EC/RN/Paramedics and my Rant

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Specializes in ICU.

i did not want to highjack any of the other threads with my concerns/rants, but i just have to get this off my chest. i have been reading a lot about ec and how specifically how ca bon has rejected ec grads. also several other states will only let lvn's that do the rn transition program thought ec gain reciprocity in there state.

my rant:

why are paramedics completely left out of the picture??? i'm sorry maybe i'm skewed in my view, by my skills/standing protocols right now are 200% above and beyond a lvn/lpn in any state.

i perform;

endotracheal intubations, digital intubations, start iv's, start interossous (io) when needed, start nasogastric tubes for gastric levage, have 40+ iv/im medications on standing order that i give based on my clinical judgment, formulate a dx, and tx the patient all with no medical (md) control or order. i can decompress someone with a pneumothorax, i can start a needle cricothyrotomywith upper airway obstructions, and yes i can even do surgical airways in the desperately ill patients. this is all based on the national standard for a paramedic that is trained in medicine. i have to established pt repore to be able to do anything with any patient. on a average day i have 10-12 patient contacts (45mins-1hour each) and i work 5-6 six days a week, on average i see 100 patients a month and i have been in ems for 8 years (for you math freaks yes that is 9600 patient contact hours).

here is my local protocol;

http://srems.com/site/protocols/als_protocols-2004_revisions_cpap.pdf

now what lvn/lpn can say they have anywhere the experience/patient contact that i have had over the last 8 years. ohhh and to top it all off, i have a b.s. in biology (northern arizona university) and a a.a.s (broome community college) in paramedicine!

as a paramedic in the field, i function comparable to a experienced ccu or icu rn. i function with in protocols (rns following a md's orders) and make my clinical judgments based on my assessments (a rn working within parameters in a ccu/icu to manage a patient)

forgive me for being a little upset, but why is my experience not up to parr with a lvns/lpns, because i have never given a patient a bed bath, packed a grade iii decub, or help a patient to the bedside comode?

i bring this up because most states except for ca are letting ec grads in if they were lvns/lpns.

and now on to my next point, why if i have graduated from ec, sat for the same exact nclex-rn as ever other rn, hired in ny worked 3-4 years in a ccu/icu/er and then try to gain reciprocity from ca they will deny me??

that my friends is a load of crap. if in 4 years i have not had my privileges suspended or revoked by any state board of nursing, why on gods green earth would i not, be an "acceptable" rn, i have demonstrated my knowledge by taking the standerized nclex-rn and demonstrated my proficiency/clinical skills in another state for many thousands of hours, yet that is not acceptable?

further because i take a "non" traditional rn school a "traditional" rn grad is better prepared for patient care, this i guess i highly disagree. i would pit my patient care/assessment up with any rn at this point functioning in a critical care area. i may not have the clinical experience to set up a swan/ganz catheter, or help a new resident start a central line in the icu, but my independent assessment and patient care is equal.

so again i state.............how can i not take my clinical experience in the field, learn/gain knowledge into nursing theory/hospital operations and then apply that in hospital. how is that any worse than a gn coming out of any nln rn school in the us (which by the way ec is a nln certified nursing school!)

my purpose is not to start a pissing war with the lpns/lvns (although i know i will have a few flamming me) on this board but as most of the public, people are just not educated on the level of profecience of a paramedic or even how ems operates (i still have some er rn's asking me "you can do that!") just a little food for thought.

thanks for listening to my rant

chris

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I think you're right; a flame war is likely with this post. The CA decision regarding EC was based on the language of the nursing practice act; which requires clinical instruction to be concurrent with theory. While EMS and nursing share some skills and methods, the conceptual models are quite different. Nursing education, esp at the ADN level, is based on processes rather than specific skills. LVN's are actually more familiar with nursing theory, and are better qualified to provide care in an inpatient environment. EMS skills, while invaluble in stabilizing critical patients; do not translate directly to nursing practice. FYI; I am a 25+ year paramedic, Excelsior graduate, and now an RN.

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As EMS personnel, we're not completely left out of the picture. You'll be licensed in NY if you apply there after graduation/NCLEX. I am licensed in Texas. A few states have some restrictions, but not most and not ours.

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You state a good case and should address it to Excelsior College. They have been backing off for years in limiting their program more and more in reaction to the pressure placed upon them by the politics in individual states.

