# Looking for some guidance -- RN to EMT-B/Paramedic



## kChoRN (Sep 1, 2012)

Hi all, I've looked through a few threads on here, but couldn't find a lot of guidance on a few things I'm wondering about.

I'm a new RN and work on a Clinical-Surgical-Ortho Unit, did a rotation through the CVICU, and clinicals at the ED, but never had any formal protracted ED or Field experience.  I have worked with and have friends that are EMT-Bs or Paramedics and am really interested in their work.

I have heard about Pre-Hospital RNs and Paramedics that work in tandem and have done some field work independently while with my Army National Guard unit, but I would love some advice on how to push forward from here.

I am planning on working on a Masters in Nursing to become a Family Nurse Practitioner, but first want to look at becoming a Pre-Hospital RN.  I am unsure of the exact process and there isn't a great deal of information on it that I can find online -- For some reason or another.

I know that Florida allows RNs that also have EMT-B certification to sit for the Paramedic NREMT Exam, but I question whether this is appropriate and if i would actually have the skills necessary without a formal schooling in Paramedic Technical Skills.  Thoughts?

The other problem I face is if I go that route, then I'd have to find a school that would work with my schedule at the hospital and my Natinoal Guard duties which is pretty impossible.  I'm hesitant to look into the online EMT-B options, but could use some guidance on that as well.

I understand that Paramedics do a profoundly different job than an RN which is why I am very unsure of how to proceed from here.  My objective is to either become a PHRN or Paramedic, then eventually a Nurse Practitioner a few years down the road.

How I get there is the big question, so any advice would be greatly appreciated -- Sorry for the rambling.

Thanks for your help !


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## firecoins (Sep 2, 2012)

Take a paramedic program if you have the time and money. Otherwise take the EMT -b class and take the medic exam.


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## usalsfyre (Sep 2, 2012)

Go to school. It's a distinctly different discipline, especially lacking significant ICU or ED experience. You wouldn't feel qualified to be a rad tech without education right? So why a paramedic?


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## Veneficus (Sep 2, 2012)

If you are not looking to work in an acute care environment, what is the purpose of emergency experience or experience where your final goal is to take somebody to the hospital?

If you know what "not sick" looks like, it is too difficult to distinguish who is "sick." 

It also used to be that ED RNs were required to have ICU experience. I don't know the exact reason but I could think of some very logicial ones...

Most critical care teams I know of hire RNs but want specifically ICU experience with ED experience either as a corequisite or just a bonus.


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## Norbi (Sep 2, 2012)

craigalanevans, your blog is AWESOME


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## Norbi (Sep 2, 2012)

sorry , wrong topic...:blush:


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## VFlutter (Sep 2, 2012)

I am in nursing school and also want to get my paramedic cert after I graduate. I personally would not just sit and take the test. You might pass but you really will not be able to function well as a paramedic. If you had some experience as an EMT and some ICU experience then I think you would be ok. 

That being said I do not think going through and entire paramedic course is the answer. I would look for some kind of bridge program. There are a few places that do them. I think one is like 3 weeks full time and offers clinical rotations.

As far as the ICU vs ED experience, I really think it depends on the hospital. But in most facilities how long do truly sick patients typical spend in the ED before getting shipped up to the ICU? Most places doing CCT want to know you have experience dealing with critical patients for long periods of time and can handle the cluster of various lines, devices, etc


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## abckidsmom (Sep 2, 2012)

I just precepted a guy who was a nurse with bone marrow transplant and PICU excperience.  He was reasonably bright, and had been through the entire paramedic class.  He was like precepting a medic student who already had a good knowledge base of medicine, but still needed time to learn how to act like a medic, make independent decisions, and keep all the people moving toward the resolution of whatever incident we were working on.  

I say, if you want to be a medic, go to medic class.  Don't take short cuts.  It's a totally different discipline. 

I say this as a medic who went to nursing school and became a nurse, worked in an ICU for a year went back to the streets.  It's not the same at all.


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## usalsfyre (Sep 2, 2012)

ChaseZ33 said:


> That being said I do not think going through and entire paramedic course is the answer. I would look for some kind of bridge program. There are a few places that do them. I think one is like 3 weeks full time and offers clinical rotations.


Then do you advocate paramedics with a CNA cert be able to do a 3 week transition? 

No offense to you personally, but nursing role creep is getting ridiculous.


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## Veneficus (Sep 2, 2012)

usalsfyre said:


> Then do you advocate paramedics with a CNA cert be able to do a 3 week transition?
> 
> No offense to you personally, but nursing role creep is getting ridiculous.



My friend, US nurses now-a-days try to do everything except nursing.

But having said that, I think we both agree, since EMS providers as a group have attempted to show being a medic is an add on cert that doesn't require any education, when a group such as nursing which has demanded a considerable minimum level including the basic foundations that permit movement into any area of healthcare, they are going to be successful at it.


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## VFlutter (Sep 2, 2012)

usalsfyre said:


> Then do you advocate paramedics with a CNA cert be able to do a 3 week transition?
> 
> No offense to you personally, but nursing role creep is getting ridiculous.



I admit I probably do bring up the nursing role too much around here and I will try to cut it down. However I just am trying to offer my opinion after being on both sides of the fence. Diversity is what makes this website great and sparks great discussion. Except the medic vs RN is just a pissing contest that no one will ever win. 

In very specific circumstances, yes. If a paramedic had an associates degree (Ideally a bachelors) which included all of the required prerequisites such as college level anatomy, physiology, pharmacology, (Mine were all separate 4 hour classes not one combined A&P) etc as well as their CNA and some experience then I would have no problem with them taking the NCLEX, preferably with some type of bridge program. I am sure they would be just as good if not better than some of the nurses diploma programs pump out. 


Also the 3 week course I am referring to is Creighton, and from what I understand it is very fast paced and condensed and is literally all day every day those 3 weeks. Personally I think a 3 month (with clinical) course would be plenty to transition.


