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NREMT Paramedic/AEMT Challenge

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I was wondering if anyone has challenged the NREMT (National Registry of Emergency Medical Technician) Paramedic or AEMT with their RN. I believe there is a method but many times someone who has gone before can shed light and save time. I called them a couple times and left VM with the program coordinator but they haven't called back. My state EMS Department knew about it and had no problem with it but didn't really know the details or know of anyone who had done it (which leads me to believe its one of those things that sounds good but the devil is in the details), they are pretty much whatever NREMT says they go with since the state accepts them as the certifying agency.

I do have many years fire service EMTB expereince and went BSN as opposed to medic school and now work per diem in an ED. My local department is short volunteer/call medics and one can only perform to the level of EMS licensure.

You are eligible to gain your Paramedic using your RN credentials. Here are the requirements the Paramedic level:

There has been one change to the Paramedic level entry for RN candidates. The program that reviews and approves the training/education can no longer just issue a certificate of completion as verification of equivalency. In order for a program to maintain accreditation, they will essentially need to take you on as their student. The program will need to ensure that you have met the same level of education and course requirements as a "traditional" paramedic student. As long as the program is willing to verify this is correct, you will select their program when filling out the application and they will electronically approve your course completion.

. Must be currently state or NREMT certified at the EMT level or higher

. Contact a state approved and CAAHEP accredited paramedic program to confirm their education meets or exceed the EMS education standards in the US. The paramedic program will take on the student and run them through as their own once they've confirmed the education

. Letter of support from the state EMS office where the applicant will be licensed and working

. Must have a current CPR credential at the BLS Healthcare Provider level or equivalent

. NREMT psychomotor exam

. NREMT cognitive exam

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Here we go again....

Please do not challenge this! Being a medic and a Nurse I can tell that the two professions are totally different with different ways of thinking! GO TO SCHOOL!!!



Has 24 years experience.

I second what AnnieOakly said!

Thanks. The paramedic schools near me aren't really interested in getting involved in anything like this. All their grads are trying to get their RN with accelerated bridge classes, but there aren't very many bridges from RN to paramedic. I work with several paramedics who do RN work on the side for the coin and they don't feel there is that much difference between hands on ED RN and paramedic except loosing alot of autonomy waiting for practitioners order. My next plan is the 2 week paramedic class in Omaha.


Specializes in Critical Care, Float Pool Nursing. Has 5 years experience.

Pretty sure there is only the 2 week program that you have to fly across the country for. Everyone seems to use Creighton. Everyone I know who was an RN and wanted to be a paramedic did it that way. There is definitely no way to simply "challenge" a paramedic exam as an RN. Paramedics have skills that RNs are not trained to perform, so for an RN to challenge it would not be possible. You still have to have some preparation.

You can challenge the EMT exam as an RN, however. I am an NREMT and I did just that. The method of doing this varies from state to state, however. I had to take a refresher.

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Ugh, please, don't ever care for me or my family if you are bridging or taking a two week paramedic class!!

It's not as easy as it looks!!


You should complain to NREMT- if its an approved course its an approved course. Get on your high horse and ride on over there.

applesxoranges, BSN, RN

Specializes in ER.

It is up to the states to approve the training level. If they want you to complete a full or shortened class, it is up to the state. It isn't NREMT that would approve it, it is your state. Some states let you apply to take the exam without having a class. It is really weird, but NREMT is not a license to practice. You need to have a state license or certificate. In fact, for most parts, NREMT is only really useful if you plan on moving.

This is an unofficial not guaranteed to be updated list (my state offers a RN to medic short class but it isn't mentioned there) : http://www.nasemso.org/NewsAndPublications/News/documents/NASEMSOsurvey051208.pdf

If you say what your state is, I'll take a look and see if I can find info.

Please, please, please do not try and fast track becoming a paramedic. Unless you have a hospital based job or helicopter/transport position lined up that would require both licenses then maybe you can get away with it. If you plan on responding to 911s then you NEED to actually learn how to be a paramedic.

There are many things that overlap in nursing and in being a paramedic but there are many skills that medics need to be comfortable with that most nurses are not trained to do. Can you intubate? RSI? Set up and manage a vent or CPAP? Can you start an external jugular iv? Or an interossous? Maybe an emergency cricothyrotomy? How about 12-leads? Can you identify a STEMI quickly and be responsible for activating the cath lab from the field? How comfortable are you with ACLS/PALS but actually running a code is one of the easier things that medics do, believe it or not.

