# PHRN transfer to EMT-P in other states?



## RegMurse12 (Jan 21, 2013)

Hi everyone,
I was referred to this forum from allnurses.com. I'm a PICU nurse and volunteer EMT-B in PA and I'm in the process of getting my Prehospital RN here. I'm currently looking at other PICU/NICU/Pedi ED jobs in PA and TX. If I end up moving to Texas, do you know if I would be able to get my PHRN certification transferred to a paramedic license in Texas. I have an EMT-B license in Texas right now. I don't want all that time/work going into the PHRN exam to go to waste. I'm really just trying to use my license to do more volunteer work at an ALS level.

Thanks!


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## chaz90 (Jan 21, 2013)

I don't know about Texas in particular, but I've never heard of a place that will automatically transfer an RN to Paramedic. You could take an RN-Medic bridge course, which should be fairly painless.


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## ExpatMedic0 (Jan 21, 2013)

I am not from Texas, but I would email there state EMS reciprocity department. emscert@dshs.state.tx.us

Regards


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## RegMurse12 (Jan 21, 2013)

Thanks for replying Chaz. 
A little more background on the PHRN certificate...we are required to take the NREMT Paramedic assessment exam to receive certification and licensure.  Do you think reciprocity would occur with that in mind?


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## ExpatMedic0 (Jan 21, 2013)

chaz90 said:


> I don't know about Texas in particular, but I've never heard of a place that will automatically transfer an RN to Paramedic. You could take an RN-Medic bridge course, which should be fairly painless.



Some states do allow this. Its not national that I am aware of but a state to state basis. How I feel about it is a whole other topic


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## reaper (Jan 21, 2013)

If FL an Rn can challenge the state exam, as long as they have their EMT-B. Tx may be same way. Call the state board and ask.


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## ExpatMedic0 (Jan 21, 2013)

RegMurse12 said:


> Thanks for replying Chaz.
> A little more background on the PHRN certificate...we are required to take the NREMT Paramedic assessment exam to receive certification and licensure.  Do you think reciprocity would occur with that in mind?



Hopfully a TX FPC or CCEMT-P (someone from flight) see's this because they might have more information. Check that email I sent above, goodluck


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## RegMurse12 (Jan 21, 2013)

schulz said:


> Some states do allow this. Its not national that I am aware of but a state to state basis. How I feel about it is a whole other topic



Thanks everyone.  Schulz, I just emailed the board...I'll let y'all know what they say.
And yes, I understand the conflicting feelings of PHRNs on the street.  PA has some loopholes for PHRNs to do an EMT-P's job without holding them to quite the same initial standard, but I feel pretty confident in my skills to keep my patients safe (not come across cocky or anything...).


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## ExpatMedic0 (Jan 21, 2013)

RegMurse12 said:


> Thanks everyone.  Schulz, I just emailed the board...I'll let y'all know what they say.
> And yes, I understand the conflicting feelings of PHRNs on the street.



Its not so much that as the old expression "its a two way road" There are plenty of degree baring CCEMT-P's or FPC's who might like to challenge the RN exam ;-)

Either way I wish you luck


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## Rykielz (Jan 21, 2013)

I know for a fact that a CA medic can transfer to Texas, Minnesota, and Nevada by simply having their NREMT-P. You said you took the NREMT-P practical exam. Is there any way for you to get your NREMT-P?


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## Shishkabob (Jan 21, 2013)

Take the Paramedic school in the state you move to.  Problem solved.


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## VFlutter (Jan 21, 2013)

Creighton University has a two week RN-Paramedic course but it requires 2 years of ICU experience, not sure if PICU/NICU qualifies or if you need Adult ICU as well. 

http://ems.creighton.edu/training-certification/paramedic-certification-healthcare-providers-0

Some community college AAS paramedic programs will credit you for your ADN/BSN and just make you take the paramedic specific classes and clinical. 

I know a few states allow direct challenge but I don't remember which ones. 

Good luck with everything and don't get discouraged if you encounter some resistance, this topic tends to turn into a heated debate. I am considering getting my PHRN/Medic in the future.


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## Summit (Jan 21, 2013)

I referred him over here. 



RegMurse12 said:


> Thanks for replying Chaz.
> A little more background on *the PHRN certificate...we are required to take the NREMT Paramedic assessment exam to receive certification and licensure. * Do you think reciprocity would occur with that in mind?



Do you take and pass both the written and practical NR Paramedic exam? If so, shouldn't that be enough for any NR state?


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## Shishkabob (Jan 21, 2013)

Summit said:


> Do you take and pass both the written and practical NR Paramedic exam? If so, shouldn't that be enough for any NR state?



I hope not.


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## Summit (Jan 21, 2013)

Linuss said:


> I hope not.



Haven't you been a staunch defender of the shake-and-bake schools? ^_^


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## Shishkabob (Jan 21, 2013)

Summit said:


> Haven't you been a staunch defender of the shake-and-bake schools? ^_^



Uh, quite sure in my years on this forum I have never been a defender of such, never advocated as such, and don't really know where you came up with that.


Mind guiding me with a direct link some place?  Clearly someone's been hacking my account.


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## RegMurse12 (Jan 22, 2013)

Summit said:


> I referred him over here.
> 
> 
> 
> Do you take and pass both the written and practical NR Paramedic exam? If so, shouldn't that be enough for any NR state?



Actually, what's interesting (and highly debated...rightfully so) is that the PHRN only requires the NREMT Paramedic Assessment exam.  The skills testing is not required.  

I'm not looking for an information/arguments about that because I'm very well aware of the mixed opinions that come with this.  My chief is allowing me to do some extensive precepting so that I'm comfortable before I go out and practice on my own.


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## Handsome Robb (Jan 22, 2013)

Linuss said:


> Take the Paramedic school in the state you move to.  Problem solved.



Thank you.

You want to play in our sandbox then go to paramedic school.

How many RNs freak when they hear about medics taking bridge courses then the NCLEX.



Sorry not trying to be an *** but I'm sick of nurses complaining about medics infringing on their jobs (Trauma Tech vs RN in my area particularly) then wanting to come work in the prehospital environment. It's a double standard and to be frank, is bull:censored::censored::censored::censored:.


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## Handsome Robb (Jan 22, 2013)

Summit said:


> I referred him over here.
> 
> 
> 
> Do you take and pass both the written and practical NR Paramedic exam? If so, shouldn't that be enough for any NR state?



No.

They don't teach RNs to manage scenes or delegate, they are taught to be delegated to


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## VFlutter (Jan 22, 2013)

Robb said:


> Thank you.
> 
> You want to play in our sandbox then go to paramedic school.
> 
> ...



I really did not want to get into it, especially not with you Rob, but come on...

Firs off I have never liked the idea of just challenging the paramedic exam. The PHRN involves classroom education as well as clinicals with a set number of supervised ALS runs. They are also required to take all the paramedic exams (At least in IL).  It is more of a bridge process.  

I agree there is a double standard which is unfortunate for medics. But what is EMS doing about it? Do you think current paramedic education is adequate? Is there any plans to improve educational standards? There are plenty of countries where EMS and Nursing education is equal. How is EMS's lobbying power? Kind of hard to talk tough when you have teenagers doing the job and a large percentage of medics who are only in it for that fire department job. 

I can see no reason to sit through a 600 hour class taught at a high school level when I have already spent 4 years in college. I know that sounds condescending and arrogant but it is what it is. Do I think I could go out on the streets today with no extra education and function as a medic? Absolutely not. But do I think I need to go through an entire medic program to get what I need? Nope. 



Robb said:


> No.
> 
> They don't teach RNs to manage scenes or delegate, they are taught to be delegated to



You are kidding, right? I can guarantee you nursing programs go over the topic of delegation way more than any paramedic program. Pick up an NCLEX review book and there will be multiple chapters dedicated solely to the topic of delegation. 

Oh I forgot that I just take orders from a MD and do nothing except get delegated to. Well, at least they pay me good for it. 

As far as scene management they are required to take an EMT-Basic course. How much of scene management did you learn in class as opposed to actual doing it in the field?


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## Dwindlin (Jan 22, 2013)

Linuss said:


> Take the Paramedic school in the state you move to.  Problem solved.



Not really sure how many times I've said the same thing about practicing medicine. . .


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## ExpatMedic0 (Jan 22, 2013)

First off, Its not this nurses fault the system is this way, that is the way its set up and I wish this person goodluck,I hope we could help. I however, do not agree with the bigger picture here and agree with others regarding the sandbox.


Chase said:


> I can see no reason to sit through a 600 hour class taught at a high school level when I have already spent 4 years in college. I know that sounds condescending and arrogant but it is what it is. Do I think I could go out on the streets today with no extra education and function as a medic? Absolutely not. But do I think I need to go through an entire medic program to get what I need?



Last time I checked most of our nations medics programs where well over 1000 hours,mine was about 1500 full time 1.5 years long and worth 50 college credits. Myself and the other Oregon medics had the same pre rec's as associates degree RN's, the only difference was our Paramedic program course work was longer than the RN's and obviously ours focused on Emergencies and Pre-Hospital care. It was also mandatory for us to hold an AAS or higher to be certified in Oregon.  Many in my class already had an undergraduate degree. From an international stand point a paramedic going to nursing is taking a step backwards in your career, like losing rank. Only in the U.S. it is not necessarily seen as this. However in my book and opinion it still kind of is ;-) 

Please get over yourself, if your such an advocate of education than surely a little extra never hurt anyone right? The right way to do it is to take the paramedic program or at least some kind of bridge for gods sake.
PS: almost everything in your thread made me laugh a loud... GET REAL


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## VFlutter (Jan 22, 2013)

schulz said:


> Last time I checked most of our nations medics programs where well over 1000 hours,mine was about 1500 full time 1.5 years long and worth 50 college credits. Myself and the other Oregon medics had the same pre rec's as associates degree RN's, the only difference was our Paramedic program course work was longer than the RN's and obviously ours focused on Emergencies and Pre-Hospital care. It was also mandatory for us to hold an AAS or higher to be certified in Oregon.  Many in my class already had an undergraduate degree. From an international stand point a paramedic going to nursing is taking a step backwards in your career, like losing rank. Only in the U.S. it is not necessarily seen as this. However in my book and opinion it still kind of is ;-)
> 
> Please get over yourself, if your such an advocate of education than surely a little extra never hurt anyone right? The right way to do it is to take the paramedic program or at least some kind of bridge for gods sake.
> PS: almost everything in your thread made me laugh a loud... GET REAL



As far as I know Texas and a few other states still have 600 hour paramedic programs. It is great that some states require an AAS but the majority do not. 

50 college credits?  That is impressive. Still not even half of a bachelors degree. Hell, my two minors were almost 50 credits. 

I have no doubt that international medics are on a much higher level. If I lived in Australia or a similar country I would probably be going that route myself. But we are no where near the standards of other countries. You have your opinion and I have mine, and I don't see either of us changing anytime soon. I am sure its no surprise I have the opposite view of which way is stepping backwards. 

I am an advocate for quality education but unfortunately many of the paramedic programs out there do not fit that description.  

And again, I have been saying people should go through a bridge program and not just challenge the exam. 

What thread are you referring to? 

But I will work on getting over myself, just for you. I wouldn't want you laughing out loud too much.


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## Shishkabob (Jan 22, 2013)

I had a long post but it seemed rather mean, so I'll just keep it to a few points;


There are parts of medicine where an otherwise equivilient Paramedic would be a better fit than an RN, but due to tradition and unions, they haven't been able to encroach upon it, such as the cath lab and trauma room.



Chase said:


> As far as I know Texas and a few other states still have 600 hour paramedic programs. It is great that some states require an AAS but the majority do not.


  Last I checked there are still RN programs that are darn near equal to medic mills.


And minimum =/= norm.  Sure, 600 minimum, sad that they exist, but I dare you to go to a single renowned EMS agency and see if you can find any Paramedics that partook in one of those programs.  Those graduates go play hose jockey at FDs, nothing more.  Just like a lot of the rather scary RNs are held to nursing homes, med/surg and the like.  (Disclaimer, not saying if you work in those areas you're bad) 





> 50 college credits?  That is impressive. Still not even half of a bachelors degree. Hell, my two minors were almost 50 credits.


  Oh yay, your extra year of school taught you theory of being an RN, how to do a spreadsheet and what else?  Apples to apples.  BSN vs BS in EMS.  Not BSN to AAS.

Heck, pit your PhD as an NP against an MD/DO. Yeah, that's worth a laugh.


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## NomadicMedic (Jan 22, 2013)

Play nice. The discussion is a good one as long as it DOESN'T DEGRADE into personal attacks. Lets keep this civil.


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## Summit (Jan 22, 2013)

I am most curious to hear what the TX EMS board says to the OP?



schulz said:


> Last time I checked most of our nations medics programs where well over 1000 hours,mine was about 1500 full time 1.5 years long and worth 50 college credits. Myself and the other Oregon medics had the same pre rec's as associates degree RN's, the only difference was our Paramedic program course work was longer than the RN's and obviously ours focused on Emergencies and Pre-Hospital care. It was also mandatory for us to hold an AAS or higher to be certified in Oregon.  Many in my class already had an undergraduate degree.



1. With prereqs, most associates nursing programs are 75-90 credits. BSN programs are 120-130.

2. I applaud OR and KS, the only two states who require associates. Other states don't and will accept NR 600 hour schools either within the state or from out of state. My state has numerous 6 month long paramedic programs with 512-600 classroom hours.

3. Plenty of nurses have degrees in other fields.



> From an international stand point a paramedic going to nursing is taking a step backwards in your career, like losing rank. Only in the U.S. it is not necessarily seen as this. However in my book and opinion it still kind of is ;-)



In other nations a paramedic is baccalaureate or masters level education... or EMS is handled by specialized prehospital nurses (or physicians). 

In the US nurses are associates minimum and trending towards baccalaureate minimum while Paramedic is, in most of the US, minimum of a GED and a couple hundred hours of vocational school.

That is a sad reality. I say it is sad because it is sad to me. I like prehospital medicine more than critical care, but the career aspect is a problem and the educational/professional state of EMS was going to make it hard for me to make a good career without going Fire and I didn't want to go Fire.



