Paramedic Vs Registered Nurse: knowledge

fhcp1220 · Nov 11, 2015

Good evening! Great question!

I just wanted to give my input because, well, I have thought about this before as well and find that I have an interesting perspective..

Just to give readers some background, I am currently practicing as a RN in Ontario, while also in school to be a paramedic. I have met amazing, knowledgeable, and incredible nurses and medics and respect both professions incredibly. Even though it may look like I am mainly defending paramedicine, I am only trying to provide a more realistic and unbias picture of their scope of practice!

First off, let me just say this:Medics DO NOT just pick up patients, give oxygen, and transport, just like how nurses DO NOT just clean diapers, make beds, and feed patients.

Anyone that understands this to be the scope of a nurse or medic, clearly lacks the understanding of the job itself. If that is all you understand about nursing/paramedicine, you clearly have some reading and learning to do. It becomes even more unfortunate (for your patients and the EMS field) if you work as a medic and continue to only have the understanding that paramedics pick up and drive patients to the hospital.

The competency/skills/judgement of each healthcare provider is different because of the "uniqueness" of.. Well, everyone. Some people feel a strong drive to keep up their knowledge, while others patiently wait to receive their pay check and wait for retirement. You will find great, competent medics and nurses, and you will interact with medics and nurses that are, er, questionable. The people that believe that a certain profession is lower on the health care totem pole, such as some writers on here, are the ones you have to question... Only because, if their responses are so bias, can their opinions even be that valid?

Generally, from my experience, it's not that one profession is "smarter" than the other, but the two careers are COMPLETELY different. The scope of practice for a paramedic may be more limited with skills, but it is not because medics cannot learn these skills, but rather do they need to? The amount of time transporting patients to a hospital is generally within minutes in the Greater Toronto Area. Other services, such as Sioux Lookout, may train their medics differently than ones in Toronto because transport time may be longer. Also know that with the varying level of paramedics (ie. Primary Care, Advanced Care, Critical Care in Canada, or EMR/EMT-B, I, P in the States), they can actually do more invasive procedures than nursing (look it up). The two careers are simply, not comparable.

I can only speak of the paramedic profession in Canada, but in terms of treatments and procedures, medics are given prewritten directives that gives you guidance and conditions for assessments and txs. Throughout school, you are asked to memorize and apply, as well as question your directives and use critical thinking to question if they are appropriate for the management of your patient. For example, the patient that has a head injury and begins to vomit: yes, gravol is an antiemetic, however, would it be appropriate for that patient with a head injury if their LOC is already compromised? Would it truly benefit the patient with a head injury? Potentially, depending on what is causing the nausea to begin with and the ability of the patient to protect their own airway. In contrast, nurses are given medical orders based on each individual patient (unless in ER, where medical directives are initially applied), and they to, are learn to understand, apply, question, and critically think.

Medics are experts on situational awareness--hands down. Medics are able to evaluate the environment and rely on strong detective-like/assessment skills, and some diagnostics, because that is all they literally have to work with. The medic that is called to the (unwitnessed) unresponsive patient inspects the environment to see if foul play, drug and alcohol use, blood sugar, stroke/seizure, and kidney failure is the cause of the patient's unresponsiveness. They do not have a hx, chart, medication list, and recent blood work (sometimes even name) to confirm their suspicions/differential diagnosis... so I would even argue that (great) medics understand, and are able to come to a pretty accurate conclusion based on their assessments and history gathering alone--research studies have found paramedic assessments to be quite accurate as well. This is why it may be frustrating to some medics when they come across staff who see them as only "lowly" paramedics.

As a nurse, you are trained to think differently, and by the time patients arrive at the hospital (and eventually to you), a clearer picture may have been gathered in triage. If you are a competent nurse, you will understand and determine appropriate assessments/treatments in order to put together an overall clinical picture of your patient, but.. Just know that there are many tools and resources available for you to help conclude your nursing diagnosis. You are generally an expert in 'your' working field however. If you put that CV nurse on an OBGYN floor, do you think she would feel comfortable? Probably not. But, holy, could that CV nurse tell you everything there is to know about arrhythmias, CV assessments, meds, tx, diagnostics, etc. As nurses, you're the main provider of their care in the hospital so it would make sense for you to understand the management/plan for your patient.

EMTP894 · Mar 10, 2016

Paramedics do have a lot of training, in fact, we practice emergency medicine without much supervision. What a paramedic can do in an emergent situation, which protocols vary state by state, and even regionally in States, is very much what the physician can do in the emergency department. In fact that's primarily what a paramedic is, an extension of the services offered by an emergency department, delivered to your home on an ambulance. We rarely require medical direction for permission, unlike an RN who may require direct orders as given by the physician in charge of the patients in the area where the RN is working. The difference in education like anything else, is dependent on the quality of education received. Paramedics learn a great deal about pathophysiology, pharmacology, and cardiac and respiratory care. We get you through the first couple hours, that's our duty and that's what we're taught to. The bottom line is that the responsibilities of the RN and the paramedic are vastly different as they are vastly different jobs. I think the disagreements between paramedics and RNs comes from being looked down upon by RNs, as we are much lesser than they are, being called ambulance driver, well that's about as bad as some of the names I'm sure you've been called by persons who are levels above an RN. It's all about perspective, and everyone having a mutual respect for each other and their role in the care of the patient, because that's what it really comes down to.

