# RN to Paramedic...



## MtRNER

Interested in obtaining my EMT-P.  Currently an ER/ICU RN with 7 years experience, EMT-B with 12 years experience.  Anyone out there know of a good bridge course that doesn't require me to do 15 months of paramedic school (yawn).  I know about the Creighton University 2 week course but I feel that is a bit too quick.  Some people have told me to challenge it but I think that is ill-advised.  Thanks for any input.


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## Akulahawk

It would help if we knew which state you're in or where  you're willing to travel to...


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## CriticalCareIFT

I see this thread great potential in the works.


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## VFlutter

Although 2 weeks is very quick I have heard good things about the Creighton University's program. Check with local community colleges and see if they will work with you. Some will credit your nursing classes and only make you take a few of the paramedic classes and then clinicals. Some states have various pathways to bridge or challenge the paramedic exam. Good luck.


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## Carlos Danger

Chase said:


> I have heard good things about the Creighton University's program.



I've worked with several flight RN's who went through this program and had nothing but good things to say about it.

Whether or not you can "challenge" the program in your state depends on state regs and the policies of the college offering the program. in SC, an RN used to be able to simply sit for the state exam and if you passed, you were a paramedic....I don't think it's like that anymore. However, all the states I've worked in gave course directors great leeway and allowed them to run customized (abbreviated) paramedic courses for RN's and RRT's.


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## ExpatMedic0

CriticalCareIFT said:


> I see this thread great potential in the works.



I would have loved to contribute to "the great potential" I think your speaking of, but I feel like a broken record after 8 years on this forum...


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## Carlos Danger

CriticalCareIFT said:


> I see this thread great potential in the works.





ExpatMedic0 said:


> I would have loved to contribute to "the great potential" I think your speaking of, but I feel like a broken record after 8 years on this forum...



Since you are being cryptic I can only assume what you are implying, but you are 100% wrong if you are suggesting that it is necessary for an experienced ED/ICU nurse to complete an entire paramedic program. That is an absolutely unnecessary waste of time and money.


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## CriticalCareIFT

Halothane said:


> Since you are being cryptic I can only assume what you are implying, but you are 100% wrong if you are suggesting that it is necessary for an experienced ED/ICU nurse to complete an entire paramedic program. That is an absolutely unnecessary waste of time and money.



I am not suggesting that. Although coming to EMT forum and saying things like paramedic school yawn and wanting serious advice is equivalent of me going to nursing forum and saying I am Critical Care Paramedic with X years experience, anyone out there know of a good bridge course that doesn't require me to do X months of nursing school (yawn).


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## wanderingmedic

Chase said:


> Although 2 weeks is very quick I have heard good things about the Creighton University's program. Check with local community colleges and see if they will work with you. Some will credit your nursing classes and only make you take a few of the paramedic classes and then clinicals. Some states have various pathways to bridge or challenge the paramedic exam. Good luck.



I too have heard great things about this program. If I remember correctly, some of the flight RN's at the University of Michigan's Survival Flight Air Ambulance system went through this program. I know there are some RN to medic bridges that occur occasionally in Michigan, but I do not have details on them.

You might also want to look into PERCOM and ask how they would place you. Their didactic portion is online, and they can usually count some of your work experience as an RN towards your required hospital clinical rotations. I know they have had several MD's, RN's, and RT's go through their program.


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## CriticalCareIFT

Halothane said:


> Since you are being cryptic I can only assume what you are implying, but you are 100% wrong if you are suggesting that it is necessary for an experienced ED/ICU nurse to complete an entire paramedic program. That is an absolutely unnecessary waste of time and money.



I think some truth need to be stated, as some nurses here have a misconception or a vague idea of what Paramedics do but comment on things with an authority and the idea that their education/training vastly supersedes formal Paramedic schooling.

1-Nurses and Paramedics perform different jobs period. Educational model, skill sets and priorities are different. One is not more superior than the other, they are different. Nurses perform their nursing assessments and help the clients with plethora of vital nursing interventions carrying out physician orders, establishing nanda diagnosis which is distinct from a physician diagnosis etc. Paramedics work on established protocols by their medical director with addition of online medical control. First line interventions are initiated in the field based on patient presentation, physical exam and a medical diagnosis. With emphasis placed on early detection and notification for hospital resources for Stroke, ACS, Sepsis etc. so the suite will get prepared and the right people are where they need to be. In addition of ambulance driving and operations, radio communications, lifting and moving patients etc. Everyone plays their part, no need to sit on the high horse and pretend one is better than the other.

2-During my formal medic school for the final 1 year of rotations I worked side by side various attending physicians and residents, predominantly EM attendings. Following and watching assessments, write ups, assisting with treatments and performing certain EM procedures. I watched Nursing students working closely with experienced Nurses and doing assessments, performing nursing interventions and charting, rarely have I seen RN students following physicians during my clinicals. It would stand to reason upon graduation each will have different experiences and different priorities. 

3- If you at least can see the difference in the respected jobs and agree that each professional was trained for their specific job that they will perform. It would be folly to assume a Medic can take a 2 week RN bridge and function as RN, or for RN to take 2 week Medic bridge and function as a Medic. Assuming for some reason that nurses have higher education is not true, believe it or not there are medics who hold Bachelors and Masters degrees with legitimate college level courses and not from an online college and they not your typical "organic chem for nursing" or "bio for nursing" classes that BSN programs have. There are Medics who spend their own money (hospital did not pay for them) to obtain further education by attending classes/conferences. (ACLS, FCCS, Difficult Airway EM, Levitan course, ACLS EP, etc. you get the point). To think that every single Medic is a retard with card is simply not true. In addition most medics have an idea of what nurses do, where nurses rarely have a clue of what we do, and its apparent in posts here and in the hospitals.

3- When I advocate for Medics to get in hospital jobs, such as RN or RTT for critical care experience. This has nothing to do with RN or RTT being higher trained, it's just that working in a hospital facilitates you seeing real medicine and seeing more patients and more cases. Where being a Medic we see less patients in addition if I wanted to gain "rotations" or "clinicals" in a hospital I always have road blocks from the hospital administrators who are usually RN's and seldom understand why would a medic want to come to the ICU. They start with Hippa this or that, you don't need to know this and laugh in your face but expect you to pack up and go in 20 minutes and switch to your equipment with ARDS patient on 10 drips, vented, A-line etc. like you a pro.

I am certain they are plethora of paper Medics or paper Nurses out there who eventually settle in and perform adequately. However don't be surprised if after 2 weeks you are not on the same level as a medic who completed formal education and training for a specific job he/she was specifically trained to perform.


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## Carlos Danger

I really didn't want to get into all this, but I think addressing some misconceptions here is germane to the topic of an RN cross-training or challenging to become a paramedic, so I'll play.



CriticalCareIFT said:


> I think some truth need to be stated, as some nurses here have a misconception or a vague idea of what Paramedics do but comment on things with an authority



2 practicing RN's and 2 RN students have replied to this thread. All have EMS experience, so I'm not sure why you assume that those who have commented have only a "vague" idea what paramedics do.

For my part, I was a paramedic for 5 years before becoming an RN, and continued to practice in the field until about a year ago when I started grad school. Before becoming a nurse I took all the EMS credential stuff (NREMTP, CCEMTP, etc.) and was one of the first FP-C's. Since becoming a nurse I have been heavily involved in training flight paramedics and flight nurses, which gives me a unique perspective into how each learns and adapts to the other's role. I have also been involved in both nursing and paramedic education, including in-house critical care education, BLS and ALS courses, and lecturing at CCEMTP and similar courses. I have also lectured about CCT issues at the national level at EMS, HEMS/CCT, and RRT conferences. I would not describe myself as an "authority" on anything; more of a jack-of-all trades who has enough background to know what I am talking about in terms of the differences in training and competencies between ICU RN's and EMT-P's.




