# Paramedic programs for RN-EMTs



## Jakeyjake (Jun 20, 2014)

I am an RN who challenged the EMT exam in my state -- looking to go into flight nursing which where I live requires you to be licensed as a paramedic and an RN.  I know of one program out in the midwest, which allows ICU nurses to take an intensive paramedic course in two weeks, but I don't know of any others.  I would be willing to travel out of state for this.  Does anyone know or have heard of any such programs?


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## rmabrey (Jun 20, 2014)

The local community college where I live created a curriculum for RN to meduc bridge. You essentially just have to take operation and do the required clinical hours. That would take more than 2 weeks though.


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## wanderingmedic (Jun 20, 2014)

What state do you live in and what programs have you already looked at? 

I believe Creighton University had one. Not sure if it still exists thou. 

Most programs are for people going the other direction (medic to RN). I know Michigan used to have a few RN to Medic programs, but you had to have an inside connection to get in. I don't think they really exist in Michigan anymore because the demand dwindled so low it is not profitable for anyone to do. 

PERCOM might also be an option worth looking into. Their didactic is all taught through online modules, and they can grant advanced class standing to students with licensure in other fields from what I understand. I know that several RN's, RT's, 68W's, and even MD's have gone through their program. They can even knock off some of your clinical hours based upon previous documented clinical experiences. I would really suggest giving them a call to find out about what options they can make available to you. They are super reasonably priced too. I did PERCOM and loved the program. The instructors were great, and despite what anyone else says, I have not noticed a difference in competency between what I learned, and what other medics who attended tractional brick and mortar programs learned.


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## Jakeyjake (Jun 20, 2014)

I live in the Northeast but am willing to travel far out of state for this.  Creighton was the one I knew.


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## wanderingmedic (Jun 20, 2014)

Let us know if you find any other RN to medic programs. It would be nice to keep a list going on these forums because I hear this question pop up occasionally. 

You might want to call around to different community colleges and find out if they have any leads on programs kept on the down low. A few years ago Survival Flight in Michigan began requiring their RN's to hold EMT-P certs, and I believe they held an internal program. I kind of wonder if flight programs in your state do internal programs to qualify nurses as medics, especially since most nurses do not hold a Medic cert...and putting a RN (especially a BSN) through a full medic program is a little silly.

I do not think that going through a full Medic program would hurt either. Yes, it takes more time. However nursing and paramedicine are inherently different. Most of my closest friends are nurses, and I can honestly say I would trust them with my life. BUT, the way we treat patients is different. A Medic's assessment is oriented towards treatment and is out of the allopathic model of medicine. I have seen nurses struggle in the prehospital setting because their assessment is more oriented towards long term care, and not treating immediate problems. You might not have this problem as much if you are already an EMT and have EMT experience, but there is a reason prehospital ALS is not usually provided by RN's.


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## Carlos Danger (Jun 20, 2014)

Jakeyjake said:


> I live in the Northeast but am willing to travel far out of state for this.  Creighton was the one I knew.



Creighton is the only one I know of. Several of my flight nurse partners went through it and what I've heard about it is almost entirely positive.

Call the paramedic programs in your state and ask them what they can do for you. In many states the paramedic program director / medical director have broad leeway in allowing individuals to test out of large portions of the program and skip most or all of the hospital clinical, even if they don't have formal "bridge programs" for nurses.


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## Anjel (Jun 21, 2014)

Since you really wouldn't be working as a paramedic and instead just adding that skill set to your existing roll, I don't see a huge problem with the 2 week thing. But I think a substantial amount of ride time should be required. 

You really have to change your way of thinking. I'm learning that quickly going from medic to RN.

Paramedics are a fix it type. We see a problem, fix it, and move to the next. With nursing you really focus on the long term, big picture stuff.

Good luck. Let us know what you find.


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## VFlutter (Jun 21, 2014)

azemtb255 said:


> I have seen nurses struggle in the prehospital setting because their assessment is more oriented towards long term care, and not treating immediate problems.



I really do not see that being an issue for any ICU nurse. The Critical Care environment is for the treatment of immediately life threatening problems. Crashing patients are the norm.


