Going into EMS?

AnnieOaklyRN, BSN, RN, EMT-P · Oct 15, 2017

Are you excited about a massive paycut? EMT is not much more than minimum wage with Paramedic typically being only slightly better unless you work for a Fire Department.
You will feel exceedingly limited as an EMT in your scope.
However, EMS is fun. The courses aren't hard.

The "courses" aren't hard? Are you a paramedic and have you been to paramedic school? I am just wondering how you formed an opinion about paramedic school not being hard if you are an EMT-B.

Annie

AnnieOaklyRN, BSN, RN, EMT-P · Oct 15, 2017

Hello,

I was in EMS long before I did the nursing thing, and I think EMS is a far better career (yes them money is less), but not really since you can easily work overtime since you aren't stressed out of your mind like you would be as a nurse (I am only speaking from my own experience).

Please do not even consider bridging, as EMS and nursing are two TOTALLY different ball games with different ways of thinking, and no short cuts should be taken ever in these fields. It is important that you become an EMT first to learn the basics and extrication etc before you become a paramedic. Remember you will be responsible for assessing an treating patients appropriately without a doctor there to make those decisions. You may also work in a system, as I do, where you are the ONLY medic on a call and are working with basic or advanced EMTs, which means there isn't someone else to ask if you aren't sure about something. You of course have medical control; however it isn't the same as being in person. You are telling them your findings and your working diagnosis, they are going by what you see, and not what they see.

To those that say you will be poor and broke working in EMS, you won't be. You will be less stressed and not short staffed and those families and patients who are needing and hitting your last nerve will only be yours for minutes instead of hours or days. I make 92K a year working full time as a medic (60 hours a week, which isn't as bad as it sounds. 24 hour shifts or 12 if you like, and I spend most of it chilling on the couch or walking laps) and per diem as a nurse (5 hours a week). I also live in the northeast where the cost of living is very high, so depending on where you live you may work less. Honestly you could even split the EMS and nursing half and half.

I worked full time as a nurse for about a year in the ER before getting totally burnt out, then I split medic time and nursing time in half, and I realized the nursing just isn't worth the stress. It sucked actually in my opinion. I went back to EMS full time and haven't looked back. I am happy to have the nursing as a back up plan for when I can't physically do EMS, or I get burnt out (19 years and still going).

One thing to remember with EMS is it can be physically demanding and it causes a lot of wear and tear on your back and joints. I am not sure how old you are, but that is defiantly something to consider. I feel it and I am only 39.

Did I take a pay cut yes, but ultimately to me what matters is my health and stress level. If my health and happiness are suffering, then the money isn't worth it, as long as the bills can still get paid!

If you have any more questions feel free to ask. I did the Paramedic thing before doing nursing if that helps.

Annie

AnnieOaklyRN, BSN, RN, EMT-P · Oct 15, 2017

That would be a step back though, less pay, less scope of practice. Do what you love though if you'd like it more than being an RN, by all means, go for it. Someone mentioned flight or CCT as an RN and I think those are great ideas. Good luck!

Actually as a paramedic I can do more than most RNs when you compare hospital RNs to pre-hospital paramedics!

Annie

SummitRN, BSN, RN · Oct 15, 2017

The "courses" aren't hard? Are you a paramedic and have you been to paramedic school? I am just wondering how you formed an opinion about paramedic school not being hard if you are an EMT-B.
Annie

You seem defensive... I don't think Nursing school is hard either, just time consuming. Perhaps you take umbrage with that as well?

Knowing the paramedic course content, requirements, workload, having read the texts, etc etc etc and working with plenty of RN/Ps and medic educators, I'm quite satisfied with my opinion that EMS classes are not hard (including medic classes). The only RN/Ps I know who thought P school was hard also found RN school hard (and harder than P school)... nothing wrong with that opinion.

However, I was trying to be realistic yet encouraging to the OP rather than raise your hackles.

PeakRN · Oct 15, 2017

The "courses" aren't hard? Are you a paramedic and have you been to paramedic school? I am just wondering how you formed an opinion about paramedic school not being hard if you are an EMT-B.
Annie

As someone who has taught paramedic students, both in the hospital and in the classroom, I will back up the statement that the classes are not hard. There is very little that is taught in P school that a competent ED nurse doesn't already know, intubation and 12 lead interpretation are the biggest things that pop into my mind but a good ED nurse should already have a good grasp on that.

P school ultimately teaches someone how to be a technician and follow protocol orders, the rest is developed through experience and self motivated study.

The biggest hurdle is to learn to think in an ems mentality, which is more difficult than most people think. Most nurses that I know that went to P school for whatever reason still think like nurses anyway, and as a result their scene management is poor to say the least.

A large amount of all of this boils down to goals. Many states either allow RNs to challenge their state exam, can practice in the field without additional licensure (but still with additional training), or have some form of prehospital nurse qualification. A volunteer group is normally happy with this, most career groups actually want to see that emt-p credential.