> The right way to do it is to take ... at least some kind of bridge



As Linus point out, who has a better understanding of EMS related topics out of school? The Paramedic has better training by far! Nurses are educated as generalists, then they specialize. However, versus a trained specialist, it is far easier for a educated generalist, particularly with experience, to bridge into a specialty with additional education and training.

The PHRN program is a bridge program of sorts.


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## VFlutter (Jan 22, 2013)

Linuss said:


> I had a long post but it seemed rather mean, so I'll just keep it to a few points;
> 
> 
> There are parts of medicine where an otherwise equivilient Paramedic would be a better fit than an RN, but due to tradition and unions, they haven't been able to encroach upon it, such as the cath lab and trauma room.
> ...



I can agree for the most part on the first few points. 

Actually only one of my BSN classes was nursing theory. The rest was geared toward evidence based medicine, research, and management. But I get your point. Also, my various general education classes are more useful than you would think. 

My comment about the quality of paramedic education was more in reference to the core sciences. It's great a lot if programs are finally requiring basic A&P classes but how many require microbiology, patho, or pharmacology? Or even basic biology and chemistry. I am talking about actual college courses with labs not the simplified watered down version out of paramedic textbooks. 

I didn't try to compare NP to MD/DO or even DNP to MD. I know some nurses like to try to make that leap but they are two different unique roles. If you want to compare apples to apples and pit NP against PA then that is a different story. But personally I think NP education outside of CRNA/ ACNP isn't anything to brag about.


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## Trashtruck (Jan 22, 2013)

The PHRN's that I know, and used to work with, never tried to pretend to be paramedics, or even EMT's. Yes, they got their PHRN cert, but only because their job required it. They were the first to admit that they had no clue how to do EMS proper, and that if we were to ever 'roll up on something' they'd have no idea where to start or what to do. Now, the PHRN's who actually worked as paramedics either prior to their nursing careers or concurrently, obviously didn't share this trepidation.
I'm a paramedic. I'll be the first to admit that even with a bridge program to nursing, I'd suck at nursing until I had some experience actually working as a nurse. Just because I pass the NCLEX, do my clinical time, and graduate with my ASN or BSN, doesn't make me proficient. 
Same for an RN passing NR, doing their ride-time, and acquiring their PHRN.


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## Akulahawk (Jan 23, 2013)

Something that should also be pointed out is that while _generally_ nursing has the Associate's Degree as the minimum educational level, I dare say that there still are RN programs that do NOT result in a degree being awarded. One such program is California's LVN->RN (30 unit option). Sacramento State, having a BSN program, has such a program that does not result in the LVN->RN grad getting the RN if they take the 30 unit option instead of going for the BSN.


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## Summit (Jan 23, 2013)

^indeed, 4% of RN programs are not degree granting, 39% are BSN, and 57% are associate level (2007). There are a growing number on ELMN programs where graduates receive an MSN and sit for RN licensure.  Many ADN RNs immediately enroll in BSN completion programs.

I wonder what % of new paramedics graduate from an associates in paramedicine program?

Also, there are non-degree PA programs and associate degree PA programs in some states. I bet they argue about these versus MS programs on the PA forums. Over on the nursing forums, the ADN vs BSN threads earned their own subforum.


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## VFlutter (Jan 23, 2013)

Summit said:


> ^indeed, 4% of RN programs are not degree granting, 39% are BSN, and 57% are associate level (2007).



I can't find more recent data but I am willing to bet those numbers have changed in the past few years. There is a huge push for RNs to go back for their BSN as well as an increase in BSN program enrollment. The few diploma programs that I know of have closed and there is currently only one program left in my state. With more hospitals applying for magnet status in the next few years I am guessing we will see a shift in the BSNs favor.


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## MrJones (Jan 23, 2013)

Summit said:


> ^indeed, 4% of RN programs are not degree granting, 39% are BSN, and 57% are associate level (2007).



And I dare say that we're being short-sighted if we don't advocate and support initiatives that result a relatively equal breakdown in paramedic education. 

As a start.


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## ExpatMedic0 (Jan 23, 2013)

*Phrn*



Chase said:


> As far as I know Texas and a few other states still have 600 hour paramedic programs. It is great that some states require an AAS but the majority do not.
> 
> 50 college credits?  That is impressive. Still not even half of a bachelors degree. Hell, my two minors were almost 50 credits.



Yes, which is more than the RN program at the same college. That was just the medic program, specifically, I also had all the same pre rec's such as A&P, Bio, Chem, ect.

While where patting each other on the back, I guess Ill pat myself on the back for my psychology minor also and the Bachelors degree I am 2 semesters away from completing.

Also the fact you bring up a 600 hour program which is not accredited nor eligible for national registry as a Paramedic is interesting since I could bring up existing diploma nurse schools which still exists and also certain online RN programs. I could further indulge in the fact that ADN, BSN, and even some Diploma RN's are hold the same RN licence. Just as my pending Bachelors in Paramedicine grants me no higher of a certification as a Paramedic. If we are judging an entire profession based on its weakest links then we have to judge nursing on Diploma nurses, even if only %4 of those still exist, Also the fact almost every community college offers an associate's in the subject which more RN's hold than a BSN.

I respect nurses and what they do for a living, one of my best friends is a nurse, but our jobs are absolutely nothing alike. From a professional standpoint she respects me and I pay her the same respect.

The only "beef" I hold with nursing is as a profession they do like to play in everyone else sandbox, there unions and representation interfere with EMS sometimes, along with the ego some of them display on this forum and in the ED (but that is more of a personal matter)

ANYWAY: This topic should been locked long ago IMO. The OP came here seeking information (regardless of anyone's opinion) That information was given to the OP and everything was accomplished.

Whats been discussed is nothing new, in fact its a broken record on this forum... yes we all agree the minimum national education standard for EMS should be raised, and yes there are some crappy medic mills out there(just as there are some crappy RN ones) and there also some good ones(15 off the top of my head that offer bachelors degree), and others which offer no degree but have 3000-4000 hours of EMS specific education/training which are still pretty good IMO(I.E. medic 1)


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## Veneficus (Jan 23, 2013)

*Advice to the OP and the broken record*

Call the state board of EMS where you are going. Tell them of your credentials and ask them what you have to do to be a paramedic in their state. 

As I know, only a handful of states have PHRN designations. But many others permit RN to medic bridge programs. Still some permit testing out of Medic entirely. 

The politics of whether this is the best or "true faith" are entirely another matter.

But I would like to speak on the education of the matter for the pages worth of nurse vs. medic (Yet again) 

I have been a part of US EMS education for a long time. I have seen every type of program from the CC college degree to the medic mill, and remain active in US EMS education and with educators across the States. (the world is another matter so we will not discuss it here too) 

Only a handful of States, and by my count 2 going on 3 require a degree in EMS of any kind. These states are the exception, not the rule. I wish it were different but it is not. 

Some community colleges require prerequisites to their EMS programs. Others do not. Most college based programs do not require you to complete their EMS degree to take and become accredited as a paramedic. 

Various colleges have tried to unilaterally "raise the bar" on paramedic education, by requiring more intensive programs, with varying levels of success. 

While many community colleges bill themselves and are transferable to universities, you must still understand what you are getting into. When I transferred from the CC world to university, I got schooled in a big way, so in the effort of sparing others that pain, let me point something out?

Transferable does not mean equal. I took a biology class in CC, transfered to university, and when I asked for credit, my academic advisor (the only good one I ever had) explained to me that in the interest of my knowledge and goals to repeat the course. After some hard bargaining to get something out of it for me, I ened up in intro to bio for science majors. I thought since I already passed this class a few years prior it would be an easy A. It was not. Infact, I am proud of my "B" in the class, because the prof can count the number of "As he has given out in his career. Today I am better for not taking the easy (and cheaper) way out. 

The purpose of the CC and associates degree, is to give you the education you need to minimally function in the job market of a given field. It does not teach you what you need to know in order to be anything but the bottom level. It also does so in a very "this is important for the job/this is theory manner."

Outside of EMS, theory counts! You will constantly be faced with decisions that are outside the "rules." You must know enough to be able to either make a decision or call for help. As it stands, nursing has more ability to make reasonable decisions than EMS providers when looked at on the grand scale. 

Where in the country you get your education matters. In the "North" education is focused around a "well rounded" knowledge. Education in the South is far more focused on job speciific. I have been there, I have seen it. Which is better is a matter of endless debate, so let's not get into it.

The average nurse in the US has more basic science education than most paramedics. Just as there is no EMT-Vene level there is no EMT-(Your name here level) being an exception to the rule does not confer your ability on your colleagues or your vocation. It does bring great credit to you. So accept it and quit trying to deflect it as the norm.

Nurses are not all equal to the ED or ICU nurse. In fact, most nurses will never be capable of or desire to operate in those environments. Do not pretend those nurses are the "norm." They are the same exceptional as the up educated paramedic.

Nurses in EMS, like every nurse in every other division of nurses will need job specific training in order to be effective. They do not need to hear A&P, pharm, or any other part of the EMS didactic that they already have superior knowledge in.

Now I know EMS providers don't like to hear this and try to make up all kinds of BS reasons why it is not so. But it is like this. Nursing is an educated profession now. It continues to raise it's own bar. EMS is a vocation trying to keep the bar low. I give you this example to put what you are arguing into perspective.

Let's say you have an engineer, with lots of education and experience in designing bridges. For whatever reason, this engineer wants to weld on bridges. HIs knowledge is far in excess of the average welder, and he just needs the welding credential, not an education in "how bridge building really works."

I just have to comment on the magnet status thing too. Magnet is a self gratifying award from nurses to organizations that suppoort the goals of the nursing lobby for the benefit of nurses. Not the benefits of patient care, safety, efficency, or cost.


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## ExpatMedic0 (Jan 24, 2013)

Veneficus said:


> The purpose of the CC and associates degree, is to give you the education you need to minimally function in the job market of a given field. It does not teach you what you need to know in order to be anything but the bottom level. It also does so in a very "this is important for the job/this is theory manner."



I would loosely agree with this statement, and also mention that both career paths offer this education(Associates) option which results in the same medical licence/certification as someone who go's beyond or below.

Unlike say a Physician, Engineer, Lawyer, or even Public Health which you can not just obtain an associate's degree or below in and begin working. When you look at it like this and your comparing "the national mainstream" minimum standards it feels a bit more like comparing apples to oranges to me at the CC level.


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## SanDiegoEmt7 (Jan 24, 2013)

schulz said:


> I would loosely agree with this statement, and also mention that both career paths offer this education(Associates) option which results in the same medical licence/certification as someone who go's beyond or below.
> 
> Unlike say a Physician, Engineer, Lawyer, or even Public Health which you can not just obtain an associate's degree or below in and begin working. When you look at it like this and your comparing "the national mainstream" minimum standards it feels a bit more like comparing apples to oranges to me at the CC level.



I think what Vene is saying is very accurate, as someone who has worked as a medic(FF?) and then gone on to the university level and medical school.

Everyone is out here measuring their ****'s.  I don't agree with the RN here or some of the medics.  I bet if I met either of you I would think highly of your abilities and you would probably be above the minimums of your fields, hence your egos and why you are fiercely defending yourselves.

The fact is generally university level studies are more rigorous than CC, furthermore a top level university can be even more demanding simply by the fact that they want to make it extremely difficult.  As someone who attended a science focused university then went to paramedic school I can attest to this.

In my role as a paramedic I am categorized with the run of the mill vocational paramedic until my colleagues (of all levels) learn otherwise.  No need to argue here.  A CC trained paramedic or nurse is not going to have the knowledge of say a John Hopkins trained nurse, simply based on the quality of study from the get go.  A rogue CC trained nurse paramedic may be smarter than that BSN but the university holds more weight, prior to gaining field experience.

Take med school prerequisites at cc then take them at a top 50 university and you'll see what I'm saying.  Unit counts have an asterisk on them.

That said, as a majority paramedics are much better trained to deal with delegation and on scene management, than a nurse, without either having field experience, (We do MICN evaluations with experienced ED/trauma RNs) and it's just different.


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## Handsome Robb (Jan 24, 2013)

Chase said:


> I really did not want to get into it, especially not with you Rob, but come on...
> 
> Firs off I have never liked the idea of just challenging the paramedic exam. The PHRN involves classroom education as well as clinicals with a set number of supervised ALS runs. They are also required to take all the paramedic exams (At least in IL).  It is more of a bridge process.
> 
> ...



Alright. You know I have respect for nurses, especially you even if you're a snot nosed rookie  ,  but you know what I'm saying is true. BSN is more education than the majority of medics receive, obviously, I'm not going to argue that but it's different education. 

They do classroom training yes, and clinicals yes, and internships yes, but every PHRN program I've heard of requires the bare minimum. You're talking 40 ALS contacts. They hit #40 and get signed off. Sure there are medic programs out there that pull this crap too but they're the minority. I did~500 hours on an ALS ambulance with >120 ALS contacts and even more BLS/ILS contacts than that. That doesn't include all the patient contacts I had working as an Intermediate during school with medics that let me "run the show" because I was driven to do so and asked if I could. Yes I learned more about scene control during my internship than I did during classroom time but it's still a topic that's covered. It's arguably the most difficult thing a medic has to learn, some may argue it's easier to teach it to a medic with no EMT experience. I'm still learning to better manage my scenes on every single call I go to. Is this all medic students? No. But despite popular belief there are plenty of very intelligent, very motivated EMS Students, EMTs and Paramedics out there. 

I'm not going to get into it with you about current EMS education standards more than I already have. You know exactly how I feel about it. 

I know nurses have standing orders just like paramedics do and can operate autonomously to a point but at the same time you're not making the decision to pull the trigger on an invasive procedure or giving medications that potentially could be fatal to that patient. Not saying nurses can't make those decisions but when I have to walk a BSN ED nurse through the dosage and administration of adenosine to only have the MD ask the nurse to give me the meds rather than ****ing around trying to explain it to him raises some questions in my mind. Is this all nurses? Absolutely not, but I've met plenty of incompetent nurses just like I've met plenty of incompetent medics. 

Nurses have a lot of education but nursing education to EMS education is apples to oranges. We're talking long term care vs. emergency medicine, *generally*

I'm absolutely open to a bridge class, with proper requirements, but nurses trying to challenge the EMT-P because they had RN and EMT-B after their name is downright insulting. That's a two way street, there are medic-to-RN bridges out there but good luck getting a good nursing job with that kind of education behind your RN license even with thousands of ALS patient contacts as the Paramedic In Charge. Unless you've spent any amount of time working in EMS you truly don't know how it works, EMT-B class does not adequately prepare you or give you a good picture of what EMS truly is. 

