EC/RN/Paramedics and my Rant

[NurseEllis]

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

[NurseEllis]

nope not to hot, thanks for being respectful!!

so let me recap what you said, the difference i would come out of an online rn based program like ec as a paramedic would be?

from what i hear there is that you (and others obviously) feel is that i would not be coming out of the ec program without the "nursing" process and/or nursing model with concurrent practicum?

what if i told you i just took and passed a class that gave me whole 4 credit hour of college credit on the nursing process/model and passed with a b?

so it sounds like most lpn/lvn just learns the theory and never really applies the "skills" until they get on the job?

so why can’t i learn those same theories/models and take the same certifying rn exam?

what differences with my hospital clinical/patient care experience/college level of education makes me “less of a rn?”

- chris

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?)

[BULLYDAWGRN, RN]

I feel your pain. But if you ever become an RN, you'll see there are plenty of Med/Surge RN's that can handle more than their share of muti-tasking and pt care.

[GoldenFire5]

There are a few Paramedic-to-RN bridge programs out there. Unfortunately I don't have the links at my fingertips, but I know they exist.

[Boston-RN, RN]

Chris,

Actually my post states that if you finish the EC program I FEEL you would have every right to work as an RN (see first and last paragraph). But that is not for me to decide.

What I did comment on in my post is that "skills" were not the focus of nursing school as you would have implied in your original post.

[NurseEllis]

MAnurseHopeful. I understand that skills are not focused on in most RN and LPN schools, and as stated before most come out not even having started a IV or place a foley, which is learned on the job. 95% of the hospitals I have been too and have talked to management in NY, state that most GN come out very deficent in real life nursing skills and most hospitals require GN's to have a "externship" and be oriented to what a nurse job requirments are in each of the departments.

With that said, why are BON's attempting to block non-traditional students. Obviously they have not even attempted to address the issue of GN passing the NCLEX with little or no "real" life experience, but you will attempt to "cull" the herd (so to speak) of bad GN's coming out EC???

[Boston-RN, RN]

Well you would think with the nursing shortage that states would be willing to be more open to non-traditional students. Don't know if they believe their schools are losing money to places like EC. I don't understand the logic either.

I see that EC is changing their format soon, we'll see if that makes any difference with states accepting EC grads.

I worked with an EC grad at a rehab hospital and she was one of the best nurses we had...and I currently work with some 4 yr BSN nurses that have no common sense (ie. giving coumadin with an INR of 4.5 without checking w/MD)

[NurseEllis]

Ya I think it has to do alot with politics and money, the two thing that make our world go round it seems. Just very disappointing seeing the near-sighted viewpoint that some of the BoN's are taking. Well Im glad NYS is were EC was developed and were the school is. I plan on taking my CPNE at albaney and sitting here in NYS for the NCLEX.

[Boston-RN, RN]

Well there are 50 states and only a handful that have issues so that leaves a wide range of places to go. And if you NEED to work in any of the other states, if you work for the VA you can work in any state you want to. The states rules don't apply to the VA hospitals.

[peaparamedic]

Interesting post. No doubt that many BON's are missing the big picture. For the record I am an 18 year paramedic ( never flew but have CCT and 911 experience) with a BS in Business, most of a BA in chemistry and new EC ASN. I am an RN in orientation in a local ER.

While I agree with 97 % of the anti-CA rant I must state that I feel like a new RN. I have a tremendous amount to learn. I do feel that I am everybit as safe as any new grad. Nursing and paramedicine are related but different. The academics in most paramedic programs are focused and intense but many of the paramedics that I know would be unable to compete in broad college level work.

I would like to see each state's RN disciplinary rates for the different catagories of education. I would be hard pressed to believe that EC rates are any higher.

[CSLee3, ASN, BSN, LVN, EMT-P]

Chris, move your butt ot TEXAS!!! We have tons of EC grads (medics to RNs) and our BON doesn't unfailrly jack with EC. In Austin and Williamson County (both named EMS systems of the year) there are several RN/Medics working on trucks and several ER nurses (like myself) that are former medics. Currently I know of at least 10 medics doing EC. Why.....money. I understand the skill level and expertise....BUT....hospitals pay nurses big bucks and EMS will never catch up. I busted my knuckles, hurt my back wrestled drunks, as you well know for a whole lot less than the ER nurses....so I made the transition. BUT that being said, We respect our medics and in return ask they respect the nurses. So, my opinion we work great in my area as a team. One mistake, please don't ever underesitmate the power and knowledge of a good LVN / LPN. Man, there are some good ones and can make your next hospital stay great or hellish!

Rock on and never give up. "RN, EMTP" looks great on a name tag!!

ERDude;)

[aDDctd2sBUX]

In the pre-hospital environment if you need to give perform endotrachael intubation, needle crichothyroidotomy, or other invasive procedures, things are bad and the patient is probably CTD. The benefit to risk ratio is worth it. To have a paramedic doing that inhospital as opposed to a CRNA or MD wouldn't make much sense. Medics serve their purpose in the pre-hospital environment, but are the middle man in getting the patient to definitive care. Most MD's as well as nurses agree that nursing theory is a load of crap. Since common sense isn't so common, however, it needs to be taught.

[NurseEllis]

Ahhh, and we come to the "it is a load of crap but u have to learn it argument"

I guess it is my realism or mabe my road experience as a medic but I have never agreed with that. If it is non-essential in the daily operations of your job or has no barring, then why should it be taught. It is a waste of the teacher/student relationship to teach unesscary information becuase were are in a mindset of trying to "justify" our positions or careers. Nursing has tried so hard to seperate itself from the "medical model" that they are now teach unuseful and irrelevant information (ie "nursing theroy and Dx"). This does nothing for patient care and or the devlopment of the profession.

Lastly, yes I guess I agree with the statement that EMS are in general middle men. But with that said it implys a sense of being less experienced or less skilled at the doing the said intervention (ie, endotrachael intubation, needle crichothyroidotomy). On the contray we must be as skilled as a Anesthologist or CRNA at the procedure to perform it to a standered of care and this done with half the schooling/practium that is taught to MDs and CRNAs. This pressure forces the best ("cream of the crop" so to speak) to the top, not allowing people to just "get by".

They say even if you getting a 60.1% in medical school, you still have MD after your name. Same is true in EMS/Paramedicine, but the outside pressure from everday patient care tends to differentate those who CAN from those who CANT very quickly and swiftly.

-Chris