# Nurse vs paramedic



## Chrashley (Mar 27, 2012)

I know that this is an EMS board so I may get some bias here but I am trying to decide on which direction to take my career. I am debating between nursing or paramedic and it seems that the big factor for me is that medic work is primarily in the field. That is what I want. I have no desire right now to be in a building all day with little to no outdoor contact. I also understand that nurses get paid more so I want to know us there a field of nursing that I can be involved in that will allow me the outdoor interaction?  In general for those of you who are medics, would you do it again or would you go into nursing and why?  Thank you in advance for your replies.


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## systemet (Mar 27, 2012)

Chrashley said:


> I know that this is an EMS board so I may get some bias here but I am trying to decide on which direction to take my career. I am debating between nursing or paramedic and it seems that the big factor for me is that medic work is primarily in the field. That is what I want. I have no desire right now to be in a building all day with little to no outdoor contact. I also understand that nurses get paid more so I want to know us there a field of nursing that I can be involved in that will allow me the outdoor interaction?  In general for those of you who are medics, would you do it again or would you go into nursing and why?  Thank you in advance for your replies.



This probably depends greatly on where you're wanting to work.  In some countries paramedics may make a wage that is close or equal to that of an RN.  In some places, they make a lot less.

Some regions use RNs in the prehospital environment doing ground CCT, or flight.  Some areas use paramedics for these roles.  If you consider flight / IFT as "being in the field", and I'd argue it probably is -- a lot of  NICU / PICU teams have an RN / RRT configuration.

In some areas it's also relatively easy to become certified as a paramedic after taking an RN degree.  In a few places, the reverse may also be true.

One of the obvious advantages of nursing is the wide range of clinical roles.  You might want to start off doing something like CCU, but decide after 10 years, that maybe you'd like to work in a public health unit, or be a research nurse, or something.  There's a range of lateral movement that is rare in most regions' EMS systems.  

Nursing offers better career pathing (in most regions), with the option to do nurse anesthesia, or become a nurse practitioner.  There's less personal danger, and while some will disagree, it's probably easier on your back.  More importantly, there are more roles that you can do with an injured back (even if many doors close).

Personally, I don't think I would have done well in nursing.  I like the illusion of autonomy that you get as a paramedic, and I don't like being in the hospital.  I don't think I would want to deal with some aspects of nursing culture (although there are many negative aspects of EMS culture).  But, while they don't have them in areas I've worked, being a CRNA would be pretty interesting, I think.


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## the_negro_puppy (Mar 27, 2012)

From what i've read on here, other sites and looking at the comparative wages, if you are in the U.S I would saying Nursing muchachos


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## Vetitas86 (Mar 27, 2012)

I wouldn't touch nursing with a ten foot pole, but that's just me. My interests lean toward field and emergency stuff. I leave the more esoteric things to nursing for the time being. 

To me, its all about preference. Do what you want. Unless it truly is a major factor, don't worry too much about the salary difference. And a lot of medics go PA, so getting further into healthcare is possible.


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## MS Medic (Mar 27, 2012)

I've been doing this a while and I do like my job, but knowing what I do now, if you are in the U.S. then I'd go nursing. You have more career options available to you. If you want "field work", there is the home health option and if you live in areas like Alaska or some portions of the Mid West, then others are available to you as well. 
In EMS, we have to deal with hours that are hard on the body and social life. And there are very few options besides riding on the ambulance or management if you want to stay in this job.


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## Anjel (Mar 27, 2012)

A lot of medics end up in the hospitals as nurses. Especially in the ERs. 

You have to do what makes you happy. If you are just doing it for the money than you will be one miserable person. Especially in this field. 

Like system said it is somewhat easy to transfer between the 2 fields. For here, it is a 3 semester course to go from medic to RN. And I might be doing that when I get older and have a family. Right now, I am 22 and getting married. I am still young and able to jump in and out of the truck all day. But I already hurt my back once, and it still bothers me. So how long am I going to be able to do EMS? You have to have a back up plan. 

But ultimately the decision is up to you. Good luck.


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## Scott33 (Mar 27, 2012)

Vetitas86 said:


> I wouldn't touch nursing with a ten foot pole, but that's just me. My interests lean toward field and emergency stuff.



Both of which can be done as an RN. 

Professional growth for medics is pretty limited compared to nursing.


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## DrankTheKoolaid (Mar 27, 2012)

Scott33 said:


> Both of which can be done as an RN.
> 
> Professional growth for medics is pretty limited compared to nursing.



Quoted for truth


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## NYMedic828 (Mar 27, 2012)

PA...

Why do 4 years to be a nurse and still have to change people and whatnot when you could do 5 years and be a PA making substantially more money.

Don't do paramedic unless that is truly where your heart lies. Your future is important for yourself and someday your family. If I wasn't waiting to be promoted to firefighter I'd be in a classroom. (and selling my car lol)


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## Scott33 (Mar 27, 2012)

NYMedic828 said:


> PA..Why do 4 years to be a nurse and still have to change people and whatnot when you could do 5 years and be a PA making substantially more money.



Some nurses are paid more than PAs.