Most of the knowledge a medic has must be available immediately from memory. You almost never have time to look up a med dose, or time to sit and think about thing for more than a few seconds and you shouldn't be contacting a doctor for orders unless you have exhausted all your protocols. Almost everything a medic does is a standing order.

You may be able to pass the 2 week class but good luck with the NREMT-P practical stations. And the written test. Not to mention if you do get through those precepting is going to be very difficult, you are NOT trained on the job. Precepting is basically a test of your skills on the road. Senior medics do not just let people skate by. EMS is a rough place.

I am sorry if this post seems harsh but out on the streets and in the back of an ambulance there is minimal help, and its you and your partner who is usually an EMT. If you can't do the job well then people die!

Please just get your EMT, you can still respond to 'cool' 911 calls. And you would be an asset to EMS.

FatsWaller, BSN, RN, EMT-B

Specializes in ER/Trauma/Travel ICU/Critical Care Transport. Has 6 years experience.

waterpeace13 said:

There are many things that overlap in nursing and in being a paramedic but there are many skills that medics need to be comfortable with that most nurses are not trained to do. Can you intubate? RSI? Set up and manage a vent or CPAP? Can you start an external jugular iv? Or an interossous? Maybe an emergency cricothyrotomy? How about 12-leads? Can you identify a STEMI quickly and be responsible for activating the cath lab from the field? How comfortable are you with ACLS/PALS but actually running a code is one of the easier things that medics do, believe it or not.

This seems to be such a hot topic, but I disagree with a few of the posters. It is completely dependent on where you work and what department you work in, especially if you have a specialty certification (TCRN, CFRN, CCRN, CEN, CTRN). I work as a trauma nurse in a busy trauma I center that sees a large diversity of patient cases and injuries. Also, most of the EMS workers in the surrounding counties (we are the only trauma center in the region, ~80 mile radius) are BLS so not much of anything has been done when the patient arrives. I can't really think of something I haven't done that a paramedic does in the field (aside from a cricothyrotomy, which aren't done very often). I was also an EMT/Firefighter for a while so I know what medics do, I am aware of the difference of being in the field from a trauma bay. But every day I initiate and titrate paralytics, intubation drugs, vasoactive drips, blood products, crystalloid and colloid resuscitation, emergent splinting and traction/reduction, I place EJs daily, IOs about twice a week, every trauma/chest pain patient gets a 12 lead and I interpret it (especially if triaging, you can't believe how many EMT/medics come in with ‘fake' patient vitals and misinterpreted 12 leads saying, they're fine�, on more than one occasion..off to the cath lab…) I often assist with chest tube insertion, insert LMA, Kings, and on some occasions ET tubes when needed, set up and maintain ventilators. I interpret ongoing lifepak rhythms and cardiovert/shock/pace as needed, codes…you are correct in that is the simplest intervention, and we run them every day. ACLS/PALS? Every trauma nurse here is proficient, and we are also required to have TNCC within 6 months and TCRN + CEN in a year and a half. We are trained in central lines to assist residents, we are proficient in USPIV placement, internal defibrillation, assisting emergent EVD placement, cracking chests, etc . I am not sitting here saying that I would be ready tomorrow to go out and act as a paramedic, but If I took a bridge course, or landed a job as a flight RN and needed my cert, I am glad states like California allow me to challenge the education because I do not need a two-year long course. you must still attend the entire 480 hours of field internship, including 40 ALS patient contacts and have to take the NREMT paramedic exams, so I don't see what else you need to prove you are competent. Hell, an intubation course to freshen up maybe. All I know is I would be 100% confident in my abilities to provide above competent care as a paramedic, especially after 480 hours and passing the boards. Now if you are an RN in med-surg, surgical services, PCU, TCU, and hell many ICU's, then yes I can see where opinions like AnnieOakley and Waterpeace stem, I would not trust these nurses either, there would be too much to learn. Not that they aren't as smart or proficient, but they do not handle emergent situations daily or at all with limited information and time. It's a completely different type of nursing, hence why the age old ER vs ICU/Floor RN thing exists.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

And in some states, like IL there is a licensure for pre-hospital RN. I've been one since 1999, licensed at the ALS level and run with local rural volunteer squad.

