Career in Healthcare - Many Different Options . . .

classicdame, MSN, EdD · Dec 21, 2012

The EMT hourly pay is not great, but remember they are paid for 24 hour stretches. So "one day" for them is more paid hours than what most people get. EMT work and nursing have things in common but are remarkably different. EMS personnnel have some difficulty adjusting to nursing. The focus is so different.

You might fit in great with ER nursing. In the USA you get a generic license, then learn more specifics on the job. You do not have to decide while in school. You also can un-decide later and change positions!

Remember, the griping you here is just because we have a safe place on this site to vent. The general public, including our families, do not understand our stressors, so we share with other nurses. Overall, I love my job and most of the people I work with.

chorkle · Dec 21, 2012

Koko--

Have only skimmed your post, but have some add'l. comments about EMT.

I worked for an EMS agency (all ALS), where there were 12-hr. shifts, & 24-hour shifts. (It was a bid process, based on seniority.)

Pay rate was expressed as an annual amount, altho based on a verbal hourly rate. Therefore, the hourly rate for 24-hr. shifts was less than that for 12-hour shifts. OK, you can say you have more paid hours, but the pay rate is less per hour. This came into play for overtime. Even if you picked up an extra 12-hour shift, you were paid at your 24-hour rate--i.e., less than someone who was a 12-hour shift person. Such a scheme discourages picking up extra shifts. So, things can vary a lot. (And, some 24-hour trucks slept all night, while others ran all night--like, 17 calls in 24 hours, some of them major, getting off late, & then staying 2 hours longer to finish the paperwork from your shift. And between calls, you were posted somewhere--never in quarters.) For some folks, the advantage of 24's was the 24-on, 48-off, schedule.

classicdame is absolutely correct about major differences between EMT and nursing. Yes, out on scene, you may work a lot more independently--and you have to be able to--than you would in hospital. This seems to "go to the heads" of many young EMTs--or, perhaps such folks gravitate toward EMS.

Also, with a nursing license, even from a non-compact state, you can work in other states, after license endorsement. (classicdame can correct me here if my understanding isn't quite complete.) In EMS, you work under the license of your system's medical director, and the protocols s/he has established. (This may be in the process of changing, with the increasing influence and importance of National Registry), but This does NOT transfer easily to another EMS system, and certainly is not likely to transfer easily to a system in another state. Sure, you can move, and find a position with another agency, but expect a process, which can become long, of testing; being precepted, perhaps extensively; and passing a protocol test; before being allowed to work independently. And all your experience from before gets you a spot at the bottom of the rotation schedule. If it's a really large agency, with a shift bid process, you can remain at the bottom for several years.

VICEDRN, BSN, RN · Dec 21, 2012

I was an EMT for four years, I had a bachelors degree when I started nursing pre reqs which I took at Georgia State ironically. (I was an EMT, then became a paralegal after college and then went and did an accelerated bachelors.) First, I can tell you what you already know (from what I glean from your post): the nursing way is the long way around to mid level provider.

You already know the EMT-A is quicker and it will give you the experience you need to gain a spot in the PA program at Emory. Since you already started down that path, my guess is that that you would prefer to be a provider and I would say that this path is the better of the two since you seem to be gravitating towards more independence rather than less. (EMT and PA vs. RN)

We have had a rash of "oh no! nurses venting a lot on here are scaring me away!" threads. I will disagree with other posters: its not just "venting" though I do come here to vent some. Nursing has long been a career with lots of job stress and turnover. Most nurses will not be staying at the RN level for long (google for statistics: turnover in the nursing field is dramatic). Georgia has some terrible working conditions on top of that.

Think about where you want to end up.

Koko4 · Dec 21, 2012

I recognize that EMT and Nursing are two remarkably different fields, and I have a great respect for what both of them do. In my current situation, I am worried that if I become an EMT, I will be at the bottom of the totem pole, like Chorkle said. Keep in mind that I would not be planning on doing EMT for forever – only long enough to get a good amount of HCE up to apply for PA school. I also think that it would expose me to some of the darker sides of healthcare, and it would really test my ability to handle those types of situations, right off of the bat. I recognize that EMT would be about a year and a half from now to accomplish, and nursing would be about 2.5 years. I could earn HCE as either, and then use those hours to apply to my program of choice.

Right now I am leaning towards PA for a mid-level provider, because of the fact they can move laterally from specialty to specialty without much difficulty. As I understand it, a NP has to choose a specific field and then go back to school and receive additional certifications if he/she wants to practice in a different area. I am also fully aware of the fact that “NP’s are more autonomous” and this does not bother me – I have never had a problem with working as a team or having a higher authority tell me what to do. I think teamwork is a valuable asset in healthcare, and don’t understand why people place so much emphasis on being autonomous.

I am just looking for the smartest way to gain HCE and reach my end goal of being a mid-level provider. My girlfriend has a job as a MA in a dermatology lab, with a bachelor’s degree in biology. I thought about trying to find something similar and work there full-time for a year or two to obtain the hours. I know this would not give me the same experience as EMT would.

If I did nursing, I would want to become an RN and maintain that level just long enough to continue on to NP. I would definitely earn more money while doing so, and would be more marketable (I feel like – correct me if I’m wrong here). If you guys were in my shoes, what would you do? A Nursing degree seems much more valuable than an EMT certification, especially since I already have an existing bachelor’s degree which I would like to make some use of. I’m sorry if I keep going back and forth – I am really at a crossroads in life and having trouble sorting this out, no matter how much reading, contemplating, and discussing I seem to do.

