RN to Paramedic Bridge Course

getoverit, BSN, RN, EMT-P · May 28, 2010

No, I'm saying that a RN with critical care experience, and field experience as a basic on high volume of critical calls will most likely be knowledgeable, confident and comfortable working as an EMT-P.

For the most part, I disagree. If you're talking about calls like ACS, CVA, acute abdomen, etc then yes, an RN would probably feel comfortable working like an EMT-P. But no amount of nursing critical care experience will prepare a nurse to perform a rapid sequence induction and secure a difficult airway, unless they have somehow been trained extensively on this. And most nurses I work with would defer to the more experienced provider when a difficult airway presents itself. Also, there is a lot of equipment that a nurse wouldn't have any reason to use unless they were experienced on an ambulance too. Even things as simple as a KED or a stair chair can be very confusing if you have to apply them single-handedly. Not to mention extricating someone from an MVC, things like scene safety have to be learned through exposure.

A nurse could probably gain the experience quickly with help from a paramedic partner, but without that experience a nurse would more than likely be at a disadvantage working as a paramedic. the same thing is true about a paramedic that believes they are ready to step into an ICU and work as an RN.

GilaRRT · May 28, 2010

Sorry, field experience as a basic is not ~ to medic regardless of having RN credentials.

SteelCity_RN · Jul 22, 2010

Is anyone aware of any RN to Paramedic programs on the east coast? I know someone said ohio but from an earlier post it sounds like that is Paramedic to RN. Any help would be appreciated. Thanks!

ZippyGBR, BSN, RN · Jul 30, 2010

I'm sure in other stats or hospitals RN's can intubate....I'm sure this is something that requires many supervised successive intubations by an MD.

the issue with intubation is sufficient practice under supervision while acquiringthe skill and then maintaining currency, this is an issue for everyone but anaethestists really, in the Uk there is a lot of debate whether intubation should remain a core skill for All paramedics and whether intubation should be undertaken by doctors without extensive anaesthetics experience and current exposure ( i.e. anaesthetists, intensivists and Emeregency medicine).

i can intubate but I haven't had sufficient initial experience to consolidate the skill and wouldn't get enough experience in either my in hospital or prehospital roles to maintain currency.

TraumaSurfer · Aug 10, 2010

For the most part, I disagree. If you're talking about calls like ACS, CVA, acute abdomen, etc then yes, an RN would probably feel comfortable working like an EMT-P. But no amount of nursing critical care experience will prepare a nurse to perform a rapid sequence induction and secure a difficult airway, unless they have somehow been trained extensively on this. And most nurses I work with would defer to the more experienced provider when a difficult airway presents itself.

The training and education Paramedics get about intubation and RSI will vary from state to state and school to school. In some states RSI is not even allowed for a Paramedic because of the meds which the RN's scope of practice may have no issue with. Yes there are a couple of states that do limit the scope for RNs and intubations but there are many more that do allow it.

In Paramedic programs some students do not even get the opportunity to intubate a human and are often checked off on the manikin. In some areas a Paramedic may not do more than one intubation per year and there are Paramedics who have not intubated since they left Paramedic school. The same may also be true for starting IVs. Just the title of Paramedic will differ from state to state as will their hour of training, scope of practice, protocols and experiences with the many different agencies.

As ZippyGBR mentioned in the previous post, intubation is also being debated here in the U.S. EMS systems for many reasons including the lack of maintaining competency and how much time is spent trying to get a successful intubation on scene especially when it compromises compressions during a code.

If an RN has been working in an ICU or ED, they have probably assisted with dozens if not hundreds of intubations utilizing RSI while also juggling multiple other drips and multi-tasking many other responsibilities. RNs who enter a credential program such as PHRN/MICN or become part of a Flight or Specialty team will be more likely to have much more chance to intubate than Paramedic student or even a Paramedic working in the field. Our RNs who do intubation as part of their job description generally have no problem obtaining the require 20 tubes per year. You may also find RNs intubating in L&D and nurseries in some hospitals.

It would be totally impractical to teach hundreds of RNs in a hospital to perform a skill and expect them to maintain competency just as the debate is with having too many Paramedics on scene who do not get an opportunity to do their skills very often. There are also many other health care professionals that can intubate and that is their responsibility during a given situation while the RN has a set of responsibilites. Not everyone can be fighting for the head of the bed.

