Nurses vs. Paramedics

[adwilcox28]

I've recently learned more about the "turf war" going on between nurses and paramedics in emergency departments for hospitals around the country. The battle seems to be heavily focused on having paramedics become licensed instead of just certified and be able to supplement ED staffs when needed and to practice their skills in the case of an off duty emergency. The paramedics I have worked with have ample skill and knowledge to handle difficult and challenging emergency situations, why then are so many nurses opposed to advancing patient care in this regard? Isn't that what our career choices are all about in the first place?

[Altra, BSN, RN]

The LVN program is 9 - 12 months in length or about 1400 - 1800 hours. If a student decides to go part time to where it takes two years, why are they the same as an RN? Do you see a resemblance in your statement?

No, I don't see the relevance, as the previous poster stated that the program she was discussing was nearly one year in length for full-time students. She did not state that it was 1000 hours.

[hiddencatRN, BSN, RN]

If you husband completed a two year degree would that mean he wouldn't do any continuing education? Guess what? It is required for the cert and license.

Aaaaaand you've lost me. I'm not sure where you're getting your information about what my husband has done education-wise since finishing his:

12 months full time

paramedic program, but it's certainly not from me.

The LVN program is 9 - 12 months in length or about 1400 - 1800 hours. If a student decides to go part time to where it takes two years, why are they the same as an RN? Do you see a resemblance in your statement?

Nope. I can't exactly defend or advance an argument I'm not making, but since you seem to enjoy building up straw man arguments to rail against them, there's really no point for me to continue in a conversation you are having with yourself.

[TraumaSurfer]

Oh how nice, another edit to your posts. Gosh, you are all over the place. If you argue enough random points I guess you'll win something[b/] and maybe steer people away from the original points of contention. I was pointing out that in my area EVEN the sketchy tech schools that churn out unlicensed medical personnel are longer than your 3-6 month figure.

You brought up MAs first for whatever reason.

Why are you talking about unlicensed medical personnel? Surgical Techs?

Did you even bother to see how many hours of training your state required for Paramedic? I already posted Texas with 624 hours.

I don't really see what points you have for not wanting the Paramedic to advance professionally first with some standard for education. EMS has enough problems with just the prehospital stuff. Nursing advanced so please allow those of us who are true EMS advocates do our jobs to push the profession forward without making excuses that the minimum is good enough. We are taking steps but it will be a long road. If you want to do something for us, lend support through your elected officials as the Bills come through. This one was just introduced, H.R. 6528. There will be others. The NREMT is fighting to maintain their stance to enforce accreditation for Paramedic schools. They will also be introducing the new levels in a couple years. But, not all states are on board.

You can also watch of more issues on this website and lend your support where possible.

Advocates for EMS

[TraumaSurfer]

Aaaaaand you've lost me. I'm not sure where you're getting your information about what my husband has done education-wise since finishing his:

paramedic program, but it's certainly not from me.

Nope. I can't exactly defend or advance an argument I'm not making, but since you seem to enjoy building up straw man arguments to rail against them, there's really no point for me to continue in a conversation you are having with yourself.

Maybe because I a just used to doing this battle at local, state and national levels for a purpose. Your perfect world sounds just like the arguments I get from the unions and the providers who rely on a few skills obtained by training but who also whine that their medical directors don't trust them to do RSI or carry a broader range of meds or make them call for all their orders.

[Altra, BSN, RN]

I can't imagine what battle you're fighting for EMS when you spend your time bashing them here at allnurses.com ...

[ObtundedRN, BSN, RN]

What level of education do NPs have compared with Paramedics? Aren't NPs considered physician extenders? Paramedics are not.

Please re-read what I posted. I wasn't in anyway comparing NPs to a paramedic. I was comparing your nasty remarks to those I've read on another website with doctors complaining NPs trying to push into their field. I was comparing YOU to another forum. In no way comparing paramedics to anyone else.

How long have you been a Paramedic? Ever talk with other Paramedics, go to union meetings or frequent the EMS forums?

Talk with medics? All the time. I'm still friends with many old co-workers. Union meetings? No, I don't live in a state with unions. Was there a point to that question?

I also don't get what you mean by "advanced skills" with what you have described. That is the job description of just about every ER Tech which can hold just an EMT-B or PCT or even a CNA cert that gets cross trained by the hospital. The hospitals I am familiar with also make their Paramedic/ER Techs take the 140 hour phlebotomy course and prefer they have it before being hired since there are probably over 100 applications for each ER Tech posting.