I truly doubt that a ADN or BSN goes over delegation vastly more than a *good* paramedic program. EMT-B courses barely even touch on delegation, that's not even a point you can use in this argument...

It's not unusual for me to run an entire ALS call, take a cardiac arrest for example, without doing a whole lot, if any, skills. Can I do all of them? You bet but I have bigger fish to fry than to get tied up drilling an IO or starting a line or dropping a KING airway or pushing an epi prefill. Some medications are all me and even if I could delegate them I wouldn't, that's just my preference. I'm sure some people will say I'm wrong for saying this but it's a fact, I'm confident in my medicine and QA/QI/Clinical Direction has absolutely no problems with the way I operate. I'm still new and have a ton to learn, I don't want this to sound like I think I'm the :censored::censored::censored::censored:, because I'm not, but I'm good at my job and always seek critiques to better myself. 

The comparison I've always hear is "A paramedic is like the conductor of an orchestra, you don't play the instruments, but you direct the musicians and bring them all together in harmony". That's not what a nurse does, sorry, you can't argue with that. I have no doubt that nurses delegate but in a sick patient, they are the conductees, not the conductor. 

Sorry, not trying to be an :censored::censored::censored::censored::censored::censored::censored: but this is something that has always irked me. I know plenty of very experienced flight nurses here that don't even try to mess around being in charge on scene calls because they know the ground and flight medic are in their element and, for lack of a better term, are better at it.


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## Veneficus (Jan 24, 2013)

schulz said:


> Unlike say a Physician, Engineer, Lawyer, or even Public Health which you can not just obtain an associate's degree or below in and begin working. When you look at it like this and your comparing "the national mainstream" minimum standards it feels a bit more like comparing apples to oranges to me at the CC level.



I would agree with you that the CC programs are usually (there is always a bad apple and I do know one or two of them) better than the vocational programes. 

However, this difference I think is becomming less and less as vocational programes in order to meet NR requirements are becoming "remote campuses" of CCs. Instead of making bad programs better though, it is dragging down the good ones.

The good programs are also understress from the bad ones in order to maintain both price and student interest. MOst students simply will not pay a CC more and attend 4 semesters of school, when they can do the same in 6 months at a voed and come out with the same cert and same job prospects. (sometimes better prospects if they are applying to an FD because they are not seen as a promotional threat or a "thinking man on a working man's job.")

When I was applying to jobs, (ok, I admit, a very long time ago) when I proclaimed I got my medc at a CC, people looked at me like "so what?" I am sure it hasn't changed that much.

The academy I taught for is a remote campus of a CC not even in the state. Those students get the same job offers at the same pay. Some are better than the CC graduates, some are not.

What you say about entry level requirements for doctors, engineers, lawyers, etc is true. But it is not true for all of CC education. You can get an entry level accounts payable/receivable job with a CC associates in economics or accounting degree. You can get a job mixing chemicals in a vat with an associates of chemistry or science. You won't be deciding which chemicals to mix, but you can still stir.

EMS, which is still considered vocational, has a strange place in the CC system. You really don't need to go to a CC to learn it. Paramedic is still the highest level of prehospital provider in the US. Which by default puts CC educated medics at the top of the EMS education food chain. Not the traditional entry level of the CC degree. 

But I also think that creates a false impression on the level of "education" involved. It artificially elevates the value of a CC in many eyes. That is why people transferrring science to university get a major wake up call when they get there. Then as I did, you must choose between paying to "retake" classes or attempt to take higher classes and make up for your knowledge deficit while studying new material. From experience, I really, really, do not suggest the later. 

If you look a most CC adverts, "the knowledge you need for today's jobs," or something of the like. (some even use the word career) These places are designed to put people to work, and as you yourself said, not at the professional level. The current shift towards the BSN in healthcare istaking nursing out of the CC level. Many programes remain, but I wouldn't wager on it being much longer unless they are going to try to complete the RN reqs of a BSN program and then suggest you could "transfer" to a university.

Don't forget CC are businesses, they want to make money. for a CC EMS is like a cash cow. They can and do even get federal money specifically for having a "public safety" program. In addition to all their other revenue streams.

It is a large draw for students too. If you are deciding what to do out of highschool, making widgets at the local factory (I am a yankee, it is what the option is) or hacking down sugarcane from sunup to sunset down South, (one of my good friends is a medic who was a former cane farmer) that picture of a firefighter, police officer, and paramedic looks really enticing. Especially for those that didn't really do well or get in line with the academic system in school.

As I have come to know you, you are probably one of the best medics in or out of the US, but your level does not even come close to being average. Take credit for your success and ability.

http://en.wikipedia.org/wiki/Dunning–Kruger_effect

"The Dunning–Kruger effect is a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability much higher than average. This bias is attributed to a metacognitive inability of the unskilled to recognize their mistakes.[1]

Actual competence may weaken self-confidence, *as competent individuals may falsely assume that others have an equivalent understanding.* David Dunning and Justin Kruger conclude, "the miscalibration of the incompetent stems from an error about the self, *whereas the miscalibration of the highly competent stems from an error about others".[*2]"

(and for the mods, that is only a short excerpt, not a copy of the whole or even majority of the link)


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## HMartinho (Jan 24, 2013)

Robb said:


> No.
> 
> They don't teach RNs to manage scenes or delegate, they are taught to be delegated to



Are you serious?

A nurse does only what is delegated by the MD?

If the doctor prescribes a drug that the patient does not need, the nurse will give it without even questioning the MD about it? Or in a inappropriate dosage?

If the doctor prescribes a drug contraindicated in a patient, the nurse will give it without questioning the MD about this? Like nitroglycerin for right ventricular AMI?

I know I'm from a different country. In the U.S. there are paramedics and I have the utmost respect for them. They do what they are trained for, But here all ALS units are staffed by a physician and a nurse, and all ILS units are staffed by an EMT and a nurse.

I had the opportunity to work with nurses who are a "disaster" to work on PH. Nevertheless, I have had the opportunity to work with ICU Nurses / Nurse Anesthetists, with additional training in ALS, TNCC, difficult airway management, etc, which are really good to work on PH.

There are good and bad professionals everywhere, Nurses, Doctors, EMT's, whatever.

*And quite honestly, I do not want to be treated by a nurse who merely do what is delegated by the MD.*


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## SanDiegoEmt7 (Jan 24, 2013)

HMartinho said:


> Are you serious?
> 
> A nurse does only what is delegated by the MD?
> 
> ...



I think delegate is in regard prehospital on scene management.  In the US, prehospital providers are trained rigorously to handle emergency scenes, something that could be taught to RNs, most definitely, but it is not the focus in nursing education.  Paramedics are trained to turn chaos into something to work with and then bring those patients to definitive care as stable as possible.  

RNs have a better breadth of general knowledge (generally) and when specialized and experience are not drone worker bees, well at least the majority (there are just as many cookbook medics too).  

The word delegate was brought up in the sense that an RN challenging the paramedic qualifications should complete a large part or all of paramedic training to be as qualified as paramedics in regard to prehospital scene/patient management which requires a certain thought process to accomplish efficiently and effectively.


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## Handsome Robb (Jan 24, 2013)

HMartinho said:


> Are you serious?
> 
> A nurse does only what is delegated by the MD?
> 
> ...



Yes I am serious. 100%. I'll argue this point all day long. If a nurse wants to work in the prehospital field they need to take a full paramedic course or a *proper* RN-to-EMT-P bridge course with appropriate clinical and classroom education along with prerequisite experience in a high acuity care setting. RN =/= Paramedic. I don't care if you have a BSN, MSN or PhD. You can't just hop on an ambulance and think you can do our job. It's not rocket science but there's plenty taught in medic school that nurses aren't taught during nursing school. Skills are easy to teach, knowing when to perform or no perform those skills or administer those medications is a totally different story. We can't just drop a tube, place a central and arterial line, draw ABGs and labs, do some radiography and ship them upstairs, that's not how it works. 

The system you work in is vastly different than that of systems in the U.S. You're comparing apples to oranges. We don't staff physicians and RNs on ambulances, we staff paramedics and EMTs. It's not uncommon in some areas, and is the norm in many, to have an ambulance with two EMTs and no Paramedic, so your argument is moot. 

See my above post about having to walk a *BSN RN* through administering adenosine, a commonly administered ACLS medication. Or having to explain what anectine is to another *experienced* ER RN. Sorry, I used a trade name, I guess I should've spelled it out for them instead 

Ever sat through an ACLS class full of BSN RNs and been the only person that can run a run-of-the-mill asystole/PEA arrest without mumbling and bumbling their way through it?

Ever seen a flight nurse defer decisions about patient extrication, packaging, immediate "stabilization" or a difficult airway to their flight medic partner or to the ground medic while their partner is tied up with another patient on a scene flight? 

RVI is not a contraindication to NTG. It's a caution. You aren't going to automatically kill someone presenting with a RVI by giving them NTG. If you aren't careful about it you absolutely can, yes, but that's not an absolute. Medication administration in any shape or form requires good clinical judgement and clinical correlation to form a differential diagnosis and treatment plan for said diagnosis. 

You just confirmed my argument. The nurses you listed all have extra training in EMS. They aren't challenging the paramedic exam and thinking they can hack it as an ALS provider because they are an RN with an EMT-B cert and passed a test that a high schooler could pass after skimming a book and taking some practice exams.  

Well then you shouldn't ever be treated in a hospital in the U.S. then if you don't want to be treated by a nurse who's following a doctor's orders. 

I've said it before and I will say it again, I have a lot of respect for nurses. Always have, always will. But there's nothing you can say that will convince me that a RN with ER or ICU experience can challenge the NREMT-P exam, especially without having to do the skills exam, and be able to operate as a competent Paramedic In Charge.

99% of our calls in EMS are not immediately life threatening, but during that one percent do you want someone who went to school for exactly that situation or do you want the nurse that went to nursing school then challenged the paramedic certification exam? You think about that and let me know.


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## HMartinho (Jan 24, 2013)

I agree that they are different systems. And I agree also that a nurse with no experience in PH has no ability to work in the area, even because work in a hospital, even with critical patients, is totally different than working in PH, but I can not see the problem of RN-Paramedic bridge programs, with all evaluations and tests it requires.

You refers this nurse who does not know the ALS algorithm, and does not know how to administer adenosine. And you think that all nurses are like that? All nurses do not know the algorithm?

I totally agree that in trauma, paramedics and EMTs are much better than most of nurses. That is unquestionable. However, I've seen nurses runing cardiac arrests, as well as MD's. They know what drugs administer, doses and when administer, as well the defibrillation sequence, and the entire sequence of the algorithm. As I have seen nurses who know nothing about ALS and emergency care. And, frankly, a nurse working in a nursing home that is not the same as an CRNA or an ICU RN, I guess.

RVI is not an absolute contraindication to NTG, but I personally would question the doctor if he really wants this medication, with special attention to monitor BP, HR and ECG rhythm.

And yes, a nurse follows the orders of MD's, but that does not mean that he/she do not  has clinical judgment to question the MD orders  whenever they deem necessary.


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## Summit (Jan 24, 2013)

*Vene's posts are the best posts in the thread.
*


Robb said:


> I know nurses have standing orders just like paramedics do and can operate autonomously to a point but at the same time you're not making the decision to pull the trigger on an invasive procedure or giving medications that potentially could be fatal to that patient.


*My responses should be  understood primarily as correcting some misconeptions about nurses, not an argument that any US RN can step into a medics shoes with no additional training.
*
Nurses are constantly giving medications to patients that require the nurses clinical judgement on whether the patient needs the medication or can handle the medication. That is true from the LTC to the floor to the ED to the ICU. The paramedic protocols cover a comparatively small formulary. 



> Nurses have a lot of education but nursing education to EMS education is apples to oranges. We're talking long term care vs. emergency medicine, *generally*


More accurately, nursing education covers general practice over both long and short term care versus paramedics training in emergency short term care.



> but nurses trying to challenge the EMT-P because they had RN and EMT-B after their name is downright insulting.


I agree... I'd also add "terrifying."



> I'm absolutely open to a bridge class, with proper requirements


Most of the bridge programs I know about require X years of Y experience, usually 2+ years of ICU/ED and an EMT cert. Usually, these programs are full of flight nurses because there just aren't a whole lot of nurses who want to become paramedics, particularly compared to the number of paramedics who want to become RNs. 



> That's a two way street, there are medic-to-RN bridges out there but good luck getting a good nursing job with that kind of education behind your RN license even with thousands of ALS patient contacts as the Paramedic In Charge.


It goes back to my statement earlier that is easier for an educated generalist to specialize than a specialist technician to become an educated generalist. A generalists experience helps them specialize far more than a specialists experience helps them generalize. That is why medic-to-RN bridge programs fall into two categories: 
1. sketchy and poorly respected 
2. hardly any time/effort saved versus a normal program



> I truly doubt that a ADN or BSN goes over delegation vastly more than a *good* paramedic program. EMT-B courses barely even touch on delegation, that's not even a point you can use in this argument...
> 
> The comparison I've always hear is "A paramedic is like the conductor of an orchestra, you don't play the instruments, but you direct the musicians and bring them all together in harmony". That's not what a nurse does, sorry, you can't argue with that. I have no doubt that nurses delegate but in a sick patient, they are the conductees, not the conductor.


Here you are WAY OFF about nurses.

EMT-Bs are not taught delegation because they can only delegate to each other or utilize a first responder to hold pressure, take vitals, a LEO to control traffic, etc. That is pretty straightforward.

Paramedics have more responsibility and complexity in delegation; they must what they can and cannot delegate to intermediates, basics, responders, other paramedics, and what requires consultation (a form of delegation) with OLMC.

RNs can delegate to other RNs and a variety of other in-hospital caregivers such as LPN/LVNs, RTs, and many UAPs (including CNA, MA, EMT, paramedics) while working in teams and consultation with other providers (RNs, RTs, PTs, CRNAs, NPs, PAs, dietician, physicians). A fairly massive portion of RN education, testing, and practice is dedicated to knowing what the RN can and cannot delegate, and what can and cannot be delegated to the RN depending on the situation. The delegation situation is arguably more complex for the RN. The details vary by situation and actor, but the mindset carries well to EMS with practice.