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## NYMedic828 (Mar 27, 2012)

Scott33 said:


> Some nurses are paid more than PAs.



CRNA maybe...


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## Chrashley (Mar 27, 2012)

Thanks for all the replies. Just for the record, I already have a family and a career in a field that I have grown to hate. I am an HVAC tech and have been for 17years. I'm highly skilled and certified and my credentials are superior but the industry does not care about that and cannot afford to reward techs who better themselves. I have been let go from three companies in the past four years because they would rather cut me loose and hire in a beginner and train him to half way do what I am capable of. Anyway, I digress. I'm looking for a fuel that will pay me as I grow. That says that my education is valuable. My wife is a nurse and is encouraging me to look into it but I just don't want to work bedside really. I started my emt basic program in January and will graduate in June. I plan to drop HVAC and get into EMS. I need to know that I can find work in the field as a nurse though. Thanks for all of your responses. Keep them coming as they have been very insightful.


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## Chrashley (Mar 27, 2012)

Excuse my ignorance but...what's a PA?


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## NYMedic828 (Mar 27, 2012)

Physicians Assistant.

Similar somewhat to an NP - Nurse Practioner 

Now that we know you have a family to support, RN is probably the way to go.

I imagine you want to work during your schooling to maintain an income. From what friends in school/graduated have told me PA is near impossible with a Job.

As a nurse you can always finish schooling and then advance to NP or CRNA down the line. CRNAs make ALOT of dinero. 150,000+ by me.

CRNA - Certified registered nurse anesthetist. 

They perform all the duties of an anesthesiologist essentially.


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## Anjel (Mar 27, 2012)

Chrashley said:


> Excuse my ignorance but...what's a PA?



Phys. Assistant


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## Melmd (Mar 27, 2012)

I think the Paramedic vs nurses debate is out of the question, they are of 2 different worlds. 

Just wanted to share this blog site, it's a good article!

http://epatchadams.blogspot.com/2012/03/candid-response-to-cause-for-concern.html


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## Chrashley (Mar 27, 2012)

Melmd-I'm not debating which is "better". I'm just curious which "world" I should live in.


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## Melmd (Mar 27, 2012)

Chrashley said:


> Melmd-I'm not debating which is "better". I'm just curious which "world" I should live in.



My bad, sorry for that sir...


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## NYMedic828 (Mar 27, 2012)

As a medic, guaranteed in the field almost always.

Nurse is rare to find in the field and you won't start there regardless. They aren't gonna put a new nurse out on their own.

Honestly, you are over 30 with a family. When you reach the later years do you want to be lifting and carrying overweight people 4 times a day or do you want to have pushing d50 and occasional cpr be the most strenuous thing you do?

You can work as an EMT while in nursing school, worst case decide you do love EMS and go for medic.

It's poorly advised to go for medic with 0 EMS experience anyway.


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## MS Medic (Mar 27, 2012)

Melmd said:


> I think the Paramedic vs nurses debate is out of the question, they are of 2 different worlds.
> 
> Just wanted to share this blog site, it's a good article!
> 
> http://epatchadams.blogspot.com/2012/03/candid-response-to-cause-for-concern.html



I read part of that blog and have to call it bunk. Maybe the fact that this person went to school 16 years ago has some effect but I was required to take the same A&P courses an ARN course requires. In fact, because I went to school at a university hospital, my lab was done with a cadaver. But even the guys who went to a CC sat in the same classes as nursing students. But rather than studying algebra and sociology, we covered patho and disease processes. 

With that said, I had an AA before getting into EMS and am 2 semesters away from a BS in health science. I just get sick of all this crap that nurses have more education because they went to a degree program and we have a certificate program.


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## Vetitas86 (Mar 27, 2012)

The issue is, no matter how you slice it, you can't get the same requirements in a certificate that you can in a true, four year degree. It's like saying that docs are just as educated as PAs.

I think what they've brought up is legit. There's needs to be a working degree in EMS.


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## Tigger (Mar 27, 2012)

Vetitas86 said:


> The issue is, no matter how you slice it, you can't get the same requirements in a certificate that you can in a true, four year degree. It's like saying that docs are just as educated as PAs.
> 
> I think what they've brought up is legit. There's needs to be a working degree in EMS.



There are degrees for EMS though, there's even Baccalaureate degrees. The problem is that in many places they are no more useful than certificates. I don't think it's much of stretch to say that in 9/10 paramedic positions in this country that it doesn't matter if you have an Associates in paramedicine (or whatever they call it) or a certificate. Some states require it, but until all of them do, it does not make often make sense for many to attend a college to get their degree. If getting an AA takes two years and a certificate takes one, why would one not take the year long course and start making money a year earlier if financial sustainability is a concern?

There is a framework in this country for EMS to become part of the higher education system, but there is no motivation for many to participate in it.


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## MS Medic (Mar 27, 2012)

Vetitas86 said:


> The issue is, no matter how you slice it, you can't get the same requirements in a certificate that you can in a true, four year degree. It's like saying that docs are just as educated as PAs.
> 
> I think what they've brought up is legit. There's needs to be a working degree in EMS.



