# Lpn vs medic school



## Itsadonna (Sep 14, 2011)

Wondering anybody's opinion on this. I am close to my assoc in science. I was wondering if yuo think it'd be more worth it to go into nursing as an LPN or Medic school ??


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## silver (Sep 14, 2011)

Itsadonna said:


> Wondering anybody's opinion on this. I am close to my assoc in science. I was wondering if yuo think it'd be more worth it to go into nursing as an LPN or Medic school ??



What's your goal?

Regardless, I'm gonna say LPN is a waste of time for everyone. If you want to be a nurse, go be an RN. If you want to be a medic, go to medic school.


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## Katy (Sep 14, 2011)

Well, it truly depends on what your ultimate career goals are. Both Paramedic school and LPN are rigorous in nature,  but focus greatly on different training. LPN's generally are focused on long-term care and rehabilitation, while Paramedics are pre-hospital setting and emergency care. Good luck in whatever you do, and both schooling's are going to be difficult, but very different but with little overlap with Anatomy and Physiology and Pathophysiology. Just take your experience as a Basic and if you like it, you will most likely enjoy Paramedic school and experience.


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## Katy (Sep 14, 2011)

silver said:


> What's your goal?
> 
> Regardless, I'm gonna say LPN is a waste of time for everyone. If you want to be a nurse, go be an RN. If you want to be a medic, go to medic school.


LPN's are certainly not a waste of time, they do a lot of specific roles that assist the RN's in the patients health, as any other healthcare provider.


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## Yarbo (Sep 14, 2011)

silver said:


> What's your goal?
> 
> Regardless, I'm gonna say LPN is a waste of time for everyone. If you want to be a nurse, go be an RN. If you want to be a medic, go to medic school.



I hope you didn't put too much thought into this comment.


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## emscrazy1 (Sep 14, 2011)

Itsadonna said:


> Wondering anybody's opinion on this. I am close to my assoc in science. I was wondering if yuo think it'd be more worth it to go into nursing as an LPN or Medic school ??



Are you asking if it would be more beneficial to be an LPN or Medic in order to get into Nursing school?


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## silver (Sep 14, 2011)

EMT 34 said:


> I hope you didn't put too much thought into this comment.



No. Clearly by the non-supported argument anyone can see that...

Why is it pointless? In today's times (in the USA) the use of the LPN is diminishing. Healthcare societies, specifically nursing, are emphasizing advanced education. BSN and MSN are often becoming common on floors/units. So supporting a position that acts almost like a RN replacer (w/ less education) is counter intuitive for people who want to see advancements in education, like me.

Why would I personally discourage it?
- The time it takes for someone to complete an LPN could be better suited getting your RN. The shortest LPN program I've seen is 10.5 months, the ADN is about 24 months.
- Bridge programs often times aren't as academically rigorous as an entry level program.
- There is limited independence as an LPN.
- There is limited growth for an LPN, but endless growth for an RN.


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## Itsadonna (Sep 14, 2011)

Yes, I should have put a little bit more detail in this post. I eventually want to move up to an RN, for the sole purpose of working on an ambulance. Working in an ambulance is my main goal, really. I've been told that RN's are needed on the riggs, and often get paid more money for doing the same thing. That, and there's more oppourtunities in general for RN's, especially where I live.I was asking between the two because there is a bridge program for MEDIC-> RN and there is also the LPN->RN bridge as well. The medic programs around here are 2 years long a couple days a week where's the LPN programs are half the length but a more intensive schedule(something that would be hard to fit into my working schedule) Was curious if anybody did either of those bridges..


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## Katy (Sep 14, 2011)

silver said:


> No. Clearly by the non-supported argument anyone can see that...
> 
> Why is it pointless? In today's times (in the USA) the use of the LPN is diminishing. Healthcare societies, specifically nursing, are emphasizing advanced education. BSN and MSN are often becoming common on floors/units. So supporting a position that acts almost like a RN replacer (w/ less education) is counter intuitive for people who want to see advancements in education, like me.


First of all, anyone who has been through a decent LPN program will tell you they are not a RN replacer. LPN's aren't usually dealing with unstable patients and don't do any advanced procedures, so how could they even be similar or as you put it a "RN replacer" ? 



silver said:


> Why would I personally discourage it?
> - The time it takes for someone to complete an LPN could be better suited getting your RN. The shortest LPN program I've seen is 10.5 months, the ADN is about 24 months.
> - Bridge programs often times aren't as academically rigorous as an entry level program.
> - There is limited independence as an LPN.
> - There is limited growth for an LPN, but endless growth for an RN.


1. Many times the wait for RN is too long and can take up to several years, by then the proposed student would have completed the bridge and gotten some experience.
2. This is true, but a lot of the LPN covers the basics of the RN program, there isn't anything an LPN can do that an RN can't, so it puts the student well ahead in the program.
3. One usually doesn't enter nursing looking for a whole lot of "independence."
4. Limited, to a degree yes. But they also have a rounded education and can work in various medical specialties.


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## Handsome Robb (Sep 14, 2011)

Not a whole lot of RNs work on ambulances, unless it's a critical care transport truck. 

If you want to work in an ambulance, get your medic.


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## Katy (Sep 14, 2011)

Another option for the OP if your state delegates it is Pre-Hospital Registered Nurse.


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## Itsadonna (Sep 15, 2011)

NVRob said:


> Not a whole lot of RNs work on ambulances, unless it's a critical care transport truck.
> 
> If you want to work in an ambulance, get your medic.



Yeah, I guess I'm a little bit confused. I was told nurses are found on ambulances as well as paramedics. I guess if this were completely true, they would eliminate the need for seperate schooling.


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## Itsadonna (Sep 15, 2011)

Happy said:


> Another option for the OP if your state delegates it is Pre-Hospital Registered Nurse.



I've never heard of that, do you know anything about what that is ?


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## socalemt123 (Sep 15, 2011)

Itsadonna said:


> Yeah, I guess I'm a little bit confused. I was told nurses are found on ambulances as well as paramedics. I guess if this were completely true, they would eliminate the need for seperate schooling.



The only time I've ever heard of a nurse being on an ambulance was during critical care transports. Our company has a nurse that only rides with us during those types of transports. Otherwise it's an EMT/EMT crew or EMT/Paramedic crew..


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## Itsadonna (Sep 15, 2011)

socalemt123 said:


> The only time I've ever heard of a nurse being on an ambulance was during critical care transports. Our company has a nurse that only rides with us during those types of transports. Otherwise it's an EMT/EMT crew or EMT/Paramedic crew..


 Where do you live at ? I was told this by one of my professors back in my EMT class. MAN ! Maybe I feel like I've been given the wrong information all along..Either way looking into eventually going for RN would be a good goal to end up in.


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## socalemt123 (Sep 15, 2011)

Itsadonna said:


> Where do you live at ? I was told this by one of my professors back in my EMT class. MAN ! Maybe I feel like I've been given the wrong information all along..Either way looking into eventually going for RN would be a good goal to end up in.



I'm in So Cal. I can tell you that you will be paid a lot better being an RN with the ability to change specialties. I have a friend who was an EMT while he went to nursing school and now he is a trauma nurse. 
The nurses that we do have on our critical care transport calls also work in ER's or ICU's at the local hospital.


