greatone1210

No healthcare provider is truly independent. Everyone defers to someone else at some point. I am finishing up my ADN now, already having my BS and my paramedic. Nursing is a different ballgame from medicine obviously. I learned more in my paramedic course about medicine and pathophysiology and pharmacology than I did in nursing. If nurses want more "freedom" the educational requirements need revamped. More hard science and the like. In addition, I would like to go on to NP school but am so nervous about not receiving enough medical training. I prefer the PA/medical model but it will be easier to go NP if I am already an RN. I am all for expanding the role of nurses, NPs, and PAs. I think the medical education system is in need of an overhaul. Sorry, just rambling.

I have been working in EMS for around five years now, three as a paramedic. I have a good bit of college under my belt and am finishing my BS in Wellness and Fitness with a Sports Management concentration. I had never really planned on nursing as a career but as I have gotten a little older and wiser ( I hope so at least), I have come to the realization that nursing is a very versatile career choice and plenty of doors can be opened with a degree. Also working as a medic, I have met some really great nurses. That being said, I am planning on the following path. Can you provide a little bit of insight on the following for me. ADN from local CC --> ADN-MSN NP Program (DNP will only be obtained if needed in the next few years) I am not sure if I should grab a BSN as well or just forgo it since I will have a BS already. I read somewhere that loan forgiveness usually only happens if you have a BSN, in which case it may be smart to obtain one or a at least a BSN/MSN program could work. Any thoughts are much appreciated. DU

EMT-Basic is just that, basic. You will do a lot of gopher work for your medic, take vital signs, assist with extrication, and drive. You will learn a lot on the job regarding illness and trauma and patient assessment however. Field experience in invaluable. That being said, an intelligent RN is better trained an intelligent EMT-B (I say intelligent because we all know some really bad ones of each). Now if you want to talk about Paramedic and RN, well I am a little bias being a medic myself. The training is similar yet very different. As a medic, I am trained to treat acute AND chronic illness as well as trauma. We are trained in pharmacology and pathophysiology. In addition, we have to develop independent critical thinking skills. I am not saying RNs do not have these skills, it is just different how we utilize them. In an emergency or critical care type case, a good paramedic is worth their salt. Give me a medic over an RN any day for an emergency (except flight nurses or PHRNs, both excellent usually). Where an RN will whoop on our butts is continuity of care and long-term management. I give any good RN all the credit in the world. They manage patients that I wouldn't want to spend five minutes with let alone five days or five weeks. They know a lot of really great medications and are amazing at assisting with the healing process. I think that is the biggest difference between us. Nursing is not medicine and medicine is not nursing, despite a good bit of overlap. I was trained to care about the psychosocial aspect but not as much as an RN. This is just my experience and I do respect a good RN and would hope you respect a good medic.

From the number of physicians and mid-level providers I have been in contact with both at my job and while considering my career path, there have been two distinct camps. 1. Finances/Job Security 2. Scope of Practice/Knowledge My thought is there is room for both. The medical system does need fixed and mid-level providers can fill in the gaps and provide excellent, competent medical care. I doubt that anyone on this forum would believe that a DNP is equal to a MD/DO in regards to knowledge. Medical school is intense and the amount of material is extreme. Now many NP/PA/DNP programs are intense and require hardwork, but let us be honest and realize medical school is much more so. But once you get into the field, things level out a bit. The point is that in the current medical system, both physicians and mid-level providers are required to make the system work. I respect both sides and realize it is the person who makes the degree, the degree doesn't make the person. DU

I am not concerned with independent practice. I do however care about autonomy, like many of you do as well. I am very well informed on the roles of mid-level providers in numerous settings. Many of my friends are NPs and PAs. Really there seems to be little difference once you are in the field. I have applied to a few PA programs, getting in to two of them. But I cannot afford it due to numerous financial obligations. Such is life. But I am not one to just give up on something. Thankfully I found a RN program I can complete while working full-time and I am aware of more than a couple BSN/MSN programs that I can complete while working full-time. That seems to be the ticket needed for me to get where I want to be. Thanks for taking the time to post, DU

The best mid-level I have ever met was/is a ACNP and a current NREMT-P. He is a mix of what I aspire to in terms of professionalism and competence. And for the most part, the NPs I have met have all been equally, if not more, knowledgeable than the PAs I have met. But like anything you will have your good and your bad. I am proud of my job and I will admit that I am very good at it BUT I call my command physician without hesitation if I have a question. I think being good at your job means knowing your limitations and understanding when to "pass the buck". I humbly admit I do not know everything and there is always room for improvement. I am in no way a "paragod". But I do have a strong desire to be excellent at my job for both myself and my patients. I teach because I enjoy the material and helping others gain a grasp on topics in EMS. My favorite class to teach happens to be Pathophysiology. Granted it is not as in-depth as an undergrad or grad course but I really try to put things together for my students. And everytime I teach, I too learn something new. My reason for diploma is the program fits my schedule as I cannot quit my job or even cut to part-time for financial reasons. I plan on getting my BSN/MSN from one of the colleges with affiliation agreements with my choice of the diploma program. The really cool thing is my diploma program is associated with Pitt (UPMC). Working in Pittsburgh I know how strong their program is. DU