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## ZootownMedic (Sep 3, 2012)

I think that RNs who want to be paramedics is a good thing, as long as they respect the profession. There are far too many nurses out there who think a RN and 3 week course makes them ready. The streets are harsh. In a hospital you have unlimited resources and lots of staff readily available. Plus let's be honest, RNs primarily work with doctors who give them dire t orders. In the field you have limited resources, just you and your partner much of the time and must make decisions quickly and on your OWN. One of the hardest things for me to get down as a new medic is pulling the trigger on advanced and dangerous interventions. I think that working with less makes you better at working with more. That's why I think paramedics make better RNs than RNs do paramedics, generally. Just my .02 cents.


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## VFlutter (Sep 3, 2012)

I agree. I think the 3 week example is extreme but still better than just challenging the test with no extra work.

The reason why I think bridge programs make sense vs taking the entire program is because most RNs have already taken A&P, patho, pharm and such (usually more indepth than a lot of medic programs) and need more focus on the specific knowledge and skills outside of the nursing profession instead of spending time going back over basic science


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## kChoRN (Sep 3, 2012)

Hey all, thanks for the advice.  I guess I stepped on a nerve and I don't want to lead y'all to the impression that I think medics are below nurses on the ladder.  I only wish there were more RN to medic transition courses out there, FL has none.

I have had experience in the CVICU and it was there that got me really interested in acute care. At my ARNG Unit, I'm forced to make independent decisions without other personnel present which is why I wanted to look into also becoming a Paramedic before venturing into advanced practice nursing.

Do y'all know of any programs that you think would be beneficial as a bridge program?  I'm not opposed to doing a full fledged program, it just isn't easy to find one that fits in my schedule and at least some of the foundational content seems like crossover...

Just wondering, thanks for all the input.


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## JakeEMTP (Sep 3, 2012)

SmokeMedic said:


> One of the hardest things for me to get down as a new medic is pulling the trigger on advanced and dangerous interventions. I think that working with less makes you better at working with more. That's why I think paramedics make better RNs than RNs do paramedics, generally. Just my .02 cents.



Can you define or give examples of advanced or dangerous?  Dangerous for you or the patient?  Do you feel you have not been adequately prepared as a new medic which makes a procedure advanced or dangerous? 

An RN may be part of procedures everyday in an ED, ICU or OR that a Paramedic may only see in a video or practice on a manikin.  An ICU or ED RN from an larger hospital may participate in 3 or 4 intubations daily by administering more medications than what is typically in the scope of practice for a Paramedic. They will also maintain the care of a patient who is on a ventilator and/or post ROSC on a daily bases using medications which become very routine to them. Some many even participate in the intubation themselves if working in L&D.  They may also be part of bedside trachs which become routine. They assist daily with central lines and some may be part of inserting them along with arterial lines.  Once you have been part of all these procedures or medications which you might deem as "scary and dangerous" on a daily basis and they are part of your normal routine, picking up extra training to perform them in another environment is not that big of a stretch.  Other out of hospital teams do this all the time and for greater distances and with very sick patients who require many advanced skills and knowledge. Some of which is even controversial and very new but often necessary to get the patient to a higher level of care.  

It is far easier to do a few skills in 3 weeks than cover 3 semesters of full time classes involving the sciences in 3 weeks.


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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> Also the 3 week course I am referring to is Creighton, and from what I understand it is very fast paced and condensed and is literally all day every day those 3 weeks. Personally I think a 3 month (with clinical) course would be plenty to transition.



The Creighton program does not take new grads.  In some states like Texas it only takes 3 months to become a Paramedic. Why should it take just as long for a nurse who already has the sciences, 1000 hours of patient contact in clinicals and some working experience to become a Paramedic? Just become someone has RN in their title they are not automatically dumber.


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## JakeEMTP (Sep 3, 2012)

To the OP:

Since you are from PBC, talk to the members of Trauma Hawk.  Talk to the EMS and nursing programs at the local community colleges.  Talk to the Trauma Nurse Specialists at the trauma centers. Take the RN certs for trauma (Basic and Advanced) at the major trauma hospitals. Network and get their opinions which will carry much more weight than what you will find here on an anonymous forum of egos.  You could also get into a hospital which has specialty transport teams such as pedi and neonatal. You will definitely be way ahead in advanced procedures and knowledge on these teams and probably won't feel the need for Paramedic school.


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## VFlutter (Sep 3, 2012)

JakeEMTP said:


> The Creighton program does not take new grads.  In some states like Texas it only takes 3 months to become a Paramedic. Why should it take just as long for a nurse who already has the sciences, 1000 hours of patient contact in clinicals and some working experience to become a Paramedic? Just become someone has RN in their title they are not automatically dumber.



I know they do not take new grads. They require 2 years ICU/RN experience as well as the various add on certs. 

I did not know it only took 3 months to get your paramedic cert in some places. Especially in Texas, with their broad scope. My EMT-B took 3 months and the paramedic was a 1.5 year associates.


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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> I know they do not take new grads. They require 2 years ICU/RN experience as well as the various add on certs.
> 
> I did not know it only took 3 months to get your paramedic cert in some places. My EMT-B took 3 months and the paramedic was a 1.5 year associates.



Texas only requires 600 hours to be a Paramedic. There was a school which ha a 12 week program plus another month or 2 of clinicals which used promoted alot. There are also  other accelerated programs where the students just to the bare minimun.  If the program allows 24 hour clinical shifts and just bases it on time, your clinicals could be done sleeping. Others might only require 40 ALS patient contacts which could be just an IV or 12 lead being done. It is often left up to the school which may be influenced by the contracts they have with certain ambulance companies or fire departments. NCTI is usually around 6 - 7 months with a 1 week A&P class at the beginning. MidPlains still has an Accelerated Paramedic program being advertised on the EMS websites.

 The average length of a Paramedic program is 1000 hours which is the number of just clinical time for other health care students.  When an EMT program is still listed by the state in required hours such as 110, 3 months does not say much except you might have only gone 1 or 2 evenings per week. An 18 month Paramedic program that does not include a recognized college degree and not a Technical Associates also does not say much except may you went 1 or 2 days per week instead of what would be considered full time. This is all just part of the inconsistency in EMS eduation.