Also, there is a lot of equipment that a nurse wouldn't have any reason to use unless they were experienced on an ambulance too. Even things as simple as a KED or a stair chair can be very confusing if you have to apply them single-handedly. Not to mention extricating someone from an MVC, things like scene safety have to be learned through exposure.

Most of the equipment will be covered in an EMT-B course. If you review the curriculum from your local Paramedic programs, you will find there are not that many hours devoted to extrication and especially those that require a lot of equipment for complex extrication or rescue. There will usually be FFs present for organizing the extrication. When you work in an ambulance you will also have a partner and no one is expected to do it all single-handedly. A nurse who is interested in emergency medicine should not be overwhelmed by a stair chair or KED if they have been through an EMT-B course.

Prehospital medicine is another specialty that can be easily mastered by RNs who have a desire to do so. RNs have proven they can branch out into almost any specialty and adapt because they have the base education to build from. It doesn't take re-inventing the wheel. The RN should be in a program that compliments and builds upon their present education and experience. Many Paramedic programs in the U.S. assume you have no prerequisite education except for EMT-B. An experienced CCU RN would probably find reading about Sidney Sinus node or Vance and Virginia Ventricle a little frustrating. Nancy Caroline's book is still a widely used text for Paramedic training. The A&P contained in this text may also be the only material required for that subject.

http://books.google.com/books?id=f3ePQZDXpwwC&pg=PT441&lpg=PT441&dq=Nancy+caroline+sidney+sinus&source=bl&ots=E1Ih3do34b&sig=f3_1fntEzzsFvsbrRSLU59zJEJ8&hl=en&ei=P2JhTNm1CoLUtQPc9ZyiCA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBIQ6AEwAA#v=onepage&q&f=false

However, I do agree that being precepted in any work environment by someone experienced in that area is extremely valuable instead of just being put on your own as a lead.

edogs334 · Aug 19, 2010

Is anyone aware of any RN to Paramedic programs on the east coast? I know someone said ohio but from an earlier post it sounds like that is Paramedic to RN. Any help would be appreciated. Thanks!

Hartford Hospital in Hartford, CT has/had an RN to Paramedic bridge program (at one point, I think). Here's the link:

Untitled Page

edogs334 · Aug 21, 2010

In terms of other programs on the east coast- there are several community colleges and other institutions that offer the RN to EMT-P bridge program in Virginia. You can find information about upcoming bridge programs by following this link:

https://vdhems.vdh.virginia.gov/ded/courseap.startup

Select "ALL" for "Regions," then select "RN Bridge to P" for "Level" and click on "Search."

Mayren · Oct 13, 2010

why would you give up being a nurse to become a low paid parametic? In los angeles, there is no reason to do such a thing. Besides, here, most parametics are firemen.....

its a paramedic not parametic. You forget that "paramedics" perform surgical procedures that rn's are not able to to in the field. Medics work more with traumatic injuries that may result in fatalities if it were not for the quick response and kiss ass attitude. Although we do report to an md for certain drugs, for the most part we make all the calls. I myself am both and honestly have felt more alive working for fire rescue than i ever have as a nurse. Why did i become a nurse? Obviously to make a little more money but the job will never be as exciting as the fire dept. Bottom line is, do what makes you happy in life. You can make plenty of money as a firefighter by simply switching shifts with other people. Before you know it you can make $120,000 in a year, i know this for a fact because i did.

TraumaSurfer · Oct 13, 2010

You forget that "paramedics" perform surgical procedures that rn's are not able to to in the field.

What "surgical" procedures are you talking about? Flight RNs can preform every "skill" that a Paramedic can. They can also manage many more pieces of equipment and medications which Paramedics can not. They can also do other invasive procedures such as UAC/UVC and chest tubes which a Paramedic can not due to limitations in their scope of practice.

Medics work more with traumatic injuries that may result in fatalities if it were not for the quick response and kiss ass attitude. Although we do report to an md for certain drugs, for the most part we make all the calls. I myself am both and honestly have felt more alive working for fire rescue than i ever have as a nurse. Why did i become a nurse? Obviously to make a little more money but the job will never be as exciting as the fire dept. Bottom line is, do what makes you happy in life. You can make plenty of money as a firefighter by simply switching shifts with other people. Before you know it you can make $120,000 in a year, i know this for a fact because i did.

