as critical care transport RN also provided a lot of autonomy. My advise is to get yourself some very high qualiety ICU experience and put yourself in a position to move up into some of the better jobs. Believe me your corpsman experience will be appreciated at this level.

Sounds like most hospital RN positions that I have ever worked in. Everything you did was understanding orders. There is a physician, NP, or PA Behind the scene who wrote the orders. Being a military medic/corpsman had nothing to do with this. My RN' s work under these conditions. As far as your experience it will depend on how good you are not just being a prior HM. this is the same for RN' s there are good ones and others who can not get out of their own way. Do not come in with a chip on your shoulder because it will get knocked off, you will need to learn how the hospital runs and most do not run any where like the military. This also goes when you change job's as a RN since each hospital does it their own way. It's the little things that are different which can hang you out to dry.

[PMFB-RN, RN]

Sounds like most hospital RN positions that I have ever worked in. Everything you did was understanding orders. There is a physician, NP, or PA Behind the scene who wrote the order

Its actually not much at all like other hospital RN positions. I have worked as a staff nurse in 4 states, 2 countries and as a traveler in another 4 states and in none of those jobs did I, or any of the nurses I worked with, have the autonomy that the RRT and transport RNs have where I work now.

Just not being assigned our own patients alone makes it a very different job. I have never worked in any hospital where a regular staff RN, who for example, notices EKG changes, orders lab tests, interprets the lab tests, them administers medication (for example mag sulfate, Lopressor, Amio, etc) without physician involvement. Of course all medications are given on protocols or standing orders.

When I worked in CVICU we would have very similar protocols but they only applied to specific patients, in that case CV surgery patients, in that one unit. Its also unusual for a regular staff RN to have the authority to transfer a patient to a higher level of care based on their own judgment of the patient's needs. Even more unusual for an RN to be able to be privileged to implement these protocols on people who are on hospital property, but not patients, like staff members for example. Few nurses would have privileges to start any patient on bi-pap, c-pap, or intubate them based on their own physical and test result assessments. For sure it's common for a nurse who is caring for a patient being treated for respiratory issues to have a standing order for these things on that particular patient, or maybe for a patient in that unit, but to be able to apply such interventions across the hospital is very unusual.

[jeckrn, BSN, RN]

Sorry but I have worked in 3 states and 5 different hospitals and everyone had standing orders and levels of independence based o. The facility and the physicians. Every med or treatment we give is under a physician's order somewhere.

[PMFB-RN, RN]

Sorry but I have worked in 3 states and 5 different hospitals and everyone had standing orders and levels of independence based o. The facility and the physicians. Every med or treatment we give is under a physician's order somewhere.

I am wondering if you lack reading comprehension, or are being deliberately obtuse.

[jeckrn, BSN, RN]

Sorry that you do not understand this but nursing does not always fit your image based on your experiences because have different experiences than yours.

[MrChicagoRN, RN]

Gateway Community College in Phoenix recently started what they believe to be the first and only program of its kind in the country: a five month military medic to LPN course. It builds on the knowledge and experience these medics already have and gets them ready to take the NCLEX-PN. After that, they're equivalent to any other LPN in Arizona, and once they get the prereqs/coreqs done, can apply for advanced placement into 3rd block of the RN program.

Veterans/LPN Bridge | GateWay Community College

Illinois has 3 c.c. offering similar programs, but I don't know any of the details

Military / Corpsman to LPN Programs

College of DuPage ............................................

Illinois Central College .......................................

Joliet Junior College ...........................................

[Gooday]

I have been reading these post and there is almost a kind arrogance in the way that some nurse's talk about Corpsman. I was a corpsman for 4yrs. I did and or was trained to do everything an RN does and some of the stuff Doctor's do. Corpsman's do sutures, labs, xrays, casts, assessment in the field, we write soap notes, prescribe medication and diagnose. We are trained to deliver baby's, even surgical procedures in the field. When not deployed we work in hospitals and do the exact same job that every other nurse does. Our training never ends, we train daily. We have to learn every medical position because in the field we do them all. A corpsman's scope of practice in combat is whatever he has been trained to do. I got licensed in CA when I got out and have practiced for over 25yrs without a blip on my record. Never even been written up for a med error. It is a shame that I orient and train many of the RNs that have come to work at my company and many others that I have worked at and been way more knowledgeable than most RNs that I have worked with yet I can't sit for a board in most state's or even transfer my license.

