Odd I know I know. But being in the ER seeing the paramedics bring us the critical/trauma patients and proceed to present the case to us and what was done on the field really exhilarates me.
In fact when I was in my late teens (now in my early 20's) I wanted to become a paramedic, mostly because I was always glued to the discovery health channel watching trauma life in the ER and Paramedics, but nursing found me lol.
I had taken my ACLS class a few months ago and was intrigued by how knowledgeable the paramedic was and even more curious after all the stories he told.
I'm an adrenaline junkie, and relish in traumas and critical situations. I feel heroic!
Being the first on the scene, intubating.......
Am I over my head? I know many may think who goes backwards? But I really think it can be resourceful to my nursing career???
There is a credential called a PHRN (pre-hospital RN) that is a national certification for emergency medical services. You 'outrank' paramedics, so if you're on a call and the patient is critical YOU get to provide care and the medic has to drive the ambulance! (being somewhat facetious, but in my experience it was true). The pathway to this certification is first being an RN, then taking the EMT practical test. If you pass, you then take a national certification exam. You should take ACLS before taking the certification test. Once you're qualified, you will need to complete 9 or 10 hours of CE credits per year. It's a more expedient path to EMS than going through a one or two year paramedic training--most of which is redundant for an RN.
i think the phrn acceptance may be state or region dependent. in texas (my home state), it appears they do not recognize phrn directly, but you contact a texas dshs-approved post-secondary educational institution to find what other coursework and clinicals are needed before you are "signed off" to test for the national registry examination (nremt-p). the clinical hours on the ambulance itself are a big deal here... there's just no real effective way of teaching the pre-hospital side and working in a small, bouncing aluminum box without experiencing it yourself, lol! starting an iv under penlight in the midnight darkness with a heavy blanket over both your and the patient's head while firefighters cut out a "newly-subcompacted" car's roof off over you is hard to teach in a classroom. particularly when the college won't let real beer-infused vomit and broken window glass be poured around you in a classroom setting, lol!
seriously though, i don't know about other states' policies.
in our region's medical protocols, only eca, emt-b, emt-i, and emt-p/lp are recognized for direct patient care without prior medical control authorization. in other words, i cannot ask an rn on scene to perform a task without contacting medical control first and receiving permission at that time as a verbal order over the radio.
now, our flight services prefer that the medical personnel are both a paramedic and rn, but will take a paramedic-only over an rn-only if needed (the paramedic is a requirement, since it is an "air ambulance" in the state's eyes). as for flight safety, one of our services is very picky about when and under what conditions they will fly, and have an excellent safety record. other area flight services are a little more scary.
do take in consideration that if you earn your paramedic certification, that you will have additional annual ce and (in our area), will be required to attend "x" number of case reviews and skills tests to maintain your medical control authorization. this can impede on your current working schedule. sometimes the ce can be used for both your rn and emt certifications, such as those acquired at conferences. other sources are specific... the ces earned for rn requirements may not fulfill the emt requirements.
i absolutely love working as a paramedic and the autonomy/assessment/skills/decision-making benefits are great, but a little frightening at the same time. you are held completely responsible for anything done that does not work out for the patient (unexpected poop happens on scene and hindsight is always 20/20) and there's no shortage of folks willing to scrutinize every aspect of your patient's care. while that keeps you on your toes, it makes for some stressful calls as well. while not an excuse for inappropriate behavior, i'm sure a lot of ed nurses notice that 'medics can be a little defensive at times (and i am really sorry for that... sometimes i don't realize it myself).
however, as a nursing student now, i am amazed at how much there is to learn out there and am really looking forward to that side of patient care. there are a lot of similarities to both professions, and some notable differences. just eye-opening though!
I'm an adrenaline junkie, and relish in traumas and critical situations. I feel heroic!
Being the first on the scene, intubating.......
