EMT-B and RN: Scope of practice limitations

[CamillusRN, BSN]

Greetings, AN friends!

I have the feeling that this topic has already been discussed, but I couldn't find it in the older threads.

I'm an RN in a critical access hospital, middle-of-no-where-ville USA. Because my area is uber-rural and the county EMS resources are stretched so thin, I gave in to the social pressure and am getting my EMT-B. My concern is that my scope of practice in the hospital doesn't transfer to the field, so I can't legally perform necessary skills - I either have to wait until the patient is in the hospital or until an ALS resource can rendezvous with my unit. I'm sure most already know, but EMT-B's can't establish IV lines, alternative airways, administer Narcan, do a 12-lead, or even check a blood glucose (along with a host of other things)!

My question for the RN/EMT's out there is how can I work around this limitation? Is the only solution going on for my EMT-P ASAP? I'd like to bridge, but there aren't any schools anywhere near my area that offer a course (nearest is 500 miles one-way). I feel bad b/c the volly EMS stations are so incredibly understaffed, but by getting licensed as basic, I'll have my hands tied in terms of providing quality patient care.

Any insights are welcome!

[akulahawkRN, ADN, RN, EMT-P]

Your concerns are certainly valid. Your in-hospital scope of practice will be limited to that of an EMT-B when you're in the field, working in that capacity. Since I'm not entirely sure of the Kansas EMS system rules/regs, I'm going to respond in general terms as it also depends upon what you want to be able to do for your patients in the prehospital environment.

If you want to be able to provide care to a patient in the prehospital environment and have a scope of practice that is somewhat close to what you do in-hospital now, your best bet is to find a way to become a Paramedic. You have indicated that there are very few bridge courses around your area, so you may have to go the "traditional" route and take the entire course. That's not entirely bad as it will help to teach you how to "think like a paramedic" as they do have a different process to deal with than nurses do. It's not better or worse, but it's just different from how you're trained. If that won't work for you, you might want to consider finding a way to become some kind of prehospital RN. For that you will have to check your state's regulations to find out if it's even possible to do that as a volunteer or whatever capacity you were considering. As far as I know, every state has some kind of provision for nurses to provide prehospital care, but how they're able to do that varies.

Here in California, I'm licensed as a Paramedic and as an RN. If I were to find a way to "reaffiliate" with an Advanced Life Support provider entity, I could provide ALS care to patients within the Paramedic Scope while "on duty" however, I couldn't provide my in-hospital scope of practice as I'm not an MICN, nor am I assigned/employed as a prehospital RN. Flight Nurses are probably the most visible of these kinds of nurses.

I wish you the best of luck doing your research into how to accomplish your goal and I applaud you for wanting to provide assistance to the community.

[jadelpn, LPN, EMT-B]

EMT's are bound by both policy and medical direction. As an RN, you would be bound by those same circumstances when acting in the role of an EMT-B.

I would find a way to get your paramedic ASAP. If, as the role of a nurse, you already are cardiac certified in ACLS, PALS that sort of thing, I would go on your state's website and see if you are eligible to comp the Medic exam, and only have to do clinicals.

Medics also do airways, and that is often something that most RN's do not usually do in an ER setting. So that would take some clinical practice. The EMT-B's in our area can also give narcan and do blood sugars--do you know this is not the case, or is it something assumed. Also, asa for suspected heart attacks as well is within the scope, but each state is different.

https://www.nremt.org/nremt/about/about_exams.asp

This is for national certification guidelines. And you could call your state board that registers EMT's and ask.

Good luck!

[CamillusRN, BSN]

Thanks for your insights! I'll plan on going forward with a traditional EMT-P program. Also, I apologize for not clarifying; the scope of practice limitations were from the Kansas Board of EMS Regulations (2011).

[GrannyRRT]

Your best bet is to call the Kansas EMS board for the state and your region. Unless someone here is an RN in Kansas under the same circumstances it is doubtful they will know how to answer correctly. I believe Kansas is one of the states which recognizes an RN in EMS for very rural situations and the scope will be dependent on the ambulance service and medical director. It would be a waste to not recognize the knowledge and education of an RN in rural America and hold them only to the very limited scope of the EMT.

[NICU Guy, BSN, RN]

Creighton has a 2 week RN-Paramedic course. I am assuming that once you pass the REMT-P exam that you can apply for your Kansas Paramedic Cert.

https://www.nremt.org/

[JustBeachyNurse, LPN]

Many states made nasal Narcan a first responder level drug. Police, EMT-B and even certain family members have a standing supply of nasal Narcan hundreds of lives have been saved as a result.

See if KS has prehospital RN status many states with rural areas do.