It is NOT a paramedic but a PHRN license.


Specializes in Adult and pediatric emergency and critical care.

In some states you don't need a PHRN or EMS certification to work in EMS, although you do have to find an agency that will support it. When I work in the field I am working under my RN license and not my EMS certs since I'm doing stuff that would be out of scope for our paramedics, but I'm (and our other critical care nurses) are supported in policy and protocol by our medical directors.

I do always love these threads when they pop up.

Do you feel comfortable starting an EJ? I start ultrasound guided IVs and art lines, and occasionally an EJ when we really can't find anything else.

Do you feel comfortable inserting an IO? That has been standard of practice for nurses for years (at least around here).

Interpret a 12 lead? Who do you think is calling the cardiac alerts? It may be ultimately up to the doc but the world doesn't end when they are in a sedation or some other hour long procedure.

Are you seriously asking if critical care nurses can manage a vent or cpap?

ET tube? Do you even retrograde intubation bro?

I could go on...

They are two different jobs, and nursing school does not train you to be a paramedic but critical care nurses can learn those skills (which is of course all dependent on your states BON). I have never fully understood the desire to go work for half the pay, nor work for an agency who doesn't recognize my current license but wants a different set of letters for their paperwork.

What many posters do not understand is that there is a majority part of the country where unfortunately you gods of paramedicine do not live, volunteer ambulance and ems services are in desperate need of providers. Many of the gods immediately jump on the pay disparity- what about the pay for volunteers, which makes me question your motives for medicine to being with. I've been around for a while there are good medics and not so good medics, there are good rn's and not so good rn's, there are good docs and not so god docs. I'll take a good rn over a not so good medic/doc any day of the week and vice versa.

How about US medics train to developed world international standards, think EU and UK which I believe is BS plus additional.

Be sure and wear hearing protection when blowing your own horn.


Specializes in Adult and pediatric emergency and critical care.

Why the concern over pay disparity? It is how much your agency values you. Certain private ambulance corporations are able to buy each other up and rake in tons of cash but are paying their staff an atrocious wage. They also work these people to the bone, expecting them to run 10+ calls in a 12 hour shift. It isn't fair and it isn't safe.

Volunteering is great but are they taking volunteers because they cannot pay, or because they are buying new equipment that they don't need (countless of our rural departments have more apparatus than they will ever have staff for them, departments that see 2 working fires a year have brand new scott packs, and BLS departments are running around with philips MRXs). I actually do volunteer my time both as a nurse and in EMS, but these are for causes that I believe in and there is no way we would ever have the money to pay people for. Our ems monitor is a old but very functional lifepak 12, most of our supplies are donated by local hospitals, and we don't bill for a penny. I am able to volunteer a good portion of my time because I make good pay at my day job, if I was still in EMS and had to pull OT to pay the bills I wouldn't be able to volunteer.

I agree that education needs to be better in the US. We rely on paramedics to seek out their own education, the mandatory minimums are in no way sufficient to get to or maintain a safe level of practice. All that 'horn blowing' I got to type, that is from education I have gone through.


Specializes in Cardiac ICU. Has 2 years experience.

I was an infantry medic in the army for many years and worked in EMS and as a Firefighter for 13 years, paid on call. As medic, I learned crics, IOs, and intubations along with quite a few standing order meds.

Having been an EMT, I understand the the prehospital role is different in very critical ways from "standard" nursing (if there is such a thing--hopefully, you catch my drift). Also, having now been exposed to the nursing program and the nursing world, I also understand that many RNs are MUCH more highly trained and capable (particularly those in critical care and working in EDs) than many in the EMS world would give them credit for. Anyway, I'm just about to finish my first semester of nursing and, I hope to work at earning my Paramedic cert when I'm done. I plan on speaking with the Paramedic/EMT director at the tech to find out what coursework HE would be comfortable with me skipping, if any.

I don't want a "shortcut", but, I'm certain I'm not going to need another year of coursework to catch me up to the paramedic standard our technical college goes by. That said, if that's what is determined that I must do to achieve that goal, I'll do it. I'll do it because I love EMS and I want to serve in as many ways as I can, even after I achieve my RN. I would, perhaps, even like to work on a helicopter, someday, if circumstances allow. Money isn't even a consideration for me--its just in my blood, cheesy as that may sound...

You can if u want too! It's up to them not u just saying