CriticalCareIFT said:


> and the idea that their education/training vastly supersedes formal Paramedic schooling.



Who said or implied that RN training automatically "supersedes" paramedic training? No one did.

We are not discussing a brand-new nursing graduate versus a brand-new paramedic program graduate. Clearly, neither one could do the other's job.

However, the OP is not a new grad......he is an experienced ICU and ED nurse, as well as being an EMT for many years. If that is true, then I assure you that the aggregate of his clinical training and experience has _way_ more than covered a paramedic curriculum's worth of information, with the exception perhaps of a few specific skills that can be easily learned. For that reason, attending a full program is not necessary.

The reverse is true, as well. If there were some way for a paramedic to gain years of experience doing RN functions in addition to showing that their education is comparable to that of what RN licensure requires, then I would say it is not necessary for them to attend an entire RN curriculum in order to test for the RN credential. Unfortunately for paramedics, such opportunities for that type of experience just don't exist.




CriticalCareIFT said:


> Nurses perform their nursing assessments and help the clients with plethora of vital nursing interventions carrying out physician orders, establishing nanda diagnosis which is distinct from a physician diagnosis etc. Paramedics work on established protocols by their medical director with addition of online medical control. First line interventions are initiated in the field based on patient presentation, physical exam and a medical diagnosis.
> 
> During my formal medic school for the final 1 year of rotations I worked side by side various attending physicians and residents, predominantly EM attendings. Following and watching assessments, write ups, assisting with treatments and performing certain EM procedures. I watched Nursing students working closely with experienced Nurses and doing assessments, performing nursing interventions and charting, rarely have I seen RN students following physicians during my clinicals.
> 
> It would stand to reason upon graduation each will have different experiences and different priorities.



These statements show a pretty big lack of understanding of how RN's function in the real world, especially in ICU's. Nurses are constantly interacting with, collaborating with, and learning from physicians, more experienced nurses, and other clinicians. They are constantly observing and assessing their patients and the way they respond to therapy. They have to think about not only what the primary problem is and how it should be managed, but all of the other important things (nutrition, sleep, positioning, elimination, etc) that are not considered in the field. They often observe or assist with invasive procedures. They monitor arterial lines and handle invasive catheters and vasoactive meds and ventilators and draw labs and deal with critically ill patients daily, not just occasionally. They respond immediately to emergencies, doing what they can until help arrives. What you did in the final year of medic school, an ICU nurse does constantly, every day that he or she is at work. And in many ICU's, the nurses do follow protocols that actually look a lot like EMS protocols. 

I do agree with the last sentence in that paragraph, but again, we are not talking about new graduates.




CriticalCareIFT said:


> Assuming for some reason that nurses have higher education is not true, believe it or not there are medics who hold Bachelors and Masters degrees with legitimate college level courses and not from an online college and they not your typical "organic chem for nursing" or "bio for nursing" classes that BSN programs have.



About 50% of RN's now hold a BSN with the number increasing quickly (I think it was less than 25% in 2000), and looking like the industry will meet or come close to its stated goal of 80% by 2020. Nursing education is broad and intentionally non-specialized, covering everything from basic physiology and pharmacology to psychology to nutrition to research, as well as all the general education courses that are required of every baccalaureate program. Some programs dabble in or offer electives in critical care or emergency nursing, but the focus is always on basic care with the idea that the RN will choose a specialty once licensed. Those who graduate from ADN programs have covered all the same material and passed the same licensing exam as the BSN graduates, minus the general education stuff and perhaps some of the clinical hours.

By contrast, while there are some degree programs for paramedics, the large majority of paramedic programs are still 2-semester (3, if you count the EMT-B pre-requisite) vocational programs that focus solely on the very narrow scope of immediate life threats and use textbooks written at a tenth-grade reading comprehension level.

I am NOT saying that nurses are all brilliant and paramedics are all dumb; I am just pointing out that there really is no comparison between the two fields, education-wise. 

I'm not sure what the fact that some paramedics hold higher degrees in science has to do with anything. I've met some of those, and I also know second-degree RN's who also have degrees in physiology, chemistry, or engineering. 



CriticalCareIFT said:


> It would be folly to assume a Medic can take a 2 week RN bridge and function as RN, or for RN to take 2 week Medic bridge and function as a Medic



Just not true. I've known many RN's with strong ICU and/or ED backgrounds come into the flight environment and after a thorough orientation, really rock in the prehospital arena. Many of these took abbreviated paramedic programs or were able to simply take the state certifying exam.


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## ExpatMedic0

I am pretty played out on this whole topic, in regards to to the OP... I hope you have found some useful information from this thread to help answer your question.

Regarding everything else, its a 2 way road. Paramedics in Oregon take mandatory minimum AAS for Paramedic at the community college which mirrors the RN associates degree in our state. 

I feel that the Paramedic bachelors degree in Washington state from CWU is also a very strong degree, especially if pared with the right general ed selection.  Aside from that, there are plenty of medics with relevant degree's covering the same classes an RN is required to take, excluding the RN program itself.
I will give you this, all Paramedic education is not created equal, and it should be assessed on an individual basis. However,  if an RN wants to bridge/challenge to Paramedic in a state, the Paramedic should be allowed to do the same if they meet the same minimum education requirements for pre-rec's, program hours, ect.  Otherwise, neither should be allowed to do it IMO.


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## Clipper1

ExpatMedic0 said:


> I am pretty played out on this whole topic, in regards to to the OP... I hope you have found some useful information from this thread to help answer your question.
> 
> Regarding everything else, its a 2 way road. Paramedics in Oregon take mandatory minimum AAS for Paramedic at the community college which mirrors the RN associates degree in our state.
> 
> I feel that the Paramedic bachelors degree in Washington state from CWU is also a very strong degree, especially if pared with the right general ed selection.  Aside from that, there are plenty of medics with relevant degree's covering the same classes an RN is required to take, excluding the RN program itself.
> I will give you this, all Paramedic education is not created equal, and it should be assessed on an individual basis. However,  if an RN wants to bridge/challenge to Paramedic in a state, the Paramedic should be allowed to do the same if they meet the same minimum education requirements for pre-rec's, program hours, ect.  Otherwise, neither should be allowed to do it IMO.




By that logic every RT, RRT, OT, SLP, PT and RD could be RNs also by just challenging the test. Even some of their assessments and charting mirror each other. But, the big difference is each of these other professions work with nurses to have an understanding of how different the job is regardless of the academics.    If any of these professionals did want to become an RN,  they would have to make sure all of their prerequisites are current and take the nursing theory classes along with the 900 - 1200 hours of clinicals.  This is even with the PTs doing 2500 hours of hospital time in their own profession and with assessment skills off the chart in some areas.


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## CriticalCareIFT

Halothane said:


> By contrast, while there are some degree programs for paramedics, the large majority of paramedic programs are still 2-semester (3, if you count the EMT-B pre-requisite) vocational programs that focus solely on the very narrow scope of immediate life threats and use textbooks written at a tenth-grade reading comprehension level.
> 
> 
> 
> Just not true. I've known many RN's with strong ICU and/or ED backgrounds come into the flight environment and after a thorough orientation, really rock in the prehospital arena. Many of these took abbreviated paramedic programs or were able to simply take the state certifying exam.