There is no difference as far pt care goes between a nurse with an AA and a BSN. The BSN allows for opportunities in areas of management, administration, and teaching. I was also only referring to situations directly associated with pt care. Sorry for any confusion


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## sir.shocksalot (Mar 27, 2012)

MS Medic said:


> I was required to take the same A&P courses an ARN course requires. In fact, because I went to school at a university hospital, my lab was done with a cadaver. But even the guys who went to a CC sat in the same classes as nursing students. But rather than studying algebra and sociology, we covered patho and disease processes.
> 
> With that said, I had an AA before getting into EMS and am 2 semesters away from a BS in health science. I just get sick of all this crap that nurses have more education because they went to a degree program and we have a certificate program.


We are talking in general terms here. Kudos to you for attaining a real education and having a strong background in the sciences! However, you are far from normal, many paramedics are not required to have any A+P education at all, or just a brief intro to A+P. Graduates of the worst nursing schools in the country have to have at least A+P, micro etc. Graduates of the worst paramedic programs in the country might know roughly enough to apply the protocols to patients.

I can only speak locally in saying that Paramedic schools in the Denver/Metro area have actually lowered admission requirements, when I went 1 year of A+P was required for admission, now it's down to 1 semester intro to A+P class. EMS may be the only profession (at least in my neck of the woods) lowering our educational standards.

As a whole, nurses are far more educated than paramedics. There are examples of nurses who don't know their head from a hole in the ground, just as there are examples of medics who can't find their way out of a paper bag. But profession-wide paramedics are sadly and drastically under-educated.


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## Chrashley (Mar 27, 2012)

Here's how I feel about it. If you make the cert or degree or license so easy that everyone can get one or you have no means of enforcing it's requirements it will cheapen the trade. I go thru this in the HVAC trade now. None of my education or certs mean anything because it's not regulated that you have them to do any work. So on paper I'm worth a bunch but since there is no one to govern anything then they are worthless. So am I in favor or a more strict degree and governing system...hell yeah I am. Cause that means that all the blood sweat and tears I put into my degree are worth something.


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## EpiEMS (Mar 27, 2012)

Remember, though, even most of the education and certification of physicians is primarily a solely private function — the strength of regulation has evolved over time.


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## Vetitas86 (Mar 27, 2012)

MS Medic said:


> There is no difference as far pt care goes between a nurse with an AA and a BSN. The BSN allows for opportunities in areas of management, administration, and teaching. I was also only referring to situations directly associated with pt care. Sorry for any confusion



For what its worth, I've seen a few programs devote more clinical and didactic time during the BSN vs. the AA. Shrug. May not be everywhere, and that wouldn't particularly surprise me.


And yeah, from what I've seen, even medics are undereducated. I've seen a few rely way too heavily on cookbook medicine. And having less educational requirements means we're going to be stuck in the low paying tech ghetto for a while. It's part necessity of actually being able to know what's going on from a medical standpoint and partially public perception. 

Other specialties in allied health have more education and have used that as leverage in pushing for more respect and pay. Nursing is case in point.

Also case in point is emergency med residencies for docs. 3-4 years after med school to even get a handle on a lot of things that they do and why. Granted, I think 99% of that would be completely unnecessary for medics, but the point remains. In patient care, knowledge shouldn't be an option. And honestly, I don't see where all the backlash against furthering education in EMS comes from as far as those who work it.


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## MS Medic (Mar 27, 2012)

Well then it is an interesting dichotomy that I live in an state with one of the most functionally backwards EMS system and then seems, based on what you guys are saying, to have a relatively progressive education system because A&P I and II are required here and everyone I know that is dual certed, including a woman who was a CC and ER nurse for close to twenty years before going into EMS says nursing school is a joke compared to medic school.


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## Chrashley (Mar 27, 2012)

But isn't some of that because of time frame?  It's 4 years to get an RN, and 14 months to get medic. And it's all got to be pretty much the same stuff (I know not exactly but you know what I mean)


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## MS Medic (Mar 27, 2012)

It might be, I'm not dual certed myself so I can't really say. I'm only going by what I'm told by those who are. If it makes any difference, there is a medic to RN bridge program that lasts 9 mths in this state but the nurses aren't allowed to bridge over due to educational reasons. Don't know it that means anything though.

But if you count basic school as a prereq which is where all the fundamentals of trauma care are taught, then that plus A&P I and II and the 12 mths of medic school, you end up with four full semesters of school. Ours is strictly medical related without any of the humanities or electives.


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## NYMedic828 (Mar 27, 2012)

Chrashley said:


> But isn't some of that because of time frame?  It's 4 years to get an RN, and 14 months to get medic. And it's all got to be pretty much the same stuff (I know not exactly but you know what I mean)



Its a whole bunch of factors and it varies depending on where you are.

Nursing is a degree program because its required by every place of employment to be a registered nurse and a requirement of that is official schooling as a nurse with a degree to prove it, followed by NCLEX testing to prove it.

Nursing has a national unified body where as EMS has next to nothing. Every region does what it wants and dictates what a paramedic can do.

