EMS/Nursing vs. Firefighting

[MrBrown]

and with talk like this it comes as a suprise that Paramedics in the US are not respected and get paid minimum wage to sit at a gas station for 12 hours then go work another two jobs?

*Brown gets in his helicopter and flies far, far away

 

[SerumK]

So you're telling me a Paramedic can't adapt either? You're telling me Community Paramedicine is a hoax?

Yes... the Community Paramedicine idea is a JOKE of a hoax until paramedicine becomes a profession with a collegiate educational underpinning as its basis.

Community Paramedicine is not a field for a technician.

What makes you think a Paramedic is completely and totally incapable of transitioning to other areas as well, with the same orientation? What makes a new grad nurse any more capable at working in an ER than a Paramedic with the same educational requirements?

3-7 years of college education, depending on the RN's degree.

The basic ADN usually has 3-3.5 years of college, 1-1.5 year of gen-ed + prereqs, then 2 years of nursing. Most ADN programs are actually 75 credits or more required, and the students have to take more than that in order to get their prereqs. BSN? 4-5 years. ABSN? 4-5 years depending on the previous degree + prereqs, then another 1.5-2 years crammed into 1-1.5 years.

But when you look at what do they want for public health nurses, the closest "equivalent" to the "community paramedic," they want a BSN.

Anyway-- medicine is full of specialized professionals. Respiratory therapist, rad techs, sonographers, etc etc. Why is it so bad that we are specialized in emergency medicine? No one has YET to explain that to me.

RTs are associates minimum with most being or heading towards bachelors now. They are therapists, specialized clinicians, not technicians.

Know what the difference is? Techs don't get to change fields with an orientation. Sonographers don't read their echos. Rad techs don't read their x-rays. They take pictures of a patient and hand it off to a doctor who interprets them then decides what to do. If paramedics decide they are specialized techs, then that is all they ever will be.

But you don't want to be. Paramedics want to assess, diagnose, determine an outcome, perform interventions, plan, evaluate their actions, etc. These are NOT the actions of a technician. These are the actions of a clinician and EMS is that LAST place in medicine where anyone is still allowed to do that without a college education.

 

[SerumK]

A Paramedic has more education in pre-hospital emergency management than a new grad nurse.

You fail to understand that there is a difference between specialist training versus educational foundation.

Paramedics have more specialized training. The requirements to be a paramedic do NOT include in-depth educational foundations to build truly advanced understanding of their specialty or general expansion into other specialties.

That is why the average ED RN has much more after a few years than a paramedic after few years, all other things being equal... and the ED nurse still has the foundations to go become an ICU nurse, an OB nurse, whatever. The basic paramedic does not.

 

[Shishkabob]

This whole thread is just turning in to a broken record.

I have never, not once, said "We don't need to learn any more". So if you continue to insinuate as much, you will continue to be wrong.




Why is it SO bad that Paramedics specialize, while nurses generalize? Why is it ok for other professions to be specialist in their respective fields, and no one doubts that they know more about that stuff than the average nurse, yet it's so "Oh my God" horrible when the same is said about Paramedics?


Oh, and please tell me... is a new grad nurse instantly a 'higher level of care', then say, Akulahawk, because he's a lowly Paramedic? Is someone fresh out of nursing school instantly better than someone with years of experience, just because THEIR chosen profession doesn't require English lit? Heck, is someone fresh out of nursing school better than someone fresh out of Paramedic school, every single time?



I don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics. Just having the title "RN" does not make you better than someone with NREMT-P. You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.

 

[MrBrown]

You fail to understand that there is a difference between specialist training versus educational foundation.

Paramedics have more specialized training. The requirements to be a paramedic do NOT include in-depth educational foundations to build truly advanced understanding of their specialty or general expansion into other specialties.

That is why the average ED RN has much more after a few years than a paramedic after few years, all other things being equal... and the ED nurse still has the foundations to go become an ICU nurse, an OB nurse, whatever. The basic paramedic does not.

Praise the Lord, preach it brother!

*Brown knows who is going to win the 2010 Orange Jumpsuit award

 

[SerumK]

Why is it SO bad that Paramedics specialize, while nurses generalize? Why is it ok for other professions to be specialist in their respective fields, and no one doubts that they know more about that stuff than the average nurse, yet it's so "Oh my God" horrible when the same is said about Paramedics?