If you attended a standard Paramedic program (not 2 weeks) and also standard nursing program you should clearly see a distinction of how the jobs differ, and how the schooling and rotations specifically prepare you for said job. 

Even though this may get your panties in a bunch here is an example: take a RN who has been an RN for 5 years went to BSN RN school and performs her nursing job well, she was well trained and educated to perform her work as a nurse and now decides to go for CRNA school. Now take a physician who has finished his residency in 3 years and now doing a fellowship in Anesthesia. One of these people was actually trained for a specific job from the start, the other after "after a thorough orientation" will eventually learn and acclimate.


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## hogwiley

I don't understand this 2 week RN to Paramedic program. What is the criteria for who can attend it, simply being an RN? Do they at least require students to be licensed EMTs?

What if you have an RN who has zero pre hospital EMS experience and may not even have Emergency room experience, are they supposed to magically know about things like vehicle extrication, understand EMS operations, communications, documentation, advanced airway techniques, etc, simply because they are an RN? Most RNs that work in a hospital are not even ACLS or PALS certified. 2 weeks to learn everything a Paramedic knows that an RN has zero experience in seems like a tall order to me, even for an RN with ER experience.

I can understand an RN taking an abbreviated Paramedic course since they already understand(hopefully) important subjects like pharmacology and pathophysiology at a much deeper level than Paramedic training gets into(with some exceptions), but it seems extremely unrealistic to me to expect an RN who has never even been inside of an ambulance to be able to function as a Paramedic after 2 weeks of training, or even 2 months of training.


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## DrankTheKoolaid

Those condensed RN - MiCP courses are not for new grad floor nurses. They are geared towards nurses with ER and ICU experience


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## Akulahawk

hogwiley said:


> I don't understand this 2 week RN to Paramedic program. What is the criteria for who can attend it, simply being an RN? Do they at least require students to be licensed EMTs?
> 
> What if you have an RN who has zero pre hospital EMS experience and may not even have Emergency room experience, are they supposed to magically know about things like vehicle extrication, understand EMS operations, communications, documentation, advanced airway techniques, etc, simply because they are an RN? Most RNs that work in a hospital are not even ACLS or PALS certified. 2 weeks to learn everything a Paramedic knows that an RN has zero experience in seems like a tall order to me, even for an RN with ER experience.
> 
> I can understand an RN taking an abbreviated Paramedic course since they already understand(hopefully) important subjects like pharmacology and pathophysiology at a much deeper level than Paramedic training gets into(with some exceptions), but it seems extremely unrealistic to me to expect an RN who has never even been inside of an ambulance to be able to function as a Paramedic after 2 weeks of training, or even 2 months of training.


The transition courses are designed to do exactly that... they take the RN and provide them the EMS operations stuff that they don't get in RN school. Then I would expect that any company that hires them to be a Paramedic would then provide them the FTO time to meet their standards. The transition course is simply designed to do the same thing that a Paramedic program is designed to do: turn out safe, beginning Paramedics. Personally, I'd prefer that any "transition to" Paramedic program have some sort of a field internship associated with it because that allows more time to get involved in the operational aspects of prehospital care and more time for a preceptor to help the RN develop an appropriate Paramedic mind-set in a structured learning environment instead of being under the eyes of an FTO, with the associated threat of failing probation while learning the ropes of ambulance life.


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## Mariemt

Iowa allows an rn to run and preform like a medic.  Our squad requires them to take a first responders course as they usually unwrap our patients, and need to leads to put the c collar and  stuff.


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## VFlutter

CriticalCareIFT said:


> Even though this may get your panties in a bunch here is an example: take a RN who has been an RN for 5 years went to BSN RN school and performs her nursing job well, she was well trained and educated to perform her work as a nurse and now decides to go for CRNA school. Now take a physician who has finished his residency in 3 years and now doing a fellowship in Anesthesia. One of these people was actually trained for a specific job from the start, the other after "after a thorough orientation" will eventually learn and acclimate.



I do not see your point. They both had a generalist eduction and then decided to further their education and specialize. The MD did not train to be an Anesthesiologist from the start, they trained to be a Physician, which in large is a totally different job role. They started training for Anesthesia when they started their fellowship. I do not think anyone is going to argue that a CRNA is the same as a MDA. But I will let Halothane respond further.

Oh and why is the Nurse a "She" and the MD a "He". That is sexist, Bro 



hogwiley said:


> I don't understand this 2 week RN to Paramedic program. What is the criteria for who can attend it, simply being an RN? Do they at least require students to be licensed EMTs?.



Most of the good programs, like Creighton, require EMT-B, 2 years ICU experience, and ACLS/PALS prior to taking the course. Some require TNCC or EPNC (Nursing specific Trauma and Emergency nursing courses). I do not know of any program that will take new grad RNs and I do not think anyone here is trying to advocate that.


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## CriticalCareIFT

Chase said:


> I do not see your point. They both had a generalist eduction and then decided to further their education and specialize. The MD did not train to be an Anesthesiologist from the start, they trained to be a Physician, which in large is a totally different job role. They started training for Anesthesia when they started their fellowship. I do not think anyone is going to argue that a CRNA is the same as a MDA. But I will let Halothane respond further.
> 
> Oh and why is the Nurse a "She" and the MD a "He". That is sexist, Bro


One "generalist education" had him  intubating, using RSI medications that he decided/ordered to use, had anesthesia clerkship even before the fellowship, was educated on a medical model to assess patients and order treatment not carry out orders and perform nursing interventions etc and was functioning in the role of a physician from the start. Certainly anyone can see RN and MD are on equal footing with their generalist education right before the start of their fellowship.


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## hogwiley

By just letting RNs test out as Paramedics or giving them some crash course with no clinicals and no field internship, you are making an assumption they have an aptitude for something they may not have. 

Nursing is a large enough and varied field that RNs can find their niche, which may not be in any acute care setting, much less EMS, but as a Paramedic your niche has to be emergency medicine. I'm not sure its such a great idea to just assume every RN who has a desire to get a Paramedic license can actually handle the job.


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## ExpatMedic0

Chase said:


> Oh and why is the Nurse a "She" and the MD a "He". That is sexist, Bro


Today, men still only make up between 5%–10% of the nursing workforce in the United States, United Kingdom, and Canada. - See more at: http://www.minoritynurse.com/articl...urses-perceptions-gender#sthash.27HvxIA2.dpuf


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## Summit

hogwiley said:


> By just letting RNs test out as Paramedics or giving them some crash course with no clinicals and no field internship, you are making an assumption they have an aptitude for something they may not have.
> 
> Nursing is a large enough and varied field that RNs can find their niche, which may not be in any acute care setting, much less EMS, but as a Paramedic your niche has to be emergency medicine. I'm not sure its such a great idea to just assume every RN who has a desire to get a Paramedic license can actually handle the job.



So I'm not sure if you are reading other responses or not, but ill reiterate.

The program requires RN+EMT + 2 years of ICU/ED + ACLS/PALS and all students are expected to self-learn all the paramedic didactic that they don't already k ow prior to showing up.

The program at Creighton, which as I understandd is primarily ambulance rides, labs and hospital clinical, (it is 2 weeks but 140 hours) to allow students to do paramedic management and skills they don't do in the ICU/ED. 

The vast majority of the RNs in that program have more than 2 years experience and are working flight RNs being sponsored by their employer.