A site commander "conducts." A medic taking charge does that too. A paramedic can be a simple musician or they can run the show depending on the call. Nurses are "conductors" and "orchestra members" on a daily basis too. Now, not all nurses are "conducting" critical situations, but an ICU nurse managing their critical patient or running the code team is a "conductor" for a critical patient.


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## CANMAN (Jan 26, 2013)

Robb said:


> Yes I am serious. 100%. I'll argue this point all day long. If a nurse wants to work in the prehospital field they need to take a full paramedic course or a *proper* RN-to-EMT-P bridge course with appropriate clinical and classroom education along with prerequisite experience in a high acuity care setting. RN =/= Paramedic. I don't care if you have a BSN, MSN or PhD. You can't just hop on an ambulance and think you can do our job. It's not rocket science but there's plenty taught in medic school that nurses aren't taught during nursing school. Skills are easy to teach, knowing when to perform or no perform those skills or administer those medications is a totally different story. We can't just drop a tube, place a central and arterial line, draw ABGs and labs, do some radiography and ship them upstairs, that's not how it works.
> 
> The system you work in is vastly different than that of systems in the U.S. You're comparing apples to oranges. We don't staff physicians and RNs on ambulances, we staff paramedics and EMTs. It's not uncommon in some areas, and is the norm in many, to have an ambulance with two EMTs and no Paramedic, so your argument is moot.
> 
> ...



I agree with a huge part of your reply here man. I have tons of respect for nurses, I as a medical provider realize the differences between the two of us as clinicians, and what I bring to the table. MOST nurses however are fairly clueless on what Paramedics can do, and the atmosphere and situations we function in on a daily basis. In my program the nurses like to toot their horn and say "It's a nurse run team", well thats all great and well until they need an EJ started, surgical airway, difficult intubation, etc, then all the sudden the nurse isn't leading as much anymore. The times where I have to come in and take over or do a "how to" lesson plan on pacing, cardioversion, while operating on a call are frequent, and with that being said these are some strong clinicians with great backgrounds. We are placed in a team configuration for a reason, we each bring stuff to the team. It's not always the case but I find many more nurses pretending to be able to muck it as a medic, then any medics claiming to know how to be a nurse. 

I guess that should illustrate my opinion on the situation. You wanna be a medic, go get your medic, and some field experience to actually back it up. I work in MD, and have worked with a handful of PHRN's. Some are decent, most couldn't hold my jock strap on a scene call.


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## ExpatMedic0 (Jan 27, 2013)

CANMAN13 said:


> I agree with a huge part of your reply here man. I have tons of respect for nurses, I as a medical provider realize the differences between the two of us as clinicians, and what I bring to the table. MOST nurses however are fairly clueless on what Paramedics can do, and the atmosphere and situations we function in on a daily basis. In my program the nurses like to toot their horn and say "It's a nurse run team", well thats all great and well until they need an EJ started, surgical airway, difficult intubation, etc, then all the sudden the nurse isn't leading as much anymore. The times where I have to come in and take over or do a "how to" lesson plan on pacing, cardioversion, while operating on a call are frequent, and with that being said these are some strong clinicians with great backgrounds. We are placed in a team configuration for a reason, we each bring stuff to the team. It's not always the case but I find many more nurses pretending to be able to muck it as a medic, then any medics claiming to know how to be a nurse.
> 
> I guess that should illustrate my opinion on the situation. You wanna be a medic, go get your medic, and some field experience to actually back it up. I work in MD, and have worked with a handful of PHRN's. Some are decent, most couldn't hold my jock strap on a scene call.



I agree, I think its also worth mentioning what I said on the other thread vene started relating to this.
According to the NREMT the Paramedic level requires 1,000 or more hours of training after EMT-B which is 110+ hours of training. This means the absolute bare bones minimum is over 1100 hours. college credit(quarter) is equal to 20 clock hours.

To be eligible to take the NCLEX-RN® examination, the student must have completed an approved program for educating nurses. It is expected that the graduate has completed a minimum of 1,398 clock hours of study.

Both of the programs specific education core is around the same amount of training. The Paramedics focuses on pre-hospital emergencies, as to where the RN's does not and focuses on a variable cornucopia of items relating mostly to long term in definitive care. 

That is all your honor, I rest my case.


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## Veneficus (Jan 27, 2013)

schulz said:


> I agree, I think its also worth mentioning what I said on the other thread vene started relating to this.
> According to the NREMT the Paramedic level requires 1,000 or more hours of training after EMT-B which is 110+ hours of training. This means the absolute bare bones minimum is over 1100 hours. college credit(quarter) is equal to 20 clock hours.
> 
> To be eligible to take the NCLEX-RN® examination, the student must have completed an approved program for educating nurses. It is expected that the graduate has completed a minimum of 1,398 clock hours of study.



How did you come to this number?

It seems a bit low for nurses. A 12 credit hour semester (I don't know anyone still using quarters) would be equal to 96 credit hours, still short of a BS. 96x20 is 1920 hours. 120 credit hours (still a bit short would be 120x20 or 2400 hours.) The 128 credit hours to bachelor's I am familiar with would be 128x20= 2560.

That is more than double of 1100 hours.

Edit: (I stopped trying to count hours of education in med school after I hit 8K)


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## ExpatMedic0 (Jan 27, 2013)

Ref: https://www.ncsbn.org/2011_Educational_Programs.pdf 
also for your perusal  http://www.acics.org https://www.nremt.org/

We still use quarter hours a lot in the NW of USA at CC but also many universities. The number varies from state to state, often the Paramedic program is longer in hours at some CC's than the RN.

I am not trying to get into another pissing contest with this though, I am just saying the Paramedic program focuses specifically on pre-hospital emergencies. Both entry level minimum education requirements to be nationally certified/licensed are still not at a university level of education, no matter how many may argue about the future of educational trends and what is expected.


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## Veneficus (Jan 27, 2013)

schulz said:


> Ref: https://www.ncsbn.org/2011_Educational_Programs.pdf
> also for your perusal  http://www.acics.org https://www.nremt.org/
> 
> We still use quarter hours a lot in the NW of USA at CC but also many universities. The number varies from state to state, often the Paramedic program is longer in hours at some CC's than the RN.
> ...



Not rying to get into a pissing contest, it just conflicted with the obvious math, so it had to be reconciled.


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## VFlutter (Jan 27, 2013)

That 1,398 figure is probably the length of a diploma program which is still technically the minimum. But as I said before the number of diploma programs in the US is insignificant, under 30 I believe, and graduate very few students. In the next few years these programs will most likely become extinct. 

128 credit hours  is about right for my BSN


Yes we are arguing educational tends and the future but as of today it still stands the vast majority of RNs hold an associate degree or higher and that the percentage which bachelors degree has been slowly but steadily increasing over the past few years. Summit posted the older statistics. What percentage of medics hold a degree of any kind?


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## ExpatMedic0 (Jan 27, 2013)

that number was for an associates degree holding RN.(current majority of RN's) Feel free to ref the document above Vene requested. Many states medics programs have more hours than the RN program at the same college, its not uncommon.

The nurse however normally has mandatory A&P classes, biology, ect which are separate classes and do not count as part of the RN clock hours. There are of course medics who have this also, but I am pretty sure its safe to say more RN's have those separate classes than most medics, unless the medic completed an optional degree.

My point however was this, both "professions" can be granted at the community college or diploma level, granting the individual the same exact medical licence to or certification as someone who chooses to take on a higher degree.

In addition to that the training/education is for 2 completely different careers.
Who is the ultimate medical authority on a pre-hospital scene? 
In most states its an off duty Medical Doctor, otherwise Its the Paramedic. Off duty RN's are not allowed to surpass the Paramedic and have no authority over even on duty EMT-B's in pre-hospital emergencies. Why do you suppose that is?


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## silver (Jan 27, 2013)

schulz said:


> In addition to that the training/education is for 2 completely different careers.
> Who is the ultimate medical authority on a pre-hospital scene?
> In most states its an off duty Medical Doctor, otherwise Its the Paramedic. Off duty RN's are not allowed to surpass the Paramedic and have no authority over even on duty EMT-B's in pre-hospital emergencies. Why do you suppose that is?



The same is for an off duty medic. 

Why do you suppose that? Because your authority as a paramedic comes from a medical director (physician), regardless if you have ever met him/her.


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## Shishkabob (Jan 27, 2013)

Chase said:


> Yes we are arguing educational tends and the future



If you REALLY want to get picky, Paramedicine is still in its infancy, and in relation to age of the profession and education required at the same point, Paramedicine is vastly superior to nursing because we have progressed in education at a much quicker rate.  Give us another 40 years.


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## silver (Jan 27, 2013)

Linuss said:


> If you REALLY want to get picky, Paramedicine is still in its infancy, and in relation to age of the profession and education required at the same point, Paramedicine is vastly superior to nursing because we have progressed in education at a much quicker rate.  Give us another 40 years.



And respiratory therapy puts everyone to shame based on that theory. Ya'll (nursing and EMS) should just gang up on them.


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## VFlutter (Jan 27, 2013)

schulz said:


> Who is the ultimate medical authority on a pre-hospital scene?
> In most states its an off duty Medical Doctor, otherwise Its the Paramedic. Off duty RN's are not allowed to surpass the Paramedic and have no authority over even on duty EMT-B's in pre-hospital emergencies. Why do you suppose that is?



When does any off duty provider, outside of a MD, have medical authority over an on duty provider? I do not see your point 

I am not trying to argue that a RN is a better pre-hospital provider than a paramedic I am saying that a RN can transition into that role with some extra education, a bridge program. Just like if I was a Med/surg nurse moving to a cardiac unit I would have to go through a unit orientation, not go through nursing school again and retake pharm, A&P, etc. 

Who technically has authority on a RN/Medic flight team? Not a facetious question


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## Veneficus (Jan 27, 2013)

schulz said:


> In addition to that the training/education is for 2 completely different careers.



I see your point, but I am not sure if I can agree with it. 

Restraining the conversation to the US, there are several examples where nurses have entered the prehospital arena, both on ambulances and in flight. 

Yes, they have undergone some additional training, but I am willing to bet nowhere near 1100 hours. 



schulz said:


> Who is the ultimate medical authority on a pre-hospital scene?
> In most states its an off duty Medical Doctor, otherwise Its the Paramedic. Off duty RN's are not allowed to surpass the Paramedic and have no authority over even on duty EMT-B's in pre-hospital emergencies. Why do you suppose that is?



I am not sure this is entirely accurate either. Usually on a nurse/medic flight team, ultimately the nurse is in charge. I have also seen industrial EMS/medical departments where the nurse hold authority over the paramedic on all aspects of on site care. 

Obviously the nurse will usually defer when appropriate, but not always, and still retains responsibility.


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## Shishkabob (Jan 27, 2013)

Chase said:


> Who technically has authority on a RN/Medic flight team? Not a facetious question



Depends on the agency's rules, but typically if it's a scene / emergency flight, it's the medic, while if it's a transfer, it's the nurse.  And every agency I've worked for has been the same:  If it's an EMS related thing, the medic is in charge.  If it's a nurse related thing, the nurse is.


Not too often (if at all) you'll see a nurse in charge of a cardiac arrest or peri-arrest when a medic is on scene if both are held to their license.


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## Aidey (Jan 27, 2013)

Our local hems is as Linuss describes. The medic is in charge on scene calls, RN on transfers. The medic is also in charge of all things airway, although the nurses obviously know how to operate everything. They chose to have medic/RN over another configuration because they do a lot of scene calls and they found having medics prevented those from being FUBAR.


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## Summit (Jan 27, 2013)

schulz said:


> Ref: https://www.ncsbn.org/2011_Educational_Programs.pdf
> also for your perusal  http://www.acics.org https://www.nremt.org/
> 
> We still use quarter hours a lot in the NW of USA at CC but also many universities. The number varies from state to state, often the Paramedic program is longer in hours at some CC's than the RN.
> ...



First, I have to correct this "contact hours per credit" thing. Most of the nation uses semester credits. 15 credits in an average semester load. 60 credits in an associates. 120 is a bachelors. Each credit supposedly has 15-18 contact hours. *In reality, lab and clinical hours are counted at about 1/2 to 1/3 of a classroom hour.* I'm speaking for science courses as much as for RN/EMS. Example: a 5 semester credit nursing class might include 64 hours of lecture, 20 hours of lab, and 96 hours of clinical.

I am not trying to get into another pissing contest with this though, but you are being disingenuous when you claim that paramedic programs "often" longer than nursing programs. I have yet to see any. The bottom line is nationally, paramedic programs are on the whole a vo-tech program that is often done in less than a year while 96% of nursing programs are at least associate degrees that take 3 years including prereqs. It is disingenuous to do hour to hour comparisons of programs themselves when most nursing programs require close to a year of full time school in prereqs that allow them to be taught at a higher level. Let me examine a program nearby that is hospital affiliated paramedic program taught out of a CC:

Paramedic: 1200 hours of class and clinical with the following prereqs
"Current EMT-Basic or EMT-Intermediate certification
Current Healthcare Provider - CPR Certification
High School diploma, GED, or college transcript
Documentation of reading level at 10th grade or above
Basic EKG & IV Approval courses (EMT-Basic Applicants ONLY)
Anatomy & Physiology (College Level) is included in the program and not a requirement for admission."

Now... 31 semester hour credits are given for the paramedic portion of the program. That is what you expect for the non 1:1 consideration of clinical and lab hours. If you make it a 62 hour AAS, they are including 14 credits for EKG, IV, and EMT-B!

It's sister college RN associates program is 750 clinical hours and 51 credits of nursing courses in an 82 credit degree with the following prereqs:
BIO 201 Human Anatomy and Physiology I
BIO 202 Human Anatomy and Physiology II
BIO 204 Microbiology
BIO 216 Pathophysiology
ENG 121 English Composition I
HWE 100 Human Nutrition
MAT 103 Math for Clinical Calculations
PSY 235 Human Growth and Development
Elective: GT Arts & Humanities or Social and Behavioral Science

It is actually 93 credits because BIO201 require 5hr BIO 101 Biology 1 with lab, and PSY235 requiers PSY 101&102 Psychology 1&II.