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## Katy (Sep 15, 2011)

Itsadonna said:


> I've never heard of that, do you know anything about what that is ?


A special certification in some states that allows Nurses to work in the Pre-Hospital setting with additional training. Depending on the area, the requirements will be different, but usually a good solid ICU or ER experience is helpful in landing a solid job, and by experience I mean 3-5 years. They are allowed to do ALS procedures and I am unaware of anything they can't do Pre-Hospital that a Paramedic can. 
*Someone please correct me if this isn't so.


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## CAOX3 (Sep 15, 2011)

Why not use your gen. ed. classes towards your RN, they should transfer.


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## jjesusfreak01 (Sep 15, 2011)

Happy said:


> A special certification in some states that allows Nurses to work in the Pre-Hospital setting with additional training. Depending on the area, the requirements will be different, but usually a good solid ICU or ER experience is helpful in landing a solid job, and by experience I mean 3-5 years. They are allowed to do ALS procedures and I am unaware of anything they can't do Pre-Hospital that a Paramedic can.
> *Someone please correct me if this isn't so.



This sounds mostly right, although i'm not sure if they are always required to get a PHRN to do that job. If the OP wants to ride EMS, they are better off getting their medic. If they want to be a flight nurse, then what happy suggests is correct.


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## joeshmoe (Sep 17, 2011)

I would think it totally depends on what your goals are. In terms of job availability and pay I think they are probably just about equal, but they are such different jobs which one you go for would depend on what your interests and talents are. I associate LPNs with things like health clinics and long term care facilities, not so much acute care. 

I personally wouldnt bother with becoming an LPN and would just go to school to be an RN if nursing was my thing, since LPNs are so limited in what they can do and where they can work. Its sort of like being an EMT Intermediate, but at least Intermediates can still do the work of Basics, LPNs on the other hand cant work as CNAs. Like Intermediates there is also chronic speculation that they will do away with LPNs, who will then either have to advance to RN or become a CNA. This has apparently been discussed for years, if not decades, so it probably wont happen any time soon, if at all, but its something to consider.


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## Katy (Sep 17, 2011)

joeshmoe said:


> LPNs on the other hand cant work as CNAs.


They actually can, as they recieve CNA training and far more in their education. Many of them work as CNA's while in school.


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## Akulahawk (Sep 17, 2011)

An RN working on an ambulance is going to be doing so in one of 3 roles: Critical Care Transport, Prehospital RN (PHRN), or as an EMT or Paramedic who just happens to be an RN. 

CCT - RN is usually has a 3-5 year ED/ICU prerequisite. PHRN may simply require RN + an orientation to the local EMS system and some internship time.

If you're looking to become an RN, I'd suggest going to RN school. If you're looking to get _some _field experience, become an EMT, do some work with that, and go to RN school. This way you're not completely lost when it comes time to meet & greet your patients. If you're looking to become a Paramedic, go to Paramedic school... and along the way, you'll do EMT school too...


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## jjesusfreak01 (Sep 17, 2011)

Happy said:


> They actually can, as they recieve CNA training and far more in their education. Many of them work as CNA's while in school.



I know all the nursing schools around my area have CNA as a pre-req, so just about all of the LPNs and RNs had the cert for at least a while. You can also challenge the CNA exam in NC (with no training whatsoever).


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## Katy (Sep 17, 2011)

jjesusfreak01 said:


> I know all the nursing schools around my area have CNA as a pre-req, so just about all of the LPNs and RNs had the cert for at least a while. You can also challenge the CNA exam in NC (with no training whatsoever).


Usually either it is a pre-req or they can challenge it after the first semester or something, depends on your area. And I wouldn't advise that for one minute. Unless someone is in nursing school or is a nurse, I don't think they should challenge the exam.


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## usalsfyre (Sep 17, 2011)

Off topic question, why in the blazes do we as a profession support the PHRN certification? Do you see RNs jumping to support an In-Hospital Paramedic certification? 

Please understand this is not sniping at RNs, it's simply the thought we should be protecting our area of practice.


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## Katy (Sep 17, 2011)

usalsfyre said:


> Off topic question, why in the blazes do we as a profession support the PHRN certification? Do you see RNs jumping to support an In-Hospital Paramedic certification?
> 
> Please understand this is not sniping at RNs, it's simply the thought we should be protecting our area of practice.


In nursing school students learn little about a lot, they have a very generalized education on human anatomy and physiology, as well as interventions and specialities. Now, when one graduates from nursing school, he or she can choose a speciality that holds interest to them, and with a very generalized education it would be fairly easy or not too difficult to adapt to that specific environment. 
Now, when one enters a Paramedic program, they are already setting themselves up to work in a specialized field, pre-hospital emergency care. Now, when one graduates that program, there main knowledge revolves around cardiology, airway, and emergency interventions. It is very difficult for one who has gone to school for such a specialized field to adapt to a whole different concept of thinking. Not saying it can't be done, but in relation RN's get far more generalized education making them more adaptable to field specialization, while Paramedics essentially graduate school with an already set speciality. Or at least, thats how I view it. ^_^


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## JPINFV (Sep 17, 2011)

usalsfyre said:


> Off topic question, why in the blazes do we as a profession support the PHRN certification? Do you see RNs jumping to support an In-Hospital Paramedic certification?
> 
> Please understand this is not sniping at RNs, it's simply the thought we should be protecting our area of practice.




Probably for the same reasons the EMS boards and oversight agencies are staffed with RNs instead of paramedics.


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## Aerin-Sol (Sep 17, 2011)

Happy said:


> Usually either it is a pre-req or they can challenge it after the first semester or something, depends on your area. And I wouldn't advise that for one minute. Unless someone is in nursing school or is a nurse, I don't think they should challenge the exam.



Why shouldn't someone challenge an exam? I looked through a CNA textbook and it seems that the position only requires certification for legal purposes. There's nothing in there that necessitates instruction.


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## Katy (Sep 17, 2011)

Aerin-Sol said:


> Why shouldn't someone challenge an exam? I looked through a CNA textbook and it seems that the position only requires certification for legal purposes. There's nothing in there that necessitates instruction.


You looked through the it, yet you didn't actually read the text nor have you sit in a classroom with an instructor, it needs instruction. Your average Joe isn't going to know how to properly give foley care, range of motion, and proper infection prevention among many other things. -_- Generally, for patient safety I would never challenge an exam, just like I don't believe in bridge courses. Anyone could look through an EMT book and learn the process and duties of the profession, but do you believe they do not need to be instructed ?


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## JPINFV (Sep 17, 2011)

Happy said:


> Anyone could look through an EMT book and learn the process and duties of the profession, but do you believe they do not need to be instructed ?


Depends on the topic. Learning the material is more important than how it's learned. Lecture isn't the only way to impart knowledge.


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## jjesusfreak01 (Sep 17, 2011)

Aerin-Sol said:


> Why shouldn't someone challenge an exam? I looked through a CNA textbook and it seems that the position only requires certification for legal purposes. There's nothing in there that necessitates instruction.



