Article: Paramedics equal to RNs

Red Kryptonite · May 16, 2015

Sorry - I can't reveal my hometown on an internet forum.

No one asked for your hometown. Just your state, and most of them are fairly big places with several cities. The fact that you refuse to answer this simple, basic question so your information can be checked makes everything you say suspect.

BR157 · May 17, 2015

Very few people post where they are from on the internet and that includes the state. Some of the patient or coworker scenarios presented here could easily point to you especially if you work in the only trauma center or specialty section in a state. So it is never a good idea to disclose a lot of info on open forums which can be viewed by anyone.

As for credibility, everything mentioned here from the bill in Texas to the degrees required can easily be verified by the colleges and the state licensing board. It is not much different than if you were checking out how to be a nurse.

This is an example of a Texas BS degree in EMS.

The University of Texas Health Science Center - School of Health Professions

amysiuk · May 17, 2015

I hear people talk about this all the time. I have been a paramedic firefighter for 15 years, nursing school is at least 10 times harder than any paramedic school.it is definitely like comparing apples to oranges. The critical thinking aspect of those NCLEX style questions is unbelievable.if you gave me a month to study, I could get 100%on a state paramedic test. Answers are cut and dry, and Word for Word out of the book. Not even close

Raven Sierra, BSN, RN · May 17, 2015

I'm not going to get into the debate about paramedic v. RN...

But I will say this: at the community college where I trained for my EMT-B, they offer a 6-month paramedic course. It is a very well-rated program in Virginia with an excellent pass rate. Now, granted, the 6-month paramedic course is 6 months of pure Hades, but it's still 6 months. The more-sane standard paramedic course is a year. Had several classmates go on to the 6-month course (they had no life for 6 months) and several go for the year-long course.

For myself, I chose to go for my BSN, to be followed by ACNP.

jadelpn, LPN, EMT-B · May 17, 2015

In most states, a paramedic IS under a "medical direction" which is an MD. Therefore, there are more and more emergency departments who will not allow a paramedic to work to scope, due to MD's not wanting to take responsibility for said medics.

Additionally, hospital and pre hospital care are 2 entirely different things.

I read an article not long ago regarding a nursing union who was taken aback at the scope of medics in ICU's. And what it boiled down to was that it was not within a nurse's responsibility to direct a medic, as medics can only be directed by an MD, who takes "responsibility" for their practice.

Add an ER that has PA's or NP's...and again not the MD medical director.

And we also have to remember, medic is an EMT certification, it is not a license. Akin to an RN who is certified in say Critical Care....it doesn't make them equal to an NP, just an RN with a specialty cert. Much like an EMT with a specialty cert of a medic.

I have said this many times--in my experience with taking classes/continuing ed with medics, they are of the thought process that they have a medical practice and clinical judgement that far exceeds that of a nurse. It is a difference of practice, not a "I am better than you" thing.

And my LPN diploma took me longer to get than going a EMT-P route...

jadelpn, LPN, EMT-B · May 17, 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.

Paramedic is a level of an EMT. Not it's own entity. I could say as an LPN I am much like an RN., have multiple clinical hours and could be a integrated part of the ER team. But I am not an RN. My scope is limited. As is a medics. We all "practice". However, unless we are at a provider level, we are not medical practitioners...

And as both an LPN and a Basic EMT, I will say that each level of EMT is "practice" based on protocol, and protocol only. One doesn't stray and do their own thing, you start with A, go to B, then add C if B looks like this....there is critical thinking but in the confines of what you are able to do. A nurse has a bucketload of options that they are able to perform, and not on a A+B=C except for every 4th hour when....

I am all for skills based learning, and skills based practice. But in order for that to happen under the constraints of protocol, there needs to be someone who has the scope to think and most especially DO outside the box.

macawake, MSN · May 17, 2015

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.

You were asked by another poster earlier in this thread if you know what social workers, case managers and home health nurses do. I am also curious to hear why you believe that a Paramedic has the relevant education to perform these jobs. For example social workers can have either a Bachelor of Social Work or Master of Social Work and the coursework for a Bachelor's degree include things like social welfare policy, social work methods, applied research, child welfare and social work for the aged. Students of social work cover hardly any of the coursework in prehospital care/paramedicine, and I suspect that the opposite is also true.

