RN and EMT

rn/writer, RN · Feb 19, 2008

I have been an EMT for years and now I am an RN. Do I need to continue with my EMT? If I am going to be sued it will be as an RN and I have read that I will be held to the standard of a RN not EMT.

If you are going to continue to practice as an EMT, you still need to keep up with your state's requirements for continuing education and maintenance of your license. It is not necessarily true that you would be held to RN standards. If you are practicing as an EMT, that is your scope of practice. In most states, you may be given permission by medical control to exceed EMT standards (such as starting an IV as an EMT-basic) if you have that skill as an RN, but you would not be required to do so.

I was both an RN and and EMT for many years. I always had to be clear in my own mind which license I was working under. Although medical principles are the same for both, scope of practice and mindset often differed, and I had to be consistent with the role I was in at the moment.

I would suggest contacting your state licensing department (both nursing and EMS) and getting specific information from the people in a position to know. You might also get in touch with the folks who conduct refresher courses for EMS.

I don't think any states allow EMTs to skip continuing ed requirements just because someone is an RN or other medical license holder. I know National Registry certainly doesn't. And that's as it should be. There are many EMS skills and procedures that need updating and practice that you probably wouldn't get any other way. Things like extrication, field packaging, Combi-tube, etc. are not likely to come up in a hospital or clinic setting.

I hope this helps.

moomoo111 · Feb 20, 2008

Hello, I am a former Paramedic in the State of South Carolina. I am currently a nursing student in my first year of ADN. In our state, we have and I know many of them that are RN/LPN with a cert in EMT-Basic, EMT-Intermediate and EMT-Paramedic. When they are operating in an ambulance, they fall under their medical control physician and they can only do what they are certified to do as an EMT, B, I, or Medic, ie, they are not allowed to do anything that does not fall under their level of cert. They can't do anything that they can do as a nurse, unless they are riding in the back with a patient that is being transferred from the hospital they work for. Some transfers require a respiratory therapist or RN and then you can only do what you are allowed to do in that respect. If you are a LPN/RN and a EMT also, you can only perform as a nurse in your hospital. The easiest way to remember is this way, if you are working in the back of an ambulance for the ambulance service, you can do what you do as an EMT and if you are working in the hospital, you can only do what a nurse does. I know plenty of EMTs who have had their cert taken for working in an ER and doing something they are only allowed to do in an ambulance. I know a Parmadic who intubated a patient in the ER after a doctor could not get the patient intubated. He was reported by a nurse and even though it saved the patient's life, he got in big trouble. Anything could happen in a situation like that. I let my cert go and I don't plan to get it back for the simple reason I don't want to have to worry about getting caught up in adrenaline rush and screw up. I also know some EMTs that intubated patients after they let their certs expire and someone could not get an IV started or could not get someone intubated and performed the skill. DHEC (Department of Health and Environmental Control) does not like that in our state. You can only do what your medical control says you can do because you are working under their doctor's license and they don't like someone taking risks with their license. Like the previous post states, I would get information from your state. I know what it feels like to be in an emergency situation and want to jump in and do whatever needs to be done but you have to respect each other before you do that. A lot of EMT's get the attitude that nurses are not as fast as they are and they put nurses down for that but after being in school a year now, I see the big difference between EMS and nursing. Nurses are doing what they are doing because they are trained differently and they are trained to be more in depth in situations and you have to respect that. It's not that they are doing it wrong, it's that they are trained to respond in a different, more thorough way. It took me getting into nursing to see that difference. It's like that with any job in the medical field. We are all trained to do what falls under that scope of practice. Hope that helps. Beth

billythekid · Feb 20, 2008

I have been an EMT for years and now I am an RN. Do I need to continue with my EMT? If I am going to be sued it will be as an RN and I have read that I will be held to the standard of a RN not EMT.