-snip-
Ahhh, yes. Heroic. First on the scene to not only spiffy neato-keen trauma, but also:
- your local "frequent flyer(s)" seeking their monthly dose of narcotics...you'll come to instantly recognize their address when the tone drops
- dealing with muscular teenagers & adults hopped up on their local substance of choice (angel dust/PCP is always fun!) when you and he/she are stuck in the small back compartment of your ambulance. The phrase "oxygen therapy" can take on a whole new meaning.
- being met at the front door of the address by your pt, carrying 2 packed suitcases
- dealing with drunk drivers, post-accident....they decide that they want to get up to pee AFTER you've got them immobilized on the backboard (+ CID/c-collar/straps)
- being toned out on "unknown problem", which could be anything from a false 911 call to a full arrest
- getting to sit in your ambulance on "standby" at a fire scene for hours & hours & hours (as your bladder screams). Yes, a size Large glove can be used as an emergency urinal.
- being yanked out of bed at 2AM to take care of somebody who got to "ride the bull" while being Tased by your local cops
- hoping that the "secure" shooting scene is truly secure - that's why you might start wearing a concealed vest after showing up on enough scenes that are anything BUT secure
Running as a paramedic is not a step down from RN, in my humble opinion. Yes, it has a different scope of practice. Less pay, but greater autonomy in many cases.
I ran as a volunteer EMT for 2 years, then volunteer paramedic for 17 more in my "copious free time" away from my first job as an engineer. I stopped doing EMS when I started nursing school, but there are times that I still miss it.
Whether your goal is flight nursing, or just giving something back to your local community as a volunteer EMT/medic, running as a medic will give you a different skill set. Operating in the field is a whooooole lot different than handling a pt when they're brought into your brightly lit, adequately (?) staffed ER. I'm a firm believer that every RN in an ER should spend some time with their local EMS agency. This might give them a greater insight into the reasons why they receive a pt with zero IVs, or maybe just one IV, or why the medic didn't give them a fully detailed report when they were on the phone/radio calling in, while simultaneously trying to keep their pt from coding.
Specializes in ED, Telemetry,Hospice, ICU, Supervisor.
To the OP,
I was thinking the exact same thing. I love the idea of being first on site providing trauma care. It is way more of a rush than anything else I can think of. Actually no getting shot at was also a rush but that's another story. The only downside I can think of is that I wont be getting that RN pay. Where I come from RNs make way more money than paramedics. My idea of the perfect job would be a paramedic with the RN pay/benefits.
I looked into flight nurse as well but there seems to be a lot of proposed changes being discussed in a few places. One of them is that because it is such a sought after position and there is such a large pool of applicants, they dont get paid the same as a staff RN on the ground. I know not all places do this, but it sounds unfair. Secind was the idea of having paramedics start to replace flight RNs. Yeah it sounds weird on the civilian side, but I have seen this happen in the military before. You have flight medics, showing up more and more.
Ahhh, yes. Heroic. First on the scene to not only spiffy neato-keen trauma, but also:
- your local "frequent flyer(s)" seeking their monthly dose of narcotics...you'll come to instantly recognize their address when the tone drops
- dealing with muscular teenagers & adults hopped up on their local substance of choice (angel dust/PCP is always fun!) when you and he/she are stuck in the small back compartment of your ambulance. The phrase "oxygen therapy" can take on a whole new meaning.
- being met at the front door of the address by your pt, carrying 2 packed suitcases
- dealing with drunk drivers, post-accident....they decide that they want to get up to pee AFTER you've got them immobilized on the backboard (+ CID/c-collar/straps)
- being toned out on "unknown problem", which could be anything from a false 911 call to a full arrest
- getting to sit in your ambulance on "standby" at a fire scene for hours & hours & hours (as your bladder screams). Yes, a size Large glove can be used as an emergency urinal.
- being yanked out of bed at 2AM to take care of somebody who got to "ride the bull" while being Tased by your local cops
- hoping that the "secure" shooting scene is truly secure - that's why you might start wearing a concealed vest after showing up on enough scenes that are anything BUT secure
Running as a paramedic is not a step down from RN, in my humble opinion. Yes, it has a different scope of practice. Less pay, but greater autonomy in many cases.
