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PS- Paramedic school is definitely doable, but judging from my experience, it isn't a cake walk. Be prepared for a major time commitment. After clinicals started in January of the year I took the program, I was either: a)at work; b)studying; c)in hospital clinical; or d)in field clinical. My program was about 12 months long- it took another 5 months after it ended to become fully certified and cleared to function on my own. All that being said, definitely go for it if you feel like it's something you want to do.

As someone who did it "backwards" (EMT while in college, then nursing school, then paramedic), I would have done it the other way around. Nursing in a hospital and being a paramedic are two different worlds- although nursing knowledge and skills compliments paramedicine- in the sense that you have a broader perspective of patient care, pharmacology and the health care continuum. Having been socialized as an ICU nurse for the first two years of my career, the hardest part for me was changing my mindset when caring for a patient in an ambulance (as an ALS provider). All of a sudden, it was up to me to make a working diagnosis (ie- get an idea of what the patient's problem is) and come up with a plan for that patient on the fly- based on what tools and protocols my partner and I had available. In the ICU, most all of my patients already had medical or surgical diagnoses, and I got a detailed, in-depth report on the patient's history, systems assessment, problem list and treatment plan. Also, I almost always had ready access to docs in the ICU to bounce questions off of. In the field, you have to quickly assess a patient you don't know from Adam and it's expected you'll make (sometimes quite hairy) treatment decisions independently based on protocols and experience. For example, you have to be comfortable with deciding whether or not to pronounce someone dead on scene (instead of initiating resuscitation) at 4:30am (when you were woken out of a sound sleep). Similarly, you may have to decide whether or not to immediately needle decompress a patient's chest with a pneumothorax. The doctors aren't going to be standing over your shoulder giving you advice. Medical Control physicians expect you to know how to function as a paramedic within your protocols and to have an idea of what needs to be done. ICU docs also expect ICU nurses to be competent and knowledgeable, but Medical control physicians aren't always available in the field (via phone or radio) and have very limited time to devote to you. As far as RN's challenging the paramedic course/exam, I would say the appropriateness depends on the RN and his/her experience and education. If you don't have much EMS experience, I would definitely take the whole class; you'd be cheating yourself and your patients by taking the challenge shortcut. I took my paramedic class in another state (outside of MA) and was allowed advanced standing based on my EMT and ICU experience. In other words, I didn't have to attend some of the introductory lectures, or attended ICU or Respiratory Therapy clinical. The aspect of the program that was most helpful was the field clinical with the local fire department. If anything, being a paramedic student on a 911 unit, with a good preceptor, will indoctrinate you into the world and mindset of a paramedic- something your nursing knowledge and experience (with the exception of flight nursing) can't really replace. In MA, RNs can achieve paramedic certification by advanced standing. The information on the challenge process can be found here: http://www.mass.gov/eohhs/docs/dph/emergency-services/forms/paramedic-app-out-of-state-300-12.pdf The link to the MA Dept of Public Health, Office of EMS can be found here: Office of Emergency Medical Services You need your EMT first, plus RN licensure, to challenge the paramedic exam in MA. I would strongly recommend against simply challenging the exam. Get some experience as an EMT, get into a reputable medic program and get your paramedic that way. Cutting too many corners will definitely show once you're out on the street.

What do you mean by lack of options? There are plenty of lateral and vertical moves you can make in nursing- especially of you get more education (ie- a masters degree). If you're one of those people who wants to do something related to inpatient care, ambulatory patients or community health, then there are plenty of options around as far as education goes. If you're like me and you want to be more involved in EMS as a nurse (doing something besides flight nursing), then your options are limited and vary greatly depending on what state you're in. I plan on starting paramedic school fairly soon and then going on to graduate school- exactly for what, I don't know. I do know, however, that: 1)IfI truly want to combine my interest in EMS with nursing, I'll need to carve out a niche for myself; and 2)I'll need a graduate degree to help me do that- especially if I want to work in administration or the policy end of things.

