PHRN transfer to EMT-P in other states?

SummitRN, BSN, RN · Jan 21, 2013

I'd contact the TX EMS board.

You might also ask over at emtlife.com

TraumaSurfer · Jan 23, 2013

Ask the TX Board of EMS and the TX BON to see who regulates nurses in prehospital situations.

EMTlife probably will not be of much use since that is a forum for mostly EMT Basics and not nurses.

Medic09, BSN, RN, EMT-P · Jan 24, 2013

PHRN is a pretty rare thing. Only a few states have it; so the folks in TX may not know what to do with it. (I don't, either.) Paramedic licenses are governed by the state EMS bureau, so they are the ones you need to speak with. They may not even know what PHRN is. Offhand, the only two states I know of that have this as an actual credential are PA and IL. CA has MICN, which is a little different. If you don't get a positive response from TX EMS bureau, go to them in person when you are there with the credential and curriculum in hand. If they don't transfer it over, maybe they'll let you challenge the EMT-P exam without having to go to school again. Be sure that PHRN included all the paramedic skills like intubation and reading twelve-leads.

RegMurse12 · Jan 29, 2013

Thanks for replying everyone. I went to the emslife forum and posted the question. They referred me to the TX EMS board and then started a battle among themselves about why nurses shouldn't be paramedics and vice-versa. Anyways, I emailed them the TX board and I'm waiting for a reply.

Thanks again!

SummitRN, BSN, RN · Jan 29, 2013

Thanks for replying everyone. I went to the emslife forum and posted the question. They referred me to the TX EMS board and then started a battle among themselves about why nurses shouldn't be paramedics and vice-versa.

If anyone wants an entertaining read:

http://www.emtlife.com/showthread.php?t=33913

Trauma Columnist · Jan 30, 2013

lol - I'm a PHRN in IL on a volunteer squad and even in states where PHRNs exist (and I've been one since 1999) there is still confusion.

TraumaSurfer · Jan 30, 2013

If anyone wants an entertaining read:
PHRN transfer to EMT-P in other states? - EMTLife.com - The #1 Online Forum for EMS-Related Discussion

I hope nobody takes any information on that forum seriously. Most of those commenting on education have only a 3 - 6 month certificate as a Paramedic and no college. Not even an Associates. They regularly bash anyone with education and are very outspoken against RNs, NPs and PAs. Strange how someone with a 6 month cert from a medic mill can criticize a nurse with a Masters or Doctorate. Unless you have actually taken college level A&P and Pharmacology courses, you will probably not know how little you do know. It is also no surprise that most instructors for EMTs and Paramedics do not hold an Associates degree. There will always be a bias against those with education.

For a nurse to transition to a certificate level course it should not be that difficult. A few new skills and additional algorithms are not that big of a deal if you have a strong foundation. Experience, past, present and future should be considered. This should be no different than an RN training another area of the hospital be it HBO, CCU, ECMO, ER, PICU, NICU, Onocology etc. We could also include those who intubate in the delivery room or do US. There is a transition period with educaiton and training but there is also respect for the education and experience as an RN. You also don't have to change your profession and can still be an RN.

In a perfect world, no RN should ever have to change their profession or totally give up their identity as an RN to work as a "Paramedic". Cardiovascular RNs don't give up their identity to work in a position where there are also CV Technologists.

Each state should have a prehospital credential and path for RNs who have the education and experience. No RN who has the experience and knowledge to make a flight team should ever have to sit through 8th grade A&P again. Other specialty teams like Peds, Neo and Organ Procurement teach advanced skills (including performing Bronchoscopies) to RNs and don't require the RNs to get another license unless it is a cert pertaining to nursing. It just makes it easier to answer to one professional board and not worrying if you do something with a Paramedic license that could be out of scope because you always did it as an RN. This is especially true with meds.

Someday EMS will drop its egos and see other professions as team members in health care rather then these ******* contests. Those in EMS who say they can do much more than a BSN RN and it only takes them 3 months to master everything need to go away with the lights and siren whackers.

Back to the topic, it seems there are some colleges which take the RNs education and experience into account and will allow you to take just what you need. This should not be a big deal since Texas only requires 600 hours including classroom and field clinicals to be a Paramedic.