[jfratian, DNP, RN, CRNA]

I suspect you're just trolling/venting here. But on the chance you're serious hoping to debate this subject:

I respect every member of the healthcare team. I also think we all have to recognize that certain barriers to entry beyond a simple written exam are needed to protect the public. You may have fantastic abilities, but public policy isn't about just you. We unfortunately have to think about what the average or sub-average person will be able to do given their training pathway.

I have worked with many former/current medics/corpsmen in my military career. Having seen the best, worst, and in-between, I just do not agree with you. My main issue is inconsistency. For example, all corpsmen are not equal. The entry level corpsmen gets a total of 19 weeks of medical training. It's possible that a 4 year enlistee these days might get out having never deployed. Further, it's possible some HMs will spend their entire enlistment in a stateside hospital doing nurse aide duties. There's absolutely no way this person should be able to call themselves an RN. Others may get fantastic deployment training that involves many advanced skills. I'll be the first to admit independent duty corpsmen (IDCs) are totally badass. So are their IDMT AF counterparts. However, in the end, there's just too much variability to make blanket statements like 'all corpsmen should have the right to challenge the NCLEX-RN.'

Frankly, I'm sure many experienced RNs/RRTs/EMT-Ps/etc could pass the USMLE STEP exams that med students have to take before they can start residency. However, you don't hear too many people advocating that they should be able to become MDs.

Even the Navy itself admits that basic corpsmen lack the training to become nurses. The Navy has a program where it shells out many thousands of dollars to send active duty enlistees to nursing school. Why would they do that if they already had the training of RNs? Why would they ever commission nurses at all if basic-level corpsmen could do the job?

[jeckrn, BSN, RN]

Well said; I was a HM(8404) for many years also and would never have considered myself an RN with the training I received. There are many HM's out in the fleet who work in a BAS or at the platoon level who do no more than basic EMT level skills. But there are others who are IDC's who do advanced skills. There is a reason why only CRNA's are allowed to push Propofol while ICU along with certain others are allowed to hang it as a drip. As an perioperative nurse I would never even think about hanging it since my skills have decreased in that area of nursing. The reason is the level of training just like HM's and other military medics have. Everything that Bugging wrote about what HM's can do RN's can do if their employer allows it.

[MyelinSheath, BSN, RN]

It is interesting to see this post come alive again. My original opinion has not changed entirely. I still believe there should be some type of pathway for medics to take LPN boards without attending the entire civilian program. Certainly there are states that accept and allow medics to take the LPN exam but of course we are discussing the states that don't. I am not going to copy my original posts from before but in short I wanted to get my state's BON to change policy but I ran into a substantial road block...no surprise there.

After speaking extensively to the executive director for the Minnesota BON, she referenced a study by the National Council of State Boards of Nursing (NCSBN). The NCSBN conducted this study a few years afters after Obama signed the Veterans Opportunity to Work (VOW) to Hire Heroes Act of 2011 which would have given both veteran and active medics the best opportunity to sit for their LPN boards.

Ultimately she said this study supports their decision to reject our training and would require a bridge program at a college...hint hint CUE THE MONEY.

So I spoke to the college she was referencing Lake Superior College in Duluth, MN. I spoke to the program director who was still in the process of creating the program. In the end, the program to "bridge a military medic" to practical nursing level is going to be nearly a year!

So for all you ADN nurses out there like myself that went to programs like WITC, we all know we could take our LPN boards after a year. So I ask what is the point of a bridge program if you save no time and none of your training gets recognized? The answer to that question is my previous hint...Money.

Anyways, the director of the BON for Minnesota sent me that study so Ill share the summary because I don't believe anyone can access it. There is no way to site the study but if anyone would like the complete analysis let me know.

A Comparison of Selected Military Health Care Occupation Curricula with a Standard Licensed Practical/Vocational Nurse Curriculum

Summary and Recommendations

1. After an extensive review of health care specialist (medic), corpsman and airman curricula and comparing it with a standard LPN/VN curriculum, significant differences in content were identified. These differences preclude granting an LPN/VN license to veterans specialized in these areas without additional practical/vocational nurse coursework and clinical experience.

2. For veterans with training and experience as health care specialists (medics), corpsmen and airmen, civilian BON-approved LPN/VN programs should develop bridge programs that are based on individual assessments of each veteran and geared towards helping these individuals acquire the knowledge, skills and abilities needed to practice as an LPN/VN safely without repeating previously acquired content.

3. Each veteran will be leaving the military with varying levels of experience. Some have inserted chest tubes and performed other small surgical procedures, while others have little, if any, experience doing these procedures and instead had other types of responsibilities (non health care related) during their military service. Therefore, it is recommended that the knowledge, skills and abilities of all veterans entering an LPN/VN program should be formally evaluated/assessed prior to beginning a program. If proficiency is demonstrated, this should be accounted for in the LPN/VN program to assist in accelerating the education process.