^^^What She Said^^^^ I learned this the hard way (I want to combine my passion for EMS with my nursing career). It's not a "step down," rather, it's a lateral move which teaches you an entirely different skill set- ie- how to care for patients in unstructured environments, in the initial moments of their crisis. People who say it's a "step down" need to ride with an EMS crew for a few 12 hour shifts. Only then would they realize that caring for a patient in their living room (or an ally or the back of a car) is VERY different from the ER and TOTALLY different from the hospital unit. As a nurse who volunteers as an EMT (and who will hopefully start paramedic school soon), I say go for it if you have a genuine interest. Next time you see EMTs or paramedics you know in your ER, ask them if you can do a ride along with their service so you can get a better idea of whether or not EMS may be right for you. They can also point you in the right direction as to where/how to obtain EMT certification. Some resources you may want to check out: NREMT - National Registry of Emergency Medical Technicians - This is the website of the National Registry of Emergency Medical Technicians- the national organization that also acts as a certifying body for EMTs and Paramedics on a national level. Some states use their tests as their certification exam and/or require EMTs to maintain National Registry EMT certification (nicknamed "registry states"); other states make their own certification exam/requirements and do not recognize NR at all. In any case, this website provides a link to State EMS Offices in all 50 states. Once you link to the EMS office in your state, you can then find out about EMT and paramedic training opportunities near where you live. One thing to keep in mind is to look for paramedic programs that are CoAEMSP accredited- because after January 2013, NREMT will only allow paramedic candidates to obtain NR certification if they are graduates of CoAEMSP accredited programs. This isn't really a big deal if you live in a non-registry state and don't plan on moving; it's definitely something to keep in mind, though. www.flightweb.com- A good website if you have any interest in flight/transport nursing. Click on "Links," then "Flight Programs for links to flight services in all 50 states. Their forums are also useful (although not 100% reliable) sources of information on getting started in the critical care transport (CCT) arena. The Road Less Traveled | New York Nursing News NurseWeek: Jodi Nevandro, on fire service nursing The first link is an article about Mobile Intensive Care Nurses in New Jersey. It's twelve years old, yet it proves that there are nurses out there who are also prehospital care providers, in areas OTHER than flight/CCT. The second link is an interesting article about a nurse in CA who works as a "Fire Service Nurse." There are other nurses around the country who work in various facets of EMS- especially in administration and education. A note on "MICN" and "PHRN" certifications: these are state-specific designations that allow nurses to function as advanced life support prehospital providers after a set training/certification process (mandated by the EMS office in that particular state) has been completed. States that I know of that offer such a certification include: New Jersey, Pennsylvania, West Virginia, Illinois, and Nevada. As far as I know, PHRN and/or MICN certifications aren't transferable to other states. Hence, you may want to consider what it would take to become a paramedic in your home state, even if your state offers such a certification; because NREMT paramedic certification is largely transferable once you earn it (and keep it current). There are ways to challenge or test out of advanced life support (ALS) training, depending on which state you live in. Whatever training option you decide to take, just keep in mind that you want to be the best prehospital care provider possible- not just another guy/gal with a paramedic card. Because: a)just like in nursing, the most significant learning takes place once you start practicing; and b)you have to have a good amount of patient care experience (in EMS) before you really become competent to care for patients in the out-of-hospital environment.

I'm a critical care nurse who volunteers as an EMT with a nearby fire department. At this point I'm EMS-only but I've thought on and off about taking firefighter training. I love doing it because- for one, although we deal with stuff that's serious business, it doesn't feel like work. Two, I love being outside of a building and getting to take care of different types of patients on every shift. Three, I love helping people in general. And four, there's nothing that gets your adrenaline going like riding to a priority 1 call full speed down the road. Plus, I've always found that I learn something new on just about every shift. I'd love to get paid to do a combination of both nursing and EMS someday. What form that will take, I have no idea.

I also feel very fortunate to have the job I have, however, rather than waking up at 5:20am on my workdays, I sometimes feel that I'd rather be: 1)Socializing with friends 2)Hiking 3)taking random road trips to places I've never been to 3)Riding the am-Buh-LANCE

So what the heck are we all collectively going to do about it? We need to do something- we can't just sit idly by and let our nurse-patient ratios increase. Prone patients and CRRTs NEED to be 1:1- they are 1:1 for a reason! We can't just accept that "it's the way things are going" because eventually you, me, or any one of us will be entwined in an unsafe situation that will result in an adverse event- like a CRRT circuit clotting and the patient losing a whole lot of blood because the nurse was busy with their crashing septic patient next door. And who will everyone else blame for that occurrence? Yeah, that's right- the NURSE. Because everything always comes back to US.

true self-scheduling using computer software (i think you're talking about nightingale?) would definitely be nice. the latter half of your reply basically describes what goes on in my unit- sometimes you get most or all of what you want, and other times you get switched to random days to cover for people in school, on vacation or going to soccer games. and my unit has been short-staffed lately so it's just going to get worse.