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Specializes in Tele, Home Health, MICU, CTICU, LTC.

The part that angers me the most is that after several years of experience as an RN we can still not be licensed in California. It would be laughable for me to go to a nursing school and say "Gee I need to start all over again because California doesn't approve of my nursing school and I want to work in California."

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Specializes in Not enough space here....................

my rant:

why are paramedics completely left out of the picture??? i’m sorry maybe i’m skewed in my view, by my skills/standing protocols right now are 200% above and beyond a lvn/lpn in any state.

forgive me for being a little upset, but why is my experience not up to parr with a lvns/lpns, because i have never given a patient a bed bath, packed a grade iii decub, or help a patient to the bedside comode?

thanks for listening to my rant

chris

the one thing that distiguishes nursing from being a paramedic is the nursing process. if you do a search, you will find stories about md's who have gone through nursing school "just for the experience". believe it or not, but they learn quite a bit. it's called "nursing theory" and it isn't about performing tasks. the entire reason why lvns/lpns are required to return to school is because they do not "in theory" know those critical thinking skills (at least those who have been in practice for years don't get to have credit for knowing those critical thinking skills.....) that give you the edge in knowing which new mom needs to know what in regards to breastfeeding her new infant, or when grandma is ready to transition from fighting for her life to hospice care.... et cetera

you are making me be afraid to have you take care of my mother. i would have to take time off of work just to sit by her and hold her hand while she was recovering from her heart attack in the icu while you performed highly skilled procedures and then left the room for her to try and figure out how to use the bedside commode on her own. i cannot think of one lvn that i know of who would put my mother in that position - because they were taught the nursing process.

i'm sure that you will be an ace in the emergency setting. but nursing is not about the glory.....

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Hey Chris,

I understand where you are comming from on this one. I had a VERY hard time getting a grip on the Nursing process while in my LPN program. I am sure your skills are great and you would be a fantastic ER Nurse, But RN covers ALOT more than ER. Even though you may only work ER, you would be an RN and that covers all of it. It would and is very hard to explain for me on here, it is one of those things where you just don't or can't get it unless you have done it. I was an EMT many years ago, then an LPN and now RN grad. from Excelsior. I can and do understand why many states want only the LPN's. As for California, look at the sorce, 90% of the crazies live and run the place. Arnald as the Gov. gimme a break.

Tom

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Specializes in Not enough space here....................

sometimes....out of the mouthes of babes. sigh. thank god the crazies came up with the staffing ratios. maybe no other state is crazy enough to follow?

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sometimes....out of the mouthes of babes. sigh. thank god the crazies came up with the staffing ratios. maybe no other state is crazy enough to follow?

hardly a babe. i do think the staffing ratio was a great idea, arnold....um nooooooooooo. if you like ol cali..good for you and i'm happy for you. i lived there at one time--never again.

tom

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Specializes in ICU.

why would you be afraid for me take care of your grandmother? if she is in icu/ccu most likely i took care of her in the pre-hospital environment. stabilized her and transferred her in a professional manner implementing standardized medicine to stabilize her based on my assessment skills (critical thinking skills), but you would be concerned if i took care of her in the icu because you think i would walk away from her when she needed to go to the bathroom? do you not think i talk/take care of my patient in the pre-hospital environment? do you think that patient never have to go to the bathroom in the field (that is laughable, because if you know anything about increased stress, you know that not to be true)? do they stop having needs because they call 911? i'm pretty sure they don't.

if you don't think i don't use "nursing" skills in the field i challenge you to ride along with our local ambulance to get a sense of what really happens (again i even have er rn's clueless about what we do in the field).

let me ask this question, when you or your loved one is in a critical condition or in a desperate time of need, as in cva/ami/cardiac arrest, who is the 1st person you call? that would be 911? i'm pretty sure a paramedic would arrive at your door. and you're telling me you are scared for that person to take care of your grandmother?

okay so now you say that all i'm in this job is for the "glory." i'm having a hard time seeing that, because i'm paid 30k a year to deal with the blood/guts/puke/crap in a thankless job, that let me state, a service that ever one demands we have. go to any community in the us and state "we are going to get rid of there ambulance/911 system and the highly trained personnel that run those ambulances" and then stand back to watch the fire works. not going to happen.