It's all about what you want a paramedic to be:
It's OK to be a specialized technician, but not if you want pay equal to an educated medical professional.
It's OK to be a specialized technician, but not if you want to have expanded roles that require advanced diagnostic thinking.
It's OK to be a specialized technician, but not if you want to expand out of your specialty.

That's why paramedics won't be community paramedics or as well paid as nurses as long as they remain HS Diploma + 6mo Trade School as the minimum entry.

Oh, and please tell me... is a new grad nurse instantly a 'higher level of care', then say, Akulahawk, because he's a lowly Paramedic? Is someone fresh out of nursing school instantly better than someone with years of experience, just because THEIR chosen profession doesn't require English lit? Heck, is someone fresh out of nursing school better than someone fresh out of Paramedic school, every single time?

Certainly not a "higher level of care!" Apples and oranges... but to your overall point:

Arguably, a NEW paramedic is more competent in their field, on average, than a new grad RN in the ED. But an ED RN with 1-2 years of experience is more capable in their realm than the 1-2 year paramedic in their realm, on average, and the disparity can grow.

-------

Lastly, going on about how college educated medical providers aren't worth it because "English Lit doesn't make you better" is based in only one of two things:

1. Ignorance of what a college education actually entails and instills. You don't know what you don't know.
2. An intentionally disingenuous attack... honest debate, please!

 

[SerumK]

Let's go on another journey to screwed-up-metaphor-land for craps and grins!

The paramedic comes out of training with a doublewide home. It's nice, but you can only do so much to it.

The nurse comes out of school with the singlewide from which to supervise the construction upon the large concrete foundation created through school.

For humor: the EMT comes out of school with two sticks, a flint, and a canvas tent... the CNA comes over to sleep with him because his tent is nicer than hers, and the exercise warms up the sleeping bag.

 

[Shishkabob]

But an ED RN with 1-2 years of experience is more capable in their realm than the 1-2 year paramedic in their realm, on average, and the disparity can grow.

That's largely debatable and intangible. I know 'newer' medics who can school 'more experienced' nurses. I know newer nurses that can run laps around some medics.


You want to compare like things?

Oregon requires Paramedics to have an AAS minimum. Same exact pre-reqs, only difference between the two is what is taught in their specific classes. Now, instead of apples to oranges, it's more like apples to red oranges.



Is the nurse still "better" because they are generalized? Or are they then the same level of care, commensurate in pretty much all aspects but specialist in their desired field of study? THAT, my friend, is what I have been trying to get across this whole thread.

 

[Journey]

I don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics. Just having the title "RN" does not make you better than someone with NREMT-P. You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.

Now you are resorting to the use of personal attacks or experiences to drag down professions based on a few incidents involving individuals you have seen. You have also stated to being a very new Paramedic and it seems like very little experience applying your newly acquired skillset or knowledge based on some of your posts. You may also only comparing nurses for their ability to do the same skills you do.


To answer your question simply, an RN requires a degree which means at least a two year committment for study. The minimum requirements are national and graduation from an accredited program is required to take a national exam. When RNs come out of a degree program, they know they will probably need an orientation program which includes more training and education. The additional training learning specific skills and protocols may even be longer than the 3 or 6 month Paramedic program.

To achieve the same level of base knowledge with the education, the Paramedic would need to have at least an Associates and then spend several more months specializing. I believe other countries do have something similar for their Paramedic programs where they get a solid education and then spend 1 - 2 years interning to become clinicians rather than technicians.

The NREMT-P is a certification which is not even used or accepted in all states. Some Paramedics believe it is useless and don't get it or keep it if they don't have to. Each state determines its own levels and minimum hours of training. RNs and a few other professionals can also challenge the Paramedic exam in a few states.

A 3 month medic mill product should not be equal to an RN or anyone in the health care professions who has a degree in their chosen profession. Would you expect a PCT with 600 - 800 hours of training to be equal to an RN? Would you expect the LVN with 1200 - 1500 hours of training to be equal to an RN? Would you expect an MA with 800 - 1000 hours of training to be equal to an RN? These techs also do several skills and provide valuable patient care but they are not RNs.

The job a Paramedic does is very important which is why it is puzzling that so many believe a few hundred hours of training are enough and that some are allowed to do so much with so little education behind them to support the whys of doing advanced skills and protocols.

 

[Level1pedstech]

Let's go on another journey to screwed-up-metaphor-land for craps and grins!

The paramedic comes out of training with a doublewide home. It's nice, but you can only do so much to it.

The nurse comes out of school with the singlewide from which to supervise the construction upon the large concrete foundation created through school.