Which is my exact point. That's why they call it modified self-scheduling, because it isn't really self-scheduling. Management (or whoever they designate to write the schedule for that six week period) ultimately decides who gets which days- which puts the final schedule beyond the employee's control. And it's pot luck as the whether other people can switch with you for the days you want off so you can keep the set schedule you want.

Every hospital at which I've worked- both as a tech and now a nurse- does modified self-scheduling. Meaning that you put in the days that you want to work (within the scheduling rules) as well as the days you want off and you may or may not get any or all of them. I'm sick and tired of having to work different days every week and not having regular days on/days off- all because different people want various days off each week. Why can't nurses just have set schedules (with weekend rotation if they don't already work a weekend day/night) and then plan their lives around those work days? Before everyone starts saying "well, nursing isn't a M-F, 9-5 profession," I've worked for ambulance companies (24/7 operations) where employees work the same shifts every day of the week and swap with colleagues if they need to take a day off. Furthermore, employees can go to the company scheduler and request a different schedule if they are going to do something like go back to school. I just don't see why hospitals can't have a similar scheduling system. It would be so much easier than having to work different days of the week to accommodate each others' needs for days off. For a single guy like me- it would be much easier to have a regular life outside of work.

If you want the specific requirements for Florida, the NREMT website usually has links to individual state EMS offices. Once you get to Florida's website you can either see if they have a specific policy or regulation listed, or you could always call their office and ask them directly. http://www.nremt.org/nremt/about/emt_cand_state_offices.asp http://www.doh.state.fl.us/mqa/EMT-Paramedic/ Whether or not you can maintain your certification without affiliating (with an ambulance service or FD) really varies by state. Some states require affiliation and others don't.

Unless you want to get back into EMS in some way, shape or form- (eg- volunteering or working part-time on an ambulance) or want to do flight/transport nursing, it may not be worth re-certifying. The only reason I kept my certification current when I wasn't on the ambulance was because I knew I wanted to: a)work on an ambulance again someday (in addition to being an RN); and 2)Because I want to get into critical care transport nursing. So I would say don't re-certify unless you have some sort of definite purpose for the certification in mind. I mean, if you're going to practice in the ER, it might serve you well to keep current on what EMTs and medics are doing in the field. A relevant analogy would be not re-certifying as a CEN if you haven't practiced (as an RN) in the ER for years and don't plan on going back. Same thing- why would you re-certify if the certification is no longer relevant to your practice?

OP here- I'm 1.4 years into my ICU experience. My time management and prioritization skills have gotten better. If by no other measure, I used to routinely leave by 9pm (shift ends at 7:30pm) because I needed that much catch-up time for documentation. I now usually leave around 8pm at the latest- which feels a lot better. However, I still feel that having two patients in an ICU setting (even one vented and one non-vented patient) is a challenge to juggle. Especially if a nurse has a vented patient like I did not too long ago who required heavy sedation, was on q1h neuro checks/IVC drainage/ICP monitoring + a non-vented patient who was quite anxious, dyspneic, and required an hour-long road trip (and of course the nurse who was "watching" my neuro patient never did my neuro check when I was off the floor). I still feel that, even though my time management and prioritization skills have improved, I still end up spending more time with one patient while my other patient doesn't get all the care and attention they deserve. Every day I'm forced to prioritize what is immediately important vs what can be put off or (sometimes) not done at all on my shift. And forget q2h, on-the-dot turning and mouth care if we're short on techs (or have no techs at all). Or giving all the patient's medications when they're supposed to be given. Overall, I feel like I'm forced to compromise my standard of nursing care for one patient so that I can spend more time with my other patient- who is almost always more sick. I'm not a "super nurse" and RNs who appear to get everything done on their shift for two busy patients really just take multiple shortcuts (some that are questionable) to get everything done. Sorry, I'm just not going to accept the status quo of 1:2 ICU patients- it's just not safe for vented patients- especially when tech and nurse staffing is low. Something needs to be done. Every vented ICU patient deserves their own nurse. I don't care what the established leadership thinks. That's my opinion based on my experience. And that kind of nurse: patient ratio can happen if something is done about the nursing shortage (yes- it still exists). ICU's in Australia routinely staff 1:1 for vented patients- why can't we?