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## Anjel (Jun 21, 2014)

Chase said:


> I really do not see that being an issue for any ICU nurse. The Critical Care environment is for the treatment of immediately life threatening problems. Crashing patients are the norm.




But ICU trained nurses are not the norm.


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## VFlutter (Jun 21, 2014)

Anjel said:


> But ICU trained nurses are not the norm.



I know but most, if not all, of these types of programs require ICU experience. Creighton requires at least 2 years I believe. None of these programs are intended to take non-critical care nurses and turn them into street ready medics.


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## Anjel (Jun 21, 2014)

Chase said:


> I know but most, if not all, of these types of programs require ICU experience. Creighton requires at least 2 years I believe. None of these programs are intended to take non-critical care nurses and turn them into street ready medics.




Ah ok. I did not know that.


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## Jakeyjake (Jun 21, 2014)

Anjel said:


> But ICU trained nurses are not the norm.



I am ICU trained, so I would probably be looking for a program like Creighton.  I may end up going that route but it would be nice to have a couple more options.


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## VFlutter (Jun 21, 2014)

For Creighton "Eligible applicants shall hold current and in good-standing licensure as  an RN, MD, or DO with a minimum of two years critical care experience.  Current EMT certification, ACLS, and BCLS for Healthcare Providers (or  equivalent) is also required. Trauma and Pediatric specialty course  certifications are strongly recommended."


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## TacomaGirl (Jun 23, 2014)

One of our RNs did the 2 week course out of state and loved it.  The 'bad' part was the ride along time he had to squeeze in before he could take his exam.  My state won't allow nurses to challenge the EMT exam and there are no RN to medic bridge programs nearby-but know they do exist.

I am considering getting my medic as well but cost, time and working FT with lots of OT is why I haven't made the leap. 

Good luck


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## hogwiley (Jun 24, 2014)

Chase said:


> I really do not see that being an issue for any ICU nurse. The Critical Care environment is for the treatment of immediately life threatening problems. Crashing patients are the norm.



I've seen ICU RNs crash and burn in the ER, which is a lot more controlled environment than a pre hospital setting.

In the OPs case Id be a little bit concerned over the fact he never even took an EMT course and as far as I can tell never worked the road as an EMT, now wanting to pass go and just do a crash course in Paramedic. 

I don't doubt being an ICU Nurse is very challenging, probably more challenging than being a Paramedic, but the two jobs are different. Its only fair to future patients that they prove competency in a controlled setting through an internship. I mean I spent more than 2 weeks just learning and proving my competency in advanced airway procedures alone, nevermind all the other things Paramedics do that RNs have no formal training in.


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## Summit (Jun 24, 2014)

and we are off!


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## wanderingmedic (Jun 24, 2014)

hogwiley said:


> I've seen ICU RNs crash and burn in the ER, which is a lot more controlled environment than a pre hospital setting.



Let's not generalize here. There are medics that have gone through traditional brick and mortar programs that crash and burn in the field. It all comes back to the OP's personal experience as a RN, as well as their decision making and leadership ability.


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## Carlos Danger (Jun 24, 2014)

Summit said:


> and we are off!



It took a lot longer than I thought it would!


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## TacomaGirl (Jun 24, 2014)

hogwiley said:


> I've seen ICU RNs crash and burn in the ER, which is a lot more controlled environment than a pre hospital setting.
> 
> In the OPs case Id be a little bit concerned over the fact he never even took an EMT course and as far as I can tell never worked the road as an EMT, now wanting to pass go and just do a crash course in Paramedic.
> 
> I don't doubt being an ICU Nurse is very challenging, probably more challenging than being a Paramedic, but the two jobs are different. Its only fair to future patients that they prove competency in a controlled setting through an internship. I mean I spent more than 2 weeks just learning and proving my competency in advanced airway procedures alone, nevermind all the other things Paramedics do that RNs have no formal training in.