Agree here too. The actual scope of practice of a CNA in NC is very limited and consists of primarily personal non-medical care for the patients. There's not really anything that couldn't be taught in about 5 hours max of hands on training. Its hardly enough to warrant the 100 hour course they have here.

http://www.ncbon.com/content.aspx?id=826


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## Katy (Sep 17, 2011)

JPINFV said:


> Depends on the topic. Learning the material is more important than how it's learned. Lecture isn't the only way to impart knowledge.


Agreed, I was simply using the same logic with a different profession. And this is true, which is why CNA training requires clinical hours.


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## usalsfyre (Sep 17, 2011)

Happy said:


> In nursing school students learn little about a lot, they have a very generalized education on human anatomy and physiology, as well as interventions and specialities. Now, when one graduates from nursing school, he or she can choose a speciality that holds interest to them, and with a very generalized education it would be fairly easy or not too difficult to adapt to that specific environment.
> Now, when one enters a Paramedic program, they are already setting themselves up to work in a specialized field, pre-hospital emergency care. Now, when one graduates that program, there main knowledge revolves around cardiology, airway, and emergency interventions. It is very difficult for one who has gone to school for such a specialized field to adapt to a whole different concept of thinking. Not saying it can't be done, but in relation RN's get far more generalized education making them more adaptable to field specialization, while Paramedics essentially graduate school with an already set speciality. Or at least, thats how I view it. ^_^


I'm still not sure how this in any way justifies the PHRN credential.


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## Katy (Sep 17, 2011)

usalsfyre said:


> I'm still not sure how this in any way justifies the PHRN credential.


Then I guess I don't understand your question, like any other certification and credential, it accounts for a specialized field of nursing.


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## JPINFV (Sep 17, 2011)

Bridge programs still, in general, require clinical hours. California, for example, allows other health professions to challenge paramedic provided they show equivalent education and have completed 40 prehospital ALS patient contacts. 

http://www.emsa.ca.gov/paramedic/files/FrequentlyAskedQuestions.pdf [question 12]


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## usalsfyre (Sep 17, 2011)

What your saying is that RNs should be allowed to fill a role where a provider already exist that is educated in that specialty. 

So should we start using RNs to do PT or shoot Xrays next? Surely we could just give them some training and make up a credential....


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## usalsfyre (Sep 17, 2011)

JPINFV said:


> Bridge programs still, in general, require clinical hours. California, for example, allows other health professions to challenge paramedic provided they show equivalent education and have completed 40 prehospital ALS patient contacts.
> 
> http://www.emsa.ca.gov/paramedic/files/FrequentlyAskedQuestions.pdf [question 12]



Which, let's face it is as complete and utter bushwa as most EMS educational programs.


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## Katy (Sep 18, 2011)

usalsfyre said:


> What your saying is that RNs should be allowed to fill a role where a provider already exist that is educated in that specialty.
> 
> So should we start using RNs to do PT or shoot Xrays next? Surely we could just give them some training and make up a credential....


I don't think anyone here or the nurses with the certification are attempting to "fill the role" of the Medic. Both the Medic and the Nurse bring a different aspect of health into the picture, PHRN is giving the nurse more training to function in a pre-hospital environment, not replace a Paramedic. Usually, these nurses have ER and ICU experience as well, thought that was worth mentioning.


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## joeshmoe (Sep 18, 2011)

Happy......In my state anyway, LPN's cannot retain their CNA or work as a CNA once they get their LPN license. As an LPN student, yes, but the moment they get their license they can no longer work as a CNA. I assume the worry is that they will exceed their scope of practice as a CNA, but Im not totally sure what the reason is. Where I worked some good CNAs had to quit their job as soon as they passed their LPN exam. Most people would rather work as an LPN than a CNA obviously, but since LPN jobs are more scarce than CNA jobs, it sucks for them they cant fall back on their CNA if they cant find work as an LPN.


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## Katy (Sep 18, 2011)

joeshmoe said:


> Happy......In my state anyway, LPN's cannot retain their CNA or work as a CNA once they get their LPN license. As an LPN student, yes, but the moment they get their license they can no longer work as a CNA. I assume the worry is that they will exceed their scope of practice as a CNA, but Im not totally sure what the reason is. Where I worked some good CNAs had to quit their job as soon as they passed their LPN exam. Most people would rather work as an LPN than a CNA obviously, but since LPN jobs are more scarce than CNA jobs, it sucks for them they cant fall back on their CNA if they cant find work as an LPN.


Interesting. What I don't understand is why these LPN's can't practice as a CNA if they can't find a LPN job, it doesn't make them any less of a CNA, it makes them a better one. But I guess thats just the way it is.


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## usalsfyre (Sep 18, 2011)

Happy said:


> I don't think anyone here or the nurses with the certification are attempting to "fill the role" of the Medic. Both the Medic and the Nurse bring a different aspect of health into the picture, PHRN is giving the nurse more training to function in a pre-hospital environment, not replace a Paramedic. Usually, these nurses have ER and ICU experience as well, thought that was worth mentioning.


In most cases that is EXACTLY what a PHRN would do, replace a paramedic. I may bring a different perspective into the ED, yet I'm not allowed to replace an RN.

Like I said, it's not about nurses personally...


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## joeshmoe (Sep 18, 2011)

> Why shouldn't someone challenge an exam? I looked through a CNA textbook and it seems that the position only requires certification for legal purposes. There's nothing in there that necessitates instruction.



Aerin-Sol

My state CNA written exam was a joke. I could have possibly passed the exam without even having taken the class, using common sense alone. 

However the practical exam was another matter. It was pretty much on par with the NREMT practical exams for EMT basics, only with even more mindless memorization of steps. Many of the RNs who conduct CNA state exams are test nazis that see themselves as the last line of defense against incompetent aides who will get out there and make RNs jobs a living hell by spreading infection like wildfire, as a result they will fail people for the most petty of reasons, and expect EVERY step to be flawlessly executed. I passed my CNA exam the first time, but MOST of my class failed it, despite the fact most of them were also going on to RN school or were already enrolled, and the fact my CNA instructor went over the skill stations with us verbatim the last few classes.

Where I used to work they would hire people who had passed a CNA class but were still awaiting their test date, but had to stop that because so many new hires ended up failing their state practical exam lol.


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## Katy (Sep 18, 2011)

usalsfyre said:


> In most cases that is EXACTLY what a PHRN would do, replace a paramedic. I may bring a different perspective into the ED, yet I'm not allowed to replace an RN.
> 
> Like I said, it's not about nurses personally...


Well, like I said, I can only speak from my experience, but if that is the case in some places then that's pathetic. I know many Paramedics who work in the ED, that doesn't mean they are nurses. I know a few Nurses who work in the Ambulance, doesn't mean they are Paramedics.


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## JPINFV (Sep 18, 2011)

usalsfyre said:


> Which, let's face it is as complete and utter bushwa as most EMS educational programs.



True, to an extent. In a physician, for example, is challenging the paramedic exam (which the only reasons I can think of is for "street cred" and staffing concerns (having 2 medics on the ambulance)), then the preceptorship is to acquaint the physician with the environment, whereas a student needs to be acquainted to both the environment and the medicine.


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## Akulahawk (Sep 18, 2011)

I have quoted a LOT of posts...