In one state you can tie a patients shoes but in another state you can do a chest tube and emergency tracheotomy.


Skills wise, A paramedic can do more than  a nurse. If a nurse can read an ECG, its because she learned to do it on her own. A nurse cannot intubate. A nurse cannot perform surgical procedures such as an emergency tracheotomy, thoracic decompression, chest tube, needle crichothyrotomy. 

Most skills past an IV/pushing meds in the hospital setting are handled by doctors and their assistants.

Knowledge wise, it depends where you get your schooling but as far as practical job related knowledge goes its pretty much the same. Sure you can say a nurse spent more time in a pharmacology class or took microbiology, but lets be realistic, after a year no one remembers any of that stuff unless they strive to maintain it on their own.

Being a good nurse/doctor/paramedic all comes with experience. No one knows everything when they finish school you learn as you go. Any time you encounter a medication or a disease or something you don't know about, you make it an opportunity to do research and learn. Over time you will grow into an experienced provider. But at the same time, there are plenty of folks on all sides who could care less to learn past what their job requires.

The problem with pre-hospital medicine is that we are a young service compared to nursing. Nursing has been in the game a LONG time. We currently have a few 100,000 people who have no means of relating to one another outside of a place like this forum. In order for that to happen, the entire country would have to decide to wise up and do something or the federal government would need to step in somehow. To randomly tell a few 100,000 people that they need to get a 4 year degree by 2020 or they cannot continue in their profession will never happen.

At some point with the rising cost of hospital healthcare, EMS will have to advance as a service. Its a long road but an inevitable one.


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## Scott33 (Mar 28, 2012)

> Skills wise, A paramedic can do more than a nurse.



I think it may have been more accurate to have said a paramedic can perform more paramedic skills than a nurse. And even that could be argued.



> A nurse cannot intubate. A nurse cannot perform surgical procedures such as an emergency tracheotomy, thoracic decompression, chest tube, needle crichothyrotomy.



Except for those nurses who can.


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## smallsislost (Mar 28, 2012)

id go for the medic career. most state have a aramedic to rn corse that isn't as bad as youd think.


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## Vetitas86 (Mar 28, 2012)

There are 4 year degrees for EMS, but they're not professional degrees. Pro degrees exist in other fields. 

From what I've seen, most of the BS EMS degrees are just that. BS. They train management and aren't focused on the practical side.

There does need to be a national effort to standardize practice. It shouldn't be dependant on region and state. And I think that's part of the reason why EMS is so divided, becuase skill sets and training differ so much.


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## Tigger (Mar 28, 2012)

NYMedic828 said:


> Knowledge wise, it depends where you get your schooling but as far as practical job related knowledge goes its pretty much the same. Sure you can say a nurse spent more time in a pharmacology class or took microbiology, but lets be realistic, after a year no one remembers any of that stuff unless they strive to maintain it on their own.


Who knows more about how the human body works, which being the most fundamental component of medicine, seems important? The RN with 2 semesters of A and P, microbio, at least some chemistry, and a semester of psych; or the paramedic with hopefully a semester of A and P prior to enrolling in medic school.



Vetitas86 said:


> There are 4 year degrees for EMS, but they're not professional degrees. Pro degrees exist in other fields.
> 
> From what I've seen, most of the BS EMS degrees are just that. BS. They train management and aren't focused on the practical side.
> 
> ...



If you get a BS in EMS, that's a professional degree. In addition to getting a bachelors, one also gets a paramedic certifcate, i.e. a license to practice. Here is a sample curriculum of a BS in EMS: 

http://www.southalabama.edu/ems/bachelor.html

We also *need* management components in our degrees. Not everyone can be a field provider nor do they need to be. One of EMS's biggest problems is a lack of progressive management, which may be partially attributable to managers being senior and often washed up former field personnel. Learning to manage people in the context of an industry is not BS, it's how professions mature.

It would be nice if EMS had a national standard to be sure, and it will have to happen for the industry to become a profession. But I am not sure I see EMS as being divided. The vast majority of providers are content to meet the present standards and will not exceed them until it's a mandate. This is nothing new, it happens in *every* profession. There are of course some of us that are calling for change, but until our voice is heard we are still doing the same job to the same standard.


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## DPM (Mar 28, 2012)

I've just read this ENTIRE thread and not one person has mentioned who would win in a fight. Let's get out priorities straight here people


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## Scott33 (Mar 28, 2012)

Your average medic could kick your average nurse's arse


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## NYMedic828 (Mar 28, 2012)

Scott33 said:


> Your average medic could kick your average nurse's arse



The nurse just has to take the high ground up a flight of stairs. Odds are the medic will be so tired by the time he reaches them he will just collapse.


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## Shishkabob (Mar 28, 2012)

Tigger said:


> Who knows more about how the human body works, which being the most fundamental component of medicine, seems important? The RN with 2 semesters of A and P, microbio, at least some chemistry, and a semester of psych; or the paramedic with hopefully a semester of A and P prior to enrolling in medic school.



Apples to oranges.

How about the states that require the same pre-reqs from Paramedics and RNs?

How about medics who do it on their own?



