Why are we often looked down upon as a profession?

[WyMedic]

I can't give you a good answer, but I'll try. When I was a full-time medic, nurses were generally supportive but some were jealous at the skills we performed. Intubation, crics, needle taps, central lines, etc. They couldn't perform these. We were/are autonomous. However, ER techs now are generally medics working in the ER. Now, as a floor nurse, I have seen that there is a general lack of knowledge as to what a paramedic is and what a paramedic can do. I am moving to the ER soon and I believe that I won't experience the same thing.

I've really wanted to ask about this. People that have become nurses, how has it compared to being a medic? I've thought a lot about it but I sorry about being an ER robot and only doing what is ordered.

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[Summit]

nurses, how has it compared to being a medic? ... I sorry about being an ER robot and only doing what is ordered.

You only do what is ordered right now. You have standing orders.

Many ERs have standing orders for their RNs. Same in ICU. Except there are actually a lot more things (and drugs) you can do or be a part of even though some might not seem as whizzbang as a cric that you probably will never do in your career. There's more thinking and accessing your knowledge base involved in choosing the action. There is a lot more collaboration. There is a lot more backup. You care for patients longer and you see a ton more patients (and more at the same time).

 

[WyMedic]

You only do what is ordered right now. You have standing orders.

Many ERs have standing orders for their RNs. Same in ICU. Except there are actually a lot more things (and drugs) you can do or be a part of even though some might not seem as whizzbang as a cric that you probably will never do in your career. There's more thinking and accessing your knowledge base involved in choosing the action. There is a lot more collaboration. There is a lot more backup. You care for patients longer and you see a ton more patients (and more at the same time).

I guess that I have only worked in ER's, I was a tech for a awhile before I got my paramedic and now work for a fire dept. The way that you describe it makes it sound a lot more appealing than what I had in my head I guess. Where do you work now? Could we talk more? I'm thinking about going back to school and i'm not sure what direction to go in.

 

[CWATT]

I honestly believe its because we have too many different scopes of practice. It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community. Thus, it's lowest common denominator that takes the win. Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it. Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.

 

[WyMedic]

I honestly believe its because we have too many different scopes of practice. It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community. Thus, it's lowest common denominator that takes the win. Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it. Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.

See, this is where i see the gap between EMS and RN's. I think that it has a lot to do with context. RN's get Bachelors degree's so they have to go through A&P Chem, bio chem, Pathophysiology etc. I really think that having that background knowledge is so important, and so lost in EMS

 

[FLdoc2011]

I agree with a lot of what has already been said. Remember as well that to some degree this is a team sport and we have roles to fill in different aspects of the care of a particular patient.

I will offer some encouragement in that I rely on you guys, among other things, to be good initial "information gatherers" as you are usually the first healthcare contact for the patient. When I'm seeing a consult the next day I always look for the first EMS report in the chart as sometimes I get a better narrative than what the ED doc documents and I want to know what you guys saw, documented and did in the field as that may affect what I do. Many times for cardiac issues you guys may be the only ones to see that SVT, episode of chest pain, VT, or transiently elevated BP that may resolve before arrival to the ED and may be all I have to base my treatment on. So I rely on our guys to be on the ball when in the field.

Back to the OP though, at least at my shop I think everyone has a good relationship with our local EMS. I'm sure there are regional exceptions to that due to whatever politics play a role but for the most part I'd say that's not the case.

 

[hometownmedic5]

I honestly believe its because we have too many different scopes of practice. It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community. Thus, it's lowest common denominator that takes the win. Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it. Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.

Maybe "moving towards" is not necessarily incorrect wording, but its all about perspective. Whether you choose to look at is as an incredibly long distance or an incredibly slow pace, either way were not going to get there anytime soon.

I think thirty years is a conservative estimate. The first ten years will be passing the legislation necessary to make it happen, and then establishing a mechanism to convert current medic cards into universally accepted credits for an associates degree(the logical jumping off point), and creating the curricula at 200 different colleges. The next ten will be getting everybody up to that standard. Keep in mind how hard this will be fought. This isn't even a union vs private thing. Everybody will be against this because this is the first step in what will end up being billions of dollars annually in increased wages. The last ten years will be the jump to bachelors.

30 years. That's about how long it took nurses, give or take regional differences; and given where nurses started, its a very fair basis for comparison. So if we start the push now, and hard, i might live to see a bachelors in paramedicine exist as a requirement for practicing.