Happy said:


> In nursing school students learn little about a lot, they have a very generalized education on human anatomy and physiology, as well as interventions and specialities. Now, when one graduates from nursing school, he or she can choose a speciality that holds interest to them, and with a very generalized education it would be fairly easy or not too difficult to adapt to that specific environment.
> Now, when one enters a Paramedic program, they are already setting themselves up to work in a specialized field, pre-hospital emergency care. Now, when one graduates that program, there main knowledge revolves around cardiology, airway, and emergency interventions. It is very difficult for one who has gone to school for such a specialized field to adapt to a whole different concept of thinking. Not saying it can't be done, but in relation RN's get far more generalized education making them more adaptable to field specialization, while Paramedics essentially graduate school with an already set speciality. Or at least, thats how I view it. ^_^


RN's do learn a little bit about a lot of different areas... and follow-on "orientation" teaches them to function in that particular field. Paramedics learn a LOT about a little bit. When they graduate, they're (ideally) almost completely ready to function in the field with little additional training. 


usalsfyre said:


> I'm still not sure how this in any way justifies the PHRN credential.


I don't see that either...


Happy said:


> Then I guess I don't understand your question, like any other certification and credential, it accounts for a specialized field of nursing.


Nursing school does not prepare the Nurse for field work. 


usalsfyre said:


> What your saying is that RNs should be allowed to fill a role where a provider already exist that is educated in that specialty.
> 
> So should we start using RNs to do PT or shoot Xrays next? Surely we could just give them some training and make up a credential....


I think that's exactly what Happy is saying... 


Happy said:


> I don't think anyone here or the nurses with the certification are attempting to "fill the role" of the Medic. Both the Medic and the Nurse bring a different aspect of health into the picture, PHRN is giving the nurse more training to function in a pre-hospital environment, not replace a Paramedic. Usually, these nurses have ER and ICU experience as well, thought that was worth mentioning.





usalsfyre said:


> In most cases that is EXACTLY what a PHRN would do, replace a paramedic. I may bring a different perspective into the ED, yet I'm not allowed to replace an RN.
> 
> Like I said, it's not about nurses personally...


Like usalsfyre says: the PHRN usually _does_ replace the Paramedic. The places that I've heard of that use the PHRN has them functioning in exactly the same role as a Paramedic, using the same protocols. Some places require a Nurse to get a PHRN credential to function in the role of a Critical Care Transport RN on a ground ambulance. 


Happy said:


> Well, like I said, I can only speak from my experience, but if that is the case in some places then that's pathetic. I know many Paramedics who work in the ED, that doesn't mean they are nurses. I know a few Nurses who work in the Ambulance, doesn't mean they are Paramedics.


Your experience may be a little weak in the area of prehospital and interfacility transport then. Most of the Paramedics I've ever heard of working in the ED as Paramedics work in the hospital's ambulance service and are seconded to the ED for additional help there. Otherwise, they're used as ED Technicians, not as a Paramedic in a Paramedic role. Nurses that work the ambulance typically are there doing strictly CCT transport and don't normally get involved in the 911 system. Incidentally, California (for example) requires that there be at least 2 EMT's onboard each ambulance. An RN, even if certified as MICN, does not meet that requirement, so most CCT ambulances have 2 EMT's and an RN on-board. Now if the RN is also certified as an EMT, that would qualify as the 2nd EMT... Flight programs are handled differently. If they weren't... weight could/would quickly become an issue.


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## Katy (Sep 18, 2011)

Akulahawk said:


> I have quoted a LOT of posts...
> 
> RN's do learn a little bit about a lot of different areas... and follow-on "orientation" teaches them to function in that particular field. Paramedics learn a LOT about a little bit. When they graduate, they're (ideally) almost completely ready to function in the field with little additional training.


This is basically what I just stated. 



IRIDEZX6R said:


> I don't see that either...
> 
> Nursing school does not prepare the Nurse for field work.
> 
> I think that's exactly what Happy is saying...


I know it doesn't, this is exactly why they prefer ICU/ER experience and must get additional certifications. And no, it isn't. Read my posts, a PHRN does not replace a Paramedic. I never said it did, never will. 





IRIDEZX6R said:


> Like usalsfyre says: the PHRN usually _does_ replace the Paramedic. The places that I've heard of that use the PHRN has them functioning in exactly the same role as a Paramedic, using the same protocols. Some places require a Nurse to get a PHRN credential to function in the role of a Critical Care Transport RN on a ground ambulance.


Not from my experience and the people I know, hence why I said "from my experience."



IRIDEZX6R said:


> Your experience may be a little weak in the area of prehospital and interfacility transport then. Most of the Paramedics I've ever heard of working in the ED as Paramedics work in the hospital's ambulance service and are seconded to the ED for additional help there. Otherwise, they're used as ED Technicians, not as a Paramedic in a Paramedic role. Nurses that work the ambulance typically are there doing strictly CCT transport and don't normally get involved in the 911 system. Incidentally, California (for example) requires that there be at least 2 EMT's onboard each ambulance. An RN, even if certified as MICN, does not meet that requirement, so most CCT ambulances have 2 EMT's and an RN on-board. Now if the RN is also certified as an EMT, that would qualify as the 2nd EMT... Flight programs are handled differently. If they weren't... weight could/would quickly become an issue.


It is, but where I lack in that area I pick up in others. They do work in the hospitals as techs, which is why I said a Nurse isn't a Paramedic in an ambulance, a Paramedic isn't a nurse in an ED. They aren't used in a Paramedic role because the Paramedic role wasn't designed for in-hospital treatment, or so the reason of the director at a local hospital I know. 
But, I"m not going to debate on this further, it is far off-topic.


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## Akulahawk (Sep 18, 2011)

JPINFV said:


> True, to an extent. In a physician, for example, is challenging the paramedic exam (which the only reasons I can think of is for "street cred" and staffing concerns (having 2 medics on the ambulance)), then the preceptorship is to acquaint the physician with the environment, whereas a student needs to be acquainted to both the environment and the medicine.


The main issue, IMHO, would be for staffing. For instance here in California, Title 22 doesn't appear to make any exceptions for non-EMT licensed/certified personnel to staff an ambulance. In effect, a physician or RN licensed persons can't be counted as crew members unless they're also certified/licensed as some level of EMT. For instance, an RN could get an EMT cert and work with an EMT driver and that would be kosher from a crew standpoint. Same with a Physician wanting to (or having to) work on an ambulance.


----------



## 8jimi8 (Sep 18, 2011)

usalsfyre said:


> What your saying is that RNs should be allowed to fill a role where a provider already exist that is educated in that specialty.
> 
> So should we start using RNs to do PT or shoot Xrays next? Surely we could just give them some training and make up a credential....





Don't forget that all of those professions you listed have their roots in nursing.  It used to be a nurse pushing all of those buttons, before it was a specialist.


Nurses replacing paramedics?... Well I'm picking up the medic card so no emts will cry if I take their job...  


Everyone here knows WHY a nurse can replace an EMT and it is diametrically opposed to why a paramedic can't replace a nurse.



E. D. U. C. A. T. I. O. N.   ( or the perception of what each one learns/ how much time was put into it.)


Happy, RN/LPN may not be hired under a lower license.  Example:  tech earns RN while working in a hospital... Once tech receives license::: poof! no job!


