Paramedic Vs. Nurse

mmutk, BSN, RN, EMT-I · Feb 12, 2018

I have not read all the posts in this thread. I will say as a medic and a nurse the following...

1. What is the biggest differences between them and what exactly are a nurses restrictions when it comes to being in the ER?

In the ER there is not much difference, you both take orders from the MD. Nurses can give more medicines and are required to do more assessments.

2. What are the restrictions of a Paramedic in the ER?

Not being a licensed nurse in a hospital is a big deal. This will restrict your ability to give medicines and triage. Also you will not make as much $$.

3. Would I be better to become a nurse if I'm only getting my associates and not my bachelors?

Associates degree and Bachelors degree nurses function the same. You may make a hair less $ as an associates degree nurse.

But your skills and abilities under the nurse practice act are the same.

mmutk, BSN, RN, EMT-I · Feb 12, 2018

If you are National Registry Paramedic then it will transfer easily.

Nurse licensure will depend on the nurse compact guidelines. You may have to apply for a new license in the new state if you move.

Crass1017 · Feb 12, 2018

How does it transfer do you have to apply? And thankyou!!

akulahawkRN, ADN, RN, EMT-P · Feb 13, 2018

Generally speaking, you should have your course completion certificate for Paramedic and your NREMT-P card. You contact the other state's EMS authority (whomever that is that licenses Paramedics) and ask them for their process for obtaining a license for that state. You then just simply follow that state's process and you'll be good to go. Some states don't have a license of their own, they just use the NREMT as their certifying body so for those states, if you have the card from the NREMT, you're good to go. That's similar to nursing license reciprocity. I'm a California RN and Paramedic, currently licensed as both. I no longer have my NRP card from the NREMT so I would have to retake the exam and then becoming a Paramedic in other states is easier. I would also have to apply for a nursing license in whichever other state I want to be licensed, and again, that process is going to be fairly simple, just follow the instructions!

To renew my licenses, I have to do 30 hours for RN and 48 hours for Paramedic. Since I have to take ACLS and PALS, that's 16 hours already taken care of for both when I renew those. Since I no longer have an NREMT certificate, I don't bother with their requirements, I just follow my state's Paramedic license renewal requirements (NREMT's does exceed this by quite a bit). I do the balance of my Paramedic CE online. As long as the CEU's for my RN license are approved by the BRN, I'll do online CE for that as well. My licenses are staggered a bit so every year I have to either renew my Paramedic or my RN license, but not both. Do note that California's EMSA does NOT accept most nursing education. Nursing school, while good for learning different ways to do patient care, did not count as Paramedic renewal CEU's. The reverse is also true...

I've been a Paramedic for almost as long as AnnieOakley. Much of what was said above is very true. Paramedics generally have far more autonomy than most nurses. When I work as a Paramedic, I have a fairly thick P&P manual that I use to treat my patients. I know the protocols pretty darned well. I base the care I give (and the protocols I follow) entirely upon my own assessment of the patient. I do have "backup" in the form of calling the Base Hospital, but the majority of my patients do not require that I call in to the BH. Other systems here in California may have requirements that I do call Base for each patient contact... Now in terms of specific skills, I can employ quite a few as a Paramedic that I usually won't be able to as an RN. I can intubate, do needle chest decompression, interpret 12-lead EKG, do needle cricothyrotomies, and so on. Depending upon the local system and state, I may be able to hang blood/blood products, do surgical crics, do RSI, and so on. That being said, there's NOTHING that I cannot do as a Paramedic that I cannot do as an RN... if I'm properly authorized to do it in my role as an RN. The big downside of being a HOSPITAL nurse is that I don't have the autonomy to do MEDICAL things unless it's pre-approved as a Nursing Protocol. That varies by each facility. The current hospital has few nursing protocols so I have to technically obtain an order first for medical interventions. The physicians do trust their nurses there so often we'll get something underway and notify the provider so they can formally put in the order. The last place I worked had nursing protocols that were very similar to EMS protocols so it was very easy to get things going quickly and bring the provider up to speed and transition to physician orders for medical stuff.

