Would like to be a PHRN. Which to get first... RN or EMT-P?

Trauma Columnist · Sep 14, 2013

I live in IL where PHRN is a license. I've been a PHRN x 14 yrs and volunteer on my rural fire dept/EMS squad. I was an RN for 5 yrs when I became aPHRN. I think I would find out what the requirements are in FL. I would just do the RN and skip the EMT, paramedic route as RNs have more flexibility and greater opportunities.

burnrn85 · Sep 14, 2013

I am not from FL but can speak from my experience. I did RN/BSN and then went back for my EMT-P while working as an RN in ICU. The flight programs in my state require 3 years experience as an RN in ICU or ER. For flight medics, 3 years of ALS. I knew I would make more working as an RN and could get the medic education while obtaining the RN experience. It made me more marketable for positions when I applied and I can fly as a medic, but get paid as an RN. Both skill sets are important but the mentality is different. For me, the medic education was easy since I already had nursing training. Applying it in the field is what takes time. But I imagine its probably a similar experience for medics who pursue nursing.

echoonethree · Sep 14, 2013

I can't seem to find any state regulations on pre-hospital nursing, aside from flying, and it looks as if the state only has EMTs and EMT-Ps (and the last I heard, that was the way the NHTSA was heading, anyway). If job searches are any indication, CCU surface transport requirements are left in the hands of the employers as far as required certifications.

Rob

Trauma Columnist · Sep 14, 2013

That could be. There are only a handful of states that have PHRNs.

TraumaSurfer · Sep 15, 2013

Florida does not have the PHRN. But, the state does have an outdated rule about RNs needing the EMT or Paramedic cert for some types of prehospital or out of hospital transports. To make this easier, the state allows RNs to challenge the Paramedic cert after they complete the EMT. There are also accelerated EMT classes. For flight and CCT transports the RN will operate by the nursing scope of practice which is broader and easier for the medical directors to design appropriate protocols.

Since CCT and Specialty teams are highly specialized and require extensive ICU experience, the more appropriate certifications should be required. PHRN might be too generalized or basic for many Crittical Care transports.

FLTRN70 · Sep 15, 2013

Hi echoonethree,

You’re search for more detailed information is a common one and I can sympathize with you.. I had the same question some 20+ years ago as I struggled the with the same decision.

I’m a flight nurse and am originally from Florida. I began both my EMS and RN careers in that state.

I’ve already read the posts above and it looks like there’s some really great opinion and advice here from your colleagues.

I do especially agree with burnrn85 . I followed a track very similar to them but completed EMT-B and worked the field about 4 years in a busy 911 system while lumbering my way through my A.A. and on to my BSN. I then went back for my EMT-P some 4 years after working in level one trauma centers and ICU’s.

I just want to go on record as saying, even though my credentials include EMT-P, I have never worked in the field as a paramedic and am cautious of not making the mistake of thinking I have the experience of those EMT-P’s I currently work side-by-side with. In reaching this point in my career, I’ve heard an abundance of controversial and needless chatter back and forth as you mention and I think it’s important to say that I have an incredible amount of respect and admiration for those medics I now work with. They’re very gifted and incredibly intelligent. I’ve learned so much from them. You’ll learn a lot if you begin your career as an EMT-P.. You’ll learn a lot differently if you begin your career as an RN.. Later, you’ll find a balance between the integrated practice of both fields and it’s very wise of you to be looking into that now but don’t overwhelm yourself.

Whichever way you choose, I’m sure, will be a path you don’t regret. It’s a fascinating field (PHRN) and one, regardless of whether you’re an RN or EMT-P first, that will challenge you daily.

Can I ask you what particular area of PHRN you plan on working? I’m in California now and they have (MICN) Mobile Intensive Care Nurse here as well as PHRN Liaison RN’s that staff the radio rooms of trauma centers. There are so many options, I was curious what you’ve been looking into..