And a side note:  ONLY, get your LPN if you plan on workin at an LTAC/Rehab/nursing home.  Most LPNs around the country have been offered to upgrade their license or stop working in the hospital.

LPN is a waste of time if you want to be an RN.   It is also a waste of time if you want to be a paramedic.

I've seen people work fulltime through both RN and Paramedic school as well.  

There is no reason to stop halfway to your RN unless you just can't handle the coursework.


----------



## Handsome Robb (Sep 18, 2011)

usalsfyre said:


> Off topic question, why in the blazes do we as a profession support the PHRN certification? Do you see RNs jumping to support an In-Hospital Paramedic certification?
> 
> Please understand this is not sniping at RNs, it's simply the thought we should be protecting our area of practice.



I'm agreeing with this. 

Separate environments, separate responsibilities, separate education. Don't try to mix the two.


----------



## JPINFV (Sep 18, 2011)

8jimi8 said:


> Everyone here knows WHY a nurse can replace an EMT and it is diametrically opposed to why a paramedic can't replace a nurse.



You must have missed the "Of course any paramedic can replace a school nurse" thread.


----------



## Katy (Sep 18, 2011)

JPINFV said:


> You must have missed the "Of course any paramedic can replace a school nurse" thread.


He must have.


----------



## Handsome Robb (Sep 18, 2011)

8jimi8 said:


> Everyone here knows WHY a nurse can replace an EMT and it is diametrically opposed to why a paramedic can't replace a nurse.



I don't. Please enlighten me.

I understand that nurses have a deeper education, but half of an ADN is G. E. N. E. R. A. L. Education. The rest is Nursing specific. So slap some gen ed on a paramedic and we theoretically have the same level of education.... Just specialized.

I like you Jimi and respect your knowledge and ability as a provider, but get off your high horse about nursing education, please.


----------



## 8jimi8 (Sep 18, 2011)

JPINFV said:


> You must have missed the "Of course any paramedic can replace a school nurse" thread.



As someone who has seen the didactic for both programs, I am exempt from that thread.

Practically speaking the only thing a paramedic is missing to be an RN is more disease pathology and clinical time taking care of more than one person for 12 hours at a time.


What is a nurse missing from paramedic school?  A class on 12 leads and check-offs on a few invasive procedures.


The education is pretty much the same, but being that you can gain entry into an ambulance with a 120 hour course...  Oh and a few decades worth of lobbyists.... 

....That's why nurses are keeping medics down... The entry level of education and political clout.


----------



## 8jimi8 (Sep 18, 2011)

NVRob said:


> I don't. Please enlighten me.
> 
> I understand that nurses have a deeper education, but half of an ADN is G. E. N. E. R. A. L. Education. The rest is Nursing specific. So slap some gen ed on a paramedic and we theoretically have the same level of education.... Just specialized.
> 
> I like you Jimi and respect your knowledge and ability as a provider, but get off your high horse about nursing education, please.



Lol... High horse...

You completely missed some of what I wrote.

Go back and keep reading, then maybe you'll realize you aren't upset with me at all.  High horse... Lol...


----------



## usalsfyre (Sep 18, 2011)

8jimi8 said:


> As someone who has seen the didactic for both programs, I am exempt from that thread.
> 
> Practically speaking the only thing a paramedic is missing to be an RN is more disease pathology and clinical time taking care of more than one person for 12 hours at a time.
> 
> ...



Jimi, I think you kinda see my point. It's not that I don't think there's a subset of nurses who couldn't function effectively in the out-of-hospital acute care environment (indeed many already do) just as I think there's a subset of paramedics who could function effectively in an ED or ICU.

My thought has more to do with protecting whatever small niche we have carved out.


----------



## Shishkabob (Sep 18, 2011)

I never quite got why some people thought a new grad nurse was more capable of learning OTJ than a Paramedic.


----------



## Akulahawk (Sep 18, 2011)

usalsfyre said:


> Jimi, I think you kinda see my point. It's not that I don't think there's a subset of nurses who couldn't function effectively in the out-of-hospital acute care environment (indeed many already do) just as I think *there's a subset of paramedics who could function effectively in an ED or ICU.*
> 
> My thought has more to do with protecting whatever small niche we have carved out.


No new grad nurse that I know of can function effectively in the ED or ICU without having a fairly extensive orientation to that environment. I would expect that a Paramedic, even though their training is quite specific, would still have to go through a somewhat modified version of the ED or ICU orientation course before they could be ready to function safely in those environments. 

While I'd be OK in the prehospital environment, I have no illusions about my ability to function as well in the ED on my own, with my own patients. In that environment, at this point, I'd suck...


----------



## Shishkabob (Sep 18, 2011)

Akulahawk said:


> While I'd be OK in the prehospital environment, I have no illusions about my ability to function as well in the ED on my own, with my own patients. In that environment, at this point, I'd suck...



But the true question is, is that due to your 'lack of education' as a Paramedic, or just like a new grad nurse, lack of experience in that area?



I'm of the firm belief that new grad Paramedics can be as good as (if not better) than new grad nurses in certain areas of the hospital that can benefit from their specialization, like the cath lab.


----------



## 8jimi8 (Sep 18, 2011)

Akulahawk said:


> No new grad nurse that I know of can function effectively in the ED or ICU without having a fairly extensive orientation to that environment. I would expect that a Paramedic, even though their training is quite specific, would still have to go through a somewhat modified version of the ED or ICU orientation course before they could be ready to function safely in those environments.
> 
> While I'd be OK in the prehospital environment, I have no illusions about my ability to function as well in the ED on my own, with my own patients. In that environment, at this point, I'd suck...




6 months would make any paramedic golden, as long as they were willing to go home and read a med/surg book on the different disease pathologies encountered.

As i said previously, the courses are almost exactly the same.  What the paramedic would be shocked to find is that most of their invasive procedures would now only be the realm of attendings and their doclings.


----------



## jjesusfreak01 (Sep 18, 2011)

8jimi8 said:


> What the paramedic would be shocked to find is that most of their invasive procedures would now only be the realm of attendings and their doclings.



You're telling me you've never seen an RN or ER Tech intubate or do an EJ in the ED??? Not even a crich?


----------



## 8jimi8 (Sep 18, 2011)

jjesusfreak01 said:


> You're telling me you've never seen an RN or ER Tech intubate or do an EJ in the ED??? Not even a crich?



Lol march yourself into your nearest ED crash and see how much room you get behind the head of the bed...


----------



## Shishkabob (Sep 18, 2011)

8jimi8 said:


> Lol march yourself into your nearest ED crash and see how much room you get behind the head of the bed...



I got a crap load the other day!


Granted, he was spitting up blood from esophageal varices with each compression and was Hep C+... so not too many people wanted to be near that end anyhow.


----------



## JPINFV (Sep 18, 2011)

jjesusfreak01 said:


> You're telling me you've never seen an RN or ER Tech intubate or do an EJ in the ED??? Not even a crich?




Are you serious, or being sarcastic?


----------



## Tigger (Sep 18, 2011)

jjesusfreak01 said:


> You're telling me you've never seen an RN or ER Tech intubate or do an EJ in the ED??? Not even a crich?