VICEDRN, BSN, RN · Dec 21, 2012

I understand. I actually suspect we are similar people with similar natures. I go back and forth and contemplate things too much too!! The trick is to not overthink things. What is the point of getting a "more valuable" nursing degree here? You aren't looking to make more money for very long. The time frame you are talking about is like maybe a year or two. The shorter training of an EMT will make up for that difference.

Hanging on to your "making use of your bachelors" theory is irrational. If you really want that, at least, acknowledge that its an emotional thing rather than a rational one.

As for the bottom of the food chain, I don't think EMTs are at the bottom of the food chain at all. In fact, they get more autonomy then RNs do in many ways! Around here, you won't have all that junior/senior truck stuff someone described. You will have to work BLS at first and then you could work ACLS trucks with a paramedic but you aren't looking to do much more than get HCE at this point and the hours are the same either way.

I am an RN and I agree with your thinking. I would prefer PA to NP because they get more clinical hours, have a rigorous, standardized education, get more buy in from the MDs, and ultimately a mid-level usually practices under the same exact protocols regardless of PA or NP. NP isn't really better off in most states. Further, it is, as you say, flexible when it comes to areas you choose to practice in.

Don't overthink this. Your original plan is awesome. Nursing school is a ton of drama!

VICEDRN, BSN, RN · Dec 21, 2012

PS. You already know you want to midlevel. Its like you are really confused about the destination. Just the journey??

Koko4 · Dec 23, 2012

Thanks for the quick reply VicedRN. I see where you are coming from. It makes sense that the EMT training still seems like a logical choice to gain that HCE that I need. I will still have to take 2 semesters or so of prerequisites, between EMT and PA, to apply for the PA program. I agree that it is an emotional issue to “utilize my bachelor’s degree”. I worked really hard to obtain it, and I just don’t want to see it all go to waste. I suppose that it won’t be a waste when applying to PA school, just during EMT it is unnecessary.

I was originally just going to go for an EMT-B certification, but I found out from my adviser that the state of GA has raised their standards, and you need at least an EMT-A. So that is what the 1-year program is all about, and I suppose that will be more valuable and provide me a better base with which to go to PA school with.

I suppose you are right about the entire destination/journey analogy. I am pretty confident that a PA position would be a good, stable position for me in healthcare, yet it is such a daunting journey! What would you do if you could do it all over again?

VICEDRN, BSN, RN · Dec 23, 2012

Like you, I already had a bachelors degree when I decided to change careers. I wish I had spent the time and money on taking medical school pre reqs instead of becoming an RN. A midlevel provider is not comparable to being a doctor. The general perception is that it is but when you start working in healthcare, you realize that the two roles are really very different.

I am trying to convince myself to get comfortable with the midlevel provider role and follow one of those routes.

There is no way you could effectively utilize the EMT-B. The year long program is definitely the way to go. You'll be riding the truck in no time!

Koko4 · Dec 23, 2012

A midlevel provider is not comparable to being a doctor. The general perception is that it is but when you start working in healthcare, you realize that the two roles are really very different.

I am also under this impression. My entire view of it is that the midlevel provider takes the more standard, straightforward cases, and lets the doctor deal with the "mystery diagnosis" type cases. Could you elaborate on that a bit? I am curious, now. I have not had the opportunity to shadow, which I feel like would give me a better perspective of everything. It's nearly impossible when you work a full-time job and are working 5-6 days a week! But that will all change soon..

VICEDRN, BSN, RN · Dec 23, 2012

I am also under this impression. My entire view of it is that the midlevel provider takes the more standard, straightforward cases, and lets the doctor deal with the "mystery diagnosis" type cases. Could you elaborate on that a bit?.

This is exactly what I am talking about. The physician does not jsut take the "mystery diagnosis" patients. They take anything more complicated than the completely obvious. In fact, many times, your job as midlevel is just playing chart auditor.

Some examples:

Derm: In my experience, a PA/NP can do a shave biopsy but not an excision as this is considered too complicated even though it requires but a few sutures and a local.

Gyn: A midlevel can do a pap smear and pelvic (which a regular RN can do in a community clinic) but not a colposcopy which is just a pelvic with a microscope. C section or delivered by MD but post op visits by midwife/NP. Unstable bleeding following delivery? MD paged, PA not involved.

ER/Trauma: A midlevel can see abscesses, simple sutures, coughs and colds that are stable otherwise but not headaches, abdominal pain, high blood pressure, etc. A midlevel will order trauma labs and scans but only after pt is seen by trauma team. This is something the RNs used to do until joint commission stopped "verbal orders" (and I consider this nothing more than chart auditing as the orders are formulaic.

In patient patients: Initial work ups and orders by an MD but pt then visited by PA. A request to PA would include: Pt's pain not well controlled, can I have orders for IV meds? Pt's blood pressure medication not ordered, can you add order? (Also something I consider chart auditing since we all know what pt might take)

In primary care: Initial diagnosis of high blood pressure by MD. Follow up visit to ensure meds working: MD. Additional visits: PA or NP to review labs and make sure no further issues.

Its not just zebra stuff that MDs do. Its really anything more complicated than common sense stuff. There is plenty of common sense work to do but it really just doesn't strike me as all that sophisticated. In fact, I think its fairly idiot proof.