4. After successful completion and graduation from the LPN/VN program, the veteran must pass the NCLEX-PN® Examination prior to licensure as an LPN/VN.

5. While the courses offered in military programs are comprehensive and rigorous, a veteran who has been a health care specialist (medic), corpsman or airman must learn the role of the nurse, the nursing process and the science of nursing care. The veteran must learn the role of the LPN/VN, the scope of practice and the principles of delegation in order to practice competently and safely. This is acquired through formal education, both clinical and didactic, and must be integrated throughout the course of study.

6. The Army LPN Program is comparable to a standard LPN/VN program approved by BONs.

Talking Points: Military Training Exception

NCSBN supports veterans entering the nursing profession. We would like these hard working individuals to succeed and experience long and rewarding careers in the field of nursing.

ƒƒThe roles and responsibilities of registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) are different from that of health care specialists (medics), corpsmen and airmen. Thus, the training for these military occupations is different from that of nursing education programs.

Even within the military, RNs and LPNs have separate roles and responsibilities from health care specialists (medics), corpsmen or airmen. The military requires RNs working in military facilities to hold a bachelor's degree in nursing and

meet all the requirements of a civilian nursing program approved by a board of nursing (BON). A health care specialist (medic) or corpsman can only become an RN in the military by completing an RN program. Educational exemptions are

not offered based on experience or another type/level of training.

Currently, the Army is the only service with an LPN occupational specialty. Certain MOS 68W soldiers (Army combat medics) can attend a course to become an entry level LPN. Students are required to sit for the NCLEX-PN® Examination and obtain licensure as an LVN. Thus, LPNs in the Army receive a substantial amount of additional education above and beyond training as a health care specialist (medic), corpsman or airman.

ƒƒLPN/VN education is different than the training received by health care specialists (medics), corpsmen or airmen.

After an extensive review of the health care specialist (medic), corpsman and airman curricula and comparing it with a standard LPN/VN curriculum, significant differences in content were identified. The military occupations lack content

in the nursing process, health promotion and prevention, care of the pediatric patient, care of the obstetric patient, care of the older adult/geriatric patient, and chronic care management. In addition, the role of the LPN/VN is different

from the military health care occupations cited in this report. The veteran needs time to learn a new scope of practice, acclimate to the role of an LPN/VN, and learn how to think and act like an LPN/VN. For those who have only worked on

the battlefield, coursework will be needed on the health care delivery system, including hospital systems and long-term care. For a full listing of the educational differences, please review "NCSBN Analysis: A Comparison of Selected Military

Health Care Occupation Curricula with a Standard Licensed Practical/Vocational Nurse Curriculum."

ƒƒAllowing health care specialists (medics)/corpsmen/airmen to bypass educational requirements and sit unprepared for the NCLEX® is costly and can undermine test taker confidence.

ƒƒGraduation from a BON approved LPN/VN program is mandatory for all individuals wishing to be licensed as LPN/VNs; however, some LPN/VN content may overlap and be repetitive of the military occupation program content. NCSBN supports and encourages the development of LPN/VN bridge programs that allow health care specialists (medics), corpsmen and airmen credit for the knowledge, skills, and abilities they acquired in the military and focus content on gaps in knowledge, the nursing process and differences between the military and LPN/VN roles and scope of practice.

The Army is the only branch of the military to offer an LPN program that provides the training necessary to be licensed as a practical/vocational nurse. NCSBN recommends the development of civilian LPN/VN bridge programs geared

towards assisting veterans in mastering the knowledge, skills and abilities needed to practice safely without repeating previously acquired content.

NCSBN represents U.S. BONs and supports the initiative to transition veterans to careers in nursing. NCSBN is working with many groups to address different aspects of this project and should be involved in any discussions regarding this

endeavor so that it can assist in assuring veterans have a safe and smooth transition into a career in nursing.

[jfratian, DNP, RN, CRNA]

I think your point that many military medics do function at the LPN level, and therefore should be able to do so in the civilian world, makes sense to me. In lieu of a bridge program, I would propose in addition to passing the NCLEX-PN, requiring a BON resume review (with references from military superiors) that explains what skills the medic has routinely performed in their military service. State nursing boards seem way too fixated on job titles for my taste.

My issue with some of those posters on this thread is that the 'military medic' term is quite broad and encompasses people whose job duties can span the continuum from physician assistant to LPN to nurse aid to clinical secretary. Each person should be evaluated on a case-by-case basis for the civilian role that they are best qualified for.