I had the very same thoughts when I started in nursing after being a paramedic for 8 yrs... how will one license affect the other? I came to the conclusion that my greatest liability was not what 'nursing' skill I would perform out of scope on the ambulance, but rather what 'medic' skill I might perform out of scope in the hospital. The specific example by Moomoo of a paramedic intubating a patient in the ER illustrates this point very well... instinctively doing the right thing in the wrong setting is a major liability.

ZippyGBR, BSN, RN · Feb 20, 2008

it will depend on the way in which the qualifications interact, here in rightpondia a Nurse who works as an EMT equivalent could peoptentially be held to RN standards of practice with the EMT levle qualification held to be proff fo specialist skills and training in Pre-hospital care.

check with both the EMS regualtar and the Board of nursing ... also does the OPs locality recognise some form of PHRN / PHHP status

Calgon-take.me.away · Feb 20, 2008

This post takes me back to the days where I was a nursing student, an EMT, working as a CNA. I was working in a LTCF and it was during meal time. One of the other patients started aspirating and there was not a nurse in sight. I knew where a suction machine was, went and got it and was able to orally suction the obstruction out.

I got in sooo much trouble. The thing is, you have to remember where you are and not to over step the boundaries where you are at that present time.

classicdame, MSN, EdD · Feb 20, 2008

we have several RN/EMT's in our facility, all in critical care. They keep their EMT status because of the required training - that really keeps them current on hands-on stuff. We hold EMS training at our facility for the City/County and our employees attend free. The RN/EMT's are great teachers because they relate to both disciplines. They also make good teachers for TNCC, ACLS, PALS, etc.

tabrown1 · May 3, 2008

I'm also a EMT and I'm in completing my 1st yr in nursing school next Tuesday. It is very confusing sometimes of what you can't do in a hospital setting as a nurse. There was a senerio in our class of what to do if a patient had a sudden emergency and was having respiratory distress. Our instructor told us unless there is a doctors orders, we can't just put a pt on O2. I couldn't believe it because EMT and Paramedics do it all the time. Especially under those circumstances. Also when I was in the FDNY academy they explain to us our brothers who are paramedic and working on a EMT bus, they only can do interventions as a EMT. That also goes for nurses can only do so much.

I wouldn't mind being a ER nurse, but in the back of my mind, there the danger of doing something that I'm qualify to do but not in my scope of practice in a hospital setting.

Christie RN2006 · May 4, 2008

I do both. I am a RN in an ICU and an EMT for a volunteer fire department. Some of your CEs will work for both licenses, but you do need to be sure to keep track of how many you have for each. You also need to be sure to keep you jobs separated. Like every one else has said, you can do things as an EMT that you can't as a nurse and vice-versa. I personally think that being an EMT as well as a RN will give you a distinct advantage over other nurses. As for the legal aspects, I would recommend talking to someone that has a little more knowledge with that.

moomoo111 · May 4, 2008

My experience is since I have been away from the ambulance setting for so long now, I know what I can and can't do and the adrenaline doesn't take over so much. I'm much calmer in the hospital setting now and the further I get in nursing school, the more I settle down and know that we have the appropriate people for emergencies and they can be called quickly when something happens. We still have one RN that was an EMT before she was a nurse and she still gets carried away but I have settled down quite a bit. I let my Paramedic Cert run out about 4 years ago and it's a big step down from being a Paramedic for 12 years and now I'm a CNA. It took me a while to get used to it but I know that each position is important for their part. I have one semester left to becoming an LPN and I plan to work a year then go back and finish to RN but I was a Paramedic one time and I made a difference and I can't save everybody so I think after you have been in a certain position for so long, you get used to what you can and can't do and act appropriately for that job. The only thing that would benefit me to keep my Paramedic in this state would be that I would be able to intubate a patient but the hospital I am employed with, does not care if you are a Paramedic. Under their roof, you can't do any advanced skills, not even start an IV. Now if they had some big disaster and it was a mess, the ER Physician Director, would have to make that call. And he just happens to be Medical Control for EMS in our County. And anyone who performs any skill out of the scope of their license, you should have learned that in EMT/Nursing school and know you can't do those things just anywhere. Good topic though and helpful info for some. :bowingpur