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## VFlutter (Sep 3, 2012)

SmokeMedic said:


> Plus let's be honest, RNs primarily work with doctors who give them dire t orders. In the field you have limited resources, just you and your partner much of the time and must make decisions quickly and on your OWN.



Just because a doctor is giving me a direct order does not mean that I did not already know and anticipate what was going to happen or would have been clueless without them. If you spend some time in an ICU you would be surprised how much input doctors actually get from nurses and how much their opinion matters in treatmeant decisions. Also, right or wrong, you will see a lot of nurses do various things first and get orders later. Just because they work under physican orders does not mean they could not function in their own.


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## JakeEMTP (Sep 3, 2012)

SmokeMedic said:


> Plus let's be honest, RNs primarily work with doctors who give them dire t orders. In the field you have limited resources, just you and your partner much of the time and must make decisions quickly and on your OWN. .



A Paramedic is not an independent practitioner. Your protocols are orders from your medical director which is no different than what an RN operates by every day in a hospital. Anything not in your protocols you call your med control and/or transport to a hospital to a doctor.  The Paramedic TAKES their patient to a doctor who is required to be present in an ED. A nurse in a hospital or long term care facility may not have a doctor present nor should they call a doctor for every little thing. You should as to see their standing orders sometime and be surprised about the decisions they do make.   The higher the level of care they provide, the more decisions about initiation of therapy and titrations they are expected to make.  Again, most of the decisions concern medications and procedures which are not normally found in the Paramedic's scope of practice.


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## kChoRN (Sep 3, 2012)

JakeEMTP said:


> To the OP:
> 
> Since you are from PBC, talk to the members of Trauma Hawk.  Talk to the EMS and nursing programs at the local community colleges.  Talk to the Trauma Nurse Specialists at the trauma centers. Take the RN certs for trauma (Basic and Advanced) at the major trauma hospitals. Network and get their opinions which will carry much more weight than what you will find here on an anonymous forum of egos.  You could also get into a hospital which has specialty transport teams such as pedi and neonatal. You will definitely be way ahead in advanced procedures and knowledge on these teams and probably won't feel the need for Paramedic school.



Thanks, I never thought of that route.  Mostly, I want to have the knowledge to provide effective and safe care in an emergent field environment --  I have a friend that is a TraumaHawk Medic-RN who went through school with me.  I'll ask her what she thinks.


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## VFlutter (Sep 3, 2012)

JakeEMTP said:


> This is all just part of the inconsistency in EMS eduation.



Unfortunately, there is also inconsistency in nursing education. Not to the same extent but still there. Most BSN schools are AACN accredited and have very specific criteria but outside of that there still a lot of diploma/ADN programs with some very low standards. But with most hospitals moving towards requiring BSNs things have been getting better. 

I was just looking trough my transcripts and it really surprised me how many various classes I had to take over the years. I really hope EMS education gets up to speed but as of right now it's not even a comparison. 


This is going to sound arrogant but it's an honest question. For the paramedics that say that a nurse should not be able to challenge or bridge, what makes paramedic education so specific to the job that is not covered in my nursing education along with my EMT-B? Yes, they teach you to think differently but it all comes down to critical thinking.


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## JakeEMTP (Sep 3, 2012)

You can also check out Florida Flight 1 at Florida Hospital and Air Care at Orlando Regional.

http://www.floridahospital.com/florida-flight-one

http://orlandohealth.com/orlandoreg...rMedicalSpecialties/AirCareTeam.aspx?pid=4496

It looks like Florida has a lot of nurse lead flight teams and some headliners for pedi and neo transport also with teams that use both ground and air.

Next year you should make a point to attend the Clincon to network.
http://www.emlrc.org/pdfs/clincon2012brochure.pdf


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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> This is going to sound arrogant but it's an honest question. For the paramedics that say that a nurse should not be able to challenge or bridge, what makes paramedic education so specific to the job that is not covered in my nursing education along with my EMT-B? Yes, they teach you to think differently but it all comes down to critical thinking.



Nurses do not come out of school to be fully able to be critical care, OR or wound care nurses either.  Some go through more classroom and bedside training in their specialty which is longer than many Paramedic programs.  But, they have an extensive base which gives them the ability to specialize with knowledge along with skills with confidence.  It is too bad the US Paramedic education does not have the preparation such as other countries where the educaiton is also emphasized and where the pissing matches that because someone can intubate they must be the superior professionals are eliminated.

The Paramedic programs focus on skills rather than the whole package. Intubation and RSI is a big deal for a Paramedic in some places. But, an RN must be comfortable with an intubated patient to manage the drugs and the ventilator for 12 hours beyond just the intubation which take a few minutes. It takes longer to decide whether the NP, PA, Transport RN or RT will intubate with their polite courtesies than it does to actually perform the skill with the RN doing all the prep work for meds and equipment.


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## usalsfyre (Sep 3, 2012)

ChaseZ33 said:


> This is going to sound arrogant but it's an honest question. For the paramedics that say that a nurse should not be able to challenge or bridge, what makes paramedic education so specific to the job that is not covered in my nursing education along with my EMT-B? Yes, they teach you to think differently but it all comes down to critical thinking.



One, independent practice (yes, it is what we do). An ICU RN is probably well accustomed to it. A LTC or floor RN is not. At the moment we aren't particularly interested in how the patient's poor social support system led to impaired gas exchange. Rather, we're interested in treating the presenting pneumonia with appropriate resuscitation measures (yes a bit of hyperbole).

Two, logistics. I'll let everyone in on a secret. Nurses, medics, and even *gasp* RRTs don't have a particularly unique set of medical knowledge. In fact the overlap is staggering. What they all have is a different view pf how to accomplish a given goal. The logistics of doing things like packing up a post ROSC patient to move are where paramedicine earns its keep. 

Finally, it's a point of professional pride. I don't go stomping around the hospital playing in their bailiwick. Nurses don't need to micturate in my sandbox. To have my own arrogant moment, I have no doubt with a bit of studying I could pass the NCLEX. BFD, it's an entry exam. Doesn't mean I'm worth what a well educated nurse is. Similarly, because a nurse can pass an entry exam doesn't mean they're prepared to make the call on continuing CPAP or performing an intubation. "Assisting in" and "pulling the trigger on" are entirely different. 

