This seems to be such a hot topic, but I disagree with a few of the posters. It is completely dependent on where you work and what department you work in, especially if you have a specialty certification (TCRN, CFRN, CCRN, CEN, CTRN). I work as a trauma nurse in a busy trauma I center that sees a large diversity of patient cases and injuries. Also, most of the EMS workers in the surrounding counties (we are the only trauma center in the region, ~80 mile radius) are BLS so not much of anything has been done when the patient arrives. I can't really think of something I haven't done that a paramedic does in the field (aside from a cricothyrotomy, which aren't done very often). I was also an EMT/Firefighter for a while so I know what medics do, I am aware of the difference of being in the field from a trauma bay. But every day I initiate and titrate paralytics, intubation drugs, vasoactive drips, blood products, crystalloid and colloid resuscitation, emergent splinting and traction/reduction, I place EJs daily, IOs about twice a week, every trauma/chest pain patient gets a 12 lead and I interpret it (especially if triaging, you can't believe how many EMT/medics come in with â€˜fake' patient vitals and misinterpreted 12 leads saying, they're fineâ€, on more than one occasion..off to the cath labâ€¦) I often assist with chest tube insertion, insert LMA, Kings, and on some occasions ET tubes when needed, set up and maintain ventilators. I interpret ongoing lifepak rhythms and cardiovert/shock/pace as needed, codesâ€¦you are correct in that is the simplest intervention, and we run them every day. ACLS/PALS? Every trauma nurse here is proficient, and we are also required to have TNCC within 6 months and TCRN + CEN in a year and a half. We are trained in central lines to assist residents, we are proficient in USPIV placement, internal defibrillation, assisting emergent EVD placement, cracking chests, etc . I am not sitting here saying that I would be ready tomorrow to go out and act as a paramedic, but If I took a bridge course, or landed a job as a flight RN and needed my cert, I am glad states like California allow me to challenge the education because I do not need a two-year long course. you must still attend the entire 480 hours of field internship, including 40 ALS patient contacts and have to take the NREMT paramedic exams, so I don't see what else you need to prove you are competent. Hell, an intubation course to freshen up maybe. All I know is I would be 100% confident in my abilities to provide above competent care as a paramedic, especially after 480 hours and passing the boards. Now if you are an RN in med-surg, surgical services, PCU, TCU, and hell many ICU's, then yes I can see where opinions like AnnieOakley and Waterpeace stem, I would not trust these nurses either, there would be too much to learn. Not that they aren't as smart or proficient, but they do not handle emergent situations daily or at all with limited information and time. It's a completely different type of nursing, hence why the age old ER vs ICU/Floor RN thing exists.