PeakRN · Oct 15, 2017

Actually as a paramedic I can do more than most RNs when you compare hospital RNs to pre-hospital paramedics!
Annie

What do you define as most Nurses? Comparing non-critical care nurses to paramedics is like comparing apples a nicely painted orange wall.

Paramedics cannot start PICCs, central lines, art lines, or access ports. The vast majority cannot perform an ultrasound exam or put in chest tubes. They cannot administer chemo, TPA, research medications, or off label medications (medical directors who put off label meds in their protocols are assuming massive risk). Paramedics cannot manage balloon pumps or LVADs. They can not administer blood products (at least in the vast majority of states). Paramedics cannot assume care of critical care or deteriorating patients after they have become an inpatient.

At least in the state that I am in there is nothing that a RN cannot do that a medic can. I do not have a no intubating, no EJ, or no 12 lead assessment limitation when I'm in the field.

I greatly appreciate our medics and I don't want this to seem like I'm looking down on them, but there is nothing to their training that a nurse cannot do. The good paramedics are that way because after school they continued to invest in their own education. There is a reason why there are 2 week RN to Medic bridges but not vice versa.

AnnieOaklyRN, BSN, RN, EMT-P · Oct 16, 2017

As someone who has taught paramedic students, both in the hospital and in the classroom, I will back up the statement that the classes are not hard. There is very little that is taught in P school that a competent ED nurse doesn't already know, intubation and 12 lead interpretation are the biggest things that pop into my mind but a good ED nurse should already have a good grasp on that.
P school ultimately teaches someone how to be a technician and follow protocol orders, the rest is developed through experience and self motivated study.
The biggest hurdle is to learn to think in an ems mentality, which is more difficult than most people think. Most nurses that I know that went to P school for whatever reason still think like nurses anyway, and as a result their scene management is poor to say the least.
A large amount of all of this boils down to goals. Many states either allow RNs to challenge their state exam, can practice in the field without additional licensure (but still with additional training), or have some form of prehospital nurse qualification. A volunteer group is normally happy with this, most career groups actually want to see that emt-p credential.

This is where you are wrong, it isn't simply see A do B, even when you get out of school, that is why you do ride time and work with a more senior medic! Having been an ER RN as well as a paramedic I can tell you they are not even remotely close, as there is MUCH more autonomy as a paramedic!!

A paramedic is NOT a technician who simply follows protocols, and maybe if you actually spent some time as a pre-hospital provider you would know that.

** IT'S NOT ABOUT THE SKILLS OR THE MEDICATIONS, IT'S ABOUT KNOWING WHEN TO USE THEM!!! ********* It requires critical thinking. Do you think physicians just see A and do B? Probably not since they would kill a few people, neither do we!!! Here's an example: I brought a patent in who was in a fib with a rapid ventricular rate to the ER. The patient's HR was about 130ish, but he was also tachypneic and hypoxic prior to oxygen therapy. He was working hard to breath and was also febrile. The ER nurse immediately asked if I gave him Diltiazem, (this was after I told her he was most likely septic and had a pneumonia) for his "rapid a fib". Imagine if I had just saw A and did B, the patient who had a history of Afib and who was tachycardic because he was compensating for the hypoxia and sepsis, and not because of his rhythm would have become hypotensive and in worse condition! So please, don't ever say paramedics are "just technicians" because we are far from that. We think more critically than most nurses and we do not do cook book medicine. I work in a state where my only medical control option medication is Heparin for STEMI, oh and thats the 12 lead ekg I INTERPRET, not a physician, not a computer, me.

Yet another person, who to my knowledge, has not done both jobs and should not be giving their opinion on paramedic education or how paramedics function in the field. You are also not a student you are teaching, that is a different ball game. Did I think paramedic school was difficult, no, but that was probably because I did the associates degree so it was spread over two years. Paramedics have to be an expert in everything, ER nurses have to also be an expert at the nursing level at everything, but nurses have a doctor to make the actual judgement on how to treat the patient if needed, so please don't ever say an ER nurse is equivalent to a paramedic, not even close!!!

I am done arguing with people on here about this topic, especially nurses who have never even set foot in an ambulance!!!

To those considering transferring into the EMS field I advise you not to bridge, that is bad medicine in my opinion and I wouldn't want you coming to my family members house!! I can guarantee if I took 10 ER nurses out of the ER and stuck them on an ambulance 8 of them would run way or wouldn't have any idea what to do (I worked in an ER for 8 years)!!!!

Annie

SummitRN, BSN, RN · Oct 16, 2017

@AnnieOaklyRN

You should hop on over to EMTLife.com and see what all the RN/P, P->PA, P->MD/DO, RN/P->CRNAs think of it. I think you'll find you hold the minority opinion in that demographic. You might even get called a ParaGod.