When I said advanced skills, I was refering to those skills that a paramedic with a CNA2 cert, working in the ED UNDER the supervision of an RN can perform as allowed by my state's BON, that a CNA2 couldn't perform without the paramedic cert. In my state, a CNA2 can't start an IV or administer non-medicated IV fluids like a medic/CNA2 combo can. They also can't give O2 or ventilate with a BVM like a medic/CNA2 combo can. As for the IV, an EMT-B and PCT can't do those either. And the only way any type of tech can draw blood is if they take the phlebotomy course first. The medic/CNA2 combo wouldn't have to take the course. Also, in my state, the medic\CNA2 combo can monitor the EKG for arrhythmias and changes, which also can't be performed by any tech, cna, or EMT-B.

And the pre-req that I was referring to was that one needs to have their EMT-B prior to taking a paramedic class. Sure it is an easy and short class, all I meant was that you have to still take that time into consideraton when talking about the length of time required to become a paramedic. I wasn't even mentioning the poor excuse for an A&P class that is required (I agree that programs don't give a real A&P class to medics).

Clinicals are not that difficult to knock out since EMS can do 24 hour shifts with a fire truck. If the state is only looking at clock hours and not patients or procedures, you could have these hours done in no time. Many tech schools do the 3 month lecture and then allow the student to arrange their own clinicals. It is rarely structured like nursing programs.

You can also see a listing of some of the programs in my previous posts.

Only one of the schools you listed taught their lectures in less than 6 months, and I would be afraid of any medic who came from that school. Also, they may not neccessarily look at number of patients or procedures, however they do look at competency of skills in order to pass. No EMS training is going to let you go through and pass without showing competency. Nursing schools can't even say that. Also, minimum clinical time is a requirement for nursing students too. And the BON doesn't take into account number of patients or procedures, just the hours. The school gives a grade and passes based on that, but you can still go through nursing school having never performed certain skills. So that's not a very valid point of yours.

EMS has almost 50 different certifications with each state having their own way of doing things. Each state can set their own minimum amount of hours for the Paramedic. Even the title "Paramedic" is not always used in every state. The NREMT exam is not used in all states.

I'm quite aware that NREMT exam isn't used in all states. My state is one of them. And out of my own curiosity, what state doesn't use the title "paramedic?" I'm aware that not all states have adopted the proper terms for EMT-B, EMT-I, and EMT-A, but I've never heard of them calling paramedics anything other then that. (I'm not saying there might not be a state that calls them something else, I'm truely asking where they don't use that term for my own information)

This thread started by talking about having medics in the ED to supplement the staff. Not replace RNs. Somehow you have twisted this thread and everything that most of us have posted. Do you have any prehospital experience? Are you a disgruntled ex-medic? Or a disgruntled ED RN? Or just enjoy trying to cause conflict on this forum?

I agree with you that EMS as a whole needs to expand their level of education and try to become more standardized to become a real profession. Medics could never replace RNs because they don't have the education behind them. They are not taught to educate patients like nurses are, nor taught how to handle all of the equipment and drugs that we do (even though much of the equipment won't be used or taught to most RNs either, it depends on your specialty). They are taught to do the things they do out of neccessity, not because they went to school for enough hours or took extra college classes in english, math, science, music, etc. I'm the first person to put a medic in their place when they try to bash nursing or think they are superior in some way. But I'm also the first to do the same to nurses who bash or act superior to EMS. EMS and nursing perform two DIFFERENT but sometimes similar roles.

[ImThatGuy, BSN, RN]

And I am tired of people saying the education is good enough. That is insulting. Take that for what it is worth but the sooner people realize the limitations of EMS education as it is now, the sooner EMS can truly become a profession. Enough with accepting the minimum as being the end all to everything. But, then if EMS raised its standards to at least an Associates, they would be on equal status for education with the RN even if in different professions.

Again, the education of paramedics is good enough for what they currently do. Expand their scope > expand their education > expand their reimbursement. Improving the profession of EMS involves three prongs, and I have just delineated them for you.

I looked at my transcripts and observed that I received 44 semester hours for my paramedic courses. I didn't apply for an associate's degree since I had a bachelor's degree. That's pretty close to having an associate's degree at that school. All one would need is English, math, science, history, etc to get the remaining 16 hours needed to get the A.A.S. there.

In Arkansas, paramedics recently received licensure with no associated change in scope of practice. There are only 16 pharmacological agents required on a paramedic ambulance in Arkansas. It doesn't take a whole lot of time to "thoroughly" train for that.

Edit to add: If you did expand the scope to some of the nonsense people have proposed for field paramedics such as suturing and so forth, or even increasing the list of required meds, then by all means increase the length of training. We'd have to. It would be unsafe and foolhearty not to, and I personally hope that paramedics are not given this scope. That's not why EMS exists.

