RN/Paramedic on a Rig?

Nurses General Nursing

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I just started the process of going after an Associate in Paramedic Science, probable got 2 1/2 to 3 yrs to go. I was thinking after this a ASN would be a good degree to accompany it. Especially with 10 yrs being the expected career of EMS personnel due to injury & burn out.

  • How many RN/Paramedics work on a rig?
  • Is there any advantage to being a RN/Paramedic in pre-hospital setting?
  • Doese Scope of Practice change for any? or become blurry?
  • In pre-hospital which liscensure or certification are you held to?
  • Is there any disadvantage to holding both in pre-hospital? or hospital setting?

I meant to say was looking into getting a ASN after getting a Associates of Paramedic Science. Not at the same time.

Go for a BSN if you want to be a nurse. Don't waste time getting two lower degrees. If you don't have the option of getting a BSN, a cert as a Paramedic and a nursing degree would be better. The prerequisites (A&P, Pharmacology) for a nursing degree are also generally higher than the Paramedic and they usually can be used for the Paramedic. Those who take a nursing degree first will have no problem with a Paramedic course later. Those who take a Paramedic course first and then nursing may get hung up on the few cool skills a Paramedic can do and put blinders on to all the detailed tasks which seem trivial to someone who is trained for emergent situations even though they are of great importance to patient care.

Your scope of practice will be limited to what your medical director writes for and in regard to the state statutes. If the medical director only writes for a Paramedic scope of pratice, you will have to follow that but you may also still be held accountable as an RN in a court or by the BON especially when it comes to assessment. The ENA has been addressing this which is why some states now have the Prehospital RN certification so that an RN can work under the license they are expected to be held accountable for.

If you do get both the RN and Paramedic credentials, don't say you are only a nurse for the money. That statement can lead your co-workers to view you as a minimalist who just clocks in and clocks out with very little effort inbetween especially if you also make it known that being a nurse is not your real job. While the money is good, there are many advantages to being an RN. This includes working in the ICUs of various types and many parts of the hospital that most Paramedics might never get the opportunity to see and will not be allowed to work in. You will also be taught many invaluable indepth assessments and the treatments associated from those including all the protocols an RN follows within the hospital.

While there is a great adrenaline rush in EMS and getting the patient to the hospital is an important part of the life saving process, there is also nothing like trying to keep someone alive for 12 hours who has multiple drips and pieces of technology attached with much data to be sorted through.

Also, many who went the RN path first find that when they get into the challenges of critical care medicine and the opportunites that exist for them, they forget about becoming a Paramedic. This is especially true if they get onto one of the specialty teams. Even going into Clinical Nurse Specialist or Advance Practice has many rewards. But, if you are still very young the Paramedic route probably attracts you now. There are also many, many other health care professions that are rewarding but are rarely thought about by those in EMS. We have several Paramedics who became Physical Therapists and Athletic Trainers. One of the PTs I work with who got his doctorate in PT was inspired by the rehab patients he transported on routine calls. Two other Paramedics who became PTs were into body building and physical fitness. They were later able to use their new career with the FDs to design fitness programs. Another Paramedic realized how little he know about sports injuries after watching the Athletic Trainers work while he was sitting coverage at football games. Another got his BS in radiation medicine after his mother had breast cancer. One Paramedic became a Respiratory Therapist after his child had a near drowing experience and he saw what their role was in advanced life support including ECMO. Another got his Nuclear Med cert after doing a few routine transports and learned what great money they made.

Lots of opportunities but it really depends on your goals which you may not have even realized what they are yet.

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Specializes in ED, pre-hospital medicine and CCT.

I too like doing both. RN's and Paramedics don't practice medicine. As a RN/medic, I am responsible for treatment according to protocol in the field just as any other affiliated medic is. In hospital, I can intubate, establish IO access and cannulate EJ's where my RN-only peers cannot.

I have recently had the experience of testifying in a criminal trial. It involved a near-drowning of a 3.5 kg infant. Fortunately, my written documentation was complete and the details of our successful resuscitation from full arrest was not in question. There was profound anoxic brain injury. My complete credentials (RN, CEN, CPEN, ACLS and PALS) were brought into the record because an expert MD witness relied upon my initial assessment description of the patient for time-line matters. From this perspective, I felt I was responsible for a "higher" standard.

If ya want it go for it. It's fun!

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Specializes in Emergency, Case Management, Informatics.
Yes, that is correct classicdame - and since I'm an advanced practice nurse, I am held to that scope while a volunteer.

So, being that you are an APN, you have prescriptive authority when you respond to medical calls on the FD? Somehow, this doesn't seem right. I think you're probably held to the scope of practice for the actual job title that you're working in at the time, since nursing and EMS fall under two completely different state boards.

But, I could be wrong. ;)

To the other poster that was asking about the RN to Medic bridge, look up Creighton University Medical Center. They have a 2-week RN to Medic bridge that makes you eligible for NREMT-P. However, you have to already have 2 years' experience in critical care, plus ACLS and PALS. And you have to get 50 patient contacts as Team Leader, so you may not be able to finish in the 2 week period -- you will finish all other requirements, and they will work with your local EMS agencies to get ridealongs for you to get your patient contacts. I did their Nurse-to-EMT Basic program a couple of years ago and enjoyed it.

However, since the NREMT levels and suggested scopes may be changing soon, I'm not sure if this program will still be valid after the change. I do plan on going through the program myself once I have enough experience, if they're still running it.

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Go for your RN, then bridge over to Paramedic. You will make more $$$ that way. Also, while you are waiting for the RN program, take the EMT-B class so you can start working in the field right away. You will be amazed how much you learn and how much it will help you in the RN program.