First, thank you for a nice forum to talk about whatever. Much nicer than some of the other forums (I won't mention names). I'm a 24 y/o guy applying to a hospital-based RN diploma program here in the Pittsburgh area. It is a UPMC hospital, BTW. I am also employed FT as a paramedic and have been involved in EMS since I was 18. I even teach some medic classes and precept students. I am very good at my job and am proud of it. The job really promotes critical and independent thinking, treatment planning, and so on. We are certainly more than ambulance drivers or stretcher jockeys. We are taught how to recognize many health issues and emergencies. I take my job seriously and am always advancing my knowledge and skills. I would like to finish my ADN and then go for my BSN/MSN with a FNP concentration. My career goal is to work in an outpatient clinic, urgent care center, or family practice. I am curious how well your average NP program will prepare you for real world medicine, to think critically, order appropriate tests, formulate diagnosis, and understand a high level of pathophysiology? The reason I ask is the debate over NP vs PA. Personally, I know some very good mid-level providers in each field. But I do recognize a significant amount of hard sciences and such in the PA curriculum compared to NP. I also have seen a few threads about the "fluff" of NP programs. Is there a way to avoid this or any specific programs that are less "fluffy" than others? I have no plans on attending a web-based or distance NP program. I like to be in the classroom. Really, I don't want to be sold short on my education. I want a good education for my own edification as well as the well-being of my patients. Thank you all so much for your time, DU

What exactly do you want me to think or say? I have seen nursing in action. Nurses in the ER and flight nurses simply do not meet your views I must say. You form a false dichotomy by almost completely separating medicine and nursing. Nursing is a different discipline, yes. But progressiveness has lead to nursing becoming much more "medically inclined". I don't know if you think that good or bad, but I respect your opinion. And let me rephrase my "caring" portion. I do "care" for my patient. I ensure comfort and take very good "care" of my patient. I have nothing but good intentions yet you seem to be so hostile. If I just wanted to be an RN to get to CRNA, I would say that. It is simply an option down the road. I am in no rush except to get into nursing. DU

Whoa now. I am pretty sure I didn't say nurses are "lowley". I think that NP and CRNA are wonderful additions to the healthcare team and are providing essential care to the patient. But they are not physicians and this must not be forgotten. Nursing is wonderful because of the opportunities it provides. Some of my best experiences of nurses interacting with patients has been CRNAs. I did a few days in the OR intubating for medic class and the CRNAs were excellent with the patients. So I respectfully disagree with you on that part. Maybe I am slightly more progressive in my views of medicine than you are. That is ok and I warmly welcome your opinion. Just for the record, I am an excellent paramedic. Not because I can intubate or start an IV, but because I really do care about my patient and what is happening to them and their family. DU

First a background on myself. 22 y/o M working as a Paramedic for a very busy ambulance service. I spend half of my day in the ER dropping pts of so I get a chance to interact with nursing staff very often. I am finishing up a college degree now and have become interested in getting my BSN. I have had some wonderful experiences with nurses and they have taught me a lot. HOWEVER . . . I have encountered a few very concerning issues with some nurses that really irk me and force me to reconsider going in to nursing. 1. I have a friend in nursing school who says she is going to get her DNP and she will be, and I quote, "at the same level as an MD/DO" and "my patients will have to call me DR". Yeah it doesn't work this way. DNP training does not equal MD/DO. I respect the DNP position but this is ridiculous. If you want to be a DR goto medical school. There are a thousand different roles to fill in healthcare, and while the MD/DO may be the "top dog" per se, they certainly do not have the market cornered and need to show some more respect. 2. In the same vein, NPs need to come down off their hight horse. The ones I know walk and talk with a sense of entitlement. They speak as if they are truly on par with physicians. Look, you may be very good at what you do but you are not a doctor. You are a mid-level provider. And if you think I am bashing NPs, I am not. I usually see my NP for most of my visits. But for somethings, you need a doctor. Sorry to disappoint. So I guess you could sum up my concerns by saying nurses have a role and are not doctors, so stop thinking you are. That being said, I have learned more from nurses than anyone else so I am eternally grateful. That is why I am considering it. I hope to get in and work in the ER. Maybe one day go on a pursue CRNA, we'll see. Special Note: My concerns are not directed at those that do not fit the above criteria. For all of you true blue nurses who are proud to be a nurse and not a doctor, thank you for all you do. You are truly the ones that make the hospitals run and you certainly are amazing. Can anyone address a few of these issues to put me at ease, lol. DU