Article: Paramedics equal to RNs

FloridaBeagle · May 13, 2015

Well, with MA's and multi-skilled techs doing much of what used to be nursing work, we RN's were told not to worry, because we're the ones who assess and do the critical thinking. Our jobs are still safe. Now who needs RN's if the EMT's can do the critical thinking?

If EMT's want to be RN's, they should become RN's. We are letting our profession disappear!!!

BR157 · May 13, 2015

The article is about Paramedics. Not EMTs. Paramedics can have an Associates degree for entry level just like RNs and they can have a Bachelors degree.

Yes Paramedics are trained for critical thinking. Paramedics also take those critical patients you want out of your ER and ICU to another hospital for more advanced care. Sometimes the Paramedic is alone for an hour or two with the patient you took care of with the same drips, ventilator and IABP. But, you had help.

Several nurses on this forum have been very supportive of wanting Paramedics in their ER with their full scope of practice. Many RNs here have complained about working short staffed due to not enough nurses. There are plenty of Paramedics who would gladly work the ER. It would be a big savings to the hospital since these Paramedics could also respond to codes and rapid responses along with intubating. There also wouldn't be any need to have RTs either since the Paramedic can do everything they can do plus a lot more. Imagine not wasting time by not having to call RT for CPAP or a ventilator. Imagine having a professional in your ER or ICU who can do RT, RN and also the skills and critical thinking of a Paramedics.

Paramedics are now performing advanced practice as Community Paramedics. They are like a Social Worker, Case Manager and Home Health Nurse all rolled into one. Paramedics are who the hospitals are turning to for keeping patients out of the hospital. Paramedics can use critical thinking skills to divert patients to the more appropriate facility or clinic instead of the hospital.

Paramedics and nurses can work well together just like on a flight team. Just don't compare Paramedics to MAs or techs. Paramedics are professionals who take many of the same classes nurses do.

SummitRN, BSN, RN · May 14, 2015

Paramedics can have an Associates degree for entry level just like RNs and they can have a Bachelors degree.

The vast majority do not have an associates degree in paramedicine.

Only two states theoretically require an associates degree, and they both have major loopholes. In fact, the number is so low that nobody keeps track and the only data is on "any degree" EMS or not.

Meanwhile about half of all RNs have a BSN or higher and the majority of new RNs have a BSN. And ERs are either requiring or highly preferring their RN applicants have a BSN or higher, not to mention years of experience, and they want extra experience and certs if the RN doesn't have a BSN.

So, I find your claim dubious.

Sometimes the Paramedic is alone for an hour or two with the patient you took care of with the same drips, ventilator and IABP. But, you had help.

This is very rare. Most patients of that type are transported by a RN/Paramedic critical care transport team and the paramedic on the team is experienced and has extra training because neither DOT nor NRP curricula covers IABP. In addition, in critical care transport teams, most places expect 3-5 years of ICU experience for the RN, so it is clear who is the most experienced with the ventilated IABP patient. There are very few places that would send that patient with just a medic. Far more places send them with two RNs than with two paramedics. Again, most are RN/P teams.

Again, your claim is misleading.

Many RNs here have complained about working short staffed due to not enough nurses. There are plenty of Paramedics who would gladly work the ER.

There is no shortage of nurses. Staffing is a hospital policy / HR issue.

It would be a big savings to the hospital

Sure, because someone with 1 year of votech school is a lot cheaper than someone with a university degree.

Imagine having a professional in your ER or ICU who can do RT, RN and also the skills and critical thinking of a Paramedics.

So we want to replace TWO people who have 2-4 years of education with a person who has 1-2 years, and call it a bonus in care?

Paramedics .. take many of the same classes nurses do.

Again, most do not. Most paramedic programs still have integrated vocational level A&P, not college level A&P. Extremely few require biology, chemistry, microbiology, pathophysiology, statistics, evidenced based practice, etc.

Paramedics are professionals.I respect paramedics as competent prehospital providers.

But if we listened to people like you, we could pretty much replace all providers short of doctors with paramedics.

US EMS is not there.