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## Carlos Danger

CriticalCareIFT said:


> If you attended a standard Paramedic program (not 2 weeks) and also standard nursing program you should clearly see a distinction of how the jobs differ, and how the schooling and rotations specifically prepare you for said job.



I already described my background, which obviously influences what I know to be true on this issue.

Being that you have not completed an RN program and then spent several years working in critical care, I really don't see what you even base your opinion on, or how you feel you can challenge me on what I should "see". 

I am quite confident you that if you ever actually become qualified to make a judgment on this issue, your opinion will be quite different than it is now.


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## Summit

ExpatMedic0 said:


> Today, men still only make up between 5%–10% of the nursing workforce in the United States, United Kingdom, and Canada. - See more at: http://www.minoritynurse.com/articl...urses-perceptions-gender#sthash.27HvxIA2.dpuf



The majority of med students are female now. 

Since we are talking ED/ICU RNs, that is more like 40% male.


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## VFlutter

CriticalCareIFT said:


> One "generalist education" had him  intubating, using RSI medications that he decided/ordered to use, had anesthesia clerkship even before the fellowship, was educated on a medical model to assess patients and order treatment not carry out orders and perform nursing interventions etc and was functioning in the role of a physician from the start. Certainly anyone can see RN and MD are on equal footing with their generalist education right before the start of their fellowship.



How many intubations do you think a Medical student gets prior to graduating? And I can assure you the Medical student is not deciding/ordering the RSI drugs. Most will step in and intubate under direct supervision of the MD only after the patient has been induced. This is usually only in the OR and if the student is lucky. I have never seen a student intubate in any type of urgent/emergent situation.

No one was arguing that RNs and MDs are equal. But your attempt to draw some conclusion about RN-Medic from the exaggerated comparison between CRNA and MDA doesn't really work. 

Anyone who thinks a RN does nothing but follow MD orders and knows nothing about medicine is mistaken. We do not sit on our hands and wait for the MD to give us an order to do something. I have standing orders and can call for verbal orders just like online medical control. There are many times MDs will ask my opinion or ask if there are any orders I want. Many times I will call a MD, give my asssessment, ask for orders, and treat the patient without the MD ever seeing the patient or giving me an order (Other than agreeing with what I asked for).


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## CriticalCareIFT

Chase said:


> How many intubations do you think a Medical student gets prior to graduating? And I can assure you the Medical student is not deciding/ordering the RSI drugs. Most will step in and intubate under direct supervision of the MD only after the patient has been induced. This is usually only in the OR and if the student is lucky. I have never seen a student intubate in any type of urgent/emergent situation.
> 
> No one was arguing that RNs and MDs are equal. But your attempt to draw some conclusion about RN-Medic from the exaggerated comparison between CRNA and MDA doesn't really work.
> 
> Anyone who thinks a RN does nothing but follow MD orders and knows nothing about medicine is mistaken. We do not sit on our hands and wait for the MD to give us an order to do something. I have standing orders and can call for verbal orders just like online medical control. There are many times MDs will ask my opinion or ask if there are any orders I want. Many times I will call a MD, give my asssessment, ask for orders, and treat the patient without the MD ever seeing the patient or giving me an order (Other than agreeing with what I asked for).


Last time I checked anastesia fellowship for md does not commence post 4 years of medical school, there is that 3 year internal medicine thing before one calls himself  a fellow.h34r:


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## Carlos Danger

CriticalCareIFT said:


> Last time I checked anastesia fellowship for md does not commence post 4 years of medical school, there is that 3 year internal medicine thing before one calls himself  a fellow.h34r:



What are you talking about?

Anesthesiology is a 3 year residency that is started immediately after medical school.


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## CriticalCareIFT

Halothane said:


> What are you talking about?
> 
> Anesthesiology is a 3 year residency that is started immediately after medical school.



Please link to a medical school that offers this in 3 years straight out of medical school.

It would be at least 4 with the base year and additional year of fellowship if you specialize.


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## Akulahawk

Halothane said:


> What are you talking about?
> 
> Anesthesiology is a 3 year residency that is started immediately after medical school.


I read that it's more like a 4 year, where the PGY1's 1st year is spent doing internal med, then PGY2-4 is spent doing Anesthesiology...


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## Handsome Robb

I have a strong opinion about RN to Medic bridge courses and the same opinion about Medic to Rn courses. 

With that said I think these things are very person dependent. You have an experienced ICU/ED nurse that also holds an EMT-B cert and presumably (sorry I might have missed it in the OP) has prehospital experience. I don't really see a short classroom portion combined with a good internship in a high performance system with a preceptor who is there to teach and not just for the shift differential is a viable option. 

Is it an good option for everyone? Absolutely not but you need to look at the individual. I'll support an OP like this all the way who seeks out a course that will provide more but not require the entire program rather than just coming here and wanting to challenge the exam.


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## Akulahawk

CriticalCareIFT said:


> Last time I checked anastesia fellowship for md does not commence post 4 years of medical school, there is that *3 year internal medicine thing* before one calls himself  a fellow.h34r:


No... 1 year internal med, 3 years anesthesiology...


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## CriticalCareIFT

If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.



Halothane said:


> I already described my background, which obviously influences what I know to be true on this issue.
> 
> Being that you have not completed an RN program and then spent several years working in critical care, I really don't see what you even base your opinion on, or how you feel you can challenge me on what I should "see".
> 
> I am quite confident you that if you ever actually become qualified to make a judgment on this issue, your opinion will be quite different than it is now.



I have no intention of completing an RN program actually that would be a drastic step back for me. Sorry I am not as omnipotent as ICU RN that can transform into a paramedic in 2 weeks or a  CCM anesthesiologist just after CRNA school. Why bother going to school for all these jobs and specialties, we can all become omnipotent RN's and take over all the specialties.


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## Handsome Robb

CriticalCareIFT said:


> If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.
> 
> 
> 
> I have no intention of completing an RN program actually that would be a drastic step back for me. Sorry I am not as omnipotent as ICU RN that can transform into a paramedic in 2 weeks or a  CCM anesthesiologist just after CRNA school. Why bother going to school for all these jobs and specialties, we can all become omnipotent RN's and take over all the specialties.



I don't think anyone in this thread is advocating that.


----------



## CriticalCareIFT

Robb said:


> I don't think anyone in this thread is advocating that.



Maybe I misread these parts 



Halothane said:


> Just not true. I've known many RN's with strong ICU and/or ED backgrounds come into the flight environment and after a thorough orientation, really rock in the prehospital arena. Many of these took abbreviated paramedic programs or were able to simply take the state certifying exam.





Chase said:


> I do not see your point. They both had a generalist eduction and then decided to further their education and specialize.


----------



## Carlos Danger

CriticalCareIFT said:


> If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.
> 
> 
> 
> I have no intention of completing an RN program actually that would be a drastic step back for me. Sorry I am not as omnipotent as ICU RN that can transform into a paramedic in 2 weeks or a  CCM anesthesiologist just after CRNA school. Why bother going to school for all these jobs and specialties, we can all become omnipotent RN's and take over all the specialties.



Alright, just as I suspected it would, this has gotten completely ridiculous. Because you can't justify your hardline stance, you are trying to detract from the initial discussion with unrelated debates over CRNA vs. anesthesiology education and the length of anesthesiology residencies.

You have never been to nursing school. You have never done critical care. You simply are not qualified to make the claims that you have here. 

Have whatever opinions you want, but for your own good I would seriously consider trying to break your habit of acting as an authority on topics of which you have very little knowledge.