My advice for you is actually very simple. If you do want to eventually be an RN, go to nursing school and do it the traditional way. That retains employment possibilities as there are some states that do not accept certain types of nursing school education formats. If you want to be a Paramedic, do Paramedic school the traditional way. You'll learn the most about how to "do" that that way. I did both the traditional way. The biggest difference between Paramedic and RN really isn't the underlying knowledge. While most nurses do take more in the way of prerequisite courses, the didactics aren't much different. Paramedic school will turn out someone that's qualified to start work as a beginning Paramedic and be capable of running 911 calls without too much difficulty. They're specialists in doing that. Nursing school turns out generalists and the clinical experiences are geared toward that result. The beginning RN gets to do a LOT of OJT where they'll learn how to be a nurse for whatever kind of floor/department/unit they're working in. In my case, I'm an ED RN. If I want to become an ICU RN, I can do that. If I want to become an opthamology RN, I can do that! I just have to spend time orienting to the new role.

Also as an RN, I do see more sick patients than most Paramedics do so I have a broader experience base with sick patients than most Paramedics do. I try to pass on what knowledge I know about patients that are more sick than they appear to the Paramedics so that they can better anticipate what needs to happen and that makes for better overall care. As a Paramedic, I see different kinds of patients than some ED nurses will see so I'll educate them about those patients and that also makes for better overall care.

TitaniumPlates · Feb 19, 2018

Everything Annie and Akulah said.

Plus one thing. As a medic, we wear bullet proof vests in some markets. There's a reason for that. You go in with PD and FD. Scene safety is priority for yourself and your crew, and there is always the stupid with the gun.

In the ED, I really never came up against a banger who wanted to finish the job. Especially with the tight security we had at my prior facility. Metal detectors and police, not security guards.

It's fun on the truck, but we also see the scene "as it is". Upside down in a ditch, extended extrications in subzero weather or driving rain...you're in there intubating and securing for transport. Lots of help. Lots and lots and lots. A real brotherhood.

In the ED, I get "cleaned up" versions. Packaged, sometimes intubated already, IVs started and there goes my ego...the medics got to do it all. I sent him to CT and surgery. Yay.

Ups and downs to both. I hated the feud between the two specialities, because it's undeserved on both ends. RNs work like dogs and never sit, sick as crap patients at a 5:1 ratio. Medics for the most part are 1:1. MCIs...you get craptons of help, multiple buses and lots of direction from command.

I do like my vest though. I feel like I should wear it in the ED for all those daggers in my back for not coming in during a snowstorm......

AnnieOaklyRN, BSN, RN, EMT-P · Feb 21, 2018

Hi OP,

I responded to some of your earlier questions. So as I was saying there is a lot of autonomy when you are a medic, and in some cases that can be traumatic as you have to make some very difficult decisions at times. You decide when to stop resuscitation efforts (in my state we can work them for 20 and make the decision to continue and transport or to stop), when to work someone, and when to do invasive interventions. It can be emotionally draining when you have that call where you felt like you put the nail in their casket, for lack of a better term, even if you didn't. I am adding a link to another thread that I posted a few days ago of such situation so that you understand being a medic isn't always fun and there is a lot more responsibility than you would have with nursing. Yes I called the doctor on this one, but she couldn't make the decision because she couldn't see the patient, and could only offer a recommendation. Others are welcome to read it as well, it truly defines when you have those terrible calls that will always haunt your thoughts. They do not happen everyday, but you will have them!

https://allnurses.com/nicu-nursing-neonatal/did-i-make-1150185.html

Annie

AnnieOaklyRN, BSN, RN, EMT-P · Feb 21, 2018

How does it transfer do you have to apply? And thankyou!!

In most staes, even if they are national registry you will still need to apply for a license. This usually entails providing a copy of your NR card, ACLS/BCLS, and often times fingerprinting for a background check.

Annie