STATION2MK · Jun 20, 2016

Tony51783, geeeees, come on. I'm definitely not going to slam nurses because I agree with everyone on here about how valuable they are. Just as important as every profession in healthcare is. Congrats to you for wanting to further your education also. I've been a Paramedic for over 20 years and yes, have saved a few lives in the field. While I don't claim to know near as much as a nurse in the hospital, or for sure a doctor, I think we both know that your description of a Paramedics limited education and intellectual potential is pretty harsh. It's only limit is how much effort you wanted to put into it. I've done a lot more than load cots and drive. In fact, I much prefer to be in the back of the ambulance treating my patient. If you don't know what a beta blocker or an ACE inhibitor does, (under the education you received as a medic), you must have skipped the cardiology, pharmacology and electrophysiology sections of the course. We were taught what every drug we give does to the body and much more. Yes, we only see the patient at their home or on the street, but we are the front line in helping what is usually the worst day in their life become better. Our greatest reward in the field is that after our short time frame of care is over, we hear maybe days or weeks later that our patient made it and went home from the hospital with a good outcome.

wlgoode · Jul 12, 2016

As a former ALS -P / Helitack firefighter for the US Forest Service let me weigh in here. As going through the EMT training required for Paramedic training I did have some cursory training in Pharmacology. Then another 2 yrs of training for Paramedic training I had a 3 Credit Hour class in Pharmacology. Then in preceptorship and ALS training I learned additionally. Beta blockers slow the heart rate therefore the BP is lowered, Ace inhibitors were developed from snake venom and work in kidneys to inhibit Angiotensin-converting- enyme within the kidney's Renin-angiotension-system. Ace inhibitors work by relaxing blood vessels and slightly reduced plasma volume to reduce BP. This stuff I learned in Paramedic training over 35 years ago. I happened to look in the 2016 College Catalog of Eastern Arizona College which has both programs. Paramedic program is either Certificate or AAS. RN is AAS.

Because regulations require EMT Cert. prior to P Cert. Combined education credit hours in Allied Health subjects for Paramedic Cert. is 48 Credit hours. Allied Health Credit hours for AAS as RN. is 36 Credit Hours.

Mlee81 · Mar 5, 2018

Currently an EMT-B working in EMS for a local ambulance companies while attending nursing school. A couple of interesting points:

1) BOTH Nurses and Paramedics are under "Standing Orders"/ Protocols. Both require verbal or written "orders" by a physician/HCP to execute OUTSIDE of those orders.

So the entire concept of one working without orders while the other does is a fallacy.

2) BOTH Nurses and Paramedics Assess, "Diagnose", Implement, and Evaluate. "Diagnose" in quotes meaning both are use their assessment knowledge in emergencies (WHICH IS EXACTLY THE SAME) to help determine an underlining cause to treat the symptoms STAT with the standing orders/protocols/Contact Medical Command/HCP allows. "Diagnose" is not referring to the actual "Medical Diagnosis" the HCP will designate post testing, etc.

3) BOTH provide much of the same MEDICATIONS for these acute emergency situations on a daily basis. The RN; however, has a VASTLY INCREASED NUMBER of meds/routes, etc that they are responsible for.

For skills that the Paramedic is expected to be much better than an RN include:

1) ET intubation - The Physicians in the ER do this the majority of the time. Paramedics are responsible for this in the unit.

2) Decompression - IBID

3) Cricothyroidotomy - IBID

ETC.. so Paramedics are more apt to do things in an EMERGENCY SITUATION that generally the ER Doc would be doing in the ER.

This continues to be a HUGE issue because ultimately RNs get paid more than Paramedics. There will always be a urine shooting match to see who can shoot farther.

There is very much an overlap. As one looking to obtain the RN as well as challenge the Medic test (allowed in my current state), I believe that would be MUCH EASIER (not saying it will be easy) to go that route than the other way around.

I also have EXPERIENCE working in EMS. So for me the issue would be to simply focus and train on the few skills that nursing doesn't focus on.

Paramedics are very strong in two systems primarily

1) Cardiac

2) Respiratory

Which comprise at least over 80% of our calls. Endocrine for Diabetics mostly.

Rocknurse, MSN, APRN, NP · Mar 5, 2018

This is an old thread but I'll weigh in here. I've never worked as a paramedic but I've done ACLS classes with them and found their knowledge to be very good. Paramedics are trained to do things that a nurse would never do, intubate, place IOs, etc. However, it depends what level nurse you are. As a CVICU nurse I would say that we do more and have a broader more in-depth knowledge because we look after very sick patients requiring skill with lots of different technology: IABP, hypothermia, Swan Ganz, CRRT etc. I'm ACLS trained and have a critical care certification, but I'm not the norm. You can compare paramedics and nurses all day long but there are many different kinds of nurses. A new grad nurse in LTC won't have the same knowledge or skill set as a senior experienced CVICU nurse. When I receive a patient in active MI from a paramedic they know their stuff and do a fantastic job. Paramedics on a flight crew will be some of the most knowledgeable people you'll come across. They're not to be confused with an EMT who don't have the same skill set. As someone mentioned, you can't really call one better than the other as the skillset is different. You can compare a brand new RN grad in home care to a veteran flight paramedic and say that the paramedic knows more, or you can compare the veteran ICU nurse to a brand new paramedic and the nurse will know more. Either way, a nurse or paramedic who has a thirst for knowledge and applies themselves to further their skills, is worth their weight in gold. Don't compare yourself to others or think you are better than someone else. Just concentrate on making yourself the best nurse or paramedic you can be. I've been in nursing for 28 years and I never stop learning.