I was an EMT, then CNA, then LVN, then I-EMT, then Paramedic, then RN. But don't get too comfortable in the hospital--it can be a little difficult for some RN's to become a paramedic as working in the field is a whole different ballgame. Working on a rig is not a job, it's an adventure!

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However, since the NREMT levels and suggested scopes may be changing soon, I'm not sure if this program will still be valid after the change. I do plan on going through the program myself once I have enough experience, if they're still running it.

Very little will change for the Paramedic with the new levels. The EMT-Intermediate with go away. They will either be Advanced EMTs or take a few more hours to bridge to Paramedic.

As for the APN comment, as an RN I doubt if the FD would allow you to transport an IABP and take multiple drip by yourself if your are just working under your scope as a Paramedic. However, as you stated, your assessment would be thorough and you would probably be able to recognize things the average Paramedic would not. If you continue with your Paramedic protocols just because that is what they state but knowing as an RN you could do harm, you would be held to the higher standard.

I too like doing both. RN's and Paramedics don't practice medicine. As a RN/medic, I am responsible for treatment according to protocol in the field just as any other affiliated medic is. In hospital, I can intubate, establish IO access and cannulate EJ's where my RN-only peers cannot.

Do you judge the other RNs as being inferior because they can not do two skills? There are many license holding people who can intubate and not just Paramedics. As long as it does not distract from you being an RN, its great to know an extra skill and provided you can maintain documented competency with that hospital.

But then, how do you bill for intubation in the hospital? Is this under your RN or Paramedic title? Have they established an extra charge and if so do you happen to know the code you are using for it?

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Specializes in Emergency, Case Management, Informatics.
Very little will change for the Paramedic with the new levels. The EMT-Intermediate with go away. They will either be Advanced EMTs or take a few more hours to bridge to Paramedic.

Thank you for that, but that's all just speculation at this point. Even if "very little" changes for NREMT-P, their program may need to be reviewed by NREMT and may need to be modified after the changes are put into place, because there WILL be changes. Point being, it'd be a good idea to go ahead and go through the program ASAP if you're an RN that meets the requirements and have interest in getting NREMT-P. :up:

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Thank you for that, but that's all just speculation at this point. Even if "very little" changes for NREMT-P, their program may need to be reviewed by NREMT and may need to be modified after the changes are put into place, because there WILL be changes.

No, it is not speculation nor should it be of any surprise since these changes have taken 15 years to come around. What is required for each level and the NREMT testing starting in 2014 has been out for a while. Every state this affects have also been updating their websites. Whatever schools that have been teaching the Paramedic and the bridge programs are probably well aware of what is coming especially if their state uses the NREMT. However, the schools teaching the Paramedic program in states using the NREMT will have to be CoAEMSP accredited beginning the first of 2013. About the only thing the new levels may do, and that part is speculation since each state can still do its own thing, is reduce the fragmentation which the nearly 40+ different EMS certs for EMR through EMT-P have caused. Some states have over 6 different cert levels each based on just one skill.

National Standards

http://www.ems.gov/education/nationalstandardandncs.html

NREMT

http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf

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Specializes in Emergency, Case Management, Informatics.

Needless semantics. My point stands.

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Needless semantics. My point stands.

Needless semantics only if you don't know what is going on.

I posted the links to get you updated. They will give the information needed for a prospective student to ask the appropriate questions when searching for a school and understand where to look to determine where their state stands on the issues. EMS is not like nursing when it comes to certification. It is very, very different and so is the education process where the minimun varies from state to state.

You can take the information provided for what it is worth or just plod along speculating.

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Specializes in Emergency, Case Management, Informatics.

In the scope of this thread, the semantics are, as I said, needless.

Until the changes are actually in place, it's all pure speculation. Plans change. Regulations change. State EMS boards' governing bodies change. We're talking about something that's possibly happening in 2014. Four years from now.

I'm not even sure where you're attempting to sidetrack off to. Once the new NREMT levels are in place, programs like Creighton's may or may not continue to be in place. That is all. Move along.

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In the scope of this thread, the semantics are, as I said, needless.

Until the changes are actually in place, it's all pure speculation. Plans change. Regulations change. State EMS boards' governing bodies change. We're talking about something that's possibly happening in 2014. Four years from now.

I'm not even sure where you're attempting to sidetrack off to. Once the new NREMT levels are in place, programs like Creighton's may or may not continue to be in place. That is all. Move along.

No.

Whoever is interested should be monitoring their state EMS website. As I stated already, each state is different. The official testing for the levels will be in 2014. However, changes are already taking place in some states. California is introducing the AEMT program and Washington State has finally switched from the 8 different state levels to just those of the NREMT in preparation for the changes to come. The states which before had their own certification process and allowed RNs shortcuts may be switching to the NREMT before 2014 which may also present changes as well. These changes can come at any time and not just in 2014. Those in the non NREMT states may have the most changes if their states switch.

Monitor your state EMS website. Don't just tell people they have until 2014. Read the links I posted and you should have a little more understanding of what has been in the making for a long time. Try to provide correct information and point people to the right source to stay informed if this is their interest.

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Specializes in Emergency, Case Management, Informatics.

I believe my advice was to take advantage of Creighton's program as soon as possible before any potential changes take place. I'm not sure how you managed to twist that into me telling people that they can wait until 2014. Additionally, you state that the Paramedic scope will change "very little", implying that Creighton's program has little chance of being changed or phased out, which would lead someone to believe that they do have the time to wait.

Talk about confusion and misinformation. :uhoh3:

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