Only the nurses from the flight program intubate at any of the hospitals I've ever been at, usually that's the ER physician or RT's realm. I'm not sure if the EJ is the same way, given the "regular" ED nurses usually seem to defer it to the flight gals and guys given that they are generally more experienced in its use, which begs the question of "how can you really perfect a skill if you always pass it off?" That and the IO is becoming more common in hospital.

So many of the RNs at the hospital that I end up in Colorado seem to have lost their ability to get that tough stick because they're passing it off to the ER techs who end up starting almost every line and blood draw. The techs then become great at it because they have more experience and it's not uncommon to see nurses doing compressions at a code while the tech gets a line.


----------



## 8jimi8 (Sep 19, 2011)

Linuss said:


> I got a crap load the other day!
> 
> 
> Granted, he was spitting up blood from esophageal varices with each compression and was Hep C+... so not too many people wanted to be near that end anyhow.





Why didn't you intubate in the field?


----------



## 8jimi8 (Sep 19, 2011)

jjesusfreak01 said:


> You're telling me you've never seen an RN or ER Tech intubate or do an EJ in the ED??? Not even a crich?



An ej, yes.  Intubation?  Surgical airway?  LOL.  You must be joking.


----------



## MedicJon88 (Sep 19, 2011)

I think both fields have its own merits. However LPN/LVN is an archaic skill level just like EMT-Intermediates- Even ADNs are starting to have difficulty finding jobs because hospitals are now starting to require BSN to apply for a position. 

You have to think about it this way- There are shared skill sets between the RN and Paramedics as there are some with LVN/LPN and Paramedic... But consider the job functions- I would not want an RN(without MICN/CritCare level training) responding to an emergency- just as I would not want a Paramedic treating me in a hospital- They are not trained for the specific function of the job. Paramedics are trained to work quickly(courteously) to deliver you to definitive care- not trained on bedside manners and holistic care(rehab, hygiene, feeding, psychological, aka total care) , (excluding Primary care paramedics you see popping up- MD replacements look it up).

Education wise- I think with your background in EMT, Paramedic is the next step up- there are bridge programs from Paramedic to RNs out there should you want to expand your medical horizon in the future- Its not much longer than the standard LVN program and you learn the same Technical skill set that you would need to move forward to RN. 

That's what I'm doing right now- paramedic and later bridge to RN- I want to do Trauma Nursing and later on Emergency Nurse Practitioner. I think the way I'm building my skill set is the best way for me- but it might not be for you- there are always more than one way to reach your goal- just make an informed decision.


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## JPINFV (Sep 19, 2011)

AchilliesOmega3 said:


> (excluding Primary care paramedics you see popping up- MD replacements look it up).


Community paramedics can do a lot of things, but replacing physicians are not one of them.


----------



## MedicJon88 (Sep 19, 2011)

JPINFV said:


> Community paramedics can do a lot of things, but replacing physicians are not one of them.




Ah yes... replacing might not be the best word choice. Kinda like a PA... it prevents admits to a hospital and promotes preventitive care...


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## jjesusfreak01 (Sep 19, 2011)

8jimi8 said:


> An ej, yes.  Intubation?  Surgical airway?  LOL.  You must be joking.



Now you're getting it!


----------



## Shishkabob (Sep 19, 2011)

8jimi8 said:


> Why didn't you intubate in the field?



Literally didn't code until after I walked in to the ER.  Up until that point, the patient was under no respiratory distress and was speaking to me like any other normal person.  No reason to intubate, or do any other airway control, prior to the code.


Esophageal bleeding didn't start until after I started compressions.






AchilliesOmega3 said:


> just as I would not want a Paramedic treating me in a hospital- They are not trained for the specific function of the job. Paramedics are trained to work quickly(courteously) to deliver you to definitive care- not trained on bedside manners and holistic care(rehab, hygiene, feeding, psychological, aka total care)



You're telling me a Paramedic is incapable of learning how to do those tasks in a hospital, the exact same way a new-grad nurse learns?



Mmmkay.


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## Sasha (Sep 19, 2011)

Ugh not this again.

Sent from LuLu using Tapatalk


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## JPINFV (Sep 19, 2011)

Linuss said:


> You're telling me a Paramedic is incapable of learning how to do those tasks in a hospital, the exact same way a new-grad nurse learns?



Nurses aren't going to be intubating or doing crics in the ED either.


----------



## 8jimi8 (Sep 19, 2011)

JPINFV said:


> Nurses aren't going to be intubating or doing crics in the ED either.



there is a level 1 trauma in one of the eastern states where the trauma services are run by CRNAs and CRNA students rotate through at the head of the bed.

There are no other professions that have a program there at this time.

So, correct. an RN will not be doing either,  But an APRN may be...

That is only a master level of education.


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## 8jimi8 (Sep 19, 2011)

Linuss said:


> Literally didn't code until after I walked in to the ER.  Up until that point, the patient was under no respiratory distress and was speaking to me like any other normal person.  No reason to intubate, or do any other airway control, prior to the code.
> 
> 
> Esophageal bleeding didn't start until after I started compressions.
> ...




So you started doing CPR in the hall and intubated the patient in a trauma bay? Where was the ED physician?


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## Shishkabob (Sep 19, 2011)

8jimi8 said:


> So you started doing CPR in the hall and intubated the patient in a trauma bay? Where was the ED physician?



CPR?  Yes.  But not intubation, because as soon as I started compressions the doc came in and intubated.  I was doing what I could to stay AWAY from the mouth with spurting blood considering all I had on was gloves 

But I DID push Epi, which strangely enough was thrown to me by the doctor.




Can't say why, but even though we were in a level 1 trauma center with more than enough help, the people who did the most were the doc, me, and the flight medic and nurse who came to help.


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## 8jimi8 (Sep 19, 2011)

Linuss said:


> CPR?  Yes.  But not intubation, because as soon as I started compressions the doc came in and intubated.  I was doing what I could to stay AWAY from the mouth with spurting blood considering all I had on was gloves
> 
> But I DID push Epi, which strangely enough was thrown to me by the doctor.
> 
> ...



you totally made it sound like you intubated that guy earlier punk!  what were you doing with all your time at the head of the bed?! lol


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## Shishkabob (Sep 19, 2011)

Making sure the doctor knew how to run a code :rofl:



I was just saying how no one wanted to get near the bloody head end of  communicable disease patient.


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## 8jimi8 (Sep 19, 2011)

did he die?


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## Shishkabob (Sep 19, 2011)

8jimi8 said:


> did he die?



Got pulses back, went to the OR, and survived long enough for family to come.  Died a short time later.



It was just an odd, odd call.


----------



## Akulahawk (Sep 19, 2011)

Akulahawk said:


> No new grad nurse that I know of can function effectively in the ED or ICU without having a fairly extensive orientation to that environment. I would expect that a Paramedic, even though their training is quite specific, would still have to go through a somewhat modified version of the ED or ICU orientation course before they could be ready to function safely in those environments.
> 
> While I'd be OK in the prehospital environment, I have no illusions about my ability to function as well in the ED on my own, with my own patients. In that environment, at this point, I'd suck...