Yes, it's true that you can take your education in "steps" with nursing- lots of people do that and find nursing to be more flexible in that respect. Whereas the educational ladder in nursing allows people to "step off" at various levels (eg- LPN, RN, NP, CRNA, DNP, PhD, etc), the path to a career in medicine is much more like a two lane road with only one way in and one way out. The road begins with one starting their pre-med courses in a 4-year undergraduate program and ends with the completion of residency and board certification/licensure (and then fellowship if studying a sub-specialty). It's much harder to change specialties in medicine- say from anesthesia to dermatology- because one has to complete an entirely different residency and/or fellowship to practice in a different area of medicine. While some obstacles to change in specialty may still exist in nursing (ie- a psych nurse wanting to practice in critical care- they'd have to get med/surg experience first), it's easier for nurses to transition to different roles in different practice environments. It's certainly not true, however, that more men go into medicine than women. Especially not after seeing all- or majority-female medicine teams in my ICU (including the attending physicians). In nursing school I learned that medicine has achieved a significantly higher gender balance than nursing because: 1)medicine is no longer looked at as an exclusively "male" profession; and 2)more and more young women are more open to exploring career choices in fields such as medicine and the bench sciences- fields that were once (but no longer) "male-dominated." In contrast, nursing is still very much a female-dominated profession, with men making up only about 6%-7% of all nurses. Although it's much easier to pursue a career in medicine if you start planning in high school or college, it can still be done at later stages in life- although it would probably not be advisable to start on the path to med school if you're >45-50 years old (unless you plan to practice until you're 80). Various people have proven that time and again. I personally met an anesthesiologist (in nursing school clinicals) who was a CRNA and went to med school in his early 40's. http://www.une.edu/spotlights/display.cfm?customel_datapageid_37554=37702 http://www.une.edu/spotlights/display.cfm?customel_datapageid_37554=41957 Although you don't need Calculus to enter nursing school, I would argue that having a strong skill set in mathematics and (especially) the sciences is a pre-requisite to becoming a good nurse. Many of my classmates in my BSN program had excellent GPAs in undergrad-level science classes- ie- the same ones that students who are pre-med take. I don't see how one can understand all of the pathophysiology, lab parameters, vital signs, pharmacokinetics/dynamics (how the body affects drugs and how drugs affect the body) if one doesn't have a good understanding of at least biology, chemistry, micro, and anatomy/physiology. Nurses are expected to know more and more about disease processes and why certain diagnostic and/or treatment measures are taken. Tell me that's not so when family members ask me trick questions about what a particular drug does and what it's side effects are, or why their loved one is getting a particular diagnostic test. Bottom line- the public expects nurses to know EVERYTHING about what they do and why they do it- and beyond. We may not always have an answer to those questions, but that's the expectation that I've seen many patients and their family members have. Lastly, it may SEEM as though there isn't a nursing shortage right now- because more nurses have come out of retirement and part-timers are going full-time. It's also that much harder for new grads these days to find a job- because the available positions are being taken by experienced nurses. There is still a shortage of experienced nurses, however, and the overall nursing shortage will get MUCH worse when the economy improves and all the nurses who came back to full-time will either go per-diem or retire indefinitely. My opinion of nursing (after a year in critical care) is mixed. On one hand, nursing has opened up a LOT of educational opportunities for me and I've seen and done things that not very many people would have a chance to do. No day goes by where I don't learn something new- especially because I practice in a teaching hospital where continued learning and education is expected of everyone (and many of the docs are willing to teach concepts, ideas and information to nurses). I'm frustrated, however, with the fact that, as a nurse, I'm expected to do EVERYTHING- from basic nursing tasks to attending rounds on my patients to transporting them to constantly monitoring them to giving their meds to assisting with procedures to informing family members of the treatment plan and updating them on the patients condition (and much more). I feel frustrated sometimes that doctors and NPs can just step back, assess the patient, order treatment and expect it to be done in a certain period of time. In other words, it frustrates me that the "big picture" of what's going on with the patient (and how to treat it) is blurred by the plethora of tasks I have to complete. This experience is why I'm thinking about going back to grad school for a MSN with a NP specialty (or possibly CRNA) someday. So "shoot for the stars" -as they say- and go to a 4-year undergraduate institution and plan on getting into a post-baccalaureate and/or graduate program (whether it be in nursing or medicine) after that. Don't settle for less if you don't have to.

http://en.wikipedia.org/wiki/Emergency_Care_Practitioner http://www.londonambulance.nhs.uk/working_for_us/from_our_staffs_perspective/ian_wilmer_-_emergency_care_pr.aspx Judging from the description of the ECP's role in the British health care system, the above position would definitely be my dream job (I currently work in an ICU). The description says that ECPs come from the nursing field as well as paramedicine. I'm just wondering what people's opinions are on whether or not such a role would be possible to incorporate into the US health care system- given the fact that we have far fewer referral resources than in the UK (especially for people who are uninsured) and that people here love to sue health care providers and institutions.