TraumaSurfer · Sep 15, 2013

Hello,
This is my first post here after lurking for a while. I've done quite a bit of searching, both here and in Google, and can't seem to find a real answer. I want to pursue pre-hospital nursing and need some advice.
I'm planning on entering the nursing pre-req program at my local community college in January, but I want to know if this is the best fit for me. Which should I pursue first... my RN, or my EMT-P? I've read the arguments for and against RN to EMT-P bridge programs (and vice-versa), and it seems as though all the constructive arguments turn into figurative genital-measuring contests about which skillset is more important/difficult/etc.
May I please have some real advise from PHRNs that have actually BTDT? BTW, I live in FL. Thanks for your advice!
Rob

Let's look at this realistically and from a more employability stand point.

What exactly is your goal as a PHRN?

In Florida as in other states, RNs who work outside of a hospital are usually CCT (Critical Care Transport) from ICU/ED to another facility usually of a higher level of care or to and from a long term ventilator or trach facility, Flight nurses or Specialty team members.

To be a Specialty team member such as CVICU, Pediatric or Neonatal you will need extensive experience in that unit and be trained in that unit. Many of these units now are looking for RNs with a BSN to start. The same for hospital based flight teams which do a lot of interfacility critical care transport. They want you to have extensive ICU experience and to see that you can handle yourself in any emergent situation which can occur with a patient and the technology attached. Skills like intubation can easily be taught to an RN on any of these teams and with greater access to performing the skill along with many other skills which the Paramedic might think is only unique to them. This will include cardioversion, central lines and IOs.

Since over 50% of the over 3 millions RNs in the US have a BSN and are forward thinking to reaching over 80% within the next 10 years, it is wise to keep on for a BSN. There are also many, many BSN programs in FL so the competition is stiff. But, it is easier to get into a good 4 year college BSN program than an ADN which could have up to a 5 year wait with no promise of a job afterwards. There is no nursing shortage right now and it is very competitive to even get a job as an RN and definitely one in the ICUs or ED. Those with just an ADN may not get a job in an ICU which will give you the necessary experience.

Bridge programs were around in the 1980s when there was a shortage of RNs. As I stated, there is no shortage now. It would be a waste of time to get an Associates degree as a Paramedic and then do at least 2 more years for just an ADN. The idea of bridge programs are talked up on EMS forums because an EMS cert does not take much to get and then something like the Excelsior or bridge program seems like another easy way to big bucks especially since some believe the Paramedic is a higher level with much skills than an RN. Simply not the case with the knowledge and experience base being very different. Also, too shortcuts don't look good either to an employer especially in today's competitive field for any type of employment.

Now for Paramedic. Florida is very much a fire based EMS state like many other states including California. Unless you work for a fire department as a firefighter, you probably won't see much action on the 911 calls. Private Paramedics are not big in Florida and are usually running second to the FF/Paramedic. You will find RNs on flight doing scene responses in Florida but you will not find them working just as RNs for the fire department or any other first response ambulance. I doubt if there are even any volunteer ambulances left in Florida since that is an all ALS state according to their taxing agendas at myFloridia.com

California is also a fire based EMS state.

If you really want to be a PHRN you might try Pennsylvania.

http://www.lyco.org/Portals/1/EmergencyMedicalServices/Documents/Prehospital%20Scope%20of%20Practice%202011.pdf

But, there are still many opportunities in Florida depending on what you want to do and if you get a BSN. But, if you just want to run prehospital 911 type calls, you may need to consider looking at becoming a FF and Paramedic.

MICNs are great in California but they are best utilized as liaisons for the county or Fire department EMS systems. They do make the best educators there.

Florida right now only certifies EMTs and Paramedics.

EMTs take the NREMT.

Paramedics take the Florida State exam regardless of being NREMT-P from another state.

RNs challenge the Florida exam after the EMT.

http://www.doh.state.fl.us/mqa/emt-paramedic/faq-certification.htm#Q5

In other states, the RN might also be able to challenge the NREMT exam (like PA). But, for Pennsylvania, the RN will be a PHRN and will work under that scope of practice which exceeds the Paramedic as state in the earlier link.

Altra, BSN, RN · Sep 17, 2013

I echo what has been said above. IF your state utilizes RNs in EMS or HEMS, high acuity ICU experience is required. If flight nursing is your goal, whether in FL or in another state, I'd focus on RN education, preferably BSN, and obtaining ICU experience. And realize that you may spend some time in another area of nursing (med-surg, surgical, tele, etc.) prior to being able to land an ICU position.

Good luck to you. :)