Linuss said:


> But the true question is, is that due to your *'lack of education' as a Paramedic, or just like a new grad nurse, lack of experience in that area?
> *
> 
> 
> I'm of the firm belief that new grad Paramedics can be as good as (if not better) than new grad nurses in certain areas of the hospital that can benefit from their specialization, like the cath lab.


Probably a bit of both. I'm most definitely saying that it's not because of ability. I do have quite the extensive background in sports med which, in some ways, goes way beyond either but also is lacking in some areas due to specialization. 


8jimi8 said:


> 6 months would make any paramedic golden, as long as they were willing to go home and read a med/surg book on the different disease pathologies encountered.
> 
> As i said previously, the courses are almost exactly the same.  What the paramedic would be shocked to find is that most of their invasive procedures would now only be the realm of attendings and their doclings.


I would have enjoyed a good course in pathophys... unfortunately, my sports med program (and most I know of) focused on injury physiology. Paramedic didn't get into pathophys much. And knowing where and how Paramedics got started, I'm not surprised that many of those same invasive procedures are in the realm of the attending and "doclings"... yet there are some procedures that I've seen in training that are out of my scope as a Paramedic. 

One of the issues I can see coming down the pike, should Paramedics in general learn pathophys and a few other things, is that they'd want to expand into other clinical areas and Physicians might take a good look at them as a "PA-Lite"... and nurses wouldn't like that precisely because these providers would be encroaching upon the nurse's traditional territories - bedside and in-clinic care. Expand the education more into critical care (way beyond the 120 hour courses) and suddenly you've got providers that can do ICU-ICU level transport without having an RN along for the ride or you'd have Paramedics functioning in the ICU under their own licenses, not under the supervision of RNs and somehow... I don't think the nurses would like that very much.


----------



## jjesusfreak01 (Sep 19, 2011)

Akulahawk said:


> One of the issues I can see coming down the pike, should Paramedics in general learn pathophys and a few other things, is that they'd want to expand into other clinical areas and Physicians might take a good look at them as a "PA-Lite"... and nurses wouldn't like that precisely because these providers would be encroaching upon the nurse's traditional territories - bedside and in-clinic care. Expand the education more into critical care (way beyond the 120 hour courses) and suddenly you've got providers that can do ICU-ICU level transport without having an RN along for the ride or you'd have Paramedics functioning in the ICU under their own licenses, not under the supervision of RNs and somehow... I don't think the nurses would like that very much.



While I certainly don't believe paramedics are incapable of in hospital critical care of any sort, the specific training that paramedics undergo would seem to me to make them best suited to go little farther than the ED in the hospital, just as a nurses education doesn't suit them to go much further than interfacility transports outside of the hospital. 

But we can't just limit this thinking to training. A nurse and paramedic could take the exact same medical classes and they still wouldn't act the same, because nurses sign up to be nurses, and medics sign up to be medics. Medics have a mindset that they want to be the definitive pre-hospital caregiver. They work under very expanded standing orders and despite what some may say, make working diagnoses in the field to effect the best outcomes for their patients. Nurses sign up to work in a more structured environment where while they operate under a limited set of standing orders and have the ability to diagnose, their treatments are ultimately dictated by the physician, not their own diagnosis. In the hospital there is also always someone behind you who can do the job if you can't, in the field you may be all the patient's got.

Granted, its my strong belief that no matter what the specialty, on the job training is the most important element of education, so a nurse can learn to do a medic's job and a medic can learn to nurse if they wish, but lets keep these specialties where they are. Do what you signed up to do, and if you want to do something else, train for it.

PS: Don't go to LPN school unless its on the way to RN school and you have a good reason to stay as an LPN for awhile.


----------



## joeshmoe (Sep 19, 2011)

Most RNs seem to have a little greater depth of understanding of human anatomy and physiology, disease pathology, and pharmacology than paramedics. This is because going to school to be an RN is more academically rigourous and covers a wider range of topics if we are talking about the bare minimum of schooling for both. 

In most medical emergencys in a pre hospital setting, I would still rather be treated by a Paramedic, not an RN who had OJT, because that is what they are specifically trained and tested for. As for Paramedics working in a hospital outside of the ED, I dont think most Paramedics would have any interest in that. ICU maybe. In my limited exposure ICU Nursing seems to be largely oriented towards maintaining machines and devices that most Paramedics rarely work with.


----------



## Akulahawk (Sep 19, 2011)

jjesusfreak01 said:


> While I certainly don't believe paramedics are incapable of in hospital critical care of any sort, the specific training that paramedics undergo would seem to me to make them best suited to go little farther than the ED in the hospital, just as a nurses education doesn't suit them to go much further than interfacility transports outside of the hospital.
> 
> But we can't just limit this thinking to training. A nurse and paramedic could take the exact same medical classes and they still wouldn't act the same, because nurses sign up to be nurses, and medics sign up to be medics. Medics have a mindset that they want to be the definitive pre-hospital caregiver. They work under very expanded standing orders and despite what some may say, make working diagnoses in the field to effect the best outcomes for their patients. Nurses sign up to work in a more structured environment where while they operate under a limited set of standing orders and have the ability to diagnose, their treatments are ultimately dictated by the physician, not their own diagnosis. In the hospital there is also always someone behind you who can do the job if you can't, in the field you may be all the patient's got.
> 
> ...


Nurses and Paramedics can take the exact same prerequisites for their coursework and at the end of their program-specific training, they will tend to think differently. 

Just remember, a Nurse's standing orders may exceed that of a Paramedic's. Ever read an ED Nurse's protocols? You might be amazed what they can initiate without specific MD direction... Other nurses working in other units may have a more restrictive set of standing orders and have to obtain specific orders for a specific patient when the care needed exceeds their standing orders.

Paramedics _could_ have a wider scope if they were educated further and only had to call for MD orders for a specific patient... but again, you're looking at bumping into the realm of PA at that point... thus my comment about "PA-Lite."


----------



## JPINFV (Sep 19, 2011)

8jimi8 said:


> there is a level 1 trauma in one of the eastern states where the trauma services are run by CRNAs and CRNA students rotate through at the head of the bed.



1. Students don't count in this equation, nor do paramedics doing some sort of shadowing for self edification or trying to follow through with local rules regarding skill maintenance. 

2. CRNA (and other APRNs) are only "RNs" when politically necessarily. It's not nursing at that point, it's medicine.


----------



## JPINFV (Sep 19, 2011)

Akulahawk said:


> I don't think the nurses would like that very much.



There's just something ironic nurses complaining about encroachment.


----------



## Akulahawk (Sep 19, 2011)

JPINFV said:


> 1. Students don't count in this equation, nor do paramedics doing some sort of shadowing for self edification or trying to follow through with local rules regarding skill maintenance.
> 
> 2. CRNA (and other APRNs) are only "RNs" when politically necessarily. It's not nursing at that point, it's medicine.


Yep. They start off with nursing model care and end up practicing medical model care. Odd, isn't it?


JPINFV said:


> There's just something ironic nurses complaining about encroachment.


Just a little irony there...


----------



## usalsfyre (Sep 19, 2011)

JPINFV said:


> There's just something ironic nurses complaining about encroachment.



Actually the upper levels are constantly complaining about encroachment from unlicensed personnel (which, they consider paramedics to be) and yet seek to push for independent practice (no supervising physician) every chance they get. Very, very ironic.