Obviously you are a firefighter and don't have much experience as a nurse or maybe just in a very limited area. You feel you must defend your position as a really exciting firefighter by downplaying what a nurse can do. You seem have very limited knowledge about what a nurse does and probably are not qualified to give advice except for the ass kissing attitude part which firefighters practice everyday with their superiors, politicians and the unions especially at election time.

Originally Posted by qwiigley
why would you give up being a nurse to become a low paid parametic? In los angeles, there is no reason to do such a thing. Besides, here, most parametics are firemen.....

In California, most firefighters are Paramedics because it only requires about 1000 hours of training and only 40 ALS patient contacts which can be as little as an IV or a 12 lead performed if the service even does that. Many don't even do 12 lead EKGs and if they do, they rely solely on machine interpretation. In California, LA is a great example of that because it is too much trouble to teach over 2000 FD Paramedics how to look for ST elevation. Since FFs may be required to have the Paramedic cert at the time of application or within 1 year of hire, the FF really doesn't need to have an interest in patient care but rather just meet the minimum requirements for the job and that is not all that difficult to do. This is not only true of California but many other states as well which are largely Fire based EMS. But, California is not the state to boast what a Paramedic can do since they have one of the most limited scope of practice of any state which is why RNs are used for Flight and CCT as well as at hospital base stations to read the protocols to the Paramedics.

However, there are those who prefer to fight fires, sleep, watch TV, go shopping, and hang at the fire station fixing up with new recipes for what to cook the guys rather than being at the beside doing patient care to several patients for 12 hours without a break. A private ambulance will probably transport the patient so the FFs can go back to cooking and sleeping. The benefits with the FD are great even at the expense of a city closing schools or filing bankruptcy while trying to fulfill those benefit and wage requirements. There are also not many jobs, especially not in nursing, that allow you to work back to back 24 hour shifts or over 9 straight as some of the headlines have indicated in some cities. Making over $200k while sleeping sounds like a great deal and if a nurse is tired of doing patient care then they should consider being a FD Paramedic.

mmutk, BSN, RN, EMT-I · Oct 17, 2010

Being a FF/EMT prior to being a nurse I must agree with the above post. And benefits were better with the city than the hospital.

Ace587RN, RN · Oct 18, 2010

Lots of good information in this thread :). Im also an ED RN looking into pre hospital medicine just to volunteer at my local FD. im from FL and i was told i could challenge the paramedic exam after getting my EMT. Anyone else from FL here? i have BCLS, ACLS, PALS, TNCC already

TraumaSurfer · Oct 18, 2010

Lots of good information in this thread :). Im also an ED RN looking into pre hospital medicine just to volunteer at my local FD. im from FL and i was told i could challenge the paramedic exam after getting my EMT. Anyone else from FL here? i have BCLS, ACLS, PALS, TNCC already

Yes you can challenge the Paramedic after EMT. All the info is on the DOH website.

EMS Home

The exam is only the written part and what makes it different from the NR is it asks specific questions about state specific trauma, DNR and IFT protocols which can also be found on the website. Definitely read the statutes also.

Division of Emergency Medical Operations - Home

If you feel you need a quick review, take a cheap Paramedic refresher course at one of the community colleges or state votechs. Don't pay a huge price at the private medic mills. You can also find a refresher online.

EMS Free Course Search

Testing and Training Resources - Bureau of Emergency Medical Services

If every FF in Florida can pass the test, a decent ED RN should be able to.

The EMT will give you the basics of the ambulance. The only skill you might fall short on is intubation but many student Paramedics don't get that opportunity either. You will find there are practicing Paramedics who have never intubated or haven't since doing one in school. If you get on with a decent flight or specialty program after some ICU experience, they will get you into an OR or ED to get some intubations.

I also recommend taking a basic and advanced burn courses through a burn center and taught by burn RNs and doctors. Of course for EMS you might have a simpler protocol for burns but if you do CCT or Flight with the RN credential, you may expected to do more.