EMS doesn't always have a lot of professional pride, but damnit we've got to start somewhere.


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## VFlutter (Sep 3, 2012)

JakeEMTP said:


> Nurses do not come out of school to be fully able to be critical care, OR or wound care nurses either.  Some go through more classroom and bedside training in their specialty which is longer than many Paramedic programs.  But, they have an extensive base which gives them the ability to specialize with knowledge along with skills with confidence.  It is too bad the US Paramedic education does not have the preparation such as other countries where the educaiton is also emphasized and where the pissing matches that because someone can intubate they must be the superior professionals.
> 
> The Paramedic programs focus on skills rather than the whole package. Intubation and RSI is a big deal for a Paramedic in some places. But, an RN must be comfortable with an intubated patient to manage the drugs and the ventilator for 12 hours beyond just the intubation which take a few minutes. It takes longer to decide whether the NP, PA, Transport RN or RT will intubate with their polite courtesies than it does to actually perform the skill with the RN doing all the prep work for meds and equipment.



I totally agree however I still do not see the justification that an RN could not very quickly learn those skills without taking an entire paramedic class. Do you think most new medics are prepared to take care of true critical care patients?

The comment about bedside training is very true. The ICU position I applied for requires a 1 year internship for new grads. 3 months classroom before ever touching a patient, 6 months with a preceptor before working alone and 3 months working with limited patient assignments before being fully allowed to work on your own.


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## JakeEMTP (Sep 3, 2012)

usalsfyre said:


> One, independent practice (yes, it is what we do). An ICU RN is probably well accustomed to it. A LTC or floor RN is not.



Independent practitioners are NPs and PAs. Paramedics are not. They do not have DEA numbers or write prescriptions. 

LTC RNs may be in charge of 100 patients and many of them might be on ventilators. How many decisions do you that than RN must make each shift to keep the patient from returning to the hospital. Doctors and hospitals will no longer be paid if their patient returns too soon which places a larger responsibility on the RNs and the LVNs caring for those patient.

Nurses do assume the responsibilty of CPAP/BiPAP and ventilators in many EDs, ICUs, LTC facilities and home care everyday.  Chances are they do receive much more training than a Paramedic on these devices.  If a nurse does intubation they usually take it seriously and will get x amount of hours of training in and their profession will expect competencies. Isn't that a big issue with EMS? Some Paramedics only intubate manikins in their programs and then get maybe one intubation a year which may or may not be successful.

If you have actually watched a procedure being done over 200 times, over and over such as an ICU or ED RN, it is not that difficult if you are given the opportunity to train for it. Paramedic student may never have seen an intubation or cric on a real patient but are expected to perform after a video and a few passes at a manikin. 

Your lack of respect for nurses stands out. But, I don't think you even have an Associates degree  on your resume but you stand critical of anyone who does and attempts to care for many patients at one time which you may have next to no experience in. Your post also shows you don't care for other professionals like RRTs which no one has even mentioned.  

EMS has a lot of issues. You have to give nursing credit for knowing how to prepare their nurses for a specialty.  Paramedic is supposed to be a specialty but yet so many are failing at the basic skills but make up for it by attacking professions which acheive education first and then the skill.


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## VFlutter (Sep 3, 2012)

usalsfyre said:


> One, independent practice (yes, it is what we do). An ICU RN is probably well accustomed to it. A LTC or floor RN is not. At the moment we aren't particularly interested in how the patient's poor social support system led to impaired gas exchange. Rather, we're interested in treating the presenting pneumonia with appropriate resuscitation measures (yes a bit of hyperbole).
> 
> Two, logistics. I'll let everyone in on a secret. Nurses, medics, and even *gasp* RRTs don't have a particularly unique set of medical knowledge. In fact the overlap is staggering. What they all have is a different view pf how to accomplish a given goal. The logistics of doing things like packing up a post ROSC patient to move are where paramedicine earns its keep.
> 
> ...




I think we are comparing apples to oranges. Just like everything else there are good and bad providers but I am referring to a very specific group since almost all programs require ICU experience. I would never try to argue a new grad nurse or hospice nurse would or should be able to challenge the paramedic exam. And I have no doubt you would pass the NCLEX, it's not difficult.


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## usalsfyre (Sep 3, 2012)

ChaseZ33 said:


> I think we are comparing apples to oranges. Just like everything else there are good and bad providers but I am referring to a very specific group since almost all programs require ICU experience. I would never try to argue a new grad nurse or hospice nurse would or should be able to challenge the paramedic exam. And I have no doubt you would pass the NCLEX, it's not difficult.



The problem is you can't write rules for the top 10%, or for that matter, the bottom 10%. You've got to try to cover the 80% in the middle.


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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> The comment about bedside training is very true. The ICU position I applied for requires a 1 year internship for new grads. 3 months classroom before ever touching a patient, 6 months with a preceptor before working alone and 3 months working with limited patient assignments before being fully allowed to work on your own.



Now if the US Paramedic was more like this....

http://www.abc.net.au/news/2012-08-...uipped-to-be-first-responders3a-union/4196992

Their education:
http://www.ambulance.vic.gov.au/Paramedics/Become-a-Paramedic/University-Courses.html

Imagine the fuss that would be raised here in the US.


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## VFlutter (Sep 3, 2012)

Just for comparssion here is a copy of my transcript. I would say it is pretty typical for most BSN programs. 4 years, 108 credit hours 







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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> I think we are comparing apples to oranges. Just like everything else there are good and bad providers but I am referring to a very specific group since almost all programs require ICU experience. I would never try to argue a new grad nurse or hospice nurse would or should be able to challenge the paramedic exam. And I have no doubt you would pass the NCLEX, it's not difficult.