----------



## jjesusfreak01 (Sep 19, 2011)

Akulahawk said:


> Just remember, a Nurse's standing orders may exceed that of a Paramedic's. Ever read an ED Nurse's protocols? You might be amazed what they can initiate without specific MD direction... Other nurses working in other units may have a more restrictive set of standing orders and have to obtain specific orders for a specific patient when the care needed exceeds their standing orders.



I would like to read some ED RN protocols, but in my experience shadowing in ERs, the nurses have no problems initiating testing and basic treatment for a number of different emergent conditions, however their treatment is only for obvious conditions, and the tests they initiate are by protocol (such as with chest pain patients). This isn't to say the nurses don't have a great idea of what's really going on with the patient, but for everything past basic treatment they ask the physician, because that's the rule.


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## JPINFV (Sep 19, 2011)

^
So, in other words, a lot like paramedics? Treat the obvious conditions and call medical control when a hard decision has to be made?


----------



## Akulahawk (Sep 20, 2011)

jjesusfreak01 said:


> I would like to read some ED RN protocols, but in my experience shadowing in ERs, the nurses have no problems initiating testing and basic treatment for a number of different emergent conditions, however their treatment is only for obvious conditions, and the tests they initiate are by protocol (such as with chest pain patients). This isn't to say the nurses don't have a great idea of what's really going on with the patient, but for everything past basic treatment they ask the physician, because that's the rule.


Sounds a lot like...


JPINFV said:


> ^
> So, in other words, a lot like paramedics? Treat the obvious conditions and call medical control when a hard decision has to be made?


Yep. Sounds a lot like paramedics to me! They have a LOT more autonomy than regular Med/Surg nurses, but that's because their protocols allow for a LOT more to be initiated without getting specific orders for a given patient. Mind you, this was only about 10 years ago, but back when I was doing my ED clinical time, we routinely started patients on O2, drew labs (including cardiac enzymes) and blood cultures (for some patients), initiated breathing treatments, ASA/NTG for cardiac chest pain... 

And somehow found time to notify the MD of what was going on so that a more specific treatment plan could be devised and implemented. 

Hmmmm.... Sounds like the ED version of a call-in for orders. 

Naaaaa.... couldn't be very much like Paramedics... not at all...


----------



## Shishkabob (Sep 20, 2011)

Sounds alot more like Intermediate level protocols if you think about it, and not Paramedic level...


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## Katy (Sep 20, 2011)

Well, this thread has gone way off topic. 
To the OP: It depends on what you want to do. If you want to go into nursing school, make more money, and flexibility. Paramedicine will give you less pay, but if you like the pre-hospital environment, I say go for that. Maybe try for your CNA or EMT-B, to get your "feet wet" in either field.


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## 8jimi8 (Sep 20, 2011)

Linuss said:


> Sounds alot more like Intermediate level protocols if you think about it, and not Paramedic level...



Keep thinking that if You want lol.  Any emergency protocol you have (aside from something that a physician would do in the hospital) is covered in standing orders or "Emergency Protocol,"  nurses can implement these orders without cOnsulting a physician.  

If it comes down to intubation or a surgical procedure, even a paramedic can't perform it inside a hospital.


----------



## jjesusfreak01 (Sep 20, 2011)

Akulahawk said:


> And somehow found time to notify the MD of what was going on so that a more specific treatment plan could be devised and implemented.
> 
> Hmmmm.... Sounds like the ED version of a call-in for orders.
> 
> Naaaaa.... couldn't be very much like Paramedics... not at all...



Forgive me, I forgot some places still use online med control... ^_^


----------



## Shishkabob (Sep 20, 2011)

8jimi8 said:


> Keep thinking that if You want lol.  Any emergency protocol you have (aside from something that a physician would do in the hospital) is covered in standing orders or "Emergency Protocol,"  nurses can implement these orders without cOnsulting a physician.
> 
> If it comes down to intubation or a surgical procedure, even a paramedic can't perform it inside a hospital.



Sorry jimi, every procedure he described can be done by an intermediate, not a single one requires a Paramedic, hence "sounds like Intermediate level protocols"

No RSI or crics, as you already stated.   

But let's go further:  

Narcotic analgesics without consulting a doc? 
Full cardiac arrest? 
Things beyond asa / nitro, such as a tridil drip, heparin, or beta blockers? 
Ativan/versed for sedation? 
Metoprolol/lopressor? 
Epi, dopamine, or Levophed drips? 


Like I said, sounds intermediate level to me, and not Paramedic level protocols. 


No, not saying nurses Cant do most of that, of course they can, I was just questioning the "protocols" of ER nurses and their extent.


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## 8jimi8 (Sep 20, 2011)

Linuss said:


> Sorry jimi, every procedure he described can be done by an intermediate, not a single one requires a Paramedic, hence "sounds like Intermediate level protocols"
> 
> No RSI or crics, as you already stated.
> 
> ...



I would love to show you the open heart recovery powerplan.  Every bit of it can be executed without once consulting the CTV surgeon.


Please don't delude yourself into thinking a doctor needs to be consulted when an emergent need is pressing.


Especially a cardiac arrest.  Just because you pick the protocol to use, doesn't mean you have autonomy.


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## Shishkabob (Sep 20, 2011)

We were discussing the ED, not CVICU.   So please, i do want to see the EDs standing ordersamd all they're allowed to initiate without a doctor ever being notified.   This isn't a medic/ nurse thing, this is a genuine inquiry. 


And just as much autonomy in deciding what to do as you, jimi


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## 8jimi8 (Sep 20, 2011)

Linuss said:


> We were discussing the ED, not CVICU.   So please, i do want to see the EDs standing ordersamd all they're allowed to initiate without a doctor ever being notified.   This isn't a medic/ nurse thing, this is a genuine inquiry.
> 
> 
> And just as much autonomy in deciding what to do as you, jimi



I've never hung my ego on my autonomy 



I'll see what i can get from my friend Sarah at Brackenridge ER.  What you don't understand is that once an emergent situation is pressing, Emergency protocols can be initiated, without a doctor.  The doctor will simply sign that he gave the order regardless if he did or didn't.  Unless there is gross negligence, then, you are on your own.


All of our "emergency protocols" are online on our intranet, within seconds of being on your screen.  It's just like having a protocol book in the back of the rig.  Which is why i've been rolling my eyes at paramedic vs nurse.  Its all standing orders.  In or out of the hospital.

In the hospital is an "individualized protocol book," (the chart) and out of the hospital is a "1 chart fits all" protocol book.

Each one of those orders is crafted by a physician with the authority delegated to licensed practitioners.


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## jjesusfreak01 (Sep 20, 2011)

Here's a fun question. Can a nurse, without consulting a physician, ignore or alter a protocol if it prescribes a treatment that goes against the provider's clinical judgement? Not all paramedics can, but more progressive systems allow this.


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## JPINFV (Sep 20, 2011)

Regardless of if it's allowed I believe it's an ethical imperative to avoid treatments that are known to be inappropriate with a potential to cause undue harm.


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## Katy (Sep 20, 2011)

I'd like someone to show where LPN's are doing CCT, because there education and training is for treatment of stable patients with predicable outcomes.


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