Trauma Columnist · Jan 31, 2013

Agree traumasurfer - you must always look to the source of info. PHRN is a viable alternative for RNs interested in pre-hospital care. It builds on our basic RN assessment skills and adds the needed pre-hospital skills. Assessment skills always trump procedures IMHO.....in other words a solid nursing assessment is worth its weight in gold and can often forestall the need for a procedure.

DE-ED-RN · Feb 11, 2013

I hope nobody takes any information on that forum seriously. Most of those commenting on education have only a 3 - 6 month certificate as a Paramedic and no college. Not even an Associates. They regularly bash anyone with education and are very outspoken against RNs, NPs and PAs. Strange how someone with a 6 month cert from a medic mill can criticize a nurse with a Masters or Doctorate. Unless you have actually taken college level A&P and Pharmacology courses, you will probably not know how little you do know. It is also no surprise that most instructors for EMTs and Paramedics do not hold an Associates degree. There will always be a bias against those with education.
For a nurse to transition to a certificate level course it should not be that difficult. A few new skills and additional algorithms are not that big of a deal if you have a strong foundation. Experience, past, present and future should be considered. This should be no different than an RN training another area of the hospital be it HBO, CCU, ECMO, ER, PICU, NICU, Onocology etc. We could also include those who intubate in the delivery room or do US. There is a transition period with educaiton and training but there is also respect for the education and experience as an RN. You also don't have to change your profession and can still be an RN.
In a perfect world, no RN should ever have to change their profession or totally give up their identity as an RN to work as a "Paramedic". Cardiovascular RNs don't give up their identity to work in a position where there are also CV Technologists.
Each state should have a prehospital credential and path for RNs who have the education and experience. No RN who has the experience and knowledge to make a flight team should ever have to sit through 8th grade A&P again. Other specialty teams like Peds, Neo and Organ Procurement teach advanced skills (including performing Bronchoscopies) to RNs and don't require the RNs to get another license unless it is a cert pertaining to nursing. It just makes it easier to answer to one professional board and not worrying if you do something with a Paramedic license that could be out of scope because you always did it as an RN. This is especially true with meds.
Someday EMS will drop its egos and see other professions as team members in health care rather then these ******* contests. Those in EMS who say they can do much more than a BSN RN and it only takes them 3 months to master everything need to go away with the lights and siren whackers.
Back to the topic, it seems there are some colleges which take the RNs education and experience into account and will allow you to take just what you need. This should not be a big deal since Texas only requires 600 hours including classroom and field clinicals to be a Paramedic.

Dear colleague,

With no disrespect intended, it is obvious that you are unaware of the curriculum of a paramedic course, certificate or associates. i am both a NREMT-P and BSN RN CEN. I can tell you that most medic programs are longer than 6 months, and the ones that are 6 months consist of 5 day per week 8 to 10 days of class room didactic and then 600-1000 hrs of clinical time. The "few extra skills" you write about include intubation, chest decompression, EKG recognition, and in some states central line placement in the field along with other immobilization, extrication, and transportation techniques.

As someone who completed BOTH programs I can assure you that paramedic school was much more challenging and when completed you are tasked with managing pt care w/o the benefit of yelling out side of the room " I need help in here!" Cause there is no one else to call. With all of this said they are different scopes of practice with different missions and goals for pt care, but both have the best interest of the pt in mind. There are many pre hospital providers with big egos and attitudes that don't understand other practices so in the end don't fall into the same trap and take the position that they are less educated or that you could just " jump" right into a pre hospital provider role. I ASSURE YOU, there is ALOT more to the job than you are recognizing.

TraumaSurfer · Feb 12, 2013

Dear colleague,
With no disrespect intended, it is obvious that you are unaware of the curriculum of a paramedic course, certificate or associates. i am both a NREMT-P and BSN RN CEN. I can tell you that most medic programs are longer than 6 months, and the ones that are 6 months consist of 5 day per week 8 to 10 days of class room didactic and then 600-1000 hrs of clinical time. The "few extra skills" you write about include intubation, chest decompression, EKG recognition, and in some states central line placement in the field along with other immobilization, extrication, and transportation techniques.
As someone who completed BOTH programs I can assure you that paramedic school was much more challenging and when completed you are tasked with managing pt care w/o the benefit of yelling out side of the room " I need help in here!" Cause there is no one else to call. With all of this said they are different scopes of practice with different missions and goals for pt care, but both have the best interest of the pt in mind. There are many pre hospital providers with big egos and attitudes that don't understand other practices so in the end don't fall into the same trap and take the position that they are less educated or that you could just " jump" right into a pre hospital provider role. I ASSURE YOU, there is ALOT more to the job than you are recognizing.