So that is 93 semester credits against 62 for Paramedic... looking at a random Oregon college (PCC), it is 122 quarter credits for an RN (not counting the required CNA) and 107 for Paramedic (which still includes EMT).

I'm not talking outliers either. I'm talking about the paramedic program I was going to attend if I didn't go nursing, and the nursing program at it's sister CC, a fairly average CC RN program. It isn't the nursing program I attended. If you want an outlier, I had 132 hours... I took 66 semester credits of nursing specific classes after fulfilling the same number of prereqs credits and I had ~1600 hours of clinical. I seek the top... that nursing education only accounts for one half of all the college credits I've earned.

You are right that neither profession has a university level requirement, but 39% university prepared entry level is a lot more than essentially 0%


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## ExpatMedic0 (Jan 27, 2013)

I went to PCC for a couple terms and since you mentioned it, lets compare that shall we.

Paramedic http://www.pcc.edu/academics/index.cfm/46,897,30,html
RN http://www.pcc.edu/about/catalog/nur.pdf

As I am sure you saw the pre-recs are the same and degree's are both entry level requirements for both providers in Oregon.

The Difference? Well one focuses only on Pre-hospital Emergencies, the other on long term care in a hospital. I think that is what should be taken away from this entire thread. If a RN wants to be a medic they should take a bridge if a medic wants to be an RN they should take a bridge. Its a 2 way road.

Also as you can see, we mostly use quarter hours in WA and OR. Its fine if you use semester hours where your at. As I posted before clock hour conversion can be found here http://www.acics.org/news/content.aspx?id=4419
In regards to the program clock hours themselves, yes many medic programs have more "clock hours" then RN programs, or are always at least comparable to one another.

I think saying 0% of us hold a degree  is a little unfair don't you? Many of us on this board hold degree's, as you know I am completing a BS and many of my previous co workers and present colleagues hold a degree with there P card. Plus there are the 2 or 3 states where everyone is required to hold a degree. I could have just as easily spent that time and money to become an RN but I chose not to. I like my job.

I am not saying the minimum education nationwide is satisfactory for pre-hospital care providers. It still has a long a way to go and I am doing my part. Slowly but surely it will continue to improve. However summing up medics as non educated bafoons who went to something like truck driving school is making a blanketed statements. Especially when you side by side compare most associate's degree programs.This may or may not reflect providers in your area but it certainly does not effect us all.


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## VFlutter (Jan 27, 2013)

schulz said:


> I think saying 0% of us hold a degree  is a little unfair don't you? Many of us on this board hold degree's, as you know I am completing a BS and many of my previous co workers and present colleagues hold a degree with there P card.



I believe he was referring to the 39% of RNs who hold BSNs compared to the percentage of medics who hold a bachelor degree which while not 0% is much much lower. I would be surprised if 39% of medics nationwide held a degree of any kind.


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## Summit (Jan 27, 2013)

Chase said:


> I believe he was referring to the 39% of RNs who hold BSNs compared to the percentage of medics who hold a bachelor degree which while not 0% is much much lower. I would be surprised if 39% of medics nationwide held a degree of any kind.



I was referring specifically to the number of medics who hold a bachelors in paramedicine or equivalent at entry into practice versus the number of RNs who hold a bachelors in nursing at entry into practice. That is essentially 0% to 39%.

I am not speaking about the highest degree achieved outside of the profession. We all know there are plenty of medics and nurses with degrees outside their field.

We could step it down to associates or higher in the field at entry to practice, then you have 96% for nurses vs what for paramedics nationwide?


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## truetiger (Jan 28, 2013)

Lets look at what the BSN degree adds as far as direct patient care education.....not much. These were listed under "nursing major" for a RN to BSN program.  http://www.centralmethodist.edu/cges/_docs/majorminors/nursing.pdf
AH316 Data Analysis for Nursing Practice (3)
AH330 Business Concepts in Health Care/Case Management (3)
NU300 Adaptation Nursing Model (2)
NU301 Physical Assessment (2)
NU303 Research in Nursing (3)
NU315 APA Formatting and Library Databases (1)
NU320 Adaptation Nursing in the Community (4)
NU325 History/Trends in Nursing (3)
NU450 Integrated Concepts on Adaptation Nursing (6) NU455 Professional Issues, Leadership, and Management (3)

I see only 2 hours pertaining to direct patient care.


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## Shishkabob (Jan 28, 2013)

truetiger said:


> Lets look at what the BSN degree adds as far as direct patient care education.....not much.... I see only 2 hours pertaining to direct patient care.



Or ADNs and their "Well I had pre-reqs too!"  Sweet, you can do a spreadsheet!  Guess what, I can RSI.


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## Summit (Jan 28, 2013)

The best numbers I could find for Paramedic graduates are from a 2008 study (that quotes a 2005 study):

<1 year certificate program: 75.4%
1-2 year certificate program: 14.8%
Associates Degree program: 9.2%

http://www.ems.gov/pdf/EMSWorkforceReport_June2008.pdf (Warning 152 page PDF!)

I’m sure the Associates numbers are higher now. As far as the highest degree of any nature, I could only find this 2006 statistic about *EMS INSTRUCTORS*:

"EMS educators reported the following was their highest level of education: 11.6% High School/GED, 38.5% Some College, 20.9% Associate Degree, 21.3% Bachelor’s Degree, 7.8% Graduate Degree. Overall, EMS instructors have similar educational credentials to the students that they are teaching."  (Note that this statistic includes physicians, PAs, RNs, and RTs who are EMS educators.)

Nursing professors all have at least a Masters degree. But what is the educational distribution of nurses?

In 2008, 49% of working RNs had acquired a BSN, nursing related bachelors, or graduate nursing degree. 13.2% of RNs had a graduate degree in nursing or a related field. Only 13.3% of working RNs did not have a nursing related degree. I’m certain the BSN+ holders are well over 50% BSN today; the profession’s goal is 80% by 2020.

37.1% of RN students between 2005 and 2008 had a degree in another field, 40% in a health related field, and the majority were bachelors or above. About 9% of RN students were employed in EMS prior to school.

http://www.thefutureofnursing.org/sites/default/files/RN Nurse Population.pdf (Warning! 359 page PDF!)



Linuss said:


> Or ADNs and their "Well I had pre-reqs too!"  Sweet, you can do a spreadsheet!  Guess what, I can RSI.



Hey, it is all about skills, right? 

But, let us just say that the same amount of time in spent in the program teaching paramedics and nurses. Who can you teach at a higher level? 

A vo-tech EMT with a year on the street taught by educators that are statistically unlikely to have a 4 year degree?

Or how about when doctoral/masters prepared professors get to spend "the same amount of time" teaching a student who walked in the door with*:
College A&P with lab
College Chemistry with lab
Microbiology with lab
Biology with lab
Pathophysiology
Psychology
Sociology
Human Growth and Development
College Algebra
English Composition
Statistics
15 semester credits of other stuff, which probably includes a class in *Micorsoft Excel* too!!!!!!!!!!!!!!!!!!! 

*Prereq list from a typical AACN or NLN accredited BSN program

*That still doesn't mean the RN can magically be a paramedic.* It does mean that the BSN RN has a foundation of general and medical education that will allow them to bridge relatively easily (as opposed to bridging from the other direction).

PS I don't like ACICS.
PPS BSN for initial licensure vs RN-BSN is a whole other thread. If you want, I'll happily link you to the RNs arguing about it at length.


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## truetiger (Jan 28, 2013)

My paramedic program awarded 40 credit hours, my emt 10. That's 50 hours specifically in one area of medicine. From the ADN program at the local cc, I see they take 58 hours in multiple areas. Having taken ACLS with our local ER nurses, they always need help through the class.


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## silver (Jan 28, 2013)

truetiger said:


> My paramedic program awarded 40 credit hours, my emt 10. That's 50 hours specifically in one area of medicine. From the ADN program at the local cc, I see they take 58 hours in multiple areas. Having taken ACLS with our local ER nurses, they always need help through the class.



Its important to note that different universities and even different programs award credits differently. For example, I took a class that required 12 hours of service a week on top of the normal class time and was awarded 3 credits, which is the same as all my other classes. Some of my labs, which were all 1 credit were either 2, 3, or 4 hours a week.

Also its important to note that we shouldn't compare apples to oranges. Nurses aren't trained on ACLS until on the job (if even) and don't frequently use the algorithms. 

This has essentially come down to each side using moot points.


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## ExpatMedic0 (Jan 28, 2013)




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## Shishkabob (Jan 28, 2013)

silver said:


> Also its important to note that we shouldn't compare apples to oranges. Nurses aren't trained on ACLS until on the job (if even) and don't frequently use the algorithms.



Once was privy to a conversation between a couple of cath lab nurses and a nursing student.  The nurses stated a new grad had no business being in the cath lab because they "can't read a 4 lead yet, and only doctors can do 12s", and they "Haven't really even done ACLS so they don't know what to do in a code".


I brought up the fact that a new medic, from day one of graduation, could run a code and do a 12 lead.



They didn't like the fact that a medic is not only more qualified, but more suited for the cath lab, than an otherwise equal nurse is.


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## Summit (Jan 28, 2013)

Linuss said:


> Once was privy to a conversation between a couple of cath lab nurses and a nursing student.  The nurses stated a new grad had no business being in the cath lab because they "can't read a 4 lead yet, and only doctors can do 12s", and they "Haven't really even done ACLS so they don't know what to do in a code".
> 
> 
> I brought up the fact that a new medic, from day one of graduation, could run a code and do a 12 lead.
> ...



Doesn't it seem strange to you that you ONLY run into below average providers? At least those are the only anecdotes you present when concluding that all providers inferior to you. One starts to wonder if it is the photographer and not the subject.


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## VFlutter (Jan 28, 2013)

Linuss said:


> They didn't like the fact that a medic is not only more qualified, but more suited for the cath lab, than an otherwise equal nurse is.



I think you have just have bad luck with dumb nurses. I have spent a decent amount of time in two seperate cath labs and it was  totally different than what you described. 

Personally I could perform and interpret 12 leads upon graduation. I also did not feel out of place during codes. 

I am not sure why you think a medic is more qualified or better suited for the cath lab. How many medics have adequate experience with IABPs and transvenous pacers?  

I am assuming you have spent some time in the Cath lab and realize how involved the RNs are in the procedure.


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## silver (Jan 28, 2013)

Chase said:


> I think you have just have bad luck with dumb nurses. I have spent a decent amount of time in two seperate cath labs and it was  totally different than what you described.
> 
> Personally I could perform and interpret 12 leads upon graduation. I also did not feel out of place during codes.
> 
> ...



Its also important to note that RNs do peri-procedural care in the cath lab. Once in the lab, it is a complex "dance" acting as a circulator. This includes managing the patient, documenting, giving medications, running/setting up non-sterile things (IABPs, pacing, vents etc. as stated), and grabbing things that are needed (and you better have what the physician wants before he/she even asks).

Sure you can run a code better, the medic/nurse will never run it in the cath lab as there is a cardiologist there. Additionally, it is such a minor part of the job of a cath lab nurse. In the extremely busy cath lab I worked in for a summer, we had two codes during daytime hours (and a couple "uh oh we put the patient in VFib" moments that didn't count).


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## usalsfyre (Jan 28, 2013)

Role creep and arguing why RNs are superior for everything is EXACTLY why much of the rest of healthcare looks at the nursing lobby with a critical eye....

Just saying


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## Veneficus (Jan 28, 2013)

usalsfyre said:


> Role creep and arguing why RNs are superior for everything is EXACTLY why much of the rest of healthcare looks at the nursing lobby with a critical eye....
> 
> Just saying



I must agree with this. 

Nursing research is basically nurses claiming what they already do is best. It is even worse than a drug company telling you they conducted research and their new drug is safe and cures all. 

Nurses even create awards for places that embrace their position, like the magnet award. (If you think it is about patients or safety, you might want to read with a more critical eye the homepage on who gives it and why)

However, if you notice...

RTs, PAs, perfusionists, and all other manner of healthcare provider has a minimum level of education to practice that is sufficent enough for them to defend their position as experts and the most capable. 

Paramedics not only do not have this, they do not embrace it, and they don't even have their own biased research to back it up. All they do is spout their gas about how great they are and how everyone else sucks.

So really, why should anyone treat them as experts or equals much less superior?

US medics don't have the education societies all over the world use as a measurable standard for every profession.

US medics do not have an organization that lobbies for them in a money talks BS walks world. (Don't even try to count the coopted NAEMT) 

US medics have not embraced evidence based practice, further degrading their expert position.

US medics do not lobby or accept responsibility for their profession. "But my protocol says..." Medical directors are a dime a dozen, demand change. (of course if you do that and something goes wrong, you have nobody to blame but yourself)

US medics focus their training on an incredibly small portion of medicine. Then claim expertise from experience. How would you like your doctor to learn on the job? Your surgeon? Your aesthesiologist? Your Ob/Gyn?

As it stands today, US nurses are more educated ad more qualified to work prehospital than medics. 

Medics have nobody to blame but themselves. 

For years I have advocated medics need to increase their education. They always say there is nothing in it for them, they don't want to front the money... I have heard it all. 

I asked then and I ask now? Is your job worth the investment? Because somebody more educated is poised to take it from you and/or so pigeon hole you in such a small role that you will be lucky to not need food stamps in a few years.

What if a group of people who think advanced edcation is valuable prehospital over your feeble skills, went out and got nusing degrees, and then started to take over EMS by also finding roles as dual providers, using your skills training as the environment specific training? 

Because nurses have done so. Look at your leaders, from educators to dare I say? the NREMT?

You claimed you did not need education. You claimed you were just there for emergencies. You claimed it wasn't worth your time and money.

You said I didn't know what I was talking about. That nurse to medic - medic to nurse street is not 2 way. You have nobody to blame but yourself.

"Even a monkey can intubate..."

A curious phrase.


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## Aidey (Jan 28, 2013)

Summit said:


> Doesn't it seem strange to you that you ONLY run into below average providers? At least those are the only anecdotes you present when concluding that all providers inferior to you. One starts to wonder if it is the photographer and not the subject.



Not necessarily. If the main local nursing program is sub par it could explain running into a high concentration bad nurses. If that can happen with medic programs, there is no reason it can't happen with nursing programs. 



Chase said:


> I think you have just have bad luck with dumb nurses. I have spent a decent amount of time in two seperate cath labs and it was  totally different than what you described.
> 
> Personally I could perform and interpret 12 leads upon graduation. I also did not feel out of place during codes.
> 
> ...




