# How stupid are nurses?



## Veneficus (Jan 24, 2013)

That got your attention didn't it?

Rather than hijack another thread on what it takes a nurse to work in the prehospital environment, I thought we could talk about it here?

Let us agree that working in the prehospital environment is not a part of fundamental nursing education.

Let us also agree that it takes extra education and training to work in the prehospital environment.

Let us now quantify what that means exactly?

In my home state, the law requires a minimum of 750 hours for paramedic education. Most places do not require a prereq A&P and add 2-4 weeks of (2) 4hour classes per week in order to meet this need. 

For the benefit of the doubt, let's call it 4. that is 32 hours of A&P education.

Increasing this paramedic benefit, let us assume that a third 4 hour lab day is also scheduled during this 4 week period. (an additional 16 hours)

This brings out total to 750+48=798 hours of paramedic education. 
Let's just arbitrarily add another 102 hours to cover the recent curriculum increases and make it an even 900?

Next, let us make mandatory ACLS, PALS, and PHTLS. (or ITLS if you like that better.)  either way, 48 hours.

This is normally taught during the basic paramedic hours and not in addition to it, so we are down to 852 hours of paramedic education. (including clinical time)

Now in these 852 hours remaining, 4 hours per week are dedicated lab skills time. Then, 852 hours/12 hours per week gives us: 71 weeks of class. 

(1) 4 hour lab day for 71 weeks= 284 hours of labratory skills. 

852-284= 568 hours. 

568/2= 284. (which from the math stad point is really convenient to say that 50% of paramedic class is clinicals, but the truth is, it is really only about 1/3.) Which means 347 hours of that is classroom learning. (rounded to the nearest hour for my convenience and poor math skills)

Leaving ~221 hours of clinical time. 

221 hours of clinicals +284 hours of lab skills, 505 hours of a 900 hour paramedic course. (Because we generously added 102 hours arbitrarily, so the actual total is 798 for medic and A&P, 798 hours/12 hours is 66.5 weeks of class. 66.5 times 4 hours for once a week lab is: 266  hours of lab. Bringing non lab medic and clinicals to 532 hours. 2/3rd of that is 351 hours of didactic and 181 hours of clinicals so, 266lab +181 clinicals hours= 447, 351 out of 798 hour is clasroom instruction of an actual course.)

Let us go back to the 900 hour course and the 505 hours?

So... Assuming nurses can start an IV and give IV, IM, and SQ injections, let us subtract the 3 lab classes usually reserved for that (12 hours.)

505-12= 494 hours.

Now we have a dilemma, we can either subtract the 150 hours of EMT-B and the skills taught there for ease, or we can actually map out every hours paramedics spend on EMT-B skills.

Let us just simply subtract 150?

494-150= 343.

343 lab hours-221 hours of clinicals, equal 121 hours of lab. 

iF we did this for 12 hours a week in a nurse to medic bridge program (4 hours 3x a week) we would be done with the lab part in 10 weeks. If we made (2) 8 hours days a week it would be 7.5 weeks. If we really go all out and make it a 40 hour week, it takes 3 weeks. 

Now we are left with 221 hours of clinicals to cope with.

Nurses do clinicals in their education. Perhaps with the exception of the ED and definately not on the truck. But many paramedic clinicals are in nursing environments. So that makes breaking this number down a bit tricky. 

If we make them repeat all the medic clinical hours, (3) 4 hours days a week) 
221/12 18.41 weeks.

18.41 weeks + 7.5 weeks 25 week course.

(but this could also be concurrent with the lab days, still giving them 1 total day off and 6 days a week of class/clinical) roughly 18 weeks or 1 semester.

If we do a total of 60 hours per week, full time + part time, (40 hours lab +20 hours clinical) we now finish in about 11 weeks.

But if we give them 1/2 credit for clinicals, 110 hours clinical + 121 lab is 231 hours. (less than the 240 pro firefighter class) and at 40 hours a week, we will be done in 5.77 or simply 6 weeks.

At 60 hours, just shy of 4 weeks.

If said nurse already had ACLS, PALS, and PHTLS, it could be done even faster.

If the nurse was given credit for all previous clinical and had the alphabet soup courses, you are looking at 2-3 weeks tops. 

That bridge program doesn't look like it really adds anything to me that couldn't be replicated by a 2 week pre-truck orientation and another couple of weeks of FTO period. For a total OTJ of 4-6 weeks max.


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## WTEngel (Jan 24, 2013)

That's basically what our nurses had to go through in order to obtain their paramedic (required within one year) when they made the flight team. 

They spent every third day in class for 6 weeks and then did 10 24 hours shifts on an ambulance (really where they go the majority of their benefit for the bridge course.)

All told it was about 300 hours or so...the majority of which was on an ambulance. Again, I think the ambulance is the most critical part of the nurse to medic bridge, because that is the one thing that most nurses making the bridge have virtually no exposure to.