On the same note there are Paramedics wearing the patch who have not started IVs, intubated or pushed any meds for months or even years. They might be one of 3 - 6 responding Paramedics. They might only do IFT. They might work a very slow station. They might have a hospital on every corner within a few blocks of all of their calls.  They are still given the same status as a Paramedic unlike nurses who get labeled by Paramedics for what they perceive to be a "lack of skills" rather than for what they know or the skills they can do even if they aren't the headline grabbing ones.  It is due to the skills and knowledge of nurses in some areas like LTC which keep patients from needing the more heroic skills


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## usalsfyre (Sep 3, 2012)

JakeEMTP said:


> On the same note there are Paramedics wearing the patch who have not started IVs, intubated or pushed any meds for months or even years. They might be one of 3 - 6 responding Paramedics. They might only do IFT. They might work a very slow station. They might have a hospital on every corner within a few blocks of all of their calls.  They are still given the same status as a Paramedic unlike nurses who get labeled by Paramedics for what they perceive to be a "lack of skills" rather than for what they know or the skills they can do even if they aren't the headline grabbing ones.  It is due to the skills and knowledge of nurses in some areas like LTC which keep patients from needing the more heroic skills



Similarly there are "CCRNs" who haven't worked bedside for years in management positions. We can find turds everywhere. Why are you intent on bringing up every prehospital shortcoming?


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## JakeEMTP (Sep 3, 2012)

usalsfyre said:


> Similarly there are "CCRNs" who haven't worked bedside for years in management positions. We can find turds everywhere. Why are you intent on bringing up every prehospital shortcoming?



Until you start to see where EMS can improve it never will. You want a broader scope of practice and fail to see where education must be included. Until you do that, YOU penalize every Paramedic who has done the seat time to get at least an Associates degree.  Take note of how other professions have moved past the pettiness of I can do everything someone else can and didn't need no education to do it.  Just because Texas allows you to do anything you want with only 600 hours of training does not mean it is right or should be the standard.

At least with the CCRN title, they did put in some time in the ICU for the CCRN age specialty test to qualify. They also must take the CEs to maintain it.


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## usalsfyre (Sep 3, 2012)

JakeEMTP said:


> Until you start to see where EMS can improve it never will. You want a broader scope of practice and fail to see where education must be included. Until you do that, YOU penalize every Paramedic who has done the seat time to get at least an Associates degree.  Take note of how other professions have moved past the pettiness of I can do everything someone else can and didn't need no education to do it.  Just because Texas allows you to do anything you want with only 600 hours of training does not mean it is right or should be the standard.



I'm well, well aware of the shortcomings of EMS education. Rather than take potshots on the internet I spend 3-4 days a week trying to actively educate paramedics in addition to a full time schedule on a unit. And I'm willing to put my real name behind my work and views, rather than any number of aliases. When was the last time you did anything to improve the situation?


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## JakeEMTP (Sep 3, 2012)

usalsfyre said:


> I'm well, well aware of the shortcomings of EMS education. Rather than take potshots on the internet I spend 4-5 days a week trying to actively educate paramedics. And I'm willing to put my real name behind my work and views, rather than any number of aliases. When was the last time you did anything to improve the situation?



Why don't you make Vene post his real name? You might be very surprised. 

Why don't you make everyone here post their real name? 

There are forums where we do post our names and you aren't on them? Why not?  Why aren't you on some of the profedssional forums which require membership?  What do you do to support education? A weekend cert doesn't count.


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## Aidey (Sep 3, 2012)

Vene's name is well known to some of us. Along with his involvement in international and stateside medicine. Are you trying to imply that somehow that is all fake? Because that would make him the purveyor of the most impressive fake internet persona in existence I think.


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## usalsfyre (Sep 3, 2012)

JakeEMTP said:


> Why don't you make Vene post his real name? You might be very surprised.
> 
> Why don't you make everyone here post their real name?
> 
> There are forums where we do post our names and you aren't on them? Why not?  Why aren't you on some of the profedssional forums which require membership?  What do you do to support education? A weekend cert doesn't count.



Actually I know his real name. 

I educate. A lot. I run QA for a decent sized service. I'm involved in local level EMS committees. 

What professional forums would you be speaking of? And I ask again, what have you done to help fix the situation you so hate lately?


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## JakeEMTP (Sep 3, 2012)

Aidey said:


> Vene's name is well known to some of us. Along with his involvement in international and stateside medicine. Are you trying to imply that somehow that is all fake? Because that would make him the purveyor of the most impressive fake internet persona in existence I think.



Check the other forums for the past 7 or 8 years.


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## Aidey (Sep 3, 2012)

You know, in the grand scheme of things it is less damning to have a different persona for each forum rather than several different persona's all on the same one.


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## JakeEMTP (Sep 3, 2012)

usalsfyre said:


> Actually I know his real name.
> 
> I educate. A lot. I run QA for a decent sized service. I'm involved in local level EMS committees.
> 
> What professional forums would you be speaking of? And I ask again, what have you done to help fix the situation you so hate lately?



You teach but are not required to have even an Associates degree. Again another inconsistency in EMS of its educators.  Your message would be you too can do all this and no college required. 

Advocates for EMS although not very active and teach a few local organizations but also stress education as well as skills. Stress teamwork instead of "nurses are only order takers" and are only "bed pan skilled" mentality.  You could probably use a lesson there.


Okay, let's all post our real names.  Let's talk with the moderators and make it a rule you can only post if you give your real name. I doubt if I will post on an open forum such as this if it is required to give my real name, address and place of employment. Kyle, your profile is now very public as I stated before and you probably should not be so open. It can work to discredit you also.


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## Aidey (Sep 3, 2012)

So wait a second. He works hard to get to a position where he can affect change and you turn tactics and attack him because he didn't use a college degree to get there? When has Kyle ever stressed anything but education and teamwork?

And Kyle has said that he stands behind everything he posts. Why are you so worried about his reputation? Speaking from experience?


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## usalsfyre (Sep 3, 2012)

JakeEMTP said:


> You teach but are not required to have even an Associates degree. Again another inconsistency in EMS of its educators.  Your message would be you too can do all this and no college required.


I've posted very publicly about that it's somewhat hypocritical for me to advocate the position I do without a degree. I encourage everyone I can to finish the degree before life gets in the way as happened to me. I'm attempting to sort college out as we speak.