This country sadly decided that the low threshhold of education for paramedics was the way to go so they could be paid low. It is all about economics. You have to staff an ambulance with two EMS providers and pay two people to usually one patient at a time for about 25% of the staffing time (in a high volume system worse in low volume). So EMS is stuck in a dead end, getting eaten by the fire departments for revenue and call volume.

Look at places like Canada or NZ or Australia where paramedics are 3-4 year degrees and sometimes graduate level. Look at other countries in Europe that staff ambulances with RNs or even MDs. They are also paid better so they aren't dying to get off of an ambulance where they were making $10/hr working 24 hour shifts with no hope of career progression unless they become a firefighter or work in an ER.

The quoted article makes the point that EMS degree rates (in non-EMS studies) are at level than nursing was at 35 years ago. Modern US EMS is only 45 years old as a profession.

EMS progression will come from raising educational standards, not smoke and mirror articles that inflate paramedic education and denigrate other professions until one can imagine equality. That actually just keeps EMS down.

I like Paramedics. I've worked with them for over a decade.

I personally know and work with stellar medics who I respect more than some docs.

My frustration is with the lack of progression in EMS education that drove me from that field to nursing. And misleading authors who write articles like the one in this post. They'd rather blow smoke than actually improve things.

BR157 · May 14, 2015

Check facts Summit RN EMT-B before you post. The author of that article provided the references.

Almost 50% of the Paramedics in Texas are Licensed which means they have at least an Associates degree. Texas does keep track of the education.

ALS Paramedics have been doing IFT for decades without a nurse and taking ventilator and IABP patients. Many ED nurses are not qualified to accompany some of the patients on an ambulance either. Several Paramedics now do have CCEMT-P certs which do cover critical care interventions.

You will also find ventilators on several 911 EMS trucks.

Some parts of this country has a hospital and ambulance on every corner. Other areas like rural America in Montana, Oregon, Washington, Mississippi, Arizona, Texas, Wyoming, New Mexico and the Dakotas, may have a 45 minute response time just to get to the caller. Not everyone flies a helicopter like they do in the cities.

Paramedics education only has to meet the minimum standards provided by the DOT. It can definitely exceed it which a lot of programs do. Look at Washington U of W, Ada County, Hawaii and the schools in Texas. Texas is also very different in the way it sets up the protocols by being doctor specific. A very rural Paramedic may need more protocols to do advanced procedures before someone in the city.

Why duplicate services with a lot of providers in a hospital when one well trained and educated person can be there. Paramedics are not asking to take the place of RNs but to work along side them as equals.

SummitRN, BSN, RN · May 14, 2015

Check facts Summit RN EMT-B before you post. The author of that article provided the references.

I did check those references. You blindly accepted them in a classic example of confirmation bias.

The author grossly misrepresents sources, some of which are questionable to begin with. For example: look at the facebook comments, I read one of those and the article about Paramedics having 90% of CCRN and CEN combined. The way they did that was to count 197 things, all equally weighted, for CCRN. So if Paramedics do not know how to manage post-op patients or interpret lab values or intrerpret PA catheters or artlines or CVPs or ICP monitors, line a patient, each one of those are only worth 0.4 or 0.5% even if they are the bread and butter of being a CCRN.

This was an incredibly unrealistic quantification which is why the article hasn't been cited much. And it was in the American Journal of Disaster Medicine and the purpose was to determine minimum competencies for supplimental staff in a disaster situation. Yet the author of the EMS1 article thinks that one poorly done article translates to a justification for general inpatient practice for paramedics as equals of CENs and CCRNs, which the cited article NEVER claimed.

Almost 50% of the Paramedics in Texas are Licensed which means they have at least an Associates degree. Texas does keep track of the education.

They might have a BA in Interpetive Dance. Texas has loopholes to count non-EMS degrees. Nursing does NOT even count a BS in Biology plus an ASN as a BSN.

Or are you proposing that ONLY paramedics with a BS or AS in EMS be given more autonomy in the hospital than RNs. Are you?

ALS Paramedics have been doing IFT for decades without a nurse and taking ventilator and IABP patients.