 

[CWATT]

@hometownmedic5 - I agree, it's going to take a while. However, I'm aware of four Bachelors of Paramedicine degrees right now, it's just they're not delivering to a recognized scope. That said, as you correctly identified, nursing along with other medical professions like Respiratory Therapy, Diagnostic Imaging, and Cytology have all moved into Bachelors degrees, so it will be easier for people to understand the same for Paramedicine. Ironically, the largest barrier I see are the current regulators. There is widespread disagreement with scops as it is, so until a central regulating authority is elected, I predict further disagreement.

 

[hogwiley]

I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.

I think some of it is the American mentality of conflating pay with worth. There is an obscene pay difference between Paramedics and RNs in the US that goes way beyond skill and education level.

Nursing is one of the few jobs where someone with a 2 year degree associates degree from a community college can make close to six figures, and the starting pay is probably around 65,000 for someone with no experience.

By comparison, most brand new Paramedics have at least a year of EMT work experience in addition to nearly 2 years of Formal training, and yet start out making less than 30,000 a year. I had an Associates Degree and 3 years EMT experience, and I started out at just over 29,000 a year.

Both experienced RNs in my class washed out of Paramedic school due to poor clinical performance and early on both were clearly not cut out for the field. They only lasted as long as they did due to being RNs.

I dont blame Nurses for that, in fact i applaud them for being able to demand such high pay and prestige relative to their actual training. They are well organized and highly successful at lobbying for pay and conditions. Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.




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[DesertMedic66]

Hospitals in my area are starting to only hire BSN. The older nurses who do not have a BSN are starting to be retire early...

 

[hometownmedic5]

Hospitals in my area are starting to only hire BSN. The older nurses who do not have a BSN are starting to be retire early...

It's been that way at the major academics in Boston for years.

 

[DrParasite]

So this is ********. I have never seen our ER staff look down on our industry as a whole or with disdain. My agency gets along famously with the staff at the ER, from the Chief of EM to the housekeepers and linen stockers. There are a couple of agencies like this. Are there specific EMTs or agencies that the staff doesnt like? YES! Why? because through the years of them bringing patients, those people/agencies have shown poor clinical judgement, acumen, and attitude.

But you are doing the same thing that I do; when you work for a decent agency, and have a decent relationship with the ER staff, what they are describing doesn't happen. How about I group you guys in with MONOC BLS, Able Ambulance, or any of the fly by night transport companies in NJ? Remember, you are often judged by the lowest quality in your field, and we had some winners, especially in the transport companies.

Hell, my department head is HATED (rightfully so) by the ER staff, while the actual line staff regularly get kegs and eggs with night shift.

You think that's bad? We used to get invited to the ER Christmas party, and I may or may not have woken up the next morning next to someone who worked in the ER......

So the profession isnt looked down on, providers are. If you stumble through a report to an RN over and over and over, activate a specialty team incorrectly multiple times, look or act unprofessional, then the ER staff isnt going to like you...but guess what? I wont like you either.

How often have you seen or heard that volunteer EMTs suck? and yet, I can show you several two hatters who are pretty decent, as well as some volunteers who are better providers than their paid counterparts. But people still group everyone in with the retards.

I've never had any issues with any hospital staff. That's not true, an L&D nurse pissed me off immensely, but I was able to get that issue resolved. I also know many MDs and RNs who would listen to my reports and ask me questions when I brought in a sick patient. But I also knew those people, and they knew me. I know of several EMTs who don't even deserve to still have their certs, and a couple medics who I am shocked were able to pass paramedic school

 

[Carlos Danger]

I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.

It is difficult to directly compare nursing and EMS education. Paramedics receive a brief, very focused but somewhat in-depth education that is meant to train them to do one thing only: get a critical patient from where you found them to the hospital, alive. That's pretty much it. Nursing education is much broader and less in-depth in any specific area. It is meant to train nurses to provide comprehensive care and support to a very broad range of patients in a broad range of settings. It is a better foundation for continued learning and specialization later on.

I don't know if the education of nurses is overstated on this forum or not, but there is a pretty big difference. You can still easily become a paramedic in 10 months of vo-tech style training that is based on textbooks written at a 10th grade reading comprehension level and only requires 9 hours or so a week in the classroom and 12 or so in clinical. I know some programs are better than that now, which of course is a good thing, but that's what my initial paramedic program was like and it still works pretty much the same way, as do many of the others that I'm familiar with. Two-year nursing programs are significantly broader and longer than that, and require actual college-level course work (albeit it lower-level). Even so, two-year programs have been judged by the nursing establishment to be undesirable in length and depth, hence the movement towards 4-year degree entry requirements that has been going on for some time now.