what if i told you in my aas degree, the same degree as most lpn's receive, that i spent 1200 clinical hours in-hospital spending 400 hours in the er, 100 hours in ob/gyn, 300 hours in pediatrics, 200 hours on the med/surg floor, 100 hours in the or, and 100 hours in phlebotomy/lab/autopsy's. working right along the same precepting rn's that all the nursing schools use. learning the same patient care techniques/nursing skills as those lpn's and even more!

now i ask you how is my clinical worse, because i didn't learn concurrent nursing theory behind my clinical skills. i really beg to differ.

what is the nursing theory; it is what i call critical thinking skills (adpie)

assessment

dx (nursing dx)

planning

implementing

evaluating

that in my assessment is what the whole nursing theory revolves around. but because i didn't learn this specific critical thinking process i would put your grandmother in jeopardy in a hospital environment?

the two for me just don't connect. what i tried to convey is that i have 'as good as' clinical assessment skills/critical thinking skills to take care of patient that is at par with any lpn/lvn, and even some rn's.

i'm the 1st person you call to take care of your dieing grandmother at your house but i'm clueless when it comes to taking care of her in the hospital. doesn't make sense to me......................

again you state that "the entire reason why lvns/lpns are required to return to school is because they do not "in theory" know those critical thinking skills."

so i cannot go to the same school and learn those same theories in school? and how (please provide proof) does that make me any less of a rn when i graduated from the same nln certified program, took the same cert exam (nclex) and work in the same hospital environment gaining the same rn experience?

what i meant by putting down what i'm trained to do is not to show that "hey i'm a bad ass, and can do cool stuff in the field," it was to show that i have been highly trained in patient care too:

assess a patient based on there current s/sx

dx using the evidence i have accumulated

plan on how this will affect pt outcomes (goals)

implement those procedures

evaluate those procedures and determine if those outcomes (goals) have been met

sounds an awful lot like the nursing process doesn't it?

and along those lines that stated i would be a good er rn. i'm 150% sure that any er rn can 'smoke' any floor med/surg rn when it comes to patient care/multi-tasking/patient care skills.

again this isn't by any means a flamming post, to me this is a logical well formulated agrument, and if you disagree (with my posts) please do so, that is what discussion/informed debate is for. please keep the personal/side attacks out of this thread

thanks

chris

the one thing that distiguishes nursing from being a paramedic is the nursing process. if you do a search, you will find stories about md's who have gone through nursing school "just for the experience". believe it or not, but they learn quite a bit. it's called "nursing theory" and it isn't about performing tasks. the entire reason why lvns/lpns are required to return to school is because they do not "in theory" know those critical thinking skills (at least those who have been in practice for years don't get to have credit for knowing those critical thinking skills.....) that give you the edge in knowing which new mom needs to know what in regards to breastfeeding her new infant, or when grandma is ready to transition from fighting for her life to hospice care.... et cetera

you are making me be afraid to have you take care of my mother. i would have to take time off of work just to sit by her and hold her hand while she was recovering from her heart attack in the icu while you performed highly skilled procedures and then left the room for her to try and figure out how to use the bedside commode on her own. i cannot think of one lvn that i know of who would put my mother in that position - because they were taught the nursing process.

i'm sure that you will be an ace in the emergency setting. but nursing is not about the glory.....

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

I agree with Chris. I haven't seen one former-paramedic-turned-RN that wasn't a darn good nurse. Sorry, but it's true. They make really good ER & ICU nurses.

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Specializes in LTAC, Telemetry, Thoracic Surgery, ED.

chris,

i agree with you that if you take and pass the same nclex-rn as anyone else and have meet the requirements you should be able to be and rn in any state. with that being said:

"im sorry maybe i’m skewed in my view, by my skills/standing protocols right now are 200% above and beyond a lvn/lpn in any state."

this comment is what the difference is. we learn "skills" in the lpn/lvn program but nothing comparable to what you learn as a paramedic and you sound awesome at what you do.

as lpn's we are drilled over and over for the entire length of the program about the nursing process...care plans, care plans, care plans.....nursing diagnosis adpie etc. so while you're saving people from dying (which is obviously something you should be proud of) nursing is dealing with the "holistic" person. some of us came out of the lpn program never have inserted a foley. the actual "skills" are something you end up learning on the job.

do i agree you should be treated differently after you have taken the nclex-rn and met all the testing/school requirement......no. and it sounds like you'd make a great er nurse and if i were in trouble, i'd be happy to have you care for me.

(there's my flame...was it too hot?)

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