I think your 12 lead ability isn't a widespread thing. To be very blunt, I know EMT Bs with better 12 lead interpretation skills than most ED nurses who have tried to do it. 

Anecdote time. A few days ago I brought in a chest pain that was positive for every stereotypical AMI symptom. Her EKG was very very suspicious for a cardiac event, but didn't meet STEMI criteria. The RN INSISTED on seeing it before I went to talk to the MD (who I had spoken to on the phone about this pt). I told her it wasn't a STEMI and I wasn't sure what to call it. She proceeds to say "Well, there is a P wave so we know it is a sinus rhythm. And she has big T waves, so that means she has hyperkalemia. There you go, now we know what it is." :glare::glare::glare: :glare::glare::glare:


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## usalsfyre (Jan 28, 2013)

Veneficus said:


> I must agree with this.
> 
> Nursing research is basically nurses claiming what they already do is best. It is even worse than a drug company telling you they conducted research and their new drug is safe and cures all.
> 
> ...



Which is why I posted the other tread about educators. Not saying we don't need to change. But simply handing the keys over via "bridge programs" ect isn't what I'm looking for.


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## Veneficus (Jan 28, 2013)

usalsfyre said:


> Which is why I posted the other tread about educators. Not saying we don't need to change. But simply handing the keys over via "bridge programs" ect isn't what I'm looking for.



Because of the lack of interest of most EMS providers, that may have been decided for you and them by parties not involving them.


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## Shishkabob (Jan 28, 2013)

Chase said:


> How many medics have adequate experience with IABPs and transvenous pacers?



And how many nurses have experience with the same exact things before they're out in the workforce and taught it?  Your point proves nothing.

Nurses don't know anything until they're taught it.  Same as Paramedics.  Same as every other provider.  Quit acting like nurses are an exception.


But since we're talking about nurses in an out-of-hospital environment...  "How many nurses have adequate experience running a cardiac arrest?  Starting IOs?  Synchronized cardioversion?  Intubation?  I can keep going if you'd like.



Summit said:


> Doesn't it seem strange to you that you ONLY run into below average providers? At least those are the only anecdotes you present when concluding that all providers inferior to you. One starts to wonder if it is the photographer and not the subject.



The stories are post-worthy because they are the exception, not the norm.  I don't post every encounter.   Someone has to be at the bottom of their respective class. 


I deal with a wider variety of providers at a wider variety of locations than someone that works in a single facility, typically at a single place, like you do.  No?  There are crappy facilities with crappy people, there are great facilities with great people. 




silver said:


> Its also important to note that RNs do peri-procedural care in the cath lab. Once in the lab, it is a complex "dance" acting as a circulator. This includes managing the patient, documenting, giving medications, running/setting up non-sterile things (IABPs, pacing, vents etc. as stated), and grabbing things that are needed (and you better have what the physician wants before he/she even asks).


  Because Paramedics can't do that stuff?  Because Paramedics are somehow unable to learn on the job the same way nurses are?  Ok...


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## Summit (Jan 28, 2013)

Veneficus hits the nail on the head, repeatedly.

Aidey: fair enough



usalsfyre said:


> Which is why I posted the other tread about educators. Not saying we don't need to change. But simply handing the keys over via "bridge programs" ect isn't what I'm looking for.



I wouldn't worry. There are far more RNs than medics, but RNs are not lined up out the door for medic bridge programs. Most of them have no interest for are variety of reasons, personal to professional to economic.


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## Shishkabob (Jan 28, 2013)

Summit said:


> I wouldn't worry. There are far more RNs than medics, but RNs are not lined up out the door for medic bridge programs. Most of them have no interest for are variety of reasons, personal to professional to economic.



I've yet to meet an RN who earned their medic the correct way that didn't prefer being a medic but work as an RN due to the pay.


Pay being equal, I'm confident more people would prefer working as a medic.  It's just more fun (per them)


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## silver (Jan 28, 2013)

Linuss said:


> Because Paramedics can't do that stuff?  Because Paramedics are somehow unable to learn on the job the same way nurses are?  Ok...



The documentation, assessment, patient advocacy, and overall continuum of care is drilled into their brains in clinicals.

And let us look at what I was responding to:



Linuss said:


> Once was privy to a conversation between a couple of cath lab nurses and a nursing student.  The nurses stated a new grad had no business being in the cath lab because they "can't read a 4 lead yet, and only doctors can do 12s", and they "Haven't really even done ACLS so they don't know what to do in a code".
> 
> 
> I brought up the fact that a new medic, from day one of graduation, could run a code and do a 12 lead.
> ...



That's strange, we weren't talking about "on the job training" but who was better suited and more qualified.


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## Summit (Jan 28, 2013)

Linuss said:


> And how many nurses have experience with the same exact things before they're out in the workforce and taught it?  Your point proves nothing.
> 
> Because Paramedics can't do that stuff?  Because Paramedics are somehow unable to learn on the job the same way nurses are?  Ok...
> 
> Nurses don't know anything until they're taught it.  Same as Paramedics.  Same as every other provider.  Quit acting like nurses are an exception.



Hey, its all about the skills and that's just OJT! Why do people go to medic school. Medics don't know anything until they are taught, so why not just give EMTs OJT?

The interventional radiologist and the cardiologist don't want an OJT trained technician. If they did, then they would train paramedics for the cath lab!

The difference is the broad collegiate foundation that nurses receive in both medical and general education from graduate prepared professors vs paramedic technical training from peers. I pointed this out, as did veneficus.

It is clear that you don't have any regard for the merits of a liberal arts education, so my words mean nothing to you. Perhaps this reality will mean something: If paramedicine was a bachelors-as-entry-to-practice, as it is in other countries, this thread wouldn't exist, I'd be a paramedic, and maybe pay would be equal!



> I deal with a wider variety of providers at a wider variety of locations than someone that works in a single facility, typically at a single place, like you do.  No?  There are crappy facilities with crappy people, there are great facilities with great people.


When you assume...
I work at one hospital, volunteer at two ems agencies, teach for an ems agency and a school, interact with another ems agency and another hospital. There are great and crappy providers of all persuasions, but I don't go out of my way to point out the negatives experience with one type.

As a new EMT, I had a crappy opinion of nurses for a year or two because that was the attitude of my first EMS mentors, and some people on this forum. I spouted the same crap I see here still: nurses only follow orders, nurses don't know how to care for critical patients or handle emergencies, yada yada yada. I didn't know any better until another job where I worked closely with nurses. 

At the same time I came to understand the limitations of EMS education and professional progression. If EMS was set up as a profession like nursing, or like EMS in other countries, I never would have gone to nursing school.


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## Aidey (Jan 28, 2013)

Lets keep this from descending purely into nurses vs paramedics ok?


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## Shishkabob (Jan 28, 2013)

Summit said:


> but I don't go out of my way to point out the negatives experience with one type.



When we're discussing just one type, you want me to bring up experiences totally unrelated to the discussion at hand?  



Summit said:


> I spouted the same crap I see here still: nurses only follow orders, nurses don't know how to care for critical patients or handle emergencies, yada yada yada





I don't spout that off because I know that's not (all) true*.  I spout off personal experiences, but alas even that isn't good enough for you.  Can't be a general, can't be specific.  Guess we're just supposed to not say anything, huh?





*Actually, it is:  Nurses only follow orders, just like medics.  Certain nurses can't care for ciritical patients, just like certain medics can't care for the chronically ill.  Etc etc etc.  But you're the one generalizing, not me.


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## ExpatMedic0 (Jan 28, 2013)

Ok... I've had my fun with the nurses. I will never see completely eye to eye with everyone on "the other side."
I think however we all agree there should be a bridge for both sides, for the medic if its a state which requires at least an AAS then the medic should hold that but still be allowed to bridge (which already exist in many states) However, nurses should have to do the same unless the RN has 1100 clock hours in "Pre-Hospital Emergencies" that meets something like the DOT and NREMT course curriculum. Nursing school and Paramedic school are two different things, two different jobs, with 2 different goals. A Paramedic is not only a specialist in Emergencies, but emergencies that happen outside of a hospital.


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## Veneficus (Jan 28, 2013)

schulz said:


> Ok... I've had my fun with the nurses. I will never see completely eye to eye with everyone on "the other side."
> I think however we all agree there should be a bridge for both sides, for the medic if its a state which requires at least an AAS then the medic should hold that but still be allowed to bridge (which already exist in many states) However, nurses should have to do the same unless the RN has 1100 clock hours in "Pre-Hospital Emergencies" that meets something like the DOT and NREMT course curriculum. Nursing school and Paramedic school are two different things, two different jobs, with 2 different goals. A Paramedic is not only a specialist in Emergencies, but emergencies that happen outside of a hospital.



I think 1100 is a bit much considering paramedics do not have such hours. Like I said in the other thread, other healthcare providers do not need to hear the basic anatomy, physiology, and pathophys that is part of that 1100 hours.


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## ExpatMedic0 (Jan 28, 2013)

Veneficus said:


> I think 1100 is a bit much considering paramedics do not have such hours. Like I said in the other thread, other healthcare providers do not need to hear the basic anatomy, physiology, and pathophys that is part of that 1100 hours.


I suppose your right about that, I forgot some states do not require A&P as a pre-rec. WA state does or at least where I was and Oregon requires(or at least use to) the whole series. I can not comment on every state, but as a national standard you are correct it is part of the 1100 I guess.


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## EpiEMS (Jan 28, 2013)

How about just let RNs bridge if they've taken an EMT course and complete a EMT-P refresher course (and NR, I suppose)? Not a lot of hours there, but it allows for training of core areas, no?


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## Veneficus (Jan 28, 2013)

EpiEMS said:


> How about just let RNs bridge if they've taken an EMT course and complete a EMT-P refresher course (and NR, I suppose)? Not a lot of hours there, but it allows for training of core areas, no?



I do not agree.

I think the EMT-B should be a prereq to any bridge.

The 2 things nurses need to bridge are medic skills training and supervised out of hospital clinical time as the primary decision maker. 

A refresher will not provide adequete time for skills like intubation, comfort with things like ACLS, familiarity with the medications, or field experience.

I would not advocate for any program that did not include ride time. 

I would also add ED time to that if the nurse did not have prior work experience or clinical time in the ED. 

I would not accept only ICU time because one of the most important skills is "sick/not sick" and there aren't many "not sick" people in the ICU.


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## EpiEMS (Jan 28, 2013)

Veneficus said:


> I do not agree.
> 
> I think the EMT-B should be a prereq to any bridge.
> 
> ...



I see what you're saying. So, beyond the EMT cert, a Medic bridge program of several hundred hours (including ride time) would be enough?


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## Veneficus (Jan 28, 2013)

EpiEMS said:


> I see what you're saying. So, beyond the EMT cert, a Medic bridge program of several hundred hours (including ride time) would be enough?



That is how the math works out:

http://www.emtlife.com/showthread.php?t=33957&highlight=stupid+nurses


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## EpiEMS (Jan 28, 2013)

Veneficus said:


> That is how the math works out:
> 
> http://www.emtlife.com/showthread.php?t=33957&highlight=stupid+nurses



Seems fair. (Not that I am either an RN or a medic.)


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## JPINFV (Feb 5, 2013)

Since this thread came up...

There's always a problem when it comes to bridging, and even more so, when it comes to giving straight equilivance. The question is, "How close are the fields?" Just comparing education level and foundation isn't enough. For the nurses, do you think a physician should be able to be hired on to act as a nurse without any additional education or training? After all, a physician is much highly trained and educated than the average nurse. Alternatively, is the practice of medicine and the practice of nursing a significant enough divide that just OTJ training isn't enough?

Similarly, is the divide between paramedicine and nursing facing a similar divide where a formal bridge course should be required to work in EMS?


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## Handsome Robb (Feb 5, 2013)

JPINFV said:


> Since this thread came up...
> 
> There's always a problem when it comes to bridging, and even more so, when it comes to giving straight equilivance. The question is, "How close are the fields?" Just comparing education level and foundation isn't enough. For the nurses, do you think a physician should be able to be hired on to act as a nurse without any additional education or training? After all, a physician is much highly trained and educated than the average nurse. Alternatively, is the practice of medicine and the practice of nursing a significant enough divide that just OTJ training isn't enough?
> 
> Similarly, is the divide between paramedicine and nursing facing a similar divide where a formal bridge course should be required to work in EMS?



In my opinion, yes. 

Having general education plus nursing education either at the ADN or BSN level doesn't qualify you to automatically jump on a truck and act as the ALS provider in charge. 

The argument keeps coming up that EMT-B should be sufficient to transition but I personally don't agree. 

I know that I have no business challenging the NCLEX, walking into an ER or ICU, tossing on a pair of scrubs and jumping into a nursing roll. They're two different fields. They have their similarities but there has to be a bridge program if you're wanting to transition from one to the other. 

I have no issue with a nurse taking an appropriate bridge course with an ALS internship just like any other paramedic student then being allowed to challenge the NREMT-P. I'd argue they need to do OR rotations as well and depending on what kind of nursing they've been doing potentially ER/ICU/CIC rotations as well. If they work in those settings I'd have no problem having experience meet that requirement. With that said, it needs to be a two way street. I'm not advocating that a paramedic be allowed to challenge the NCLEX but why would it be inappropriate for a AAS/BS Paramedic taking a bridge course with some clincals as well then being able to challenge the NCLEX and not be viewed as an "inferior" nurse?

Just for :censored::censored::censored::censored:s and giggles I did the math on my education hours the other day.  
With EMT-B, I, and P I'm sitting at 1950 hours of prehospital education (EMT-B was 200, EMT-I was 250 and Medic was 1500), not including the smattering of general education classes I've taken at the CC and University level. Where does that fall when compared to nurses? I'd be willing to bet that it's just as much if not more than most ADN programs. Add in the prerequisite general education and sciences BSNs are required and I'm sure we're just about dead even. My google-fu is failing me when I try to find out total clock ours for ADN and BSN, just keep getting the credit hour requirements. 

I just don't understand how nurses think they can challenge our exam then can run the show...every nurse that's every done a ride along with me for either EMT class or for fun has told me they were completely lost on scene as to what was going on and how to manage things. Now this is anecdotal but I think it's a pretty solid example. All of this can be fixed with an appropriate bridge course but thinking they can just jump in the ring and box is disrespectful, in my opinion.