----------



## CriticalCareIFT

Halothane said:


> Alright, just as I suspected it would, this has gotten completely ridiculous. Because you can't justify your hardline stance, you are trying to detract from the initial discussion with debates over CRNA vs. anesthesiology education and the length of anesthesiology residencies.
> 
> You have never been to nursing school. You have never done critical care. You simply are not qualified to make the claims that you have here.
> 
> Have whatever opinions you want, but for your own good I would seriously consider trying to break your habit of acting as an authority on topics of which you have very little knowledge.



I am just stating my opinion. Authority?, I was not the one to write my autobiography here, of where I lecture and who I teach.  I suppose we should take your word because you are an authority on 2 week RN to Medic transition?


----------



## Akulahawk

CriticalCareIFT said:


> If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.
> 
> 
> 
> *I have no intention of completing an RN program* actually that would be a *drastic step back for me*. Sorry I am not as omnipotent as ICU RN that can transform into a paramedic in 2 weeks or a  CCM anesthesiologist just after CRNA school. Why bother going to school for all these jobs and specialties, we can all become omnipotent RN's and take over all the specialties.


Then what else in your educational background do you have that makes you an authority, for what you claim, about what nurses actually know, do, and are capable of? What do you have in your own educational background do you have that provides you such a superior knowledge-base that becoming an RN would be step back?

I'm certainly no authority about nursing, but seeing as I've completed most of RN school, at this point, I'm quite likely a far higher authority than you are in this particular subject matter.


----------



## Akulahawk

CriticalCareIFT said:


> I am just stating my opinion. Authority?, I was not the one to write my autobiography here, of where I lecture and who I teach.  I suppose we should take your word because you are an authority on 2 week RN to Medic transition?


Well, given that Halothane has both a strong Paramedic and Nursing background, with experience in critical care, yes, I would expect that there's sufficient understanding of the requirements of making a safe, entry-level Paramedic, and how to achieve that when dealing with competent, experienced ICU RN's. Much of that would involve teaching the psychomotor and operational components to the RN's, and that doesn't take all that long to accomplish. RN's that don't work in the ICU/ED setting would probably have a MUCH more difficult time transitioning to Paramedic. A 2 week transition course would probably NOT be for those nurses.


----------



## VFlutter

CriticalCareIFT said:


> If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.



Do not try to back pedal now. Why would you quote the requirements for a dual fellowship when trying to make an argument comparing CRNA/MDA? The vast majority of MDs do not take that route. Most MDAs do not do critical care fellowships. You either intentially tried to exaggerate or you have no idea what your talking about. I am guessing the latter.


----------



## CriticalCareIFT

As an ICU/ER Nurse how many patients do you RSI/intubate a month? 

As an ICU/ER Nurse how many codes/traumatic codes do you run as a team leader a month (ACLS/PALS/NRP and call the times and push the meds, interpret rhythms and difib)? 

As an ICU/ER nurse how many Mass Casualty Incidents that you respond to, triage, and render care?  

As an ICU/ER Nurse how many cath lab activations that you determine from a 12 lead that you yourself perform and read and call do you do a month?

As an ICU/ER Nurse how many medications based on your standing orders without notifying the MD, only based on your physical exam and patients complains did you administer a month?

As an ICU/ER Nurse how many patients have you carried or a stair chair down the stairs a month?

As an ICU/ER Nurse how many patients did you use KED, Longboard, Scoop a month?

As an ICU/ER Nurse how often did you drive the ambulance with lights and sirens on an emergency call last month? 

etc. etc. etc.

I would image all of these would get "0" from an experienced ICU/ER Nurse, yet in 2 weeks time from a course she will be fully competent to do all of them. 

Authority? It's called not suffering from delusions of grandeur.


----------



## Akulahawk

Oh, you just _had_ to go there...

I'm going to comment, inline, in red...





CriticalCareIFT said:


> As an ICU/ER Nurse how many patients do you RSI/intubate a month?
> How many patients did CFRNs intubate/RSI per month before they joined a flight program?
> As an ICU/ER Nurse how many codes/traumatic codes do you run as a team leader a month (ACLS/PALS/NRP and call the times and push the meds, interpret rhythms and difib)?
> ICU/ER nurses probably do that a lot more than you think... especially since they're often on an RRT or Code Blue team within the hospital and have to initiate care prior to an MD arriving from somewhere else in the hospital.
> As an ICU/ER nurse how many Mass Casualty Incidents that you respond to, triage, and render care?
> How many MCI's did you run before you became a Paramedic?
> As an ICU/ER Nurse how many cath lab activations that you determine from a 12 lead that you yourself perform and read and call do you do a month?
> I would suspect that the ICU/ER nurse probably reads 12-leads and calls the cath lab to expect a patient rather often and calls the physician... "I have a patient that needs to go to the cath lab, here's why..."
> As an ICU/ER Nurse how many medications based on your standing orders without notifying the MD, only based on your physical exam and patients complains did you administer a month?
> Probably more than you do...
> As an ICU/ER Nurse how many patients have you carried or a stair chair down the stairs a month?
> EMT level stuff, and psychomotor. Easily learned OJT.
> As an ICU/ER Nurse how many patients did you use KED, Longboard, Scoop a month?
> EMT level stuff, easily learned OJT.
> As an ICU/ER Nurse how often did you drive the ambulance with lights and sirens on an emergency call last month?
> EMT stuff.
> etc. etc. etc.
> 
> I would image all of these would get "0" from an experienced ICU/ER Nurse, yet in 2 weeks time from a course she will be fully competent to do all of them.
> 
> Authority? It's called not suffering from delusions of grandeur.


----------



## STXmedic

*disclaimer: I'm not a nurse; I'm a paramedic. My wife is, however, an RN in the STICU.

CriticalCareIFT, I mean no disrespect, but you seem to have a very poor idea of what an ED/ICU nurse does; and a very inflated sense of what a paramedic does and how difficult it is to learn.

An ICU nurse certainly does push meds, often (and I mean multiple times per shift), based on their own decision-making. 

An ICU nurse certainly does run codes. Maybe not through the entirety, but they are certainly able. Especially if they're on the hospital's RRT/Code team.

RSI is not the best argument, either. While nurses other than CFRNs do not perform RSI, neither do the vast majority of paramedics. Many are never even taught; many more are never in a system that allows it. And for the systems that allow it, most will put the medics through RSI training and clearing. What makes a nurse incapable of sitting through the same training once they're in a system utilizing RSI.

MCIs? Seriously?

All of the operational stuff you pointed out is mute as well. How hard is it to learn how to bring somebody down in a stair chair? (Hint: not hard at all.) 

Your view of what we do as paramedics is definitely a bit falsely elevated. Is our job a cake-walk? No. It certainly takes education to be proficient at what we do. Can any nurse jump in an accelerated program and be successful as a paramedic? Of course not. Can an ED/ICU nurse with several years of experience? I have no doubt. Especially an ICU nurse, and especially if they were an EMT beforehand.

Go shadow some nurses on these floors and see what it is they actually do. Many will run circles around you.