I understand your frustration/concern.  The way I see it, a huge chunk of the "meat" of the training is already redundant to the RN.  You can't compare a 'student' that is going from scratch with that one that has already been-there-done-that.  Additional skills can be easily taught if you have the baseline/experience already there.  The real 'experience' will come with real-life encounters and practice, practice, practice (read:time).  Perhaps a 2-week crash is not the best way to go but many nurses have been very successful.  I am sure that is why those 2-3 week programs exist and are geared to those that just need to learn specific skill sets.

Some places require the medic as an addition to the RN for various reasons.


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## Handsome Robb (Jun 24, 2014)

It's not the skills that are difficult to teach, it's the mindset. Hence why ICU experience is a requirement since ICU nurses generally run off standing orders plus whatever the attending provider writes for. 

I think bridges/challenges are good for certain people but they're not for everyone.


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## hogwiley (Jun 24, 2014)

> I think bridges/challenges are good for certain people but they're not for everyone.



I agree, the problem is that how are you supposed to know which people they are for and which they aren't. 

I'm not against a bridge course from RN to Paramedic, as pointed most of a Paramedic course would be redundant for an RN. How much of it is redundant is the issue. My Medic course is a year and 6 months long without a break(added on to EMT school which was 5 months). Are you telling me a year, and 5 months would be redundant? One RN in my Paramedic class(who has struggled mightily) would certainly disagree with that statement, as would one of our instructors who is an RN as well as a Paramedic.


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## TacomaGirl (Jun 24, 2014)

^^ I wholeheartedly agree.


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## STXmedic (Jun 24, 2014)

hogwiley said:


> I've seen ICU RNs crash and burn in the ER, which is a lot more controlled environment than a pre hospital setting.



Most of the ICU nurses I know that didn't like the ED after ICU were because of patient load more than anything. Going from 1:1 or 2:1 to sometimes 6:1 can be overwhelming. Their patient care of the individual patient is generally still stellar, though.* That wouldn't have any crossover to prehospital ability in my opinion. You can throw out the mass casualty example if you'd like, but I'd put money on most paramedics handling the same incident in a sub-par manner also. It's not something heavily touched on in school, and is a very low frequency event.

An ICU nurse with several years experience, in my opinion, would do fine in an accelerated transition program. I'd take many of the ICU nurses I know and work with them on the box tomorrow, and they'd still probably outperform many of the medics I already work with.

*Assuming they weren't already :censored::censored::censored::censored:ty nurses in the ICU


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## Carlos Danger (Jun 24, 2014)

hogwiley said:


> I mean I spent more than 2 weeks just learning and proving my competency in advanced airway procedures alone, *nevermind all the other things Paramedics do that RNs have no formal training in*.



When I worked as an ICU nurse the ONLY skill that I didnt do in the unit that I did as a paramedic was intubate. But considering that many paramedics graduate their program with only a handful of live intubations, and that ICU nurses are generally very familiar with the process of intubation (assisting anesthesia and / or intensivists), that simply isn't as big an issue as you'd think. Also consider that many of the things that a paramedic needs to know how to do, ICU nurses do much more often than paramedics.

The only real difference is the environment. But ICU nurses tend to be very comfortable dealing with sick patients, and they tend to be flexible and adaptable. I've know many ICU nurses who became flight nurses, and most made the transition very smoothly and easily.


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## TacomaGirl (Jun 24, 2014)

Great post Remi.  I think the one's that aren't cut out for the accelerated course, will weed themselves out.  You just cannot 'wing it' in my opinion.

I cannot speak as a medic, because I am not one.  My respects to their skills and amazing work; however, I agree that the major difference is the environment and I would add AUTONOMY.  Hospital the environment is controlled and an order must exist for every move.  In the field, there is much more autonomy and therefore some skills get to be used/practiced that might not in a hospital setting.


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## STXmedic (Jun 24, 2014)

TacomaGirl said:


> I cannot speak as a medic, because I am not one.  My respects to their skills and amazing work; however, I agree that the major difference is the environment and I would add AUTONOMY.  Hospital the environment is controlled and an order must exist for every move.  In the field, there is much more autonomy and therefore some skills get to be used/practiced that might not in a hospital setting.



In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.


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## Carlos Danger (Jun 24, 2014)

STXmedic said:


> In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.