I am not ardently opposed to having an established back and forth bridge program for something like:

Paramedic <------> Paramedic/ADN <------> ADN

I think paramedics with an associate's degree should be able to transition just as easily to ADN as nurses with an associate degree can transition to paramedic. I understand that the transition to ADN may require more hours, but I don't see why it should be significantly more. Certainly nothing that a semester of classes wouldn't satisfy.


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## VFlutter (Jan 24, 2013)

WTEngel said:


> Paramedic <------> Paramedic/ADN <------> ADN
> 
> I think paramedics with an associate's degree should be able to transition just as easily to ADN as nurses with an associate degree can transition to paramedic. I understand that the transition to ADN may require more hours, but I don't see why it should be significantly more. Certainly nothing that a semester of classes wouldn't satisfy.



Vene's plan sounds great to me. I think a 3 month part time program would be ideal. 

The one thing I always beat a dead horse :deadhorse: about is core science education. As long as there is equivalency between the the paramedic and nursing prerequisites then I have no problems.


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## WTEngel (Jan 24, 2013)

Agree 100%


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## RocketMedic (Jan 24, 2013)

I think a lot of it depends on that nurses's background too. The SNF BSN RN I ran into last week who thought that "I can't breathe" was code for "please walk away and see if it's persisting at the next bed check" comes to mind.

An ER nurse would probably make at least an equally-competent paramedic as I, with probably-better pharm and A&P.


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## HMartinho (Jan 24, 2013)

Rocketmedic40 said:


> I think a lot of it depends on that nurses's background too. The SNF BSN RN I ran into last week who thought that "I can't breathe" was code for "please walk away and see if it's persisting at the next bed check" comes to mind.
> 
> An ER nurse would probably make at least an equally-competent paramedic as I, with probably-better pharm and A&P.



Indeed. 

An SNF nurse is quite diferent trainning and competences than an ICU/ER Nurse or even an CRNA.


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## ExpatMedic0 (Jan 24, 2013)

WTEngel said:


> xposure to.
> 
> I am not ardently opposed to having an established back and forth bridge program for something like:
> 
> Paramedic <------> Paramedic/ADN <------> ADN



Ya Travis sounds fine, but it SHOULD be a two way road, and its not.

Also Vene I think its only fair to compare the United States MINIMUM standard which is the National Registry. Most states exceed that but a  handful of states do not meet the minimum standards for national certification. 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. One quarter college credit 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.

That is black and white information pertaining to the programs themselves.

Ref: http://www.acics.org https://www.nremt.org/ http://www.bon.texas.gov/


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## ExpatMedic0 (Jan 24, 2013)

Also i would like to add, since both programs are very similar in training hours, 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


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## WTEngel (Jan 24, 2013)

Agreed. A 2 way street is what it should be, but only when EMS gets its head in the game and makes the standards include basic level sciences, including A&P, chemistry, and biology.

Vene, it appears that we are the choir, and you are preaching. No disagreement from the majority of EMS folks who've been around the block.

We even have "that" nurse Chase on board, and we all know how disagreeable and "nursey" he can be! (nothing but love Chase!)


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## VFlutter (Jan 24, 2013)

HMartinho said:


> Indeed.
> 
> An SNF nurse is quite diferent trainning and competences than an ICU/ER Nurse or even an CRNA.



SNF is a totally different environment than most inpatient units. The average floor nurse is no where near the level of a ED/ ICU nurse. CRNA shouldn't even be part or the conversation since it is so far beyond what typical nursing is. 

I am in no way justifying incompetent care but to give SNF RNs credit I could never do their job. Some are responsible for 15-20 patients at a time with very little resources and support. It really is a crappy situation to be in and it's not entirely their fault.


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## JPINFV (Jan 24, 2013)

Chase said:


> SNF is a totally different environment than most inpatient units. The average floor nurse is no where near the level of a ED/ ICU nurse. CRNA shouldn't even be part or the conversation since it is so far beyond what typical nursing is.



I saw that... but than saw that he is from Portugal and assumed that he meant CNA.


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## VFlutter (Jan 24, 2013)

WTEngel said:


> We even have "that" nurse Chase on board, and we all know how disagreeable and "nursey" he can be! (nothing but love Chase!)



Maybe I just got tired of poking the bee hive on the forum


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## Christopher (Jan 24, 2013)

WTEngel said:


> That's basically what our nurses had to go through in order to obtain their paramedic (required within one year) when they made the flight team.
> 
> They spent every third day in class for 6 weeks and then did 10 24 hours shifts on an ambulance (really where they go the majority of their benefit for the bridge course.)
> 
> ...



This is pretty reasonable. I think 1 month of classroom and 2-3 months of truck time would probably prepare any ED/ICU nurse for EMS.