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## VFlutter (Feb 5, 2013)

Robb said:


> Just for :censored::censored::censored::censored:s and giggles I did the math on my education hours the other day.
> With EMT-B, I, and P I'm sitting at 1950 hours of prehospital education (EMT-B was 200, EMT-I was 250 and Medic was 1500), not including the smattering of general education classes I've taken at the CC and University level. Where does that fall when compared to nurses? I'd be willing to bet that it's just as much if not more than most ADN programs. Add in the prerequisite general education and sciences BSNs are required and I'm sure we're just about dead even. My google-fu is failing me when I try to find out total clock ours for ADN and BSN, just keep getting the credit hour requirements.



Eh, adding in the EMT-I is a little redundant since you could have gone right from EMT-B to EMT-P and it does not add anything that was not covered during your paramedic course. That would be like me going from CNA to LPN then BSN and claiming that I had more education then other BSNs because of the hours from the CNA and LPN when in reality all of that was covered in the BSN program. More experience maybe but education no. 

My BSN was ~ 125 credit hours. According to google 1 credit hour = 18 class hours so that would come out to 2,250 hours. 

But comparing straight hours is worthless. You can not compare vocational hours to college credit hours. 

200 hours of EMT-B is not equal to 200 hours of university course work. 

My science labs alone add up to over 200 hours.

1 hour of sitting in an EMT class learning about how blood flows through the heart is not equal to 1 hour of anatomy lab dissecting a heart. 



Robb said:


> I just don't understand how nurses think they can challenge our exam then can run the show...every nurse that's every done a ride along with me for either EMT class or for fun has told me they were completely lost on scene as to what was going on and how to manage things. Now this is anecdotal but I think it's a pretty solid example. All of this can be fixed with an appropriate bridge course but thinking they can just jump in the ring and box is disrespectful, in my opinion.



While some may argue differently it seems that many of the RNs that come to this site, including me, do not hold the view that we can challenge the exam and jump right on the truck. The majority are looking for some type of bridge program and usually are seeking Flight or CCT jobs. Even my arrogant self will admit that I could not jump on the truck today and function as an independent paramedic. But I am confident it would not take me much to get there, definitely not an entire paramedic program.


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## VFlutter (Feb 5, 2013)

As far as prerequisites go here is my school's requirents

    Minimum 3.0 cumulative undergraduate GPA
    Minimum of 54 credit hours in the following prerequisite courses:
        Anatomy and Physiology I with lab* †
        Anatomy and Physiology II with lab* †
        Microbiology with lab* †
        Human Growth and Development (across the lifespan) †
        Nutrition †
        Statistics †
        Ethics
        College Algebra
        English Composition I
        English Composition II
        Introduction to Sociology
        General Psychology
        History or Political Science
        Biology, Chemistry, Genetics, or Physics
        General Elective
        Humanities Elective
        Social Science Elective

54 credit hours is the bare minimum but many will have more before getting accepted. I think i had 66


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## Handsome Robb (Feb 5, 2013)

Chase said:


> Eh, adding in the EMT-I is a little redundant since you could have gone right from EMT-B to EMT-P and it does not add anything that was not covered during your paramedic course. That would be like me going from CNA to LPN then BSN and claiming that I had more education then other BSNs because of the hours from the CNA and LPN when in reality all of that was covered in the BSN program. More experience maybe but education no.



Agreed, it is redundant but I also worked as an Intermediate so it was something that's required of me. So in that case, take out Intermediate and it drops me to 1700 hours. 



> My BSN was ~ 125 credit hours. According to google 1 credit hour = 18 class hours so that would come out to 2,250 hours.



Your google-fu is stronger than mine!



> But comparing straight hours is worthless. You can not compare vocational hours to college credit hours.
> 
> 200 hours of EMT-B is not equal to 200 hours of university course work.
> 
> ...



This is assuming that every EMS education program is created equally. The minimum standards are low but many schools go past the minimum. I'll admit vocational =/= university level but I will argue that there are Medic programs out there that are taught at a higher level than you would think. 

Maybe I'm an exception but my medic school was taught by plenty of instructors with teaching at the CC and University level. Ranging from EMT-Ps, CC-Ps, RNs, NP/CRNAs, PAs all the way up to MDs. Did they all have collegiate level teaching experience? No, but many of them did. My graduation certificate is also issued by a state University. I will agree though that my program is not the norm. 



> While some may argue differently it seems that many of the RNs that come to this site, including me, do not hold the view that we can challenge the exam and jump right on the truck. The majority are looking for some type of bridge program and usually are seeking Flight or CCT jobs. Even my arrogant self will admit that I could not jump on the truck today and function as an independent paramedic. But I am confident it would not take me much to get there, definitely not an entire paramedic program.



Like I said, I have no problems with a bridge course. The problem I have is the inability for medics with education past a vocational program to bridge into nursing. Even if it isn't a degree related to medicine, why can't a medic with a associates or bachelors with appropriate science prerequisites bridge into nursing? 

It just seems like a double standard to me. Maybe I'm just being young and naive though.


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## VFlutter (Feb 5, 2013)

Robb said:


> My graduation certificate is also issued by a state University.



So was my EMT-B graduation certificate. I am not sure that really adds to the value. It looks pretty cool though h34r: 




Robb said:


> Like I said, I have no problems with a bridge course. The problem I have is the inability for medics with education past a vocational program to bridge into nursing. Even if it isn't a degree related to medicine, why can't a medic with a associates or bachelors with appropriate science prerequisites bridge into nursing?
> 
> It just seems like a double standard to me. Maybe I'm just being young and naive though.



There are a few Medic to RN programs out there however they are longer than what I would consider a "bridge" program. 

I agree there is a double standard. And I am younger and probably more naive then you


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## Handsome Robb (Feb 6, 2013)

Chase said:


> So was my EMT-B graduation certificate. I am not sure that really adds to the value. It looks pretty cool though h34r:



Alright, you got me there. Can't really argue with that. 



> There are a few Medic to RN programs out there however they are longer than what I would consider a "bridge" program.
> 
> I agree there is a double standard. And I am younger and probably more naive then you



I, admittedly, don't know what all it would take to make a good medic a good nurse. I also don't know exactly what it would take to make a good nurse a good medic. 

Skills is an obvious area. Scene management and operations is another. Delegation, well I'll leave that alone since it blew up the last time it was brought up. Patient packaging as well is an area I think that would need to be covered. ECGs for sure (I know lots of RNs that can read 12s as good if not better than most medics I know just like I know lots of nurses that can't tell you a whole lot about a 12-lead other than "it's sinus..."). I'm sure there are more but those are the ones I can think of off the top of my head. 

One question I will ask is how far into "initial" presentation of different illnesses and injuries does nursing school go? I'm sure it's just as much if not more than Paramedic, just asking more than anything. 

I've said it a million times before and I'll say it again. I have a lot of respect for nurses and what they do, I don't know half the stuff nurses do. With that said, there's plenty that we do that many nurses aren't aware of. There are plenty of moron paramedics out there but at the same time, there's plenty of moron RNs as well.


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## STXmedic (Feb 6, 2013)

*generic comment intended to stir the pot*


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## VFlutter (Feb 6, 2013)

Robb said:


> One question I will ask is how far into "initial" presentation of different illnesses and injuries does nursing school go? I'm sure it's just as much if not more than Paramedic, just asking more than anything.





We studied the whole continuum of a disease including initial presentation not just late or chronic. We only covered the basics of trauma but the medical was very comprehensive. 




PoeticInjustice said:


> *generic comment intended to stir the pot*



Do you and your wife have Medic Vs RN debates at the dinner table? I am guessing she wins


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## Handsome Robb (Feb 6, 2013)

Chase said:


> We studied the whole continuum of a disease including we initial presentation not just late or chronic. We only converted the basics of trauma but the medical was very comprehensive.



That's what I figured. Trauma care isn't all that complicated in the prehospital setting. Probably something that should be covered more though, we spent 5 weeks on trauma during class. 



> Do you and your wife have Medic Vs RN debates at the dinner table? I am guessing she wins



They always win, no matter what! It's a pain in the ***.


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## ffemt8978 (Feb 6, 2013)

Chase said:


> Do you and your wife have Medic Vs RN debates at the dinner table? I am guessing she wins



Wives ALWAYS win the arguments...if she doesn't, it's because she is an ex-wife.


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## STXmedic (Feb 6, 2013)

Chase said:


> Do you and your wife have Medic Vs RN debates at the dinner table? I am guessing she wins



It's actually pretty even since we both have our strengths  But I'm taking advantage of it while I can, because I'm pretty certain after a year working in the NSICU she's going to be running circles around me... :sad: :lol:


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## STXmedic (Feb 6, 2013)

ffemt8978 said:


> Wives ALWAYS win the arguments...if she doesn't, it's because she is an ex-wife.



:rofl: :rofl: :rofl:


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## Handsome Robb (Feb 6, 2013)

ffemt8978 said:


> Wives ALWAYS win the arguments...if she doesn't, it's because she is an ex-wife.



I was gonna say I always win arguments with my gf...then I realized she's an ex gf now :rofl:

Like arguing with a tree though, not on par with a ICU nurse


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## Summit (Feb 6, 2013)

JPINFV said:


> Since this thread came up...
> 
> There's always a problem when it comes to bridging, and even more so, when it comes to giving straight equilivance. The question is, "How close are the fields?" Just comparing education level and foundation isn't enough. For the nurses, do you think a physician should be able to be hired on to act as a nurse without any additional education or training? After all, a physician is much highly trained and educated than the average nurse. Alternatively, is the practice of medicine and the practice of nursing a significant enough divide that just OTJ training isn't enough?



Uh... what would a physician need to go back to school to learn about nursing? The only things I can think of are nursing philosophy, advocacy, and roles. Everything else would be OJT. Obviously, the example is silly. The only doctors I ever met who did nursing were the foreign docs who figured they could make more money coming to the US and going to an ABSN program.


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## JPINFV (Feb 6, 2013)

Summit said:


> Uh... what would a physician need to go back to school to learn about nursing? The only things I can think of are nursing philosophy, advocacy, and roles. Everything else would be OJT. Obviously, the example is silly. The only doctors I ever met who did nursing were the foreign docs who figured they could make more money coming to the US and going to an ABSN program.




I have no idea why a physician would want to be a nurse, but I highly doubt that nurses would just allow a physician to take the NCLEX and become an RN. Even with the drastic disparity of education.


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## Veneficus (Feb 6, 2013)

*I can do your job, you can't do mine.*



JPINFV said:


> Since this thread came up...
> 
> There's always a problem when it comes to bridging, and even more so, when it comes to giving straight equilivance. The question is, "How close are the fields?" Just comparing education level and foundation isn't enough. For the nurses, do you think a physician should be able to be hired on to act as a nurse without any additional education or training? After all, a physician is much highly trained and educated than the average nurse. Alternatively, is the practice of medicine and the practice of nursing a significant enough divide that just OTJ training isn't enough?
> 
> Similarly, is the divide between paramedicine and nursing facing a similar divide where a formal bridge course should be required to work in EMS?



Something I have never had to say to a nurse.

I think it depends on your education model. Where I went to school, we had to get signed off on just about every hands on skill imaginable. I actually had a little book I had to get signed.

In fact, 1st year I actually had a clinical called "nursing practice" followed on by a semester the 2nd year of "first aid" which was basically a mini paramedic class with lecture, seminar, lab, and clinicals.

There is quite a difference between a medical degree and a doctor 

Some places teach you to function only in their system, some teach you to function anywhere.  Depends on your goals I guess.


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## usalsfyre (Feb 6, 2013)

Chase said:


> But comparing straight hours is worthless. You can not compare vocational hours to college credit hours.



I think you VASTLY overestimate the quality of all of the "colleges" that have nursing programs. There are RN mills every bit as surely as there are paramedic mills. I'd say there are fewer of them, but I'm not as certain anymore.


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## usalsfyre (Feb 6, 2013)

Chase said:


> We studied the whole continuum of a disease including initial presentation not just late or chronic. We only covered the basics of trauma but the medical was very comprehensive.


This is admittedly one of the bigger issues with paramedic school. There is way too much focus on end-stage disease processes and not nearly enough on early detection.


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## VFlutter (Feb 6, 2013)

usalsfyre said:


> I think you VASTLY overestimate the quality of all of the "colleges" that have nursing programs. There are RN mills every bit as surely as there are paramedic mills. I'd say there are fewer of them, but I'm not as certain anymore.



I never denied that there are still bad nursing schools out there. At least with nursing programs, BSNs in particular, there are various accrediting agencies that ensure at least some degree of uniformity and quality. But not all schools are accredited. 

But none the less you still can not compare total hours. 200 hours of 8th grade level reading is not the same as 200 hours of college (university*) level science classes. 

Now many people taking an EMT-B class could pass a college microbiology class?

I used my own education as an example but I will admit I may not be the average. I never went to a community college I did all my prereqs at a state university and then went to nursing school at a nursing college which is affiliated with one of the best hospitals and med schools in the country. Personally, I think my education and clinical experience was top notch. But I know not everyone has that same experience.

*Disclaimer: I have seen some pretty crappy science courses at community colleges.


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## JPINFV (Feb 6, 2013)

Chase said:


> Now many people taking an EMT-B class could pass a college microbiology class?



Including all o the pre-meds who are taking an EMT course to pad their application?


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## Summit (Feb 6, 2013)

There are definitely some sketchy nursing schools out there. The thing is, their graduates have a very difficult time getting jobs outside of nursing homes. Also, they tend to be far fewer than the sketchy EMS programs. The nursing mills are few and have a low output. The opposite seems to be true for EMS  mills. Nursing programs are accredited academically (regionally for most schools but nationally by some of the sketchy schools), by their state board of nursing, and for the better programs, by national nursing education accrediting agencies (NLNAC for ASN and some BSN, AACN-CCNE for BSN and MSN/DNP). Unlike EMT/Medic mills, the sketchy nursing programs are not pumping out large percentage of the new nurses or shortening the programs. They are producing a fraction of new grads and seem to suffer primarily in the admission GPA standards and lower acuity clinical placements (a result of hospitals preferring non-skietchy programs, which ultimately results in poor employability for grads from sketchy programs).