Again, National Registry NRP and DOT Paramedic and most paramedic programs in the USA do not teach management of IABP. Which is good because there isn't enough volume to keep all medics competent. In nursing school, IABP is onyl covered in critical care elective courses. That is why RNs who enter into critical care take ECCO and nursing residency classroom/preceptorships before they are allowed to care for critical care patients. Experienced medics take the CCEMTP course as a basic introduction to critical care where they learn about things like IABP.

You will also find ventilators on several 911 EMS trucks.

Some do, but a lot of the prehospital ventilators particularly on 911 units are very simplistic and below the standard of care for hospitals except short term transports to imaging.

Paramedics education only has to meet the minimum standards provided by the DOT. It can definitely exceed it which a lot of programs do. [references to a few great programs]

DOT standards is why most paramedics recieve vo-tech education without college level A&P. It is why EMS should be under Health and Human Services because EMS should be treated as healthcare, not public safety.

Those high quality outliers in EMS education should be emulated. However, the national EMS education system is not represented by them. Pointing to the ouliers and saying that everything is fine is irrational.

Pointing to the existence of advanced protocols is unimpressive to anyone outside EMS. EMS has a focus on skills rather than education and outcomes. RNs could be doing all those skills too, but that is not needed in the hospital.

Imagine having a professional in your ER or ICU who can do RT, RN and also the skills and critical thinking of a Paramedics.

You think that a paramedic can do just about anything and with the same level of care?

Why duplicate services with a lot of providers in a hospital when one well trained and educated person can be there.

You think that perhaps we don't need anything but paramedics?

Why don't we just have RNs do all the things that you want paramedics to do?

Psychomotor skills training is not a big deal. Why do we need a paramedic?

Paramedics are not asking to take the place of RNs but to work along side them as equals.

But RNs and RTs and everyone else shouldn't worry. Paramedics just want to be equals.

BR157 what are your healthcare qualifications and experience? You don't have any listed?

Red Kryptonite · May 14, 2015

Well, with MA's and multi-skilled techs doing much of what used to be nursing work, we RN's were told not to worry, because we're the ones who assess and do the critical thinking. Our jobs are still safe. Now who needs RN's if the EMT's can do the critical thinking?
If EMT's want to be RN's, they should become RN's. We are letting our profession disappear!!!

I see posts like this and can't help but think that RNs pushed the development of such roles as MA and CNA in order to free themselves from being task-oriented and elevate the profession into a more cerebral one. And then I see posts complaining about how those same workers are going too far, doing too much, and RNs need to protect their role. Well which is it? Seems to me the options are to take back the tasks and eliminate us, or shush and enjoy the "higher" status you wanted.

As to EMTs, there would seem to be little difference between an associate-degreed ED RN and associate-degreed paramedic in skill level and knowledge. Whether they should be legally equal I leave to better minds than mine.

ixchel · May 14, 2015

Paramedics are now performing advanced practice as Community Paramedics. They are like a Social Worker, Case Manager and Home Health Nurse all rolled into one.

I'm curious to know what you believe social workers, case managers and home health nurses do.

macawake, MSN · May 14, 2015

The author of that article provided the references.

Have you read the references? The article in the American Journal of Disaster Medicine talks about utilizing paramedics in intensive care during times of disasters, acts of terrorism or public health emergencies when the regular emergency or intensive care nurses may not turn up for work. The article clearly states that paramedics don't have the training required to care for the patient population normally cared for in ICU's and it's not how the authors suggest they be utilized. Unless my reading comprehension skills have completely abandoned me, the article is about disaster preparedness.

From the article Reilly, M, Markenson, D (2010) Utilizing Paramedics for In-Hospital Critical Care Surge Capacity Am J Disaster Med. 5(3): 163-68:

Discussion
Although there are clearly knowledge gaps between the education and training of the CEN, CCRN, and the paramedic, they do not seem to be insurmountable. The majority of these are not likely to overlap with care provided during times of disaster, terrorism, or public health emergencies. These competencies and skills that a paramedic does not possess may be required for patients who are in the hospital unrelated to disasters, terrorism or public health emergencies but would not represent patients who would be assigned to a paramedic.