I got in to this debate with a nurse a few months ago.  She thought she had more schooling because she had a 2 year degree, until I clarified that Paramedics also have 2 years of education, just more specific in nature.  Her fallback defense? "Well, I also have pre-reqs"

My response? "Cool, so doing spreadsheets on a computer makes you a better healthcare provider?"





To the OP:  Realize that EMS tends to be a young persons job, and you won't see too many Paramedics in their 40's and beyond, having done it for decades.  Most likely way to stay in is to go in to management or education.

I myself have realized this.  I don't regret becoming a Paramedic, but I know I probably won't retire from it.  I am saving some money so I can go back to school full time and earn another degree, such as my PA or RN.  RN DOES give more options in where you can work when your body decides it no longer wants to.  Even if that means working 3 days in a hospital and 1 day on an ambulance for my 'fix'.

As hey, field work is just that awesome.


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## Tigger (Mar 29, 2012)

Linuss said:


> Apples to oranges.
> 
> How about the states that require the same pre-reqs from Paramedics and RNs?



Are there states that do this?

Wouldn't you agree that the standard paramedic course requires 1 semester AandP? Obviously some require more, but to generalize this is the standard, no?


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## Handsome Robb (Mar 29, 2012)

smallsislost said:


> id go for the medic career. most state have a aramedic to rn corse that isn't as bad as youd think.



The base knowledge is similar but that's about where the similarities end. 

One of the biggest things I have learned throughout my clinical time for school is that Paramedicine and Nursing are two totally different beasts. I felt useless during my ICU rotations, we just don't have that type of education. In the ER one could argue that paramedics might be a better fit than nurses but the nursing union says otherwise. Also most paramedics I know don't like having to wait around for someone to tell them what to do. 

Comparing Nursing to Paramedicine is like comparing apples to oranges, just like Linuss said. 

My program completes an "equivalent" a college level A&P course, but that's not the norm.


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## Tigger (Mar 29, 2012)

NVRob said:


> The base knowledge is similar but that's about where the similarities end.
> 
> One of the biggest things I have learned throughout my clinical time for school is that Paramedicine and Nursing are two totally different beasts. I felt useless during my ICU rotations, we just don't have that type of education. In the ER one could argue that paramedics might be a better fit than nurses but the nursing union says otherwise. Also most paramedics I know don't like having to wait around for someone to tell them what to do.
> 
> ...



I'd argue that the base knowledge is no where needs to be for paramedics and is probably quite far from the nursing side of things. I can't figure out why this is however. As is mentioned frequently in these discussions, RNs are limited in both their autonomy and skill set. In most cases paramedics can provide many more interventions than a Nurse. Yet if a medic course requires a semester of A and P it's considered above and beyond. Wouldn't it make sense to provide our pre-hospital providers with a core understanding of the human body since they're responsible for so much more? In many cases it seems medics "do" more with less education than nurses do. The positions are really not that similar, but they both require a detailed understanding of the human body. Shouldn't we be getting that?


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## MS Medic (Mar 29, 2012)

I keep hearing you guys talk about this piss poor education background for medics and this new info for me. Like I said earlier, we are required to take the same A&P classes nurses and then move on to patho and disease process  ect. Can someone give me an idea of what the "average" (i guess for a lack of a better word) education for medics is. 
I have heard horror stories about a medic school run by Acadien that teaches pharmo by box color and farms the students to pass registary but I always thought that was an exeption to the rule.


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## systemet (Mar 29, 2012)

Linuss said:


> I got in to this debate with a nurse a few months ago.  She thought she had more schooling because she had a 2 year degree, until I clarified that Paramedics also have 2 years of education, just more specific in nature.  Her fallback defense? "Well, I also have pre-reqs"
> 
> My response? "Cool, so doing spreadsheets on a computer makes you a better healthcare provider?"



People who argue that they're better than someone else based on the level of their education are asshats.  It doesn't matter if they're MD/PhDs who're dual residency trained, nasa astronauts, or an RN with an Associate's.

It's not worth arguing with them.  If someone's actually educated and competent, they don't usually need to point it out every five seconds.

RN's do a longer educational program than paramedics in most parts of the world.  It undoubtedly prepares them better to be RNs.  I imagine it makes them pretty poor welders on average.

I have a friend who has a PhD in English Literature.  They're definitely more educated than me.  Does it matter?



> I don't regret becoming a Paramedic, but I know I probably won't retire from it.  I am saving some money so I can go back to school full time and earn another degree, such as my PA or RN.  RN DOES give more options in where you can work when your body decides it no longer wants to.  Even if that means working 3 days in a hospital and 1 day on an ambulance for my 'fix'.
> 
> As hey, field work is just that awesome.



I think this is a good attitude.


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## systemet (Mar 29, 2012)

MS Medic said:


> I keep hearing you guys talk about this piss poor education background for medics and this new info for me. Like I said earlier, we are required to take the same A&P classes nurses and then move on to patho and disease process  ect. Can someone give me an idea of what the "average" (i guess for a lack of a better word) education for medics is.



I think this varies greatly with geographic region inside the US, from what I've heard, and can vary greatly outside of the US.