Exactly.


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## hogwiley (Jun 24, 2014)

Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?

If its not an issue then they should be able to handle being the lead medic on every ALS call from day one and cruise through their internship. Trauma calls, MVAs with entrapment, Pediatric calls, none of it should be a problem for em. That may very well be the case for all I know. 

Again, the RN in my class and the lab instructor who is an experienced Paramedic and Emergency Room Nurse(I forgot to mention shes currently a NP) think the jobs are completely different and require a different mindset and skillset, so its apparently something not everybody agrees on.


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## hogwiley (Jun 24, 2014)

STXmedic said:


> In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.



A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known. And while having to triage in the field doesn't happen regularly, it is something you need to know how to do WHEN it does arise, and you never know when that might be.

A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio. Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.


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## Handsome Robb (Jun 24, 2014)

That's exactly why they need a transition course...you just answered your own rhetorical question.

Let's be realistic how much time have you spent on extrication operations in school, EMT or Medic? Same goes for troubleshooting. I think it needs to be a two way street, personally. There should be a medic challenge for RN but until we have the education to support it we can't do much about it.


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## STXmedic (Jun 24, 2014)

I am absolutely in agreeance that there should be some sort of field internship. It's a different environment that they are not accustomed to. So yes, they should have x amount of hours under a preceptor. Ideally, their employing agency would provide that anyway. That's not always the case, so I wouldn't be opposed to a certain amount of hours being required after the transition course. The same thing would be done if they changed floors in the hospital.


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## Summit (Jun 24, 2014)

hogwiley said:


> Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?



For those who are going into field paramedicine, they will get their field internship from their FTO on their service. They are not going to be thrown into a lead 911 medic with an EMT partner with zero orientation. They don't do this to fresh medics either.

Why do these accelerated bridge courses REALLY exist? Few ICU RNs are interested in switching to paramedicine and the few who are typically have field experience as an EMT. Most RNs in these courses are either interested in being a flight RN or are already employed as a flight RN looking for the dual qualification. 



> A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio.


When the crap hits the fan for 911, it isn't the lone wolf paramedic for _most _calls in the US (yes, I know rural is different, I did rural and I do WEMS). It's _usually _two paramedics, the 6 firefighters EMTs, and a cop or two on that street corner doing compressions, defibrillating a patient, starting an IO, pushing some drugs, and dropping a tube. That is high intensity, high pressure, but not high complexity.



> Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.



The only urban EMS patient movement issues that are technical (vs physical) challenges are vehicle extrication (you have FF help) and convincing altered patients to get in the ambulance. Now wilderness, water, technical, snow, and high angle rescue, there is a challenge.


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## Carlos Danger (Jun 24, 2014)

hogwiley said:


> Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?





hogwiley said:


> Again, the RN in my class and the lab instructor who is an experienced Paramedic and Emergency Room Nurse(I forgot to mention shes currently a NP) think the jobs are completely different and require a different mindset and skillset, so its apparently something not everybody agrees on.





hogwiley said:


> A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known. And while having to triage in the field doesn't happen regularly, it is something you need to know how to do WHEN it does arise, and you never know when that might be. A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio. Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.



Look man, you are seriously exaggerating how difficult it is to learn to put people on stretchers.


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## STXmedic (Jun 24, 2014)

Remi said:


> Alright, you just proved with those statements that you don't know the first thing about ICU nursing, and *you are also grossly romanticizing the challenges of working as a paramedic. *
> 
> The truth is, the types of crap-hits-the-fan calls that you refer to are uncommon, unlikely to be encountered in a internship, and because of that many paramedics don't handle them stellarly, either. Also it just isn't that hard to learn to put someone on a cot and get them in the ambulance. And after that, the protocols are the protocols....nothing magic about pushing drugs in the ambulance vs. in the ICU. Don't make it into a bigger thing than it really is.



This. And the bolded portion is what I'm taking away from this as well.


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## Summit (Jun 24, 2014)

hogwiley said:


> A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known.



I want to help you understand a little about the ICU that you haven't gotten to understand in your career as a PCT/volly MFR with a year of ED tech and medic school. I don't mean that as condescending, just that your career hasn't provided you with ICU experience to contrast with your fledgling view of paramedicine.