Nursing is one of the few jobs where someone with a 2 year degree associates degree from a community college can make close to six figures, and the starting pay is probably around 65,000 for someone with no experience.

Compensation is largely regional, but this is a bit misleading. An entry-level welder can make close to those numbers and much more with experience; it isn't hard to make that kind of money if you simply choose to enter a field with demand and are then willing to go where the money is. A paramedic working for a city or county in SoCal or the Pacific Northwest can make way more than a RN here in the rural southeast.

Paramedics around here start around $15/hr, which with the OT built into their (48hr/wk) schedules translates to about $40k/yr to start, and then they move up a little from there over a few years. They pretty much cap out in the mid $40s unless they work extra OT, which many do. It's not great money by any means, but cost of living around here is low, and lots of people who work full-time get by on less.

New grad nurses here start around $50k. They'll get up to about $55k, maybe close to $60k in a couple years, but that's about all they'll ever make aside from small annual increases if they stay in the same position. So the difference between what paramedics and RN's make around here is significant but not massive. Probably $10k-$15k or so, assuming the nurse stays in the same entry-level position. Keep in mind that most new grad nurses spent 3x as long in training (if they have a BSN) as compared to the new grad paramedics. It's fairly hard for a new grad ASN to get a good job in a hospital around here.

Some RN's do make quite a bit more than that, but these are generally folks who work in specialty areas where they spend quite a bit of time on call, AND had to go through quite a bit of additional training to get, which makes them more valuable.

 

[DrParasite]

I don't know if the education of nurses is overstated on this forum or not, but there is a pretty big difference. You can still easily become a paramedic in 10 months of vo-tech style training that is based on textbooks written at a 10th grade reading comprehension level and only requires 9 hours or so a week in the classroom and 12 or so in clinical. I know some programs are better than that now, which of course is a good thing, but that's what my initial paramedic program was like and it still works pretty much the same way, as do many of the others that I'm familiar with. Two-year nursing programs are significantly broader and longer than that, and require actual college-level course work (albeit it lower-level). Even so, two-year programs have been judged by the nursing establishment to be undesirable in length and depth, hence the movement towards 4-year degree entry requirements that has been going on for some time now.

Honestly, this has always been something that irked me.... if the NCLEX is the bar that nurses need to pass, shouldn't the diploma nurses be unable to pass the exam because they lack the education? and the ADN nurses should have the same issue. in fact, if a BSN is what is needed, than only BSN nurses should pass; after all, if you don't have the knowledge to pass the baseline exam, it's obvious that your program was deficient.

otherwise, it's a lot of fluff to pour more money into the college system, to generate instructor jobs for MSNs, in academia, to require elevated degrees (without any change in mortality, I mean, you would think with all the increased education patients would have much high death rates in the past vs today) to do the same job that their grandparents did.

 

[NysEms2117]

My take as a current part time BSN, student is this. I have a degree in another science field, I'm currently back at school to become a RN, for a part time job. I am currently an EMT, and just the little experience I have at the moment the way the people handle themselves at the hospital(RN's, ER techs, MD's, ect) compared to EMS, is different... You can tell the difference in professionalism in my opinion. Not to say all EMS providers are horrible and disrespectful, however I notice quite a big difference between the two. I've come to notice in the short time I've had in the "adult world"(<5 years) that the pay scales really aren't that far off in most professions. So I think at this moment where you can still be a paramedic without having a degree, they shouldn't be getting the money an RN is getting(base). If a company mandates to have a bachelors in paramedicine, then yeah pay up. However, additional certs on top of a base medic should add value, same for RN. I really think it comes down to regulation. Simple as making a national minimum for EMS, especially since the NREMT isn't recognized by all states, sure it can help, but there needs to be a national minimum, where if you pass the national cert you CAN be an EMT, or paramedic in every single state.

An aside about college in general, it's becoming the new hs diploma, the trades are going away, so like remi said, electricians, car mechanics, welders, plumbers can all charge higher prices because nobody is going into those fields.


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[Summit]

I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.

I think some of it is the American mentality of conflating pay with worth. There is an obscene pay difference between Paramedics and RNs in the US that goes way beyond skill and education level.