Some of the European systems require that you first have a BSN, work for a year or two in the ER or ICU, then complete a year or two of specialty nursing training to be a paramedic.  Interestingly, many of these systems don't RSI.

From some of our members from Australia and New Zealand, it sounds like their new paramedics that are working at something between an intermediate and an ALS level are educated to a Bachelor's degree standard, and they complete a further year of two of training to get to the higher "Intensive Care Paramedic" level.

The UK system is a little confusing to understand, but it sounds like they now have entry-to-practice programs at the Bachelor's level as well.  (Correct me if I'm wrong, anyone).  They also have a fairly novel "Paramedic Practitioner" level, that I believe has a Master's degree.

One of the Canadian provinces has a two year diploma for BLS providers, followed by another year to upgrade to an ALS level, and a further year to upgrade to a true critical care level that includes real education on ventilator management, x-ray interpretation, management of invasive lines, and enables them to independently manage more complicated pieces of technology like IABPs.

There are other systems that choose to staff their ALS ambulances with one or more physicians.  It sounds like the Germans often use physicians for critical pediatrics.  I believe they form the ALS tier of the French SAMU.

I think the South Africans have a degree level paramedic, as well.

------------

My personal opinion, having a little less than 3 years of total training to become a paramedic, was that a lot of things could have been taught better, and that the situation would be vastly improved if the training programs were improved by a year or two.

Unfortunately whenever you put forward this viewpoint on a forum like here, you immediately here how little money everyone makes, and how no one would be willing to accept the extra training time until the pay increases, which won't happen until we get more educated.  




> I have heard horror stories about a medic school run by Acadien that teaches pharmo by box color and farms the students to pass registary but I always thought that was an exeption to the rule.



After posting on here for a while, it has been pointed out to me that there are some US programs that are as short as 6 weeks of didactic for paramedic.  This floored me.


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## MS Medic (Mar 29, 2012)

systemet said:


> Unfortunately whenever you put forward this viewpoint on a forum like here, you immediately here how little money everyone makes, and how no one would be willing to accept the extra training time until the pay increases



As I've stated in other threads, I feel that more education isn't the silver bullet for EMS it keeps getting made out to be, atleast here in the U.S.A. A large bulk of the education I did receive was essentially useless to me. In the field, I can assess and diagnose a pt but can't do anything about it. In other instances, I have no way to apply knowledge beyond a theoretical point. Then on arrival to the hospital, after giving a C/C, the staff ignores EMS and that is if they listened to anything at all, so all this info gleened during assessment isn't good for anything other than filling out a report that will only be read by the service QA and billing.

While I think a 6 week course ought to be criminal, I also think requiring a degree without fixing other things in a broken system puts an undo burden on EMS personnel, especially with the current cost of education.


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## systemet (Mar 29, 2012)

MS Medic said:


> As I've stated in other threads, I feel that more education isn't the silver bullet for EMS it keeps getting made out to be, atleast here in the U.S.A. A large bulk of the education I did receive was essentially useless to me. In the field, I can assess and diagnose a pt but can't do anything about it.



I think it could be argued that the same thing probably happens to a lesser extent in the ER.  The physicians may be able to identify some esoteric pathology, but their actual course of action is to punt the patient to another service.

There's obvious limitations in the prehospital environment.  But some of these are being pushed back.  For good or bad, ultrasound is starting to appear in some environments.  While a lot of the point-of-care technology is some combination of too expensive / too delicate / too inaccurate / too slow, it's also making it's way in there.  As these things develop we'll probably have a greater role in identifying pathology, and initiating treatment.

One role that's been discussed a lot is screening for sepsis using prehospital lactate measurement, although this benefit might be restricted to systems transporting to either busy / congested ERs, or those with long transport times.

The word "diagnosis" is loaded with all sorts of badness that get physician's mightily upset, but if we accept that you or I may occasionally identify the root cause of someone else's medical problem through luck or sheer genius, I think this is valuable when it happens.  I can't say that it's been that often for me.




> In other instances, I have no way to apply knowledge beyond a theoretical point. Then on arrival to the hospital, after giving a C/C, the staff ignores EMS and that is if they listened to anything at all, so all this info gleened during assessment isn't good for anything other than filling out a report that will only be read by the service QA and billing.



Don't take this the wrong way, because it's not intended as a slam, but I feel like sometimes we need to be honest with ourselves about what we're doing.  

I can't speak to anyone else's experiences or competency, but for me, I know that on a given day, even a fairly poor ER physician is going to be able to assess and examine a patient much better than me.  They're going to have seen most presentations more often, they're going to have experience with real-life examples of most of the zebras that might be hanging around, and they're going to consider a much wider list of differentials, including things that I haven't even thought of.

I think what we can bring to the ER is a description of the circumstances in which the patient was found, information from bystanders and neighbour's about how the current situation developed, or what happened in the days prior.  We can also be useful in describing how the patient's presentation has changed, especially if we fixed a problem, or have given analgesia.  That's stuff that the physician isn't necessarily going to be able to get via physical exam or history taking.

I'm not saying that I haven't been in a situation where I've pointed out something that's been missed, but it's pretty rare.