It smacks a bit of hubris, or at the very least a severely lacking level of understanding, to think that one education not only covers it's own area of expertise but can also replace several others.

While a paramedic's education can be an Associates or Bachelors degree, it can also demonstrably (shown with a link in this thread) be as short as three months and approximately 400 clinical hours.

I'm not looking down my nose at paramedics. I think that they are a valuble profession in healthcare. Paramedic training is geared towards the prehospital arena and it's short-term care. It's about keeping a person alive and if possible stable until they reach a hospital where they'll receive the more long-term care (relatively speaking, acute care hospitals are rather short-term too). Paramedics seldom care for a patient for more than an hour or two, often shorter periods of time. The things that nurses encounter and need to address when caring for a patient for days, weeks or longer seldom become an issue/priority. Social workers often work with their clients for an even longer time period with personal dynamics, knowledge and legal issues specific to their profession.

Again, I'm not denigrating paramedics. I work in pacu and anesthesia and I'm well aware that things can go awry in a much shorter timespan than an hour. Paramedics do important work. I just don't think that it's realistic to think that a paramedic can replace a RN, RT, homehealth nurse, case worker and social worker. Seriously how much education do you think you can squeeze into three months - four years? What do you think all these other professionals actually spend their time studying? Even if a paramedic indeed has a Bachelor's degree I don't see how it's possible to cover their own coursework and that of all the others.

I and other posters have mentioned weaknesses in the cited research in the article on EMS1. The conclusions in article published in the American Journal of Disaster Medicine wasn't the paramedics can step into a ICU and be equal with a CCRN. The whole purpose of the article was to determine if it's realistic/doable to let paramedics boost the staffing numbers in disaster situations when the regular nurses may be absent from work. The suggestion presented is that paramedics care for a limited part of the patient population. And when arriving to the conclusion that a paramedic and CCRNs have similar educational background they assigned weighting factors to various tasks and areas of responsibility that in my opinion skews the numbers somewhat and don't accurately reflect ICU work.

Do you have any comments or reflections to add on the things I and others have pointed out? I am curious about your thoughts on the matter.

SummitRN, BSN, RN · May 17, 2015

You don't have to stay locked into the DOT standard. That is only the minimum guidelines for testing. Washington and Oregon both exceed them as to a lot of other states.

You keep ignoring the fact that most paramedic program requirements in the US are at the minimum to meet DOT/NREMT. You keep pointing to outliers as if they justify your broad claims.

Washington has plenty of 9-12 month programs. (Link WA DOH Paramedic Programs)

Oregon is the closest in the US to to requiring an associates degree for medics, but it doesn't have to be in Paramedicine and paramedics can practice without a degree although they eventually have to get an associates in something after a few years.

It is clear that you do not think it possible for anyone but a medic to stay abreast of the developments in EMS education requirements, but it isn't that hard.

Even the link you posted for the Texas Regs clearly states "AS in EMS" for licensure.

Or ANY bachelors degree...

3 month votech medic program + BA Interpretive Dance = Licensed Paramedic

Again, I point out that NO DEGREE IS REQUIRED TO BE A PARAMEDIC IN TEXAS. Only if they want to be licensed in addition to certified.

SummitRN, BSN, RN · May 17, 2015

Almost all the states now offer paramedicine through an AAS.

Almost all states now offer MSN-RN entry programs. Few RNs earn a Masters as their initial licensure degree and few paramedics earn an associates with their initial certification.

Many paramedics now choose to go on to a four-year degree (BS in emergency services related field)

You keep making this claim, and provide no evidence. Nobody is going to buy it until you offer some evidence. You are going to have a lot of trouble finding any because extremely few paramedics start with a BS and a minority have any Bachelors.

What state are you from? That must be one of the few states that do not require a two to four degree for jobs :)

Try to find evidence to back up your point.

NO STATE REQUIRES A DEGREE TO PRACTICE AS A PARAMEDIC.