[Alex Egan, LPN, EMT-B]

Just going to throw it out there. I would wonder if you would be able to practice as a paramedic at the service your volunteering at? My vol company is a BLS service. We have paramedics who run with us as volunteers but they practice at the BLS level when they are working under our employ, for lack of a better word, because that is what our medical director, licenseure, and insurance cover.

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi,

I am both an RN and a paramedic. Unfortunately the skills do not cross over in either direction, in other words when I work as an RN I cannot intubate and when I work as a paramedic, well actually I can do more as a medic than I can do as a nurse I feel. As an EMT-B you have to work at that level and cannot do things that you can do as a nurse, in other words you can only do skills that are within the scope of practice of an EMTB because your RN license does not carry over to the ambulance as it is a different licensing agency, the Liability Insurance of the ambulance service/FD limits your coverage to that of an EMTB, and the medical director you are working under is only covering you as an EMTB.

I will suggest though that you get a lot of experience as an EMTB before you jump into being a medic, maybe even work per diem or part time in a busier system, and then before you even consider working in a system that allows for a solo medic (you work with an EMTB or intermediate, or advanced), I suggest you work in a busy system as a medic with another medic prior to doing so, as I am speaking from experience here! Being a paramedic versus being a nurse are two totally different ball games, as a medic there is no doctor or another nurse to help you, and in some cases in the field there isn't even another medic to help you. It is A LOT of responsibility to be a solo medic and when things go wrong they can really go wrong, and that increases when you don't have any EMTB experience or medic experience. Please take this suggestion to heart, you may see experienced medics that make it look easy, but it isn't!!

I strongly appose Paramedic-RN bridge programs and RN-Paramedic bridge programs as the thinking process for both professions is profoundly different, so please take a traditional paramedic course when you get to that point!

Good luck

HPRN

[BR157]

Happy, Nurses do intubate in the field. Nurses can have an extensive scope of practice in the field.

If the service is licensed only for BLS, then getting your Paramedic would be useless and unnecessary. But there are BLS services which allow an RN to act like an Intermediate since ALS might be an hour or two away.

Kansas is a state which has a scope of practice for nurses under some Frontier medicine act.

[BR157]

I suggest you contact your local EMS provider and the state. Do not rely on the speculations of some posting here if you are serious. Some claiming to be Paramedics (and RNs) barely understand the certifications in their own state and really should not speak for all states.

RN-1

• Registered Nurse as licensed by the Kansas Board of Healing Arts
  
• CPR Healthcare Provider
  
• Basic Trauma Life Support (BTLS), Prehospital Trauma Life Support (PHTLS)
  
• Advance Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), or equivalent curriculum
  
• RN-1 designation does not allow technician to perform the following skills: intubation, cricothyrotomy (surgical or needle), needle decompression, direct laryngoscopy, or RSI
  
• Person may perform those skills listed under curriculum as contained in statutes approved by the Kansas Board of EMS for the EMT-I. Additionally, RN-1 may administer the following medications at the ALS level
  
  • Fentanyl
    
  • Morphine
    
  • Ativan
    
  • Versed
    
  • Valium
    
  • Diphenhydramine
    
  • Epinephrine
    
  • Atropine
    
  • Amiodarone
    
  • Lidocaine
    

RN-2

• Registered Nurse as licensed by the Kansas Board of Healing Arts
  
• CPR Healthcare Provider
  
• Basic Trauma Life Support (BTLS), Prehospital Trauma Life Support (PHTLS)
  
• Advance Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), or equivalent curriculum
  
• RN-1 designation does not allow technician to perform the following skills: intubation, cricothyrotomy (surgical or needle), needle decompression, direct laryngoscopy, or RSI
  
• Experience in either an ER, ICU, or air transport setting
  

RN-3

• Registered nurse as licensed by the Kansas Board of Healing Arts
  
• All testing requirements must be met
  
• Experience in either an ER or ICU setting
  
• Basic Trauma Life Support (BTLS), Prehospital Trauma Life Support (PHTLS)
  
• Advance Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), or equivalent curriculum
  
• Must have documented 10 live successful intubations annually
  
• CPR Healthcare Provider
  

[codeblue67]

I have experienced the same confusion. Creighton does have a two week course, which I am headed for soon myself, but you don't just pass the National Registry Test and then go get a Ks License. You have to finish FI in Kansas, and then if you pass National Registry you get a Nebraska License and transfer it to Kansas.

Your scope of practice as an RN on an ambulance depends on your services medical director. Get him/her to write standing orders for you instead of protocols. Then you can essentially function as a nurse on a truck, or at least with in the scope of whatever your medical director writes for you to practice. Good luck.