----------



## CriticalCareIFT

STXmedic said:


> *disclaimer: I'm not a nurse; I'm a paramedic. My wife is, however, an RN in the STICU.
> 
> CriticalCareIFT, I mean no disrespect, but you seem to have a very poor idea of what an ED/ICU nurse does; and a very inflated sense of what a paramedic does and how difficult it is to learn.
> 
> An ICU nurse certainly does push meds, often (and I mean multiple times per shift), based on their own decision-making.
> 
> An ICU nurse certainly does run codes. Maybe not through the entirety, but they are certainly able. Especially if they're on the hospital's RRT/Code team.
> 
> RSI is not the best argument, either. While nurses other than CFRNs do not perform RSI, neither do the vast majority of paramedics. Many are never even taught; many more are never in a system that allows it. And for the systems that allow it, most will put the medics through RSI training and clearing. What makes a nurse incapable of sitting through the same training once they're in a system utilizing RSI.
> 
> MCIs? Seriously?
> 
> All of the operational stuff you pointed out is mute as well. How hard is it to learn how to bring somebody down in a stair chair? (Hint: not hard at all.)
> 
> Your view of what we do as paramedics is definitely a bit falsely elevated. Is our job a cake-walk? No. It certainly takes education to be proficient at what we do. Can any nurse jump in an accelerated program and be successful as a paramedic? Of course not. Can an ED/ICU nurse with several years of experience? I have no doubt. Especially an ICU nurse, and especially if they were an EMT beforehand.
> 
> Go shadow some nurses on these floors and see what it is they actually do. Many will run circles around you.



We are talking 2 week program to learn all these competencies, that after 2 weeks the nurse can jump side by side with you in your truck and perform as an equal because of her extensive ICU/ER experience.


----------



## TransportJockey

CriticalCareIFT said:


> We are talking 2 week program to learn all these competencies, that after 2 weeks the nurse can jump side by side with you in your truck and perform as an equal because of her extensive ICU/ER experience.



Most of the things they are learning are stuff that we expect brand new baby basics to do (stair chair, LSB, scoop, gurney ops, EVO, etc) even if they come from a bootcamp 1 week EMT-B course...
And they most likely will have to go through FTO and mentorship time if they want to work as a medic on a truck... if they're already operating as a flight nurse then a lot of this they have been doing. Same if they are ground transport nurses on a CCT truck.


----------



## Akulahawk

CriticalCareIFT said:


> We are talking 2 week program to learn all these competencies, that after 2 weeks the nurse can jump side by side with you in your truck and perform as an equal because of her extensive ICU/ER experience.


Given that we're talking about an experienced ICU/ED nurse, I'd have to say that I would expect that after the 2 week course, that nurse would be as competent as a new grad medic, which is what they'd be considered, and probably could run circles around many medics...


----------



## CriticalCareIFT

I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.


----------



## STXmedic

CriticalCareIFT said:


> I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.



Go shadow an ICU. Seriously. You seem to have no clue how an ICU works.


----------



## VFlutter

CriticalCareIFT said:


> I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.



During the days most doctors have 30+ patients they have to see besides procedures they do. They can not be on every floor all the time. At night most hospitals only have a few doctors in house, the CCP and the ER docs.


----------



## STXmedic

Chase said:


> During the days most doctors have 30+ patients they have to see besides procedures they do. They can not be on every floor all the time. At night most hospitals only have a few doctors in house, the CCP and the ER docs.



And that's if they're lucky enough to have a CCP. Many times its just a hospitalist.


----------



## CriticalCareIFT

STXmedic said:


> Go shadow an ICU. Seriously. You seem to have no clue how an ICU works.



Sorry, I have not been to the ICU's where Noctors are in charge.


----------



## STXmedic

CriticalCareIFT said:


> Sorry, I have not been to the ICU's where Noctors are in charge.



Nor have I. I don't think I ever stated that was the case, either.


----------



## Handsome Robb

You realize that we follow orders just like a nurse does, right? Who do you think wrote/approved the protocols you follow?

You really think that a nurse has to go and ask a doctor anytime they titrate a pressor or a paralytic or sedative? Of administer analgesia? You think a patient goes into VF the nurse isn't going to start CPR and immediately defibrillate the patient as soon as the code cart gets there? How efficient would that be? 

No one said they run the entire code but they do start it off until a physician gets to the bedside. Sometimes that can be one or two rounds, sometimes more until the ERP makes it there. Another floor doc might get there sooner but how many codes has that physician run this year? Answer me that. 

The majority of what nurses are going to have to learn are skills, which don't take that long to learn, operations which again don't take long to learn and they're going to have to learn scene control, which is hard to learn for those that to through a formal medic program as well. Also, how many skills do we do that a nurse hasn't already learned? There aren't many. 

No one here is advocating any nurse in the world can take a bridge course and operate as a medic but there are those out there that can. Just like there are medics out there that could operate in a nursing roll with some training. It's a two way street. 

You're taking everything everyone says and responding to it or quoting it as the extreme of what they said. Respond to what's said, don't twist things to make it look like you're right because the people in this thread aren't dumb enough to fall for it.


----------



## Summit

CriticalCareIFT said:


> I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.



Not counting ED, whose one night doc is not a deployable resource, we have 225 beds, 25 of those are ICU, covered typically by one hospitalist and one intern. What do you think happens when there's a bedside procedure a code going at the same time?


----------



## CriticalCareIFT

Summit said:


> Not counting ED, whose one night doc is not a deployable resource, we have 225 beds, 25 of those are ICU, covered typically by one hospitalist and one intern. What do you think happens when there's a bedside procedure a code going at the same time?



Patient will receive noctor care, due to the misfortune of ending up in a hospital where there is no doctors?


----------



## Carlos Danger

CriticalCareIFT said:


> Patient will receive noctor care, due to the misfortune of ending up in a hospital where there is no doctors?



You again display your ignorance of critical care units and how they work.

This has actually become humorous.


----------



## CriticalCareIFT

Halothane said:


> You again display your ignorance of critical care units and how they work.
> 
> This has actually become humorous.



Are you actually claiming that in critical care units nurses practice medicine due to doctor shortage?


----------



## VFlutter

CriticalCareIFT said:


> Are you actually claiming that in critical care units nurses practice medicine due to doctor shortage?



No one claimed that nurses practice medicine. We have standing orders and "online medical control" exactly like medics. 



CriticalCareIFT said:


> Patient will receive noctor care, due to the misfortune of ending up in a hospital where there is no doctors?



Pretty much every non-academic hospital is run that way. 

You claim to be a CCEMTP and do Critical Care IFT yet you seem to know absolutely nothing about how critical care units function or what ICU nurses do. Who do you think set up that balloon pump, titrated the pressors, and managed the vent?


----------



## CriticalCareIFT

Chase said:


> No one claimed that nurses practice medicine. We have standing orders and "online medical control" exactly like medics.
> 
> 
> 
> Pretty much every non-academic hospital is run that way.
> 
> You claim to be a CCEMTP and do Critical Care IFT yet you seem to know absolutely nothing about how critical care units function or what ICU nurses do. Who do you think set up that balloon pump, titrated the pressors, and managed the vent?



Perfusionist/IR Cardiologist, nurse titrated pressors after calling the doctor, respiratory therapist... wait wait sorry I meant omnipotent ICU RN.

I will repent for all my transgressions at the alter of Florence Nightingale.


----------



## VFlutter

CriticalCareIFT said:


> Perfusionist/IR Cardiologist, nurse titrated pressors after calling the doctor, respiratory therapist... wait wait sorry I meant omnipotent ICU RN.



The Cardiologist places the IABP but once the patient is in the unit it is my responsibility. I adjust settings as needed. I titrate and wean pressors to maintain MAP, I do not call the doctor. I adjust vent settings based off ABGs. 

Omnipotent? No. Competent? Yes.


----------



## NomadicMedic

Okay. I've had about enough. Any personal attacks or name calling are going to result in forum vacations. 

I've removed the off topic posts ... You're all presumably adults. Try to behave accordingly.


----------



## Summit

CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?