BR157 · May 18, 2015

In most states, a paramedic IS under a "medical direction" which is an MD. Therefore, there are more and more emergency departments who will not allow a paramedic to work to scope, due to MD's not wanting to take responsibility for said medics. ...

Almost every allied health professional in the hospital works under a medical director. That includes RTs, SLPs, OTs, PTs and Rad Techs. In the ERs of progressive hospitals, usually the Medical Director for Paramedics is the chief doctor of the ER. He or she will write the protocols for the Paramedics.

Additionally, hospital and pre hospital care are 2 entirely different things.

Yes but many aspects are the same.

I read an article not long ago regarding a nursing union who was taken aback at the scope of medics in ICU's. And what it boiled down to was that it was not within a nurse's responsibility to direct a medic, as medics can only be directed by an MD, who takes "responsibility" for their practice.
Add an ER that has PA's or NP's...and again not the MD medical director.

Which is why a doctor assumes the medical director role for the Paramedics just like any other health care department.

And we also have to remember, medic is an EMT certification, it is not a license. Akin to an RN who is certified in say Critical Care....it doesn't make them equal to an NP, just an RN with a specialty cert. Much like an EMT with a specialty cert of a medic.

NO. The EMT (no more EMT-B), AEMT and now Paramedic (no more EMT-P) are all separate certifications through the NREMT after you complete a certain amount of education for each level. You take the NREMT credentialing exam and then you must apply to the state for a license as a Paramedic or in the case of the EMT, a certification from the state. The FP-C, Tactical Paramedic and CCEMT-P are specialty certifications.

I have said this many times--in my experience with taking classes/continuing ed with medics, they are of the thought process that they have a medical practice and clinical judgement that far exceeds that of a nurse. It is a difference of practice, not a "I am better than you" thing.
And my LPN diploma took me longer to get than going a EMT-P route...

Aren't you making the same judgment against Paramedics? You are an EMT-B and have not completed the education of a Paramedic which means you have never had the responsibility of a patient as a Paramedic.

If you want to renew your EMT certification, you need to review the NREMT and your state's EMS website for a better understanding of the certification and licensing process.

BR157 · May 18, 2015

Almost all states now offer MSN-RN entry programs. Few RNs earn a Masters as their initial licensure degree and few paramedics earn an associates with their initial certification.
You keep making this claim, and provide no evidence. Nobody is going to buy it until you offer some evidence. You are going to have a lot of trouble finding any because extremely few paramedics start with a BS and a minority have any Bachelors.
Try to find evidence to back up your point.
NO STATE REQUIRES A DEGREE TO PRACTICE AS A PARAMEDIC.

You contradict yourself in an earlier post:

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.

Here is Kansas:

The Kansas Board of EMS requires each Paramedic
graduate in Kansas to acquire (or have) at least an AAS degree before
taking the National Registry EMT-P examination.

MICT Program Prerequisites

Oregon is the other state. It has had some loop holes but those are going away now that more ALS providers are available in rural areas.

Here are the stats in Texas. Licensed Paramedic means they have met the degree requirement.

https://www.dshs.state.tx.us/emstraumasystems/statistics.shtm

You seem to be in the belief that Paramedics are not capable of acquiring higher education. Maybe before when there were limited opportunities but now there are new paths and today's Paramedics are advancing their education to take advantage of the new opportunities. Not all Paramedics are uneducated as you want the nurses here to believe and you are unwilling to accept change. EMS has moved on. You didn't move on in EMS. You became a nurse.

I think this article provides some more answers to your questions.

Texas ENA's Unprofessional Attack on EMS | The Unwired Medic

It was from a discussion on the website you suggested earlier EMTlife.

You also need to review the NREMT and your state's EMS website for the current information if you want to keep your EMT cert.

BR157 · May 18, 2015

You keep ignoring the fact that most paramedic program requirements in the US are at the minimum to meet DOT/NREMT. You keep pointing to outliers as if they justify your broad claims.

Nursing only has an Associates degree and some states still use the diploma for credentialing. Why do nurses bother with the BSN? You just refuse to accept that there are more opportunities now for Paramedics and the education is there for the taking. All those outliers are coming together as more states are passing legislation to help Paramedics make a difference.