Paramedic vs. RN

Oh boy, can of worms, barrel of monkeys, and all that.

Poor pay in EMS is multifactorial:

You have fire departments with varying degrees of interest in EMS advancement running the show in many areas.

You have people lining up to work at volunteer services in some areas.

EMS is not well organized and does not have strong, cohesive across the board support like nursing.

Education is in fact not equivalent to nursing in all cases. The education is in fact all over the place. You have outstanding paramedic programs that graduate top notch providers and you have shake and bake medic mills where medics are kicked out after several hundred hours. Therefore, educational standards vary significantly.

The advanced procedure argument is not entirely valid as RN's working specialty areas can have varying degrees of autonomy and access to procedures.

I can see your point! Some hospitals are using Paramedics AS RN's in the ER, but not paying them the equivalent as an RN.

I used to live in Texas and have managed many ED's there so I will try to explain this issue from the standpoint of what I was told by the state regulators who regulate EMS care.

I had many EMT's and a few Paramedics who worked in the ED. They worked as techs. They were not allowed to practice their advanced skills in the ED because of the way the law was written in Texas. Each EMS system has to have a medical director and when the paramedics are out on a call they are working under the direction of a physician, either indirectly according to established protocols or by radio contact with the ED that will be receiving the patient.

In the ED they are not hired by the doctors and the doctors are not the one's who employ them or supervise them. Who ever signs their paycheck is the person responsible for their supervision and that would be the hospital they work for. They would be working under me as their supervisor (or the nurses on duty) and as such, they have to meet the standards as set forth under the board of nursing rules of delegation. Those rules do not allow for the practice of those advanced skills unless you are certified as an advanced practice nurse who has that specific training.

If a hospital is using a paramedic as an RN and allowing them to perform the same duties, they had better check the laws for their state to assure that they can do that. They need to check with the board of nursing for their state to assure that they are not in violation of the nurse practice act for that state. In addition, they must have on file the training that they have had that is the same as what is required of the RN. I guarantee you that the nursing board has some specific rules of delegation that the hospital is in violation of if they are allowing paramedics to perform certain duties, especially when it comes to giving IV meds. Someone needs to check this out. If you are the RN caring for this patient or you are the nurse in charge and you are allowing the paramedic to function in the same capacity as an RN, you are placing your own license at risk. If something goes wrong, you will be held accountable as the supervising nurse, not the paramedic. Trust me on this.

Another variable in the mix is that nurses most often work for hospitals while, until fairly recently, paramedics worked for either municipalities or ambulance services, both of which are notorious for low pay.

For the record, I don't believe that most paramedic pay is anywhere near what it should be considering the risks and responsibilities of the job.

WHY does a Paramedic get paid so little compared to an RN? They both require the same amount of college, experiences, testing, etc.

Not true. The comparison is apples and oranges. Major differences here between pre-hospital and clinical work. The Paramedic education is not equivalent to a nursing program. In some states Medics can challenge LPN boards but without some clinical training they traditionally do very poor during boards. It's just not the same.

.....

There are diploma programs for both paramedic and nursing. Most RNs have at least an associate degree, I don't believe the same is true for medics. Regardless, the training is different. A medic comes out of school much more capable of handling emergency situations than an RN does (by and large), but a nurse has a much more comprehensive understanding of the whole impact of disease and patient's health. They each provide essential services, but are difficult to compare. I've known medics who basically considered themselves CCRNs but they didn't really understand critical care as well as they thought they did (not being derogatory, but it's true).

As for doing advanced procedures that RNs cannot do, that's the old reference to intubation. Some RNs can intubate and another can of worms is the current consideration to remove ETI as a general prehospital skill. RNs can do many, many more things than paramedics can...it may not be fair and people may not agree with it, but it's true.

Also, like Gila said, there are people lining up to volunteer in some areas that are saturated with paramedics. After 911, there was a flood of people wanting to get involved with emergency services, which is good but many administrators took the attitude of "If you don't like something, then quit because I've got a stack of applications of people waiting to take your job". I work part-time at the local fire dept as a paramedic and I can make twice as much in a 4 hour OT shift at the hospital than I can doing a 24 hour shift at the fire house. The pay is about 3x more for me as an RN than a medic.

Good luck with nursing school.