For humor: the EMT comes out of school with two sticks, a flint, and a canvas tent... the CNA comes over to sleep with him because his tent is nicer than hers, and the exercise warms up the sleeping bag.

Do you live in fantasy land or are you just completely oblivious to what is available as far as pay and benefits to people who do take the initiative and improve their educational pedigree? I like your way of thinking but are you willing to put in all that time then try and raise a family on under 100k a year. I don't see very many people in any area of EMS making that kind of cash unless they are putting in massive amounts of over time. I'm sure someone can honestly say that they make that kind of money without living at work but its not the norm and is probably the result of many years of hard work. I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve.

I have said it before and until you can give me concrete proof that the system will change you are preaching to people who would love to get an advanced education (myself included) but are not willing to work for chump change. Please don't even try and make it about taking pride in being considered a medical professional rather than a technician thats an insult to all of those that have given years of excellent service as lowly technicians. Try telling that to an employer when you ask them to double what they have been paying their technicians for years. I'm glad you would get a warm feeling with your new found stature but can you pay your bills with your new title.

I'm curious what kind of money you think a person should expect to make if you had your way and could change the current system? I can help you out a little, I as a teamster truck driver with no advanced education but after a lot of hard work make right at 90K add in my benefits and its a 130k package give or take a few grand. I struggle to make ends meet and support a family of five and by no means do I live a fancy life. When I think of a salary that reflects the time your asking people to commit I think 150k+ to start, I don't think your going to see that in our life time.

I don't know how much real world experience you have but many of the folks on this board have very little and they need to know the cold hard facts about what awaits them. Felling great about your professional status is nice, providing outstanding patient care is job one but people need to be able to find jobs that provide a base to not only improve their professional life but their family life as well. I don't see a whole bunch of those jobs out there maybe you could help me out. I do applaud your efforts and really have changed my way of thinking about how the system needs to be improved over the years but sadly especially in this economy you truly are living large in fantasy land. Maybe wait and give it a shot after 2012 when we regain control of our country and the economy returns to where it needs to be if you want your visions to come to fruition.

 

[SerumK]

ancdotes anecotes anecdotes and OR

That's why I said "largely" an "ON AVERAGE." There's always individually exceptions.

As far as OR, educated generalists are NOT "better" than educated specialists, just different (and more versatile in the long run). Three realities remain in this debate:

1. Generalists can specialize far easier than specialists with no generalist foundation and education can switch specialties.

2. As long as OR remains a national anomaly re EMT-Ps, the insurance/government policy reflecting reimbursement will not allow commensurate pay with their education, although surely it is better vs standard of living than some other areas in a given facet of their employment, if only by reducing the influx of fresh meat.

3. EMS is debating whether to require AAS degrees to become a paramedic, while only a few paramedics are getting degrees and nobody is requiring it. Meanwhile, nursing is debating whether to require BSN as the MINIMUM with BSNs rapidly approaching 50% of new grads, employers requiring or preferring BSNs, AND a slew of ASN to BSN programs out there which are OFTEN FUNDED BY THE NURSE'S EMPLOYER.

To think, my ambulance service was incredibly progressive because they would reimburse EMTs to take A&P. What a rare concept!

 

[SerumK]

Do you live in fantasy land or are you just completely oblivious to what is available as far as pay and benefits to people who do take the initiative and improve their educational pedigree? I like your way of thinking but are you willing to put in all that time then try and raise a family on under 100k a year. I don't see very many people in any area of EMS making that kind of cash unless they are putting in massive amounts of over time. I'm sure someone can honestly say that they make that kind of money without living at work but its not the norm and is probably the result of many years of hard work. I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve.

I have said it before and until you can give me concrete proof that the system will change you are preaching to people who would love to get an advanced education (myself included) but are not willing to work for chump change. Please don't even try and make it about taking pride in being considered a medical professional rather than a technician thats an insult to all of those that have given years of excellent service as lowly technicians. Try telling that to an employer when you ask them to double what they have been paying their technicians for years. I'm glad you would get a warm feeling with your new found stature but can you pay your bills with your new title.

I'm curious what kind of money you think a person should expect to make if you had your way and could change the current system? I can help you out a little, I as a teamster truck driver with no advanced education but after a lot of hard work make right at 90K add in my benefits and its a 130k package give or take a few grand. I struggle to make ends meet and support a family of five and by no means do I live a fancy life. When I think of a salary that reflects the time your asking people to commit I think 150k+ to start, I don't think your going to see that in our life time.