I fully concede that more education and training is great (it's why I'm in a BSN program), but if the EMS provider can't lawfully do anything about the new "conditions" that someone has why learn about it? It doesn't make fiscal sense. You'll do nothing but increase the cost of education with no associated reimbursement for the provider or employer and elongate the training period thus keeping paramedics off the streets. We've already gone rounds about how there's a shortage of them here. The statistical likelihood of Arkansas being the only state (out of 50) with a shortage or paramedics seems small.

[dianah, ASN]

please remain on-course, per the terms of service, discussing the issue rather than posting insults or personal attacks.

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thank you.

[BCRNA]

I would imagina that paramedics would have to learn quite a bit more about pharmacology and disease processes before working independantly in an ER and doing the same role as a RN. Though I don't know anything about the education they receive, I can't comment on that. I would say the ones I have worked with are really good and deserve respect. Before they administer drugs they need to know what they are and about the diseases they are treating. I would imagine there are many drugs that aren't covered just becuase they don't give them already. And since they focus on being first responders their focus is different, the initiate the treatment and stabilize until they can be taken for more definitive treatment. I would love to see them improve enough to function in place of an RN, especially with all of the understaffed ER's. I personally refused to work in the ER because of the unsafe staffing practices there. The hospital I worked at was so understaffed it was dangerous. You kept getting new traumas and level 1's regardless of how many patients you already had. Regularly you never got lunch or breaks. You were working your butt off from start to finish.

I would recommend that another tier of paramedic be added, one that adds the skills similar to an RN so that they can function as a RN in the emercgency room setting only. Would require further education and clinicals. Not to mention the fight they will have to have with the nursing boards trying to protect nurses scope of practice. I would stand up for them if they provided more education and training to protect the patients.

What kind of education in regards to pharmacology and pathophysiology do paramedics get? Is the pharmacology part limited to only what they can administer, or do they learn about everything? I think before any nurses just up and say no to this, they need to learn about paramedics education as it is now and how it can be changed to change their scope of practice.

[P_RN, ADN, RN]

Well I'm alive cause a paramedic recognised a BAD arrythmia so......

[ImThatGuy, BSN, RN]

I would imagina that paramedics would have to learn quite a bit more about pharmacology and disease processes before working independantly in an ER and doing the same role as a RN. Though I don't know anything about the education they receive, I can't comment on that. I would say the ones I have worked with are really good and deserve respect. Before they administer drugs they need to know what they are and about the diseases they are treating. I would imagine there are many drugs that aren't covered just becuase they don't give them already. And since they focus on being first responders their focus is different, the initiate the treatment and stabilize until they can be taken for more definitive treatment. I would love to see them improve enough to function in place of an RN, especially with all of the understaffed ER's. I personally refused to work in the ER because of the unsafe staffing practices there. The hospital I worked at was so understaffed it was dangerous. You kept getting new traumas and level 1's regardless of how many patients you already had. Regularly you never got lunch or breaks. You were working your butt off from start to finish.

I would recommend that another tier of paramedic be added, one that adds the skills similar to an RN so that they can function as a RN in the emercgency room setting only. Would require further education and clinicals. Not to mention the fight they will have to have with the nursing boards trying to protect nurses scope of practice. I would stand up for them if they provided more education and training to protect the patients.

What kind of education in regards to pharmacology and pathophysiology do paramedics get? Is the pharmacology part limited to only what they can administer, or do they learn about everything? I think before any nurses just up and say no to this, they need to learn about paramedics education as it is now and how it can be changed to change their scope of practice.

Paramedics generally only cover the pathophysiology concerning the types of thing paramedics treat. The same applies to pharmacology. We covered the classes of meds pertinent to us, but we seemed to cover it more in depth than this RN program does granted we have many fewer drugs to learn about as medics.

[dspaldrn/emt]

To answer the Question that started this thread...

As a paramedic who worked both the "truck" and in the ER, and as a RN let me tell you what the big deal is.

since i have been on both sides of the matter.

Paramedic are mad because WE CAN DO MORE THAN A NURSE but dont get paid as much or get any respect from the medical community due to the fact that we are "technically" trained rather than holding a degree. some states have associate degrees others dont.

RN's are mad because WE HAVE A BROADER KNOWLEDGE BASE than medics and thus we get mad when we think someone with less knowledge is trying to take our job.

you will still find nurses (alot of them on this forum) who have not a clue to the complexity of paramedic training or abilites that they perform but still find it necessary to spread misinformation about a profession they no little to nothing about.

you will also find Medics who think they know it all and can do all even though they have spent less than two years in school to get there license/certificate .

YOU WANT TO MAKE A MEDIC HAPPY? listen to his pt report and dont ask condescending questions, thank him when he starts that IV on the pt with no veins instead of just dropping him off in your er with no line.

THE BOTTOM LINE>>>>>> ems needs more respect and more education