Nursing is one of the few jobs where someone with a 2 year degree associates degree from a community college can make close to six figures, and the starting pay is probably around 65,000 for someone with no experience.

By comparison, most brand new Paramedics have at least a year of EMT work experience in addition to nearly 2 years of Formal training, and yet start out making less than 30,000 a year. I had an Associates Degree and 3 years EMT experience, and I started out at just over 29,000 a year.

Both experienced RNs in my class washed out of Paramedic school due to poor clinical performance and early on both were clearly not cut out for the field. They only lasted as long as they did due to being RNs.

I dont blame Nurses for that, in fact i applaud them for being able to demand such high pay and prestige relative to their actual training. They are well organized and highly successful at lobbying for pay and conditions. Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice..

You have so many misconceptions, underestimations, and overestimations all backed up by an anecdote or two, I'm not even sure where to start correcting you.

 

[DesertMedic66]

They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.

I don't think anyone would agree with either of these statements.

As for the reduced scope of practice, it depends on hospital or agency. My girlfriend is a CCT nurse on a ground transporting ambulance part time. The only and I mean only thing that I can do as a medic that she can't is intubate. Now if we move into the HEMS in my area the nurse can do literally anything the medic can do and more. The nurse can tube adults/pedi, needle/surgical cric, RSI, needle T/chest tube, and much more but as a medic I am limited to adult intubation and needle T.

 

[Carlos Danger]

Honestly, this has always been something that irked me.... if the NCLEX is the bar that nurses need to pass, shouldn't the diploma nurses be unable to pass the exam because they lack the education? and the ADN nurses should have the same issue. in fact, if a BSN is what is needed, than only BSN nurses should pass; after all, if you don't have the knowledge to pass the baseline exam, it's obvious that your program was deficient.

otherwise, it's a lot of fluff to pour more money into the college system, to generate instructor jobs for MSNs, in academia, to require elevated degrees (without any change in mortality, I mean, you would think with all the increased education patients would have much high death rates in the past vs today) to do the same job that their grandparents did.

You are 100% correct that regardless of which degree you've earned, basic clinical nursing is all the same. This is exactly why everyone takes the same NCLEX whether your initial nursing education was a diploma program, ASN, BSN, or MSN. It's a hoop that we all have to jump through to prove baseline competency and show that we are all on the same page with the basics of entry-level nursing.

Your degree program is a completely different thing, though. Preparation for the NCLEX is only part of what your degree program is meant to accomplish. You just don't have time for much more than the basics in an ASN program, but the nursing establishment has long felt (and rightly so, IMO) that professional nurses should be learning more than the very basics, which is why the BSN has been pushed. The "fluff" in a BSN program is meant to better prepare you to do things like interpret research, teach, manage, get some exposure to the basics of healthcare policy and regulation, think critically, and communicate better. So in a BSN program, you still spend roughly two years learning the basic nursing stuff that prepares you for entry-level clinical nursing and the NCLEX, and the rest of the time is meant to better prepare you for a professional role.

The analogy to EMS would be that everyone takes the same NREMT-P exam, but then some of the more motivated paramedics go on to earn a 4-year degree in EMS or a related field. That degree probably won't help them do a better job with their basic paramedic role or score better on the NREMT recert exam, but it has other benefits. If there were more 4 year degree initial paramedic programs, it'd be the exact same situation as nursing.

 

[Carlos Danger]

Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.

I don't think anyone would agree with either of these statements.

As for the reduced scope of practice, it depends on hospital or agency. My girlfriend is a CCT nurse on a ground transporting ambulance part time. The only and I mean only thing that I can do as a medic that she can't is intubate. Now if we move into the HEMS in my area the nurse can do literally anything the medic can do and more. The nurse can tube adults/pedi, needle/surgical cric, RSI, needle T/chest tube, and much more but as a medic I am limited to adult intubation and needle T.

Wow, I missed that gem the first time I read and quoted his post.

Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.

 

[EpiEMS]

@Remi makes a great point - and there is a good body of research (linked to some examples - not necessarily great ones) demonstrating improved patient outcomes for baccalaureate prepared nurses. So, as might be evident, better workers make more money...sure, there is some "sheepskin effect", but it is not *all* that.

Of course, hospital administrators have incentives to hire better nurses - you know, quality-based payment and all that - while it's not clear that most EMS administrators have the same direct revenue-side incentives (all else equal)

Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.

This, this, this!