----------



## wanderingmedic

We are all here to help people who are sick. Can we work together to do that please? Both Nurses and Medics play an important role in patient care, and neither one is better than the other.  

If there is anything we in EMS should be encouraging, it is getting other healthcare providers acquainted with our capabilities, scope, and role. This opens the door to better training opportunities and a better integrated healthcare system for our patients. 

I'm a huge fan of cross training providers because it provides a more diverse workforce with a larger base of knowledge, and gets more people involved in the different phases of patient care. 

Please! Encourage this person to continue their education and get involved in EMS!


----------



## Handsome Robb

Summit said:


> CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?



That's a great question.

Paraoctoring?


----------



## triemal04

Robb said:


> That's a great question.
> 
> Paraoctoring?


Para*n*octuring.

Couldn't resist...:lol::beerchug:


----------



## Clipper1

azemtb255 said:


> If there is anything we in EMS should be encouraging, it is getting other healthcare providers acquainted with our capabilities, scope, and role. This opens the door to better training opportunities and a better integrated healthcare system for our patients.



It should be a two way street. Obviously there are some in EMS who have zero clue about what nurses do and there are plenty of discussions on this forum to show this usually in a very negative light.  Why should other professions have to know what you do in detail? Also, EMS changes its titles and scope every few years or is vastly different from one area to the next to the point which it becomes absurd to care especially when those in EMS can not explain their titles and scope of practice or how to get certified. We see EMS on TV (fact and fiction), in all types of media and have you featured in parades almost daily or at least weekly.  Maybe it is time you also see what others do and see they also have a role in health care.


----------



## JPINFV

CriticalCareIFT said:


> If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.




That's a pulmonology/critical care fellowship, which is a 3 year fellowship following a 3 year internal medicine residency. 

Unlike most specialties (however there are a fair number like this), anesthesiology is a 3 year *residency* following a 1 year *internship*. Most specialties incorporate the intern year as a part of their residency. That internship year can be a medicine internship program, surgery internship program, or a transitional internship program. 

Also plenty of specialties offer fellowship sub-specialty training besides internal medicine. Toxocology and EMS are two recognized sub-specialties in emergency medicine.


----------



## JPINFV

CriticalCareIFT said:


> I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.



There's this period of time between recognition of a cardiac arrest and the time for the responding physician to arrive at said cardiac arrest. It's generally seen as bad form for the nursing staff to stand around with their thumbs up their butts watching the patient die.


----------



## JPINFV

Robb said:


> You really think that a nurse has to go and ask a doctor anytime they titrate a pressor or a paralytic or sedative?


If there's not a standing order (unit protocol, etc) or PRN order... yes. However generally said orders are already formally put into place with a "if lab value X, then increase rate by X and bolus Y).


----------



## Clipper1

JPINFV said:


> If there's not a standing order (unit protocol, etc) or PRN order... yes. However generally said orders are already formally put into place with a "if lab value X, then increase rate by X and bolus Y).



If the patient is on a paralytic you can be pretty sure they are on a ventilator. Modern ICUs have ventilator protocols which have been found much more effective than calling a physician every time.  In a unit running 30 ventilators with multiple drips, various gases and different ventilators, no CCM doctor can be everywhere all the time. It has also been shown to hinder patient weaning if RNs wait for doctors to get around to writing orders for every patient which needs to get  and not just lay around waiting.


----------



## JPINFV

Clipper1 said:


> If the patient is on a paralytic you can be pretty sure they are on a ventilator. Modern ICUs have *ventilator protocols* which have been found much more effective than calling a physician every time.




Do you want to know how I know you didn't read or understand my post? Hint: We used the same word.


----------



## CriticalCareIFT

JPINFV said:


> That's a pulmonology/critical care fellowship, which is a 3 year fellowship following a 3 year internal medicine residency.
> 
> Unlike most specialties (however there are a fair number like this), anesthesiology is a 3 year *residency* following a 1 year *internship*. Most specialties incorporate the intern year as a part of their residency. That internship year can be a medicine internship program, surgery internship program, or a transitional internship program.
> 
> Also plenty of specialties offer fellowship sub-specialty training besides internal medicine. Toxocology and EMS are two recognized sub-specialties in emergency medicine.



My main point here was to illustrate that a physician was trained to perform physicians job and practice medicine from the start, he was not practicing nursing and then decided to specialize and go into anesthesia. Practicing nursing and practicing medicine are too different things, yet nurses always want to practice medicine and claim they already do so in their nursing roles.



JPINFV said:


> There's this period of time between recognition of a cardiac arrest and the time for the responding physician to arrive at said cardiac arrest. It's generally seen as bad form for the nursing staff to stand around with their thumbs up their butts watching the patient die.


Granted no argument there, however it's far cry from paging code "insert color of your hospital". wheeling the cart over and beginning CPR and waiting for a doc to arrive. How is it equal to field code with paramedic team lead resuscitation and post arrest management?

If due to hospital resources there is a physician shortage or due to geography nurses "run" the code because it takes the doctor 30 minutes to get there, this is certainly not the norm, at least not where I work. To expound of your noctoring medical practice by stating there is no doctors available or they are busy in a hospital out of all places is just plain stupid.


I will leave it at that, as this topic already ran it's course here and I have no intent to further dwell in it.


----------



## CriticalCareIFT

Summit said:


> CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?



Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.


----------



## Clipper1

JPINFV said:


> Do you want to know how I know you didn't read or understand my post? Hint: We used the same word.



A little sensitive?

You are not the only one who can comment on "protocols" and give specific examples. 

The are many, many "unit" protocols as well as disease specific.


----------



## Clipper1

CriticalCareIFT said:


> Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.


No, that is not necessarily true. When a patient arrives to almost any unit in the hospital, procols are initiated. Even with admits a physician may not have to see the patient for 4 hours or write orders except to admit.

Paramedics can also call for anything which is not obvious to initiate their protocols. Your protocols are also written in broad terms which are relatively easy to follow. You do not have many known factors to consider which can split protocols into many different pathways. Your protocols are written to take into consideration some of the unknowns which is probably why you use a nonrebreather frequently per your protocol.  Nurses are able to order certain labs to enhance their decision making.

Yes nurses do run codes. Following an ACLS flow chart is not that hard to do.


----------



## VFlutter

CriticalCareIFT said:


> yet nurses always want to practice medicine and claim they already do so in their nursing roles.


 
Semantics. Nurses are not unintelligent slaves who blindly follow physician orders. To think they have no involvement or input in practicing medicine is ignorant. 

Next time a MD puts in an order for a medication that I think is inappropriate should I just give it? Am I practicing medicine by holding it?



CriticalCareIFT said:


> Granted no argument there, however it's far cry from paging code "insert color of your hospital". wheeling the cart over and beginning CPR and waiting for a doc to arrive. How is it equal to field code with paramedic team lead resuscitation and post arrest management?



And how many in-hospital codes have you been involved in? I tend to do a few more things than just start CPR. 



CriticalCareIFT said:


> If due to hospital resources there is a physician shortage or due to geography nurses "run" the code because it takes the doctor 30 minutes to get there, this is certainly not the norm, at least not where I work. To expound of your noctoring medical practice by stating there is no doctors available or they are busy in a hospital out of all places is just plain stupid.



How do you know what the norm is? How many hospitals have you worked in? How many times have you been involved in a code on a nursing floor? How many night shifts have you worked in a hospital? 



CriticalCareIFT said:


> I will leave it at that, as this topic already ran it's course here and I have no intent to further dwell in it.