Operations are a big part of EMS, and in-hospital nurses have similar things (like overhead paging, sending crap to the lab via tubes, where the cafeteria is, who do you call when X happens), so some classroom time covering that stuff.

If they're just a rider, then you can skip EVD/EVOC time. Probably an LZ class and an extrication awareness class (glass is sharp, metal is sharp, leave going into the car to the firefighters playing paramedic), and maybe 1 hour on radio ops.

But 300 hours total with the bulk in the field? Very reasonable. Our medics who transition to the ED go thru a similar orientation schedule.


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## JPINFV (Jan 24, 2013)

Why the hell do you need 1 hour on radio ops? It's called, "trainee does all radio communications."


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## Christopher (Jan 24, 2013)

JPINFV said:


> Why the hell do you need 1 hour on radio ops? It's called, "trainee does all radio communications."



That's usually how I do it, but I've found even 15 minutes of a "heads up" for a newbie will keep them from being eaten alive by dispatchers.

(it is also important to cover how to hollar for help constructively)


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## mycrofft (Jan 24, 2013)

Loading torpedoes....


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## Summit (Jan 24, 2013)

Veneficus said:


> If said nurse already had ACLS, PALS, and PHTLS, it could be done even faster.
> 
> If the nurse was given credit for all previous clinical and had the alphabet soup courses, you are looking at 2-3 weeks tops.
> 
> That bridge program doesn't look like it really adds anything to me that couldn't be replicated by a 2 week pre-truck orientation and another couple of weeks of FTO period. For a total OTJ of 4-6 weeks max.



This makes sense. As would requiring EMT, ACLS, PALS, and PHTLS as prereqs.


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## fortsmithman (Jan 26, 2013)

Here in Canada all the new RNs graduating all hold BScN degrees.  Our LPNs are now graduating from 2 year college diplomas (here in Canada we call our Associates degrees college diplomas.


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## Sandog (Jan 26, 2013)

Christopher said:


> leave going into the car to the firefighters playing paramedic



Seriously? The majority of medical calls in my area are handled by "Firefighters playing paramedic"


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## Carlos Danger (Feb 6, 2013)

schulz said:


> Ya Travis sounds fine, but it SHOULD be a two way road, and its not.



How is it not a two way road?

It is generally the policy of most schools to give you transfer credit *if* the description and credit level of the courses you are trying to transfer reasonably match up to that of the courses that you are trying to replace. 

When I started nursing school, the science and social science courses that I had done for my AS in Paramedicine transferred just fine to my nursing degree. The paramedic course numbers only transferred as elective credit, but that wasn't because the nursing faculty was trying to "hold the paramedics down", it was simply because there were no equivalent courses in the nursing program for my paramedic courses to transfer to. I would have run into the same problem if I was trying to transfer credits from a business degree into an engineering degree program.

CC and university nursing programs are structured in a credit-based way that is very typical; it is not the fault of the nursing programs that most paramedic programs are structured in a vocational format that makes it difficult to evaluate and match up previous coursework to that in the program you are applying for. Nor is it their fault that many / most paramedic programs still don't require or include college-level science or social science courses.

Now, if a paramedic had taken credit-bearing microbiology, A&P, and psychology courses that were clearly comparable to those required by the nursing program, but the nursing program wouldn't grant them credit for those courses _just because_ they were taught as part of a paramedic curriculum, then I'd be with you on the whole "RN's are holding us down" thing. 

But I've never seen or heard of that.


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## mycrofft (Feb 6, 2013)

*The other way around.*

I looked into getting a bridge to EMT-B from RN (say what? Yeah, employers want cheap EMTs instead of nurses, go figure), but none of the local schools would honor my credits and insist upn my taking the whole courses, despite a Calif law stating the WILL (not "can") offer bridging from RN to EMT.


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## Summit (Feb 8, 2013)

Robb said:


> Just for s and giggles I did the math on my education hours the other day.
> ...
> 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.



For ****s and grins I decided to do the math on my nursing... and ended up with a larger than expected spreadsheet to get all the numbers below. Now, I'm not including all my other undergraduate (which exceeds my nursing credits including prereqs), my EMS courses, or many hundreds of hours of EMS CEs.

Other caveats: semester credits in science and nursing, like EMS, do not follow the conventional 16 contact hours per credit. The median nursing and science course was 32 hours per credit! I present only my personal educational experience which probably does not represent the average:

PREREQS: ~1500 hours
30 credits of sciences + 36 other credits

NURSING BSN: ~2600 hours
66 credits of nursing including ~1600 hours of clinical.

POST-LICENSURE: ~1600 hours
This is the critical care education and new graduate nurse program through my employer: ~550 classroom hours + ~1050 1:1 precepted hours (not counting about ~2500 additional probationary hours that are independent, but closely supervised)

So, that is 5700 hours of education and clinical before independent critical care nursing practice.


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