ER nurses compared to EMT's

Anna57 · Mar 26, 2005

I wished you were working in my ED back when I was on the street.

Spread the word.
Retired Medic - Rambob

RAMBOB, my attitude comes from being an EMT-B and and ER Tech before being a nurse. One thing that I vowed was to NEVER forget where I came from. Yes, I get paid more now... but my goal is the same as it always has been and that is to have the best outcome possible for my patient. Granted, there are days that I get tired of the BS and Frequent FLyers, but then that patient comes in that really needs my help, and I make a difference in someone's life. That is the ULTIMATE reward of this job.

rn29306 · Mar 26, 2005

Second of all, I have RN's that run with me and they are NOT in charge.

On our CCT that also does scene and 911 backup, the RNs take lead when doing interfaq transports and paramedics take lead when doing 911 and trauma. Has worked out very well and all our people are top notch.

RHONDANURSE · Mar 26, 2005

I am an ER nurse, my sister and brother-in-law are paramedics. We are fortunate to work in the same area so we get to see each other a lot at work and really see what each other does. I am totally proud of my sister. She is the smartest person I know. I could never do her job. I like the warm dry cozy indoor controlled enviroment where I can call respiratory, lab, xray, and whoever I need when I need them. She has herself on the back of that truck. She can intubate like nobody's business, I can't, but I can give insulin, and she can't. why would I want to inubate someone? I have a physician and RT in the ER. Why would she want to give insulin? She wouldn't be around in an hour to evaluate the BS. I have seen this fight try to play out many times, often brought up by new nurses who are intimidated by the knowledge and skill of EMT-Ps. And vice versa, by new medics intimidated by grouchy ER nurses (ha-ha).

As for nurses putting in chest tubes, you better be a flight nurse putting my butt on a helicopter and I better have obvious tracheal deviation and hypotension, because if a 3 month old ER nurse comes at me with a chest tube I would be picking up my liver and crawling to another facility. :rotfl:

jemily · Mar 27, 2005

if you do some careful research, you will find that there are a very low percentage of COPD'ers that are actually CO2 retainers. Remember, it's easy to make them breathe again if they stop breating due to high O2 levels.

anubis9727 · Mar 27, 2005

Greetings,

I have been a paramedic for 15 years, and just recently began an RN transition program. The decision was difficult for me because I am VERY proud of what I do, and even though it means more money, its hard to face giving it up. I have always had what I call my "universal law of public service". It can be summed up in four words- WE ARE NOT NORMAL! "Normal" people would run screaming from some of the things I've been required to do in the field. We work on horribly injured patients in the worst sort of environments imaginable, Occasionally with potential death or injury staring us in the face, and then we go grab lunch. My point being this- its an entirely different mindset from being an RN(something I'll have to work on). The system needs those oddballs out there like me, with our "go anywhere, do anything" outlooks, but it also needs the RN who will take my patient and everything I've done for them, and expand upon it to make sure the patients long term prognosis is the best it can be. We work in two entirely different worlds, but where those worlds overlap is the patient, and that should be our primary concern.

(The universal law works for FD and PD also- One is running into burning buildings when everyone with good sense is running out, the other has a job that requires them to carry a gun! "Normal" is entirely in your point of view).

"Why is it when you talk to God you're praying, but when he talks to you you're crazy?" - Roma Downey, "Touched by an Angel"

Rambob · Mar 27, 2005

Greetings,
I have been a paramedic for 15 years, and just recently began an RN transition program. The decision was difficult for me because I am VERY proud of what I do, and even though it means more money, its hard to face giving it up. I have always had what I call my "universal law of public service". It can be summed up in four words- WE ARE NOT NORMAL!
Almost 30 years in the field, I saw the profession go from funeral homes to a BS degree. Yes, you are correct. The mind-set is different. I almost didn't get into Nursing school because they told me "EMT's didn't do well"
Well, too bad for EMT's, I'm a Parmedic with a degree !
At times it was so frustrating. Our school only "skimmed" the surface of many subjects, citing the usual.....
"You will learn more about this once you get a job."
Airway management = 1 lecture and 1 lab :uhoh21:
EKG = 1.5 lectures and no lab :zzzzz
CPR = never reviewed
Simple first aid = none
24 more class days (clinicals included) and it is over !
Oh how I miss the streets :smiley_ab
Good luck and Keep your cool
Bob

TinyNurse, RN · Mar 28, 2005

I agree that all cannot be compared evenly........but a level I coming into your level I trauma center,,,,,,,,,,,,,,,,, a Good paramedic in the ER is your best friend.

nicenurse911121 · Mar 30, 2005

You know I have read all of these replies and I agree with one point- we are all in it to help the person lying before us- why squabble about whos in charge- hopefully we are all proficient in what we do and can work as a team, there is ultimately ONE in charge up above. Have a good day all!