The information is very easy to look up on each state's website.

Most states in the US require only 600 - 1000 hours total. No FD, which now many areas for Fire based EMS, is going to put their FFs through a 2 year program or the number of hours you suggests.

Texas is only 600 hours total.

California is just over 1000 hours total.

The Carolinas and GA are only 800 - 900 hours total.

The other states also fall within that range.

The exceptions are Kansas but then in that state RNs are given special provisions when working or volunteering with an ambulance.

Oregon always gets mentioned as having a 2 year degree requirement but if you actually read the website, you will find there are many exception and a certified Paramedic can take up to 5 years while working to complete it and there are also options for extensions.

You also have to consider that the EMT text book is written at the 8th grade level and the Paramedic text is at the 10th grade level. This is common knowledge. The Paramedic program is often taught at a tech school or in the Votech section of a college.

You also have to consider that the Paramedic programs usually have only the requirement of an EMT cert with a HS or GED diploma. Many of the "hours" you might have in a Paramedic program is spent teaching an overview of A&P. There is no reason an RN should go for an extra 6 - 9 months retaking basic A&P and Pharmacology which is not even considered a college level standard course for other health care professions. Overviews are vastly different in content and hours required for outside learning along with required labs.

Another point is that many of the clinical situations are actual hours and not necessarily patient contanct. You might spend 400 of a 500 hour rotation sleeping in an ambulance or FD station. The only hours awake might be if you are in an ER rotation. A few states like California might require 40 ALS patient contact but that might just mean sticking a cardiac monitor on and calling it ALS just to get the number for the student. Again, each state is different and each school may be free to interpret training in a different way.

Another point to consider is that intubations are suggested but not always required in a Paramedic program. Due to the degree of difficulty of finding sites to allow Paramedic students to intubate, many are coming out of programs with just successful manikin intubations. The same for IVs. It is a hit or miss so to speak. Therefore, the Paramedic student is at the same level for actually performing the skills as the RN. But, the RN may have witnessed dozens or even hundreds of intubations before attemption on. The new Paramedic will not have that advantage. The RN who has worked in the ED and ICU will also have the advantage of already have given many,many meds which are not even in a Paramedic's protocols or allowed by the state. Not many states allow for meds used for RSI. But, in states like PA which uses the PHRN, the RN can give the meds not allowed by Paramedics. The RN may also have performed or seen many of the skills which are reserved only for Flight Paramedics (maybe) and some like NG/OG placement will be common place but often not found in many Paramedic protocols.

And yes, I have seen and worked both sides for a long time. That is why I am an advocate for higher education standards for Paramedics across the board rather than just one exceptional FD or ambulance company. I prefer not to bury my head in the sand and ignor existing problems in EMS which are well published if you care to do a simple search. They have the topic in the national level of politics for awhile since reimbursement has been an issue. The sooner you realize not all is rosy in EMS the sooner you can get on board to support Paramedics.

TraumaSurfer · Feb 13, 2013

Dear colleague,
some states central line placement in the field

I do have to ask one thing and I don't mean to distract from the original question, but, why in the year 2013 would any Paramedic do a central line in the field when IOs are so readily available or even doing an EJ? Also, this is where an RN would be of value to give an insight on risks vs benefit for central lines since that has been a hot issue in hospitals now for over 10 years. Actually, it has been longer than that since PA catheters formerly known as Swan Ganz catheters decreased in use about 15 years ago. Any EMS agency still bragging about inserting central lines in the field is about 20 years behind. That was a thing of the 70s and 80s. Even prehospital intubation can now be in despute about risks vs benefits and increased survival by not intubating in the field. Skills should be about best practice for patient outcome and not bragging rights to stroke egos.

The RN would bring to the table vast knowledge of infection control and have an understanding about what hospitals and what is expected by those who monitor them for accreditation and reimbursement.

This differs from the EMS beliefs that hospitals pull lines and tubes just so they can charge for another or just to pick on Paramedics.

I think the PHRN would raise the standard in EMS especially with new concepts and evidence based medicine as well as education. I really hope more states start to realize the value.