JakeEMTP said:


> Advocates for EMS although not very active and teach a few local organizations but also stress education as well as skills. Stress teamwork instead of "nurses are only order takers" and are only "bed pan skilled" mentality.  You could probably use a lesson there.


Interesting how you know what I teach without ever sitting in one of my classes. I think you'll find I regularly speak of the team approach here, and have tremendous respect for providers of all levels. I'm in no way prepared to be a LTC LVN. But that doesn't mean I think they can be medics either. 



JakeEMTP said:


> Okay, let's all post our real names.  Let's talk with the moderators and make it a rule you can only post if you give your real name. I doubt if I will post on an open forum such as this if it is required to give my real name, address and place of employment. Kyle, your profile is now very public as I stated before and you probably should not be so open. It can work to discredit you also.


As I've said again and again, I stand by the good and bad. I've grown since I started posting here. I think you would have to work very, very hard to use my current views to discredit me. 

I never asked for any personal info. Only what you personally have done lately to help the EMS educational situation. I've yet to see an answer, but I've seen a lot of smoke and mirrors.


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## JakeEMTP (Sep 3, 2012)

usalsfyre said:


> Interesting how you know what I teach without ever sitting in one of my classes. I think you'll find I regularly speak of the team approach here, and have tremendous respect for providers of all levels. I'm in no way prepared to be a LTC LVN. But that doesn't mean I think they can be medics either.



You asked for what I belong to and teach. My comments about your attitude is a direct reflection of what you post.  You have posted mostly negative things about nurses and 





> *gasp* RRTs


. Anytime education comes into play you do your best to discredit as many professions as you can who have gone the distance to improve education and their profession. 


Shame on the OP, an RN, for asking this question on an EMS forum and upsetting you.


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## Aidey (Sep 3, 2012)

There is a HUGE difference between discrediting education, and speaking out against one profession taking over another one.


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## kChoRN (Sep 3, 2012)

I read over the reponses over the last couple pages and just wanted to say a few things as I think it is relavent to the topic as a whole:

I personally, see a lot of similarity between LPN and the standard Paramedic training programs.  There aren't a lot, if any pre-requisites, from my knowledge.  The LPNs that I have worked with know the same stuff in the clinical setting, but where they often lack -- only sometimes -- is in the theoretical background.  I feel like this may be the same with some of the more rudimentary Paramedic programs.  Correct me if I'm wrong, but that is why there are degree programs for EMS and such now.  At the end of the day, those Acute Care LPNs are just as good at their jobs as the RNs, I'm yet to see a huge difference in clinical ability.

3)  I think the only didactic difference between RNs and Paramedics is the theoretical background in micro, chem, etc.  Not all Paramedics are required to take that as part of a standardized curriculum outside of what is included within the program like many LPN/LVN programs also do.

4)  Plenty of Paramedics that I know have gone on to become nurses, but I do not know of a single RN that has gone back to become a Paramedic.  I wonder why that is.  I personally think the demographics are different in the two fields and that some fields that are more male heavy -- Trauma, Wound Care, etc. -- also include nurses that are more likely to look into also being EMT-Ps.

5)  I think that the ENTIRE argument about who is better or whatever pissing contest people want to go on lies within the prof organizations.  From my understanding, ARNPs, advanced practice degrees, hell...even standardized BSN programs have created new horizons for nurses.  From an academic standpoint, more and more nurses are pursuing advanced degrees and gaining autonomy in the states.  I think that if Paramedics were better recognized by governments and organizations, then in-turn their own prof organizations invested in the individuals, then Paramedics would see similiar changes in their education requirements.  I think one reason medics haven't been able to advance themselves as much as nurses in the last hundred years is because so many are employed directly by government or public funding programs like Fire Departments so the salaries aren't really what they deserve.  Nurses, on the other hand, have gotten paid by a variety of sources.  That extra cash means more money goes into the organizations when thoe RNs have some dough to throw around, I wonder if Paramedics have had the same chance -- The local governments don't give Medics and EMS personnel the same kind of recognition a they should, in my view.  Bottom line:  Paramedics deserve better pay and more respect from their employers.

6)  Ideally, I think that Paramedics and Nurses should have a similiar education track.  Kind of like dentists and physicians -- Have the medics split off and the nurses split off and do their own stuff after all of the foundational classes, make Baccalaureate Degrees in Emergent Care or Paramedic Studies a real thing -- Unless it already exists.  Make avenues for Paramedics to make a B-line to become Physician Assistants similiarly to how Nurses have a fairly easy avenue to become Nurse Practitioners.  Thoughts?  Does this already exist?

7)  At the end of the day, from the Army Medics I have collaborated with -- junior, senior, new, or seasoned -- the civilian Paramedics (EMT-Ps) and EMT-Bs, LPNs, and CNAs -- Not to mention all the other allied health care workers I have met in my work like RTs, OTs, PTs, etc. -- I think we all have a lot more in-common when it comes to education and that Excelsior Online College makes some sense when it lets other clinicians pursue an RN degree.  I think that there should be more program for RNs to do that into other areas as well.

8)  I didn't mean to start this heated debate, but I do appreciate the input.  I posted specifically on an EMS forum instead of a nursing forum (like AllNurses.com) because I wanted the opinion of the subject matter experts:  You guys.  We all have our niche in the health care cycle and each merits respect.

Finally, I posted this just to get feedback on how I can cultivate the skills to be a good provider of emergency medical care.  As a paramedic or otherwise, every clinician should be able to do that in my view -- I just was looking for some guidance from some subject matter experts .


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## usalsfyre (Sep 3, 2012)

JakeEMTP said:


> You asked for what I belong to and teach.


No, I asked what you've done. You can be as general as you want. But again...nothing.



JakeEMTP said:


> My comments about your attitude is a direct reflection of what you post.  You have posted mostly negative things about nurses and .


Obviously sarcasm is not your strong suit...

I DO have a serious issue with nursing role creep. Not individual nurses. But the ivory tower of the nursing profession is trying very hard to push everyone from physicians to CNAs aside in favor of RNs. As a paramedic I have a vested interest in this not happening.