ufmedic · Mar 30, 2005

However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge. ]
1. Most RNs cannot sedate, paralyze, and intubate a patient that is sitting in an upright position while trapped in a crushed car that is in the woods on the side of the interstate. Most RNs simply do not have the training and experience to safely intubate any patient. Paramedics are required to perform a minimum number of successful intubations in school, and then quarterly in most EMS systems. There are numerous studies that show paramedics' success rates for intubation, both with and without RSI, is almost identical to the success rates of physicians.
2. The RN would NOT be in charge. Paramedics and EMT are licensed by their own state regulatory agency, not the state board of nursing. Anyone practicing in the pre-hospital environment on a ground ambulance is required (in GA and FL where I work) to be licensed as an EMT or paramedic, regardless of what other license the person holds. I had to obtain a BSN and pass the NCLEX before I could practice as a critical care nurse. An RN would have to complete paramedic school and pass the state boards before being in charge of a ground ALS ambulance.

ufmedic · Mar 30, 2005

Being both a nurse and paramedic, I don't know why there are so many nurses that look down on paramedics. Paramedics undergo extensive and rigorous training (taking about 2 years to complete when you add in the pre-requisite EMT training). Paramedics recieve in depth pathophysiology, pharmocology, patient assessment, and critical thinking. The major difference is that EMS training focuses on emergencies (imagine that) and nursing is more holistic. Paramedics are not unlicensed assistive personnel. They are licensed by there own state regulating agency (the department of human resources in GA, and the Dept. of Health in FL). Many paramedics have at least an associate degree, and many have a bachelors or graduate degree. I myself had both a bachelor's and a master of public health before I ever thought about going back for my BSN.

We are all here to do the same job: provide competent, safe, and effective patient care. Not every health care provider on the planet falls under the scope of the state board of nursing. Emergency Medical Services is it's own profession, just like respiratory therapy, physician assistants, nuclear medicine technologist, and dieticians.

RoxanRN · Mar 30, 2005

I have been a paramedic for 15 years, and just recently began an RN transition program. The decision was difficult for me because I am VERY proud of what I do, and even though it means more money, its hard to face giving it up. I have always had what I call my "universal law of public service". It can be summed up in four words- WE ARE NOT NORMAL! "Normal" people would run screaming from some of the things I've been required to do in the field. We work on horribly injured patients in the worst sort of environments imaginable, Occasionally with potential death or injury staring us in the face, and then we go grab lunch. My point being this- its an entirely different mindset from being an RN(something I'll have to work on). The system needs those oddballs out there like me, with our "go anywhere, do anything" outlooks, but it also needs the RN who will take my patient and everything I've done for them, and expand upon it to make sure the patients long term prognosis is the best it can be. We work in two entirely different worlds, but where those worlds overlap is the patient, and that should be our primary concern.

Congrats on continuing your education. I've been in pre-hospital for 18 years (11 as a paramedic - AAS/EMICT). Nursing was a childhood dream which was sidelined when I found out how fascinating an ambulance was. I returned to school the summer of 2001 to get my nursing degree and had a blast doing it. I probably found lecture easier than most in my class as my paramedic class touched at least the surface of most of the disease processes. I was able to concentrate on the "deeper" issues. EKG/cardiology and IVs were absolute no-brainers (tried not to snore to loudly in class :sleep: ) It also got interesting when I couldn't help but call a guest lecturer on inaccurate ACLS information she was presenting. :nono:

I found clinical time to be rather boring. I didn't get fun/challenging until the last semester when we were required to take entire teams of patients (4-6, sometimes up to 8).

You will also find as you go through school, your thinking in the pre-hospital environment will change (difficult to explain how - you'll know when you experience it). But on the same token, your thinking and patient evaluations in clinicals will be greatly influenced by your pre-hospital way of thinking.

Good luck and have fun!!!

Roxan

EMICT, RN

RoxanRN · Mar 30, 2005

However, I would say anything that a EMT/Paramedic can do an RN can do. The only difference is that the EMT is out on there own, if there were RN's who worked with them, then the RN's would be in charge.

I have yet to see an RN be able to put on a KED, extricate from a crush, overturned car, place a Hare Traction splint and be off a scene in less then 10 minutes - much less place an EJ and intubate upside down and with only the light of the pen light held in your mouth (not trying to say EMT-P is better than RN - just been there, done that, haven't seen a nurse do it yet). Yes, I'm justified in that statement - I hold both licenses (preparing to be flamed).

In any of the services (KS, OK, MS) I've worked on, an RN must have protocol APPROVED by the service medical director to be able to practice at an ALS/RN level. Otherwise they were relagated to EMT-B or First Responder levels of practice (depending on the local protocols). I have never worked with a "plain" RN on the ambulance. They have all had EMT-P attached to their alphabet.

This is such an age-old argument, to get into it would be opening a can of worms the size of Africa.

Roxan

EMICT, RN