I don't know how much real world experience you have but many of the folks on this board have very little and they need to know the cold hard facts about what awaits them. Felling great about your professional status is nice, providing outstanding patient care is job one but people need to be able to find jobs that provide a base to not only improve their professional life but their family life as well. I don't see a whole bunch of those jobs out there maybe you could help me out. I do applaud your efforts and really have changed my way of thinking about how the system needs to be improved over the years but sadly especially in this economy you truly are living large in fantasy land. Maybe wait and give it a shot after 2012 when we regain control of our country and the economy returns to where it needs to be if you want your visions to come to fruition.

You have absolutely pegged the catch 22 of the system... and the solution sadly has to come from the political/professional organization realm at this point. The infrastructure of the EMS reimbursement system at this point is built around vocational technicians and certain parties have found that these low standards can be good to their bottom lines. The paradigm shift required to go from the current system to something like NZ or Canada requires such a shift in professional requirements, system structure, and reimbursement guidelines, that I do NOT pretend to know how it can be done without a government mandate brought on by professional organization political lobbying.

That, however, will never happen without political will on the part of us, the rank and file EMS provider. So in a way, yes it is about pride... and about having a sufficient educational base built into the EMS system that we can say: "yes, make the requirements (and duties) higher, there are enough of us there already, the rest will rise up or bow out. The higher requirements and service will reduce cost in the whole healthcare system, command better reimbursement, reduce labor turnover (and supply), all of which will economically justify the wages that justify the requirements we are asking EMS to meet."

That's about the only way I see the "chicken or the egg?" quandary being solved on the subject of EMS professional education and reimbursement.

And yes, I realize I ACTUALLY live in reality. That's why I have detoured from EMS into a BSN program. I did it knowing I'd be humped for the short run because of the RN job market, but set for the long long run. Of course, if I really wanted some money, I never would have left my plush IT job for EMS. I guess that's why I went back to IT when I realized my prospects in working in EMS, and just volunteered while I worked and went to school for nursing. I freely admit such a course is the luxury of being a working professional with no family to support.

 

[Journey]

Oregon requires Paramedics to have an AAS minimum. Same exact pre-reqs, only difference between the two is what is taught in their specific classes. Now, instead of apples to oranges, it's more like apples to red oranges.

I also thought Oregon required an Associatates degree but that is not the case for reciprocity so I am correcting any previous statements that may have led you to believe this is an absolute truth.

In Oregon, a person transferring from another state must just show submit proof of having worked for at least three years out of the last five years as a paramedic in either another state or in the Military at the Paramedic level. If you don't meet either of those requirement and you don't have a degree you can also still apply for a provisional license.

The website is also not specific if the Associates degree has to be in EMS or the health sciences.

Without a set entry requirement, it would still be difficult to use Oregon as an example for the degree based Paramedic.

 

[Journey]

I just don't see any of the privates or the fire service prying open their wallets and offering up wages that reward the educational efforts of those that really want to improve.

I don't know much about private ambulances but FDs do offer monetary rewards for education.

Here's an example and this is a very low one. Many FDs base their promotions with an educational requirement.

The following is additional incentive pay available if an employee meets the following certification or degree requirements:
$300 a year for ACLS Instructor
$300 a year for IV certification (Emergency Medical Technicians only)
$300 a year for 12 lead certification (Emergency Medical Technicians only)
$900 a year for an Associates Degree (State supplemented)
$1,920 a year for a Bachelors Degree (State supplemented)

 

[Level1pedstech]

You have absolutely pegged the catch 22 of the system... and the solution sadly has to come from the political/professional organization realm at this point. The infrastructure of the EMS reimbursement system at this point is built around vocational technicians and certain parties have found that these low standards can be good to their bottom lines. The paradigm shift required to go from the current system to something like NZ or Canada requires such a shift in professional requirements, system structure, and reimbursement guidelines, that I do NOT pretend to know how it can be done without a government mandate brought on by professional organization political lobbying.

That, however, will never happen without political will on the part of us, the rank and file EMS provider. So in a way, yes it is about pride... and about having a sufficient educational base built into the EMS system that we can say: "yes, make the requirements (and duties) higher, there are enough of us there already, the rest will rise up or bow out. The higher requirements and service will reduce cost in the whole health care system, command better reimbursement, reduce labor turnover (and supply), all of which will economically justify the wages that justify the requirements we are asking EMS to meet."