In the 911 emergency patient, there is usually an algorithmic or semi-algorithmic approach to 1 maybe 2 major problems with very limited treatment options aimed at stabilizing and transport, because that is all you can do with limited knowledge of the patient and typically short periods of care. 

Yes, in the ICU, there's the availability of an intensivist, a RT, a pharmacist, a RN, and specialists and imagery and lab and... but 90-95% of the time it is just the assigned ICU RN. 

The reason you need those extra resources in ICU is because compared to 911 EMS, the ICU setting is definitive care addressing more complex patients with multiple complex problems in more complex ways over longer periods of time covering sometimes multiple critical periods. (We won't distract by talking about procedural care). The paramedic does not deal with those complexities. If the RN only had the paramedic's limited formulary, they would have less use for an ICU pharmacist. If the RN didn't have to run 12 drips, the pacer, the IABP, CRRT, and read the PA cath, they wouldn't need the RT to help with the vent (there is little most RT do, apart from intubate, that the ICU RN doesn't do). 

Yet you see these resources and assume that the ICU RN couldn't hold their own in the ICU if the other providers were busy. What you haven't thought about is that situations occur all the time that put the ICU nurse on their own in bad situations longer than you might think, longer than the transport time for most urban EMS. Here, they have algorithmic solutions to sudden emergency situations just like EMS.


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## hogwiley (Jun 24, 2014)

I'm not really basing my comments on working as an EMT(both volley and paid if it matters) or working in the ED, or working as a PCT, or Paramedic school, none of which makes me any sort of expert on the matter. I'm basing my comments on what RNs themselves have told me, including those that have been Paramedics. (Including an RN I'm engaged too). 

Obviously not everyone agrees and you make valid points. I still don't think its going to hurt some of these RNs to take a Paramedic course, abbreviated or not. More knowledge and training is usually a good thing no? If they want to be a flight nurse bad enough it shouldn't be THAT big a deal, and its not like there is a shortage of RNs wanting to fly.


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## VFlutter (Jun 25, 2014)

hogwiley said:


> More knowledge and training is usually a good thing no?



Repeating the same material, usually at a much lower level, does not mean more knowledge and training. After taking college Anatomy w/ lab, physiology, pharmacology, and pathophysiology (All separate 4-5 hr courses) with literally thousands of pages of textbooks I am skeptical there is advanced knowledge hidden in a paramedic textbook, which thinks it is adequate to cover all of those courses in one book, that I missed. Besides that after an EMT-B course there really isn't that much to cover. 

I totally agree there should be extensive ride along time but you will not convince me that taking an entire paramedic course is needed or beneficial.


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## TacomaGirl (Jun 26, 2014)

Chase said:


> I totally agree there should be extensive ride along time but you will not convince me that taking an entire paramedic course is needed or beneficial.



Not to mention the cost of re-taking redundant material.


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## RALS504 (Jul 17, 2014)

Eastern New Mexico University- Roswell has an RN to Paramedic bridge. It involves 3 wks of didactic training in Roswell, online course work, & then a local internship at your location. I have only second hand knowledge of this program, but the RNs in this program steak highly of it. Pre-reqs are RN or RRT & EMT-B license. Their affordable tuition & programs are top notch. If you need a online refresher or an Associates or BS Degree in EMS online they offer that as well.

see page #11:

http://www.roswell.enmu.edu/documents/ems/hybrid_paramedic_application.pdf


http://www.roswell.enmu.edu/


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## EMT4EVA (Jul 18, 2014)

Hi JakeyJake,

Have you checked with Creighton University in Omaha, Nebraska?  Here's their main number:
(402) 280-2700




Jakeyjake said:


> I am an RN who challenged the EMT exam in my state -- looking to go into flight nursing which where I live requires you to be licensed as a paramedic and an RN.  I know of one program out in the midwest, which allows ICU nurses to take an intensive paramedic course in two weeks, but I don't know of any others.  I would be willing to travel out of state for this.  Does anyone know or have heard of any such programs?


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