One thing is clear, you've lost sight of the fact that paramedics work under standing orders, just like nurses. Nurses ask for pt specific orders, just like Paramedics. Paramedics are not writing their own orders. You have a protocol and the protocol may be an algorithm or a guideline in a good system. You've also focused on comparing medic psychomotor interventions to those of RNs operating in an environment where an ordering provider is ever-present (ED). I suspect you are not trying to be disingenuous, but rather you are just don't know what critical care nurse practice is like (which is where RNs desiring more autonomy at the bedside tend to gravitate, then to the helicopter). That said I've seen some pretty spectacular protocols for ED RNs.

One thing is indisputable, Paramedics do get to do highest risk skills with least education compared to any other healthcare worker (the average medic doesn't have even an associates degree or college level A&P). The reason is a combination of risk v reward and cost vs benefit. In the field it makes sense to take that risk because you can't staff a couple of MDs and RNs in every ambulance service under the US system... not economical. RNs could do in the hospital all those "things" medics do in the field... , but there is literally no reason for them to do so in the ED under the current system. That is why paramedics don't get to do most of their whizbang skills when working in most hospitals... it isn't worth the risk!

You should see what happens in ICU though.

Remember, Nursing is not focused on skills. Nursing is focused on education. Skills can be easily added on in a necessary area. That is why RN scopes of practice are often reduced to something like "were you taught to do this? did you receiving training? is it in your policy? then it is in your scope."

I can do things you can't. I bet you can do things I can't. Why? In most places, RN scope relies of skill/judgement competence supported by a foundation of education.
It is why a PICC Nurse can place a PICC and a Flight Nurse can intubate, but not vice versa.
It would be impractical to list out all the possible procedures, skills, and medications within the average RNs scope, much less all encompassing.

This is as opposed to EMS where a scope of practice and skills are specifically enumerated in a couple of pages of document from the state board. EMS can only do that because their scope is so narrow. How many drugs are in a paramedic's formulary? ~30 drugs in the NRP forulary! Many medics will rarely if ever give some of those 30 drugs in a year. As a RN you probably give several dozen different drugs every day. RN's couldn't possible have a scope that enumerated all the specific skills, drugs, procedures and routes. It would be the size of a dictionary!

PeakRN · Oct 16, 2017

Yet another person, who to my knowledge, has not done both jobs and should not be giving their opinion on paramedic education or how paramedics function in the field.

Well, If you had actually read my first post on the first page you would see that is not the case, I'll quote it below for you.

I went from being a Firefighter/EMT to ED nursing and wouldn't go back. I do volunteer at a pediatric cancer camp as the critical care nurse (we provide ALS care and will ride in as the ALS provider).

I think you need to take a step back and take a deep breath, you seem to be getting very worked up over all of this. You are loosing sight of what the role of critical care nurses and paramedics are, and more importantly why this whole thread started.

You are right that there is thought beyond the protocols, but that does not change the fact that paramedics work under protocols and are not independently licensed. I suggest that you look at SummitRN's post, I don't think repeating much of what she wrote is particularly helpful.

Paramedics have to be an expert in everything, ER nurses have to also be an expert at the nursing level at everything, but nurses have a doctor to make the actual judgement on how to treat the patient if needed, so please don't ever say an ER nurse is equivalent to a paramedic, not even close!!!

Such a generally cringe-tastic statement. Paramedics are not experts in everything, I hope you don't actually believe this. This is such a dangerous view to have.

ER nurses are not experts at everything, I call ICU, OB, etc... all them time and pick their brains. By the way neither are the ED Docs, there is a reason why they consult other services and it turns out we don't keep admitted patients in the ED.

And I don't think anyone actually said that ER nurses are equivalent to paramedics, I think that the closest thing to this is a handful of people who have said or alluded to having the same scope of practice in the field.

I am done arguing with people on here about this topic, especially nurses who have never even set foot in an ambulance!!!

I spent many, many years working in the field as an engineer on a heavy rescue, and I cross staffed an ALS bus with a Paramedic (all of whom were good people).

Editorial Team / Moderator · Oct 16, 2017

I think if we standardized paramedic education and really treated it like a profession, arguments/discussions like these may become extinct.

SummitRN, BSN, RN · Oct 17, 2017

I think if we standardized paramedic education and really treated it like a profession, arguments/discussions like these may become extinct.

I think that if Paramedic was a 2-4 year college degree at minimum instead being 1yr (or less) of trade school at minimum, it would achieve that goal. It is that way in many other countries and their compensation is understandably on par with nurses. If that was the case in the US, I'd have likely never left EMS for nursing. I miss the ambulance; it was a blast.

Editorial Team / Moderator · Oct 17, 2017

I did my P at a community college and it came with an AAS degree.