I ran as a volunteer EMT for 2 years, then volunteer paramedic for 17 more in my "copious free time" away from my first job as an engineer. I stopped doing EMS when I started nursing school, but there are times that I still miss it.
Whether your goal is flight nursing, or just giving something back to your local community as a volunteer EMT/medic, running as a medic will give you a different skill set. Operating in the field is a whooooole lot different than handling a pt when they're brought into your brightly lit, adequately (?) staffed ER. I'm a firm believer that every RN in an ER should spend some time with their local EMS agency. This might give them a greater insight into the reasons why they receive a pt with zero IVs, or maybe just one IV, or why the medic didn't give them a fully detailed report when they were on the phone/radio calling in, while simultaneously trying to keep their pt from coding.
@ crufflerjj - also VERY well put. As a Paramedic currently going thru RN school (only to get better pay), you have very well stated some of the "truths" of the job. I get very frusterated with those, especially those in the medical field, who think we are just "ambulance drivers" and have no concept of the responsibility involved in doing the job. I wholeheartedly agree that EVERY E.R. RN, and what the heck, E.R. doc as well, should spend some time in the back of the ambulance. I believe it would open their eyes significantly.
When I'm done with nursing school, and hopefully working as an ER RN, I still plan to work as a Paramedic as well, and I'm excited for the opportunity to be an advocate for EMTs and Paramedics, instead of the one criticizing them.
I've been a paramedic for 15 years and a nurse for 8. Thank you for showing respect for EMS that we don't often get from nurses. Being on your own is very different. In the ER you have an entire hospital to back you up. In the field you are most often the "highest" training on scene. I love it for the fast paced problem solving and fluid situations. You have to be extremely flexible and creative in getting things done while following your protocols and standards of care. It can be dangerous and you need to have a lot of operational knowledge to be safe. I've had a gun pointed at me, been threatened by family members, dragged stabbing victims out of crowded bars, and backed down tough guys. It's not always that fun but once you've saved a life, by yourself, you get hooked. Your nursing knowledge will help you cut to the patient's problem and what needs to be done. Go for it.
If it will make you happy, then you should do it! Who cares if others think you are going backwards, what you want is what counts. I am not sure what it can do for your nursing career (other than flight nursing which you do not seem interested in. I live in the Boston area and we have at least 1 MedEvac company but I had to really search to find it, so I am sure that there is one in the city you reside in, especially if there are level 1 trauma centers, it is just not well known. ) but I do not see how it could hurt your career.
After many years of doing what others thought I should do, I have decided to go back to school for Nursing which is something that I have always been interested in. From my personal experience, worrying about what others think will only make you unhappy in the long run. You want to be a paramedic and possibly be a 1st responder? Do it! If you like the adrenaline rush of dealing with trauma patients at the scene of an accident or shooting, then do it!
Good luck and enjoy!!!
^^^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. Onething 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 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 glad FlyingScot posted that very helpful info for you. I'm an ICU nurse, which I guess is the path to flight nursing, and while it intrigued me at first (since you sometimes get the most critical of situations, and it's in the field), I decided against pursuing it due to safety. While helicopters are mostly safe, when something goes wrong in a helicopter, you're in trouble. Think about how a helicopter works. Any trouble occurs, you're way more likely to crash than any plane out there. (And, I need to say, commercial flights are the safest way to travel. Period (other than trains, which really aren't used in the US, except in 2 major metro areas).
I digress lol. We need good flight nurses, but they risk their lives every time they get up in the chopper. I am so glad we had a guest flight nurse speaker back when I was in nursing school (which was only 2 years ago, but seems like ages ago) and explain it. We got to see the chopper, walk in it (it's small!), but she did mention that it's a risk any time they get up in that chopper, so that's why they really don't appreciate being called for non critical situations, especially in inclement weather.
SummerGarden, BSN, MSN, RN
3,376 Posts
I know a RN who worked in the ED before becoming a Paramedic for similar reasons posted above. He is much happier now! Good Luck!