If you're having issues where they're not looking at your 12-leads, and tossing them in the garbage, then they're just being stupid.  But this really shouldn't be happening anymore -- because this represents the loss of valuable information that may affect the patient's treatment.



> While I think a 6 week course ought to be criminal, I also think requiring a degree without fixing other things in a broken system puts an undo burden on EMS personnel, especially with the current cost of education.



I guess this is a major issue in the US.  I paid the equivalent of about $3,000 US / year for two years for my paramedic, and about the same for my EMT.  I also did some university, and paid between $4,000-$6,000 / year.  I imagine in the states those numbers would be much higher.

If it cost $20,000 / year to take a four year Bachelor's degree, then, yeah, there's definitely an issue there.  But, at the same time, we really can't call ourselves professionals and having it mean any more than the professional in "professional hair dresser", if we don't start demanding that our paramedics have a baccalaureate.


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## MS Medic (Mar 29, 2012)

That isn't a slam. Your absolutely right about the ER report. I wasn't whining that they should pay more attention to me (although I see where my statement can be interpreted as such), I was merely pointing out that there are other things that should worried about than if we have a degree or not when it will make little if any difference how we go about our job.


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## Scott33 (Mar 29, 2012)

systemet said:


> The UK system is a little confusing to understand, but it sounds like they now have entry-to-practice programs at the Bachelor's level as well.  (Correct me if I'm wrong, anyone).



Commonly a paramedic-specific 2 Year Diploma or 3 year bachelors degree. But this is not mandatory in the whole country as yet - I am sure it will be some day. Some existing 'old school' NHS techs, and non-degree medics, can use the open university as a means of 'bridging' to a degree.

http://www3.open.ac.uk/study/undergraduate/qualification/x08.htm


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## MedicSansBrains (Oct 25, 2014)

In Texas you must have Intro to A&P to have an accredited EMT-Intermediate or EMT-Paramedic program. 

Also, an EMT-Paramedic certification is just steps away from an Associates of Applied Sciences (AAS) in Emergency Medical Services. Of course in order to issue an Associates Degree requires the educational institution to be an accredited college i.e. community college. 

With an AAS in EMS you can be a Licensed Paramedic (in Texas). As it goes in Texas there are 4 levels of certification in EMS with the aforementioned being the highest

EMT (Formerly EMT-Basic)
Advanced EMT (Formerly EMT-Intermediate)
EMT-Paramedic
Licensed Paramedic

The above are given/determined by the Texas Department of Health. 

To become an EMT-Paramedic you have to earn a level II certificate. A Licensed Paramedic has an AAS in EMS as aforementioned. 

The difference between these two levels of certification is that an AAS in EMS requires some "peripheral" classes including 

-College level Math/Algebra
-English & Composition
-Speech Communications
-"Culture" Elective i.e. Art History, Philosophy
-Elective

Also, Licensed paramedics are required to have 

-PALS Certification (Pediatric Advanced Life Support)
-ACLS Certification (Advanced Cardiac Life Support)
-PTLS Certification ( Pre-hospital Trauma Life Support) 

The certifications above are all AHA (American Heart Association) certifications. 

Besides the inherent wealth that the extra education offers and the certifications I'm not aware of many employment/advancement advantages between a EMT-Paramedic patch or a Licensed Paramedic patch besides the cool factor and prestige. (In Texas of course..) 

That being said the employment space is really policing up on the type of education required to practice as an EMT/Paramedic. As my professor said "It used to be that all you had to have was the paramedic patch and you'd get hired. Now, they're looking into where you got your education from."

I know that here in Central Texas there are a few EMS systems that have outright changed their hiring policies to exclude all paramedics with paramedic schooling from anything other than an accredited college.  

The field of paramedicine is progressing but it truly is the lack of a national level of policy making that keeps us from making these changes non-variable. 

However, I'm not so sure how appropriate that is in EMS. Here in Austin we are comfortable in saying we have one of the most progressive EMS systems. Austin Travis County EMS (ATCEMS) pioneered the "pit crew" technique along with many other innovations in EMS and other progressive systems have picked it up like wild fire. Likewise, ATCEMS has been able to pick up innovative practice from others. 

I think that is in no small part due to the autonomous nature of EMS systems in their policy and procedure. If you have a well funded system with good people and a progressive medical directors office you have a lot of leverage in improving care. I'm not sure how a strong national regulatory agency would fare on the side of progress in patient care. It almost always does the opposite. 

EMS in many areas can do advanced surgical and airway procedures while others can't. I think that a national regulatory push would bring things to a mean requiring the laggers to come up a little and the advanced systems to come down. Then again I guess the scope of practice always relies upon your medical director anyways. Although, states do have legislative influence in this area. If anyone has in depth analysis on this side of things I would appreciate such knowledge. 

Back to the original post of "RN vs. Paramedic" there is little similarity in the type of medicine practiced, the environment it's practiced in, and the employment standards and practices. 

The education is also different. An RN must have at least an Associates Degree in Nursing (ADN). This is a national requirement and is highly regulated. The degree must be administered by a regionally or nationally accredited college with an accredited nursing program. 