Interestingly, ACICS is a national academic accrediting agency that is usually is found to be academic accrediting body for the sketchy nursing schools (eg ITT Tech) but is often considered a POSITIVE mark for many paramedic programs!!!




JPINFV said:


> Including all o the pre-meds who are taking an EMT course to pad their application?



How is this outlier example relevant to the general discussion of educaitonal equivelence in depth/rigor between EMS and Nursing education?


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## Carlos Danger (Feb 6, 2013)

Veneficus said:


> Nurses are not all equal to the ED or ICU nurse. In fact, most nurses will never be capable of or desire to operate in those environments. Do not pretend those nurses are the "norm." They are the same exceptional as the up educated paramedic.
> 
> *Nurses in EMS, like every nurse in every other division of nurses will need job specific training in order to be effective. They do not need to hear A&P, pharm, or any other part of the EMS didactic that they already have superior knowledge in.*
> 
> Now I know EMS providers don't like to hear this and try to make up all kinds of BS reasons why it is not so. But it is like this. *Nursing is an educated profession now. It continues to raise it's own bar. EMS is a vocation trying to keep the bar low.* I give you this example to put what you are arguing into perspective.



This is the probably the best summary of the situation that I have every read or heard.


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## Shishkabob (Feb 6, 2013)

Veneficus said:


> Nursing is an educated profession now. It continues to raise it's own bar. EMS is a vocation trying to keep the bar low.



Let's get something straight.  Actual EMS providers ARE trying to raise the bar.  The IAFF, other fire unions, and firefighters in general, are trying to keep the bar low as to keep recruitment easy so they can go "Hey we can run ambulances!  Give us they money!"


Don't put me on the same level as them.  We aren't, and never will be, and you of most people should know that.


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## Carlos Danger (Feb 6, 2013)

Linuss said:


> Don't put me on the same level as them.  We aren't, and never will be, and you of most people should know that.



I don't think anyone put YOU are any other individual on any level at all.

The statement was that EMS *is a vocation* trying to keep the bar low.

And unfortunately, that is quite true.


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## Shishkabob (Feb 6, 2013)

old school said:


> The statement was that EMS *is a vocation* trying to keep the bar low.
> 
> And unfortunately, that is quite true.



Apparently there must be some sort of error on the original reply I posted because I could have SWORN I already stated a response to that.  Here, let's try again.



The IAFF, other fire unions, and firefighters in general, are trying to keep the bar low as to keep recruitment easy so they can go "Hey we can run ambulances!  Give us they money!"



NOT the whole of EMS.


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## Wheel (Feb 6, 2013)

Summit said:


> There are definitely some sketchy nursing schools out there. The thing is, their graduates have a very difficult time getting jobs outside of nursing homes. Also, they tend to be far fewer than the sketchy EMS programs. The nursing mills are few and have a low output. The opposite seems to be true for EMS  mills. Nursing programs are accredited academically (regionally for most schools but nationally by some of the sketchy schools), by their state board of nursing, and for the better programs, by national nursing education accrediting agencies (NLNAC for ASN and some BSN, AACN-CCNE for BSN and MSN/DNP). Unlike EMT/Medic mills, the sketchy nursing programs are not pumping out large percentage of the new nurses or shortening the programs. They are producing a fraction of new grads and seem to suffer primarily in the admission GPA standards and lower acuity clinical placements (a result of hospitals preferring non-skietchy programs, which ultimately results in poor employability for grads from sketchy programs).
> 
> Interestingly, ACICS is a national academic accrediting agency that is usually is found to be academic accrediting body for the sketchy nursing schools (eg ITT Tech) but is often considered a POSITIVE mark for many paramedic programs!!!
> 
> ...



The thing is, even diploma nursing programs (from what I've seen) are still taught by bsn's, while my community college medic program was taught by a 20 year diploma medic. She was great, a very good paramedic and clinical instructor, but lacked any ability to explain even basic physiology, chemistry, algebra, etc. If we want to advance then this isn't acceptable.


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## Veneficus (Feb 7, 2013)

Linuss said:


> Let's get something straight.  Actual EMS providers ARE trying to raise the bar.  The IAFF, other fire unions, and firefighters in general, are trying to keep the bar low as to keep recruitment easy so they can go "Hey we can run ambulances!  Give us they money!"
> 
> 
> Don't put me on the same level as them.  We aren't, and never will be, and you of most people should know that.



Linuss, just because there are a handful of providers out there that are more than the minimum doesn't raise the bar or the level of the general population.

You are in an area where it may seem like every provider is something better.

The reality is, there is no national EMS lobby to raise the bar. A majority of the US population is covered by fire service based EMS and it is a bit more complex than "hey give us money."

The fire service is not alone in keeping the bar low. Everyone from EMS education centers to volunteers, to private companies are involved.

What I of all people know is if you are looking for professional respect and a higher bar, US EMS is simply not the place, you must move on.


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## Handsome Robb (Feb 7, 2013)

Veneficus said:


> Linuss, just because there are a handful of providers out there that are more than the minimum doesn't raise the bar or the level of the general population.
> 
> You are in an area where it may seem like every provider is something better.
> 
> ...



Which is why Linuss and I are going to start lobbying for increased education standards in EMS, he just doesn't know it yet. 

I don't see why EMS CAN'T change, it seems like we don't WANT to change. Like Vene said, we have a minority of providers who are actively trying to better themselves and our chosen career path from a vocation to a profession. However, until that minority turns into the majority the ones who are trying to improve don't have a whole lot of options. 

I love EMS. I would love to spend my career as a single-roll EMS provider and eventually move into a supervisory and/or QA/QI roll. Add in rescue and TEMS and I'd be a happy camper. Unfortunately, unless something drastic changes or I get lucky, that doesn't seem like it's going to be an option without driving myself to the brink of insanity. 

There has to be a better answer to this problem than "move on". Like I just said, I don't want to move on, I chose this career because I'm passionate about it. I love going to work every day. How many jobs out there allow you to show up, grab 200K plus of gear, then head out into the world and act with near complete autonomy besides going where the radio or CAD terminal tells you? Not many. What's it going to take to change us from a vocation to a profession?


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## Summit (Feb 7, 2013)

I agree with vene. Robb I felt just as you did. I didn't know what the solution would be, but I knew it wasn't coming soon. So, I went to nursing school.

I probably should have tried to emigrate. But, I enjoy what I'm doing now. It is different than EMS in many ways, but the same in many ways... more complex. I still enjoy EMS on the side. As vene said, volley can be a hold back for those who do it primarily, but it can also be an outlet for professionals.


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## Veneficus (Feb 7, 2013)

Robb said:


> Which is why Linuss and I are going to start lobbying for increased education standards in EMS, he just doesn't know it yet.



You wouldn't be the first. Nor the last. But unless you have the one thing that is holding it back, you will never have any better results than many great people who have tried and spent their careers and sometimes lives trying to get the same.

Buy-in from the rank and file.

"What's in it for me?" A common question in the US. A far cry from the generations of people, most of the greatest of which are now gone, who asked "How do we make it better for future generations?"

EMTlife is a microcommunity of EMS providers. We surround ourselves with like minded people and since people like that are who we spend the most time with, both here and in our non-online life, we can easily be fooled into believing we are representative of "everybody."

The fact remains, most US EMS professionals, from people who get an EMS cert to get a FD job, To IFT providers just earning a paycheque instead of driving a taxi or working in a factory, to providers who are so in love with their feeble skills thinking they alone hold the key to saving lives, that they tell new people "the book learnin stuff isn't what happens in the field and you are good at the former, you probably can't do the later."

Now medical directors could hold the key to fixing this by flexing their muscle, but the fact is they don't. What is worse, they voluntarily give up this power for things like state wide protocols. (A medical director friend of mine is currently struggling with this. He can't raise the bar higher because the State fixed the bar in 1990)

As I discovered, even being a physician no longer influences EMS practice. Myself and yet another medical director had a conversation on how her medics don't think she has any "street cred" and so they resist all of her efforts to change. 

The rank and file no longer even recognize the street cred of docs who are current or former medics like they used to. With every excuse from "You have forgotten what it is like" to "just because you raised yourself doesn't mean the rest of us want to." My favorite: "This is not a job for smart men, it is a job for working men." (A fancy way to say dumb laborer, and it was multiple EMS providers who said it)

They see Fire and EMS as the last bastions of hope for a vocational laborer to have an admired role in the civilian world. It is not that they are incapable, most I have met are extremely capable. But they lack the desire to change from an age of industry to an age of knowledge. It is not the first time in history this has happened.  But they constantly drag people who can transition down. What is worse, most of the leadership believes this, and whether it is moral or not, pleasing your leader is how you become a leader yourself, not by making a stand for what's right. That is how you go about needing to look for another job. 



Robb said:


> I don't see why EMS CAN'T change, it seems like we don't WANT to change.?



Exactly my point.



Robb said:


> I love EMS. I would love to spend my career as a single-roll EMS provider and eventually move into a supervisory and/or QA/QI roll. Add in rescue and TEMS and I'd be a happy camper. Unfortunately, unless something drastic changes or I get lucky, that doesn't seem like it's going to be an option without driving myself to the brink of insanity.



Fortunately, there is an easier solution...

http://www.westcorkrapidresponse.ie/pre-hospital-medical-emergency-training/



Robb said:


> There has to be a better answer to this problem than "move on". Like I just said, I don't want to move on, I chose this career because I'm passionate about it. I love going to work every day. How many jobs out there allow you to show up, grab 200K plus of gear, then head out into the world and act with near complete autonomy besides going where the radio or CAD terminal tells you? Not many.



Are you passionate about it enough to take yourself to the next level? To move to where you can be what you want? 



Robb said:


> What's it going to take to change us from a vocation to a profession?



The evolution of US society in the exact opposite direction it is currently taking.


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## Wheel (Feb 7, 2013)

Robb said:


> Which is why Linuss and I are going to start lobbying for increased education standards in EMS, he just doesn't know it yet.
> 
> I don't see why EMS CAN'T change, it seems like we don't WANT to change. Like Vene said, we have a minority of providers who are actively trying to better themselves and our chosen career path from a vocation to a profession. However, until that minority turns into the majority the ones who are trying to improve don't have a whole lot of options.
> 
> ...



I'm struggling with this myself right now. I really love what I do, and I see potential for growth in the profession. I just don't know if there are enough like minded people who will voluntarily finish degrees and lobby for others to do the same to justify reimbursement and to make ourselves relevant.


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## Tigger (Feb 7, 2013)

Linuss said:


> Apparently there must be some sort of error on the original reply I posted because I could have SWORN I already stated a response to that.  Here, let's try again.
> 
> 
> 
> ...



There are no doubt many EMS that want to raise the bar, but it seems shortsighted to fix all the blame on the fire service.

It is not in many for-profit companies best interest to see an increase an education and the subsequent increase in difficulty in recruiting. Eventually more educated providers are going to demand more money. I don't know what will happen first: will EMS providers go out and get more education in expectation for more money or will they be paid to upgrade their education?

I don't think the answer matters to most in for-profit EMS, no matter how they get there, better educated providers will have to be paid more and that hits the bottom line.


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## Handsome Robb (Feb 8, 2013)

Veneficus said:


> Now medical directors could hold the key to fixing this by flexing their muscle, but the fact is they don't. What is worse, they voluntarily give up this power for things like state wide protocols. (A medical director friend of mine is currently struggling with this. He can't raise the bar higher because the State fixed the bar in 1990)
> 
> As I discovered, even being a physician no longer influences EMS practice. Myself and yet another medical director had a conversation on how her medics don't think she has any "street cred" and so they resist all of her efforts to change.
> 
> The rank and file no longer even recognize the street cred of docs who are current or former medics like they used to. With every excuse from "You have forgotten what it is like" to "just because you raised yourself doesn't mean the rest of us want to." My favorite: "This is not a job for smart men, it is a job for working men." (A fancy way to say dumb laborer, and it was multiple EMS providers who said it)



This is just sad. 

I don't necessarily think statewide protocols are a bad thing, provided the physicians creating and overseeing them are progressive and motivated to further EMS, rather than leave us stuck in the 90s like your friend's area is, for example.

I think another thing that would help would be a restructuring of the NREMT. Not saying get rid of it. Quite to the contrary, I believe that if we truly want to further EMS and move towards recognition as a profession rather than a vocation we are going to need consistency at the national level. The 12407813403917428 different EMSAs, counties and states all requiring different things and levels of education across the country isn't the answer. With that said, the way the NREMT is setup now is definitely not the answer. This is definitely something where we could use some help from our nursing healthcare team members in using their system (The NCSBN, National Council of State Boards of Nursing) as a model for unifying our own. 

But that is another thread on it's own. 



> They see Fire and EMS as the last bastions of hope for a vocational laborer to have an admired role in the civilian world. It is not that they are incapable, most I have met are extremely capable. But they lack the desire to change from an age of industry to an age of knowledge. It is not the first time in history this has happened.  But they constantly drag people who can transition down. What is worse, most of the leadership believes this, and whether it is moral or not, pleasing your leader is how you become a leader yourself, not by making a stand for what's right. That is how you go about needing to look for another job.



Again sad, but very true. 




> Fortunately, there is an easier solution...
> 
> http://www.westcorkrapidresponse.ie/pre-hospital-medical-emergency-training/



Looks like an awesome setup. Unfortunately I don't live in Ireland and can't volunteer to support myself. Be an awesome side gig though!



> Are you passionate about it enough to take yourself to the next level? To move to where you can be what you want?



I like to think so. The question is what is that going to take? There are agencies out there that would absolutely allow me to spend my career in single roll EMS. The problem is the locations of these agencies. Work is extremely important, but I personally think loving where you live is just as important. 



> The evolution of US society in the exact opposite direction it is currently taking.



Well that's not an answer I wanted to hear 

Sorry if this is kinda broken and tough to read.


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## Shishkabob (Feb 8, 2013)

Tigger said:


> There are no doubt many EMS that want to raise the bar, but it seems shortsighted to fix all the blame on the fire service.



Seeing as how they are 1/3 of the providers of EMS, they have without a doubt the biggest union with the most clout, and the average civilian think most EMS is run out of the FD... I don't.  Most surely the majority of the blame can be pinned on them.


People who don't want to do EMS, actually doing 1/3 of EMS and having political sway?  Yeah, that's not doing any harm...


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