I agree with most that has been said already. I am going to nursing school for the very reason that I can make so much more as an RN than I could when I was working as a paramedic. One nice thing about being a paramedic is 24 on, 48 off shift. Depending on the location and day of the week, you may do nothing for 24 hours, or you may run wide open for 24 straight. Normally it is somewhere between the two. Generally speaking, the nurse works for the entire shift, more of a business vs. EMS which is more of a service like fire or law enforcement. Many people are attracted to the red lights and rush of EMS, including myself. Comparing the two is really apples to oranges. There are some skills overlap, but nursing is not just about clinical skills. EMS is mainly about skills and patient assesment. Nursing (ADN) requires much more education than paramedic, over twice as much. Paramedics carry a small number of meds that they know well, nurses push an unlimited variety of meds. Nurses can spend more time with a patient in a more or less calm enviorment vs. EMS which is often 20-30 minutes of crazy. Much of it is supply and demand. EMT-basics are a dime a dozen, and lets face it, they can handle the majority of EMS calls with a little experience. There is a huge range in the abilities among EMTs, from those who are great at band-aids to those who are da** good at what they do. Nursing has a better established baseline, there is some variation but less than EMTs. EMT-Ps, a.k.a. paramedics can do some things an RN can't, i.e. ETtube, defib., can make decisions about care and give it to a extent, and have experience geared toward emergencies. Most RNs graduate with no ER experience at all. Paramedics and nurses are both valuable, respectable, and needed members of the health care team but they are different.

Interesting side note:

to be a flight nurse one must have the RN plus the EMT-P, hmmm,... that says a lot to me

I agree with most that has been said already. I am going to nursing school for the very reason that I can make so much more as an RN than I could when I was working as a paramedic. One nice thing about being a paramedic is 24 on, 48 off shift. Depending on the location and day of the week, you may do nothing for 24 hours, or you may run wide open for 24 straight. Normally it is somewhere between the two. Generally speaking, the nurse works for the entire shift, more of a business vs. EMS which is more of a service like fire or law enforcement. Many people are attracted to the red lights and rush of EMS, including myself. Comparing the two is really apples to oranges. There are some skills overlap, but nursing is not just about clinical skills. EMS is mainly about skills and patient assesment. Nursing (ADN) requires much more education than paramedic, over twice as much. Paramedics carry a small number of meds that they know well, nurses push an unlimited variety of meds. Nurses can spend more time with a patient in a more or less calm enviorment vs. EMS which is often 20-30 minutes of crazy. Much of it is supply and demand. EMT-basics are a dime a dozen, and lets face it, they can handle the majority of EMS calls with a little experience. There is a huge range in the abilities among EMTs, from those who are great at band-aids to those who are da** good at what they do. Nursing has a better established baseline, there is some variation but less than EMTs. EMT-Ps, a.k.a. paramedics can do some things an RN can't, i.e. ETtube, defib., can make decisions about care and give it to a extent, and have experience geared toward emergencies. Most RNs graduate with no ER experience at all. Paramedics and nurses are both valuable, respectable, and needed members of the health care team but they are different.

Interesting side note:

to be a flight nurse one must have the RN plus the EMT-P, hmmm,... that says a lot to me

Not to antagonize you...but I do take issue with several things you posted. Nursing is definitely more of a service than a business. The business aspect is the hospital administration which the majority of nurses are not interested in.

Also, to be a flight nurse you don't need an EMT-P cert. I don't know where you work or the flight programs that serve your area but I'm not aware of any services that require an EMT-P. Two different animals, I've only flown with a couple nurses who had paramedic cards that had actually been paramedics and worked EMS full-time.

Some RNs can intubate, I don't know of any RNs who can't defibrillate a patient (either manual or AED) and RNs in a clinical setting make decisions about care all day long.

RNs graduate with little ER experience, but there's no need for them to have any. For the same reason that paramedics graduate with no med-surg or oncology experience.

Other than that, I agree with your post and wish you the best in nursing school.

a lot of positions for flight nursing around in my area, especially one at Vanderbilt University Medical Center, require flight nurses to have their EMT-IV certification.

im thinking of getting my emt certification as well just because ive been extremely interested in flight nursing. ex-military, what can i say

After being a paramedic for six years (straight out of high school) I decided to change professions and become an ER nurse (2 years) specifically for this reason. They pay was terrible as a paramedic for the amount of work, stress, physical lifting, and poor job safety (i.e. PD arriving late to scene, patients becoming combative in ambulance- we don't have security like we do in the ED). I miss being a paramedic but also love being an ER nurse and love the bigger paychecks. I worked in a region in which our SMO's were pretty intense (ez IO, surgical crich's, 12-lead ekg etc) I really miss intubating and working a code with one other person (seemed to run a lot smoother than having the MD's, residents, RT, XR, nursing students, medic students, ER techs all in the room talking and shouting at once!) Starting an IV is so much easier in a well lit ED room on a stationary bed than being in a dim ambulance going 50mph over train tracks! I believe pay is cheaper because getting into a paramedic program is so much easier than a nursing program (with a two year wait period) here in chicago, thus yielding more paramedics. I found paramedic school a lot more challenging than nursing school also, nursing school seemed to have a lot more "busy work" and the materials were broken down so you have a little bit at a time instead of in paramedic school where all the same material is crammed into one year compiled with much more clinical/ride time hours.

Not true. The comparison is apples and oranges. Major differences here between pre-hospital and clinical work. The Paramedic education is not equivalent to a nursing program. In some states Medics can challenge LPN boards but without some clinical training they traditionally do very poor during boards. It's just not the same.

Name a state, I have a hard time Believing that.