JakeEMTP said:


> Anytime education comes into play you do your best to discredit as many professions as you can who have gone the distance to improve education and their profession.


Huh?!? I'm fairly certain I've always advocated for increased educational requirements. I have occasionally pointed out the difference in training models and how this may affect out-of-hospital care...but I've never tried to discredit an entire profession... 



JakeEMTP said:


> Shame on the OP, an RN, for asking this question on an EMS forum and upsetting you.


I voiced my opinion...which is what your doing. Heaven forbid...

Your doing a fine job at putting words in other peoples mouths. Perhaps if that energy was focused on helping educate paramedics you wouldn't have to hate them so much.


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## kChoRN (Sep 3, 2012)

BTW...some of the best Nursing professors I have had were Medic-RNs.  I have the utmost respect for Paramedics -- Military and Civilian -- that's why I posted on an EMS forum, yall.

I'm not sure what you mean about "nursing role creep", but that is not why I was looking into branching out and bridging into a Paramedic program.


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## kChoRN (Sep 3, 2012)

usalsfyre said:


> Go to school. It's a distinctly different discipline, especially lacking significant ICU or ED experience. You wouldn't feel qualified to be a rad tech without education right? So why a paramedic?



Are there any bridge programs that you could reccomend that I look into?  Florida would be nice, but...any would be helpful.  There are plenty of Paramedic to RN Programs -- The State College I went to, in fact, has it set where LPNs and Paramedics can skip between one and two semesters of the four clinical semesters.  I feel like there should be something similiar for RNs.  No?


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## VFlutter (Sep 3, 2012)

I wish some of our international members, who hold bachelors, would provide some information about the paramedic-nurse dynamic in their country. Does requiring degrees for paramedics stop nursing creep? Is there more respect for the profession. Based on the two education structures, do you feel a nurse could easily transition into a paramedic role? And vice versa


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## JakeEMTP (Sep 3, 2012)

kChoRN said:


> I'm not sure what you mean about "nursing role creep", but that is not why I was looking into branching out and bridging into a Paramedic program.



It is best to get the info from the credible sources which are in your area.


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## Aidey (Sep 3, 2012)

kChoRN said:


> 5)  I think that the ENTIRE argument about who is better or whatever pissing contest people want to go on lies within the prof organizations.  From my understanding, ARNPs, advanced practice degrees, hell...even standardized BSN programs have created new horizons for nurses.  From an academic standpoint, more and more nurses are pursuing advanced degrees and gaining autonomy in the states.  I think that if Paramedics were better recognized by governments and organizations, then in-turn their own prof organizations invested in the individuals, then Paramedics would see similiar changes in their education requirements.  I think one reason medics haven't been able to advance themselves as much as nurses in the last hundred years is because so many are employed directly by government or public funding programs like Fire Departments so the salaries aren't really what they deserve.  Nurses, on the other hand, have gotten paid by a variety of sources.  That extra cash means more money goes into the organizations when thoe RNs have some dough to throw around, I wonder if Paramedics have had the same chance -- The local governments don't give Medics and EMS personnel the same kind of recognition a they should, in my view.



Paramedics haven't been around nearly as long as nurses, so it is slightly unfair to compare how developed the fields are as a whole. Nurses have done a good job of creating advanced education requirements, but there is a down side to that, which is that the increased education has been used to "creep" into other areas that are not traditionally nursing. 

There are many non-RN health care roles, such as RTs, Radiologists etc. Through the years it has been argued on a national scale that RNs should be allowed to do all of those things too, based on their RN education. In reality many of those programs are stand alone multi year programs. There has also been some push to require that people in those roles become RNs too. Does that help explain creep?


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## JakeEMTP (Sep 3, 2012)

ChaseZ33 said:


> I wish some of our international members, who hold bachelors, would provide some information about the paramedic-nurse dynamic in their country. Does requiring degrees for paramedics stop nursing creep? Is there more respect for the profession. Based on the two education structures, do you feel a nurse could easily transition into a paramedic role? And vice versa



Considering nurses are a major part of some other EMS systems, I think it speaks volumes but then so does the education to get there.

In the UK, Emergency Care Practitioner can be either a Paramedic or nurse.

The Netherlands has an interesting system.
http://www.emtlife.com/showthread.php?t=22081


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## kChoRN (Sep 3, 2012)

Thanks all for the explanations and guidance.  I didn't mean to cause such a ruckus.


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## VFlutter (Sep 3, 2012)

kChoRN said:


> Thanks all for the explanations and guidance.  I didn't mean to cause such a ruckus.



You didn't start anything. It's a constantly reoccurring discussion/debate.


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## usalsfyre (Sep 4, 2012)

kChoRN said:


> Thanks all for the explanations and guidance.  I didn't mean to cause such a ruckus.



Not a problem, you just stepped off in a constant sore spot. For the record I don't like any type of bridge program be it medic to RN, RN to medic, medic to Amazon witch doctor, ect. Have the respect to go through the full Monty.


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## kChoRN (Sep 4, 2012)

Understood...I was just thinking that skipping the basic A&P portion of an integrated EMT-P curriculum would just be smarter than doing it all over again...lol.


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## usalsfyre (Sep 4, 2012)

kChoRN said:


> Understood...I was just thinking that skipping the basic A&P portion of an integrated EMT-P curriculum would just be smarter than doing it all over again...lol.



Look for a college based program, usually a stronger education anyway.


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## VFlutter (Sep 4, 2012)

usalsfyre said:


> Not a problem, you just stepped off in a constant sore spot. For the record I don't like any type of bridge program be it medic to RN, RN to medic, medic to Amazon witch doctor, ect. Have the respect to go through the full Monty.



There is nothing disrespectful about trying to get credit for material already covered. There is no point waisting X amount of time going over basic sciences that you have already passed at a higher level. 

Like I used as an example before...Anatomy, physiology, microbiology, pathophysiology, biology, Chemistry, and pharmacology were all separate 4 hour college classes (most with extensive labs) for me. Why would I sit through a paramedic class going over these topics when they would not even begin to scratch the surface of what I learned in the stand alone classes?