Conclusions
Paramedics are not replacement or proxies for board certified registered nurses. However, in the reality of healthcare preparedness planning and with the data available on absenteeism and the ability and willingness of hospital workers to report to work during a disaster, act of terrorism, public health emergency, paramedics may be a suitable resource to assist in bridging the staffing shortages and meeting patient care needs. Paramedics do lack experience in assisting in surgical procedures, the monitoring of postoperative patients, and the interpretation of laboratory values.

Even if one believes that the critical care skills of a CCRN and a paramedic are equal (which I don't, the knowledge gaps identified in the article seem to include a rather large part of an intensive care nurse's daily responsibilities), one can't ignore that an RN had a generalist nursing degree before s/he obtained the CCRN. That means that s/he has knowledge about things that don't strictly fall under the umbrella of emergency or intensive care but nonetheless are vital to her/his patient. Wound care, prevention of pressure ulcers, oral hygiene and nutrition to name a few. Since paramedics don't normally care for patients for weeks at a time, I would assume that they lack training and experience in many of these areas.

I also value the holistic approach in nursing when it comes to caring for the critically ill patient and interacting with the patient's loved ones. I'm only guessing here but I assume that paramedic training takes a more task-oriented approach?

It may seem that I'm negative towards paramedics. I'm not but I am of the opinion that if I were a critical care patient I would prefer that a CCRN care for me since I think that person has the most suitable training for that particular setting.

FloridaBeagle · May 15, 2015

I see posts like this and can't help but think that RNs pushed the development of such roles as MA and CNA in order to free themselves from being task-oriented and elevate the profession into a more cerebral one. And then I see posts complaining about how those same workers are going too far, doing too much, and RNs need to protect their role. Well which is it? Seems to me the options are to take back the tasks and eliminate us, or shush and enjoy the "higher" status you wanted.
As to EMTs, there would seem to be little difference between an associate-degreed ED RN and associate-degreed paramedic in skill level and knowledge. Whether they should be legally equal I leave to better minds than mine.

Well, it wasn't me pushing for MA's and "techs". It's foolhardy to delegate away all of our work. Pretty soon we won't need RN's and it'll be our own fault.

BTW: I have nothing against paramedics. I have a problem with my profession disappearing.

BR157 · May 15, 2015

Summit, you obviously posted this article to start a fight and one which you would not try on an EMS forum. I posted a similar article which asked for the RNs support but it was immediately locked. I am outnumbered here. It is strange how nurses can say how much they like working with Paramedics in one discussion and then turn nasty if there is a chance a Paramedic might become their equal in the hospital with equal education.

This bill in Texas will pass and Paramedics will gain their place in the ER as equals.

SummitRN, BSN, RN · May 15, 2015

you would not try on an EMS forum.

This is a regular topic of discussion on an EMS forum I post on. I'd say it gets discussed there about 20x as often as here.

Head on over to EMTLife and tell them how Paramedics are more educated than nurses, can serve as equals of CCRNs, CENs, and RTs in the hospital, plus if they take one CP community college class they become "Advanced Practicioners" and become the equal of "LCSWs, Case Management RNs, and Home Health RNs."

Try it. It won't go the way you seem to think it will.

I am outnumbered here. It is strange how nurses can say how much they like working with Paramedics in one discussion and then turn nasty

You came here to post in this thread and just said you have been here before to "advocate" for EMS. Nobody is reorting to ad hominems. Nobody is dogpiling. But you are refusing to respond to any point or question raised in response to your posts. You clearly aren't interested in debate, just telling the RNs how the more educated clearer thinking Paramedics are here to save their butts in the hospital.

Paramedic might become their equal in the hospital with equal education.

Hey, if the hospitals want to require that paramedics have a BS or at least an AS with the same science prereqs that RNs have, there wouldn't objections on the grounds of education. I've been advocating for that for 10+ years, long before I ever considered nursing.

But that isn't happening and it isn't what you are advocating for.

The EMS services would never allow it because then they'd have to pay Paramedics a liveable wage. Your attitude dumps right into their playbook. You aren't helping EMS. You are hurting it.

I again point to Canada, New Zealand, and Australia. They have highly educated practitioners who are autonomous sometimes to the prescription level, are well paid and make careers that don't involve advancement only through going into management or a different job title/environment.

US EMS will never get there until an AS is the basic level of entry to work on an ambulance.