That's about the only way I see the "chicken or the egg?" quandary being solved on the subject of EMS professional education and reimbursement.

And yes, I realize I ACTUALLY live in reality. That's why I have detoured from EMS into a BSN program. I did it knowing I'd be humped for the short run because of the RN job market, but set for the long long run. Of course, if I really wanted some money, I never would have left IT for EMS. Then again, that's the luxury of being a working professional with no family to support.

Good to see you have given some thought to what lies ahead. You have to admit that there are many out there who share your vision but have absolutely no idea on how to make it happen. To many the idea of an MD and an RN on every EMS unit would be a wet dream come true but lets come down out of the clouds and take a look at what reality has to offer and what needs to be done for them to realize their visions of grandeur for the EMS service.

Where on the list of must do's to get this country back on the road to prosperity do you see the importance of vast improvements to the EMS system. I'm sure your well aware that federal state and local budgets are hemorrhaging money at an alarming rate. To realize your vision you are going to need revenue along with cooperation of both parties in Washington. Revenue for the changes you seek comes largely from taxes,I don't know about you but I'm taxed to death and until I see a more disciplined government I'm not going to offer up any more and I think most of the country are in my corner. Tax levys are getting passed but at a rate much lower than in previous years. People see waste and fraud and a complete lack of respect for our hard earned money and they are growing very tired.

Privates as well as municipal agencies need to have money coming in in order to pay wages and right now there is are not enough sources of revenue to satisfy the commitments already made. The American people are tired and fussy and in general have no idea what problems their EMS services suffer from. You dial 911 and boom you get help from a provider, maybe not with the educational pedigree that some desire but in the heat of the moment do you think Mr John Q Public really gives a rats rump. I do think change is possible but we have bigger eggs to crack before we ask for something as huge as a full remodel of our EMS system. Your a stand up guy for taking the time to see the problem from both sides and for understanding what a major job its going to be to reach your goal. Like I said I think to many people want change but have not thought the process thru to the finish.

Good job making the move to the BSN program I know its alot of work but there is a pay off and you will truly be a more satisfied health care professional. Dont be discouraged there are RN jobs even ER RN jobs for the right people especially with a pre hospital EMS back round. You may have to work on call or per diem at more than one hospital but take heart you wont be the only one and at least you wil be working. I can only hope to get there myself someday but the window is almost closed and its not looking good. I only work in the ER at this time and I can tell you I'm not as frustrated at the end of a shift like I sometimes was after a shift at the fire house. I do keep in touch with people working on the outside and they seek change but most are glad to have a job these days even one that pays chump change it's sad but I feel a change is coming.

 

[Level1pedstech]

I don't know much about private ambulances but FDs do offer monetary rewards for education.

Here's an example and this is a very low one. Many FDs base their promotions with an educational requirement.

As a former fire guy I truly do appreciate your example but as you know the fire service is not exactly flush with jobs at the present time and that's probably not going to improve any time soon. And when jobs are available your looking at a very competitive career choice so its really not fair to put it in the mix. Even with all the add on's and assuming you top out at a captain or above you will not generally break that 150k barrier unless like I said before your swimming in OT. Of course BC's and other Chief staff are up there but that's not a likely scenario for most even the ones that manage to get a fire job in the first place. The examples you used add up to about 76 dollars a week which is a start but far from where it needs to be even in the fire service which we all know generally pays far better than private agencies.

The kind of money I'm talking about is 150k for a normal work week if your going to invest 4-7 years of time to advance your education. To be honest the fire service would be the first to secure resources to reward their employees that seek the higher EMS education being discussed but you have to remember it all goes back to revenue which comes from taxes and you know that drill.

 

[gicts]

The biggest hindrance I see is even if it was decided we deserve more, where would it come from? Ambulance bills can reach $1,000 or more, departments are cutting back, insurance companies will only foot so much, and many people transported simply never pay.

How could your agency get the funds to essentially double their staff budget? Heck, ours can barely keep the trucks on the road.

That is the reason IMO EMS will never be a well paying gig. :wacko:

 

[Level1pedstech]

The biggest hindrance I see is even if it was decided we deserve more, where would it come from? Ambulance bills can reach $1,000 or more, departments are cutting back, insurance companies will only foot so much, and many people transported simply never pay.

How could your agency get the funds to essentially double their staff budget? Heck, ours can barely keep the trucks on the road.

That is the reason IMO EMS will never be a well paying gig. :wacko:

Well said, I guess there are more people out there that question where all the money to pay for these changes is going to come from. You