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## usalsfyre (Sep 4, 2012)

ChaseZ33 said:


> There is nothing disrespectful about trying to get credit for material already covered. There is no point waisting X amount of time going over basic sciences that you have already passed at a higher level.
> 
> Like I used as an example before...Anatomy, physiology, microbiology, pathophysiology, biology, Chemistry, and pharmacology were all separate 4 hour college classes (most with extensive labs) for me. Why would I sit through a paramedic class going over these topics when they would not even begin to scratch the surface of what I learned in the stand alone classes?



Most colleges are going to take the credit from those classes. Plus, review never hurts.


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## Aidey (Sep 4, 2012)

I don't think it is always necessary to do every class over again. For example, someone who is getting 2 bachelors degrees doesn't repeat all of the core English and math credits. 

The issue with most bridge programs is that they tend to skip over a lot more than they should. Plus there can be benefit to relearning material you already know from a different perspective.


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## kChoRN (Sep 4, 2012)

Aidey said:


> I don't think it is always necessary to do every class over again. For example, someone who is getting 2 bachelors degrees doesn't repeat all of the core English and math credits.
> 
> The issue with most bridge programs is that they tend to skip over a lot more than they should. Plus there can be benefit to relearning material you already know from a different perspective.



Point taken, I never thought about it that way -- Though, I still wonder how much differently they'd teach about the Alveoli and the Nephrons in comparison to my high acuity nursing courses...however, I'll try and find an EMT-P course somewhere in my area.  I think that would be the most logical option -- I am a hands-on learner anyway.


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## usalsfyre (Sep 4, 2012)

kChoRN said:


> Point taken, I never thought about it that way -- Though, I still wonder how much differently they'd teach about the Alveoli and the Nephrons in comparison to my high acuity nursing courses...however, I'll try and find an EMT-P course somewhere in my area.  I think that would be the most logical option -- I am a hands-on learner anyway.



You may learn quite a bit more about how things like positive pressure interact with the alveoli than you would in nursing courses. Nephrons...probably not as much as you should...

There's no shame in additional education.


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## JPINFV (Sep 4, 2012)

In this thread, Allied Health Professions problems (rifting off of the First World Problems meme). 



usalsfyre said:


> Most colleges are going to take the credit from those classes. Plus, review never hurts.




If it takes a semester to review what can be refreshed in less than a day, especially with courses that monitor attendance, then yes... the waste of time in death by PowerPoint lectures does hurt. If a physician wanted to work on an ambulance (say as a medical director, or a physician volunteering for a local service who needed an EMT or paramedic license to fulfill minimum responder levels), should the physician be forced to take Anatomy and Physiology for Paramedics because "it's good review?" Should a physician who has ATLS be forced to take BTLS too?


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## kChoRN (Sep 4, 2012)

Well, i'm looking into EMT-B courses in FL now, but NONE of them in my area would work with a full-time work schedule at the hospital.  Anyone in FL know of any good weekend or night programs?  Furthermore, what about the online programs?  At the very least I want to get headed in the direction towards EMT-P.  TNCC and other courses for nurses are the other option, but...I dunno.


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## VFlutter (Sep 4, 2012)

kChoRN said:


> Well, i'm looking into EMT-B courses in FL now, but NONE of them in my area would work with a full-time work schedule at the hospital.  Anyone in FL know of any good weekend or night programs?  Furthermore, what about the online programs?  At the very least I want to get headed in the direction towards EMT-P.  TNCC and other courses for nurses are the other option, but...I dunno.



Don't take an EMT course online (Not sure if even possible). You really need to be hands on doing the skills. Things like KEDs, traction splints, etc sound easy but take some getting used to.


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## kChoRN (Sep 4, 2012)

ChaseZ33 said:


> Don't take an EMT course online (Not sure if even possible). You really need to be hands on doing the skills. Things like KEDs, traction splints, etc sound easy but take some getting used to.



They have all of the didactic online, but then you go to the clinical site for skills and do ride-alongs locally.   Apparently, I'm a bit hesitant about looking too far into them b/c I doubt their actual effectiveness.


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## Veneficus (Sep 4, 2012)

JakeEMTP said:


> Check the other forums for the past 7 or 8 years.



I am not really sure how I became the subject of such importance...

But I would just like to point some things out...

1. Since I started at the very bottom I have held many titles on my way up the ladder.

2. My perspectives of the world, medicine, etc, change over time, especially as new information is gained. Citing my opinion from 7-8 years ago is simply not a valid reflection of what I think today.

Here is a stunning revalation about discrediting me, when I was a teenager (A long time ago in a galaxy far far away) I was rather heavily involved in what was then the Goth subculture. My original email address was: mask@goth.net (strangely enough, I had to change it to get people to call me back for job interviews, can't imagine why...) 

Now that we got that out of the way...

I think that your preoccupation with me is a bit patholigic. You have posted several times about warning people that you can track them down and discredit them. 

Some people might actually see that as a threat. 

I could also draw a rather accurate conclusion about people thinking they are doing a righteous favor to society or knowing/seeing something the rest of us didn't, being the mentality of more than one school shooter or postal worker.

I don't know or care who you are, but you seem like you really need some help.


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## VFlutter (Sep 4, 2012)

While searching the forum I came across this thread (http://www.emtlife.com/showthread.php?t=21063) "Replacing EMS with nurses" started by Veneficus back in 2010. 

Good thread to read through


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## sabRN05 (Sep 20, 2012)

ChaseZ33 said:


> Just because a doctor is giving me a direct order does not mean that I did not already know and anticipate what was going to happen or would have been clueless without them. If you spend some time in an ICU you would be surprised how much input doctors actually get from nurses and how much their opinion matters in treatmeant decisions. Also, right or wrong, you will see a lot of nurses do various things first and get orders later. Just because they work under physican orders does not mean they could not function in their own.



I am new here, but agreed! I have 6 six years critical care experience as a registered nurse, and I am interested in getting some field experience (plan to take an EMT-B course in the Spring and I would like to get a pre-hospital nurse certification). I am hoping to find some info here. Any suggestions would be appreciated. I live in MS - not sure of the rules here


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