Good. You have proven nothing except that you are totally ignorant to the way hospitals are ran or what RNs do. You have no credibility and no constructive argument. 



CriticalCareIFT said:


> Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.



We have floor protocols and standing orders that we can use for any patient based off our assessment. This is different than PRN orders put in place by the MD after assessing the patient. Do you think that the MD is the first person to see a patient? Like I have stated before many times I will get verbal orders on patients based off my assessment alone. Do you think RNs can not assess? 

I will continue to "Noctor" and provide excellent patient care. I have an excellent relationship with all the MDs I work with and guarantee that they would describe me as a colleague, not a servant.


----------



## Jawdavis

I have to agree with chase. Yes there are many areas of nursing and yes there are many floors that dont require you to have ACLS but when a patient codes or is about to they dont call a team of physicians to the room they call a rapid response team which is usually a few nurses and maybe an RRT. Half of the floors in the hospitals dont have a doctor near them half the time. Yes paramedicine focuses on emergency but nurses, if specialized, can perform these as well. In medicine I dont think that there is one branch that is higher than the other, if we didn't have one group the medical system would collapse.


----------



## ExpatMedic0

Doctors treat and cure diseases/illness, RN's treat patients under direct/indirect orders/supervision. They perform support functions. They certainly do not practice medicine in my opinion 

The lowest possible education to obtain an RN licence is a certificate program in a few states(although not many exists any longer) However, for the sake of argument, we will say community college education and an associates degree. The lowest possible education to obtain the title of MD would be medical school.

I think both sides of this argument are a bit extreme, nurses are not mindless zombies and are capable of functioning with out holding a doctors hand for every single thing. However, the nurses are getting defensive. At the end of the day the Doctor is in charge and that is who is practicing medicine, the guy/girl who took a degree in medicine.... Not nursing... or whatever...

If you don't like it, take some  initiative and go to medical school, this goes for any and every healthcare occupation, not just nursing. Otherwise, swallow your pride, realize your not the one in charge, get off your high horse and enjoy your career choice of assisting the doctor in whatever capacity you have chosen as a career.


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## Christopher

MtRNER said:


> Interested in obtaining my EMT-P.  Currently an ER/ICU RN with 7 years experience, EMT-B with 12 years experience.  Anyone out there know of a good bridge course that doesn't require me to do 15 months of paramedic school (yawn).  I know about the Creighton University 2 week course but I feel that is a bit too quick.  Some people have told me to challenge it but I think that is ill-advised.  Thanks for any input.



You're likely overqualified educationally for the role as a paramedic. As an RN you'll be lacking on the operations side and probably the "dealing with the street" side...except you're an EMT.

You'll be fine in a 2 week class plus some field time, probably 100 hours or so would be more than enough.

Don't listen to the townfolk who tell you otherwise, your credentials are more than satisfactory. I only wish the folks in my paramedic classes were as well prepared as you are.


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## epipusher

As a current student in a Medic to RN program I am most definitely witnessing both sides of this argument.


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## ExpatMedic0

epipusher said:


> As a current student in a Medic to RN program I am most definitely witnessing both sides of this argument.


 Love the avatar man ;-)


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## Mariemt

I am currently looking into both.

I can obtain my paramedic in one year, only prerequisite being my EMT. Yes it is a fast track program, 4 hours a day, some Saturdays.
For me to get my RN, I need one year of perquisites before starting the 2 year program.
If I choose the Paramedic Associates program, also 2 years and become a specialist,  the only difference in the course study is the concepts of nursing and concepts of paramedicine.

I can become an EMTP. AFTER one year or a PS after 2. 

Nurses have more schooling than some NREMTPs do and are not mindless idiots. They are plenty capable and have pushed plenty of drugs on codes to know what they are doing. In out ambulance they also have standing orders like our medics.


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## Carlos Danger

CriticalCareIFT said:


> Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.



Look, I've had enough of trying to correct the misinformation that you refuse to stop spewing. At the end of it all, I honestly could not care less what you think, no matter how flawed it is. It just doesn't affect me. At all. It costs not one speck of dried skin off my back for your to maintain your ignorance. 

So, keep on thinking that RN's are mindless drones who can do nothing without having their hand held by a doctor, while paramedics are elite clinical warriors valiantly and tirelessly battling the grim reaper in the streets. Keep on thinking that paramedicine is such a vast and specialized body of knowledge that no one else can possibly grasp it without spending the same amount of time in vo-tech school that you did. Keep on thinking that only MD's are capable of knowing things and making decisions. Keep on thinking that nurses shouldn't be able to challenge paramedic programs. Keep on thinking that there should be no CRNA's or NP's. Keep on thinking that you know more about the differences between nursing and paramedicine than people who have actually done both. Keep on thinking that your 2-week "critical care paramedic" credential is anything other than a hastily-thrown together money making scheme for UMBC. Keep hoping and praying that paramedicine will someday have some credibility as an actual allied health profession, and that it will someday require the use of a textbook written at higher than a 10th grade reading level and more than 8 months of vo-tech training. Keep fighting over lousy jobs on VFR Bell 206's and "CCT trucks" schlepping around NSTEMI's on heparin drips. 

And while you cling to and draw comfort from those delusions, RN's will keep following protocols and making minute-to-minute decisions in ICU's. RN's will keep having vast career options. RN's will keep successfully challenging paramedic programs. CRNA's will still pull down average salaries of almost $180k, with NP's not too far behind. Most flight programs will still not allow paramedics to do CCT without an RN present, and those that do utilize paramedics will keep doing so primarily because paramedics are willing to work for $10-$15/hr less than any decent RN will. And paramedicine will still look almost exactly like it did 30 years ago (which is to say, pretty sad).

So you keep doing your awesome paramedic street-medicine-god thing, CriticalCareIFT, and we meak and mindless RN's will keep doing ours....having real degrees, making more money, having more career options, going to NP or CRNA school if we want, and even playing paramedic on the weekends if we choose.


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## epipusher

In summary,  Halothane doesn't care what you think and is not affected.


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## ExpatMedic0

I bet some Doctor is reading this thread right now laughing his/her *** off... And yes welcome to EMTLIFE, the ultimate RN egotistical **** measuring forum in all of community college's elite discussion boards.


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## DrankTheKoolaid

And in before the lock


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## ExpatMedic0

DrankTheKoolaid said:


> And in before the lock



I am surprised it lasted this long lol


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## Akulahawk

epipusher said:


> As a current student in a Medic to RN program I am most definitely witnessing both sides of this argument.


And as a current Paramedic in a traditional RN program, I also see both sides of this issue. However, as a well-educated person that went into Paramedicine, and later into Nursing, I can certainly see that it's possible for a well-educated Paramedic to perform as well as a well-educated Nurse, given a proper orientation in each respective area. Here's the problem. Paramedics often aren't anywhere near well-educated enough to make that kind of transition unless they've obtained the education on their own, or the Paramedic Program required essentially equivalent education of their students as a Nursing program requires of theirs prior to entry. Those would most likely be the "degree" programs instead of the "certificate" programs or an "Associate's of Applied Science" degree.


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## FLdoc2011

ExpatMedic0 said:


> I bet some Doctor is reading this thread right now laughing his/her *** off... And yes welcome to EMTLIFE, the ultimate RN egotistical **** measuring forum in all of community college's elite discussion boards.



There have been some chuckles...


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## Akulahawk

FLdoc2011 said:


> There have been some chuckles...


Hopefully not this kind of chuckles...


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## NomadicMedic

We're gonna take a little break now.


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