An ADN program has pre-requisites including 

-Microbiology
-Anatomy 
-Physiology
-Statistics 

In Texas, the length of an accredited ADN and AAS in EMS are theoretically the same. In fact the AAS in EMS is longer by a semester (Who's counting anyways). While it's true an AAS in EMS doesn't require Microbiology and only requires a compressed "Intro to Anatomy & Physiology" course I'm not sure how much bearing that has on providing treatment in the field. 

EMS education is much more focused on practice and skills because an EMT is expected to practice on their own outside of direct supervision of an MD. Of course they are operating under an MD and do rely on them and contact them frequently when needed but they don't have an MD standing over their shoulder while they administer an advanced airway or cut into someones throat (doesn't hardly happen but you know). 

It does hurt my feelings when someone, especially a nurse, talks down to or disregards EMS in the light of all this. The truth is that a Paramedic in a busy and progressive county practices more "medicine" than 90% of nurses, under more uncertain conditions, with less resources. However, I would never talk down to a nurse or consider their role in patient care less critical or their education less pertinent or in-depth. 

Also, let's not forget that, in my area at least, starting RN's make on average 50% more than Paramedics. Both have similar length in schooling however, an ADN is hands down less intense than a good AAS in EMS program.

Anyways, rant on an old thread is done and maybe it'll help someone have a more in depth understanding in the differences between RN and Paramedic education, employment, and practice.


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## Ewok Jerky (Oct 25, 2014)

Holy crap. Nice first post!


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## VFlutter (Oct 25, 2014)

NYMedic828 said:


> CRNA maybe...



On average PAs make around $20K more a year in my area depending on where they work. PAs working in specialty areas make substantially more than Hospitalist PAs. Personally, I make the same if not more than some Hospitalist PAs working as a Staff RN with overtime and Bonus pay.



NYMedic828 said:


> Skills wise, A paramedic can do more than  a nurse. If a nurse can read an ECG, its because she learned to do it on her own. A nurse cannot intubate. A nurse cannot perform surgical procedures such as an emergency tracheotomy, thoracic decompression, chest tube, needle crichothyrotomy.



If you judge a profession solely on the ability to perform procedures, that your are horribly undereducated and under-trained for, then Nursing is certainly not for you. Take the Ego out of it. How often do you perform surgical airways, decompressions, chest tubes, ect? I assists with most of these procedures daily and likely see more in a month then you will in your entire EMS career. If It wanted to preform the procedures myself I would go to Medical school not become a paramedic. I enjoy my job and it does not bother me that I am not the one putting the plastic between the cords.

And I don't think I'm too shabby at reading EKGs..



NYMedic828 said:


> Most skills past an IV/pushing meds in the hospital setting are handled by doctors and their assistants.



That statement is just idiotic. What "most skills" are you refereeing to?  MDs spend 5 mins a day with a patient and nothing more. Nurse assistants can not do anything except for the most basic tasks and do not assess the patient in anyway. Have you ever worked in a hospital?




NYMedic828 said:


> Knowledge wise, it depends where you get your schooling but as far as practical job related knowledge goes its pretty much the same. Sure you can say a nurse spent more time in a pharmacology class or took microbiology, but lets be realistic, after a year no one remembers any of that stuff unless they strive to maintain it on their own.



I use the information learned in my pharm and micro class every single day.


OP, I would suggest shadowing both fields and see what you enjoy the most. Advice on forums should be taken with a grain of salt because RNs and Medics understand very little about each other and have many false misconceptions. Personally, I think nursing is the way to go. I think I received a great education, have a rewarding job, and am financially stable. I could work 3 days a week and still support myself easily.


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## TacomaGirl (Oct 27, 2014)

Perception, opinions and finally your decision.  I am not an EMT nor paramedic and after 10 yrs critical care in the hospital setting (NICU/PICU/ICU/ER), I decided to get into prehospital. I have been very successful thus far with the minimal training provided by my employer.  I don't feel any less or disadvantaged for being a nurse, nor made to feel that way by them.  There is a bit of pay discrepancy between the two.  About $10/hr diff where I work.  I didn't become a nurse for the money but I sure in hell expect to be compensated adequately for my responsibilities and skills.  I have no regrets in becoming a nurse.


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## joshrunkle35 (Nov 4, 2014)

Also, be aware that nursing is a very broad field. Emergency nurse's jobs are very different from other fields and departments. So, for example, I was very turned off from nursing while doing clinicals in EMT/medic in the hospital...but it took a while to realize that is only one type of nursing, and also, one area of the country. 

I would do nursing, keep working hard somewhere that will pay for school, and do nurse practitioner while you work.


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## TimRaven (Nov 4, 2014)

Just a minor correction, but PHTLS is a NAEMT cert, not AHA.

Here in SF Bay Area, most Paramedic schools require college level A&P, current EMT-B cert, 1,040 hours clinical work (does not limit in EMS, can be CNA or CMA).
The school itself is 12-14 months long, with three full days a week. Tuition is anything between 3,000 - 12,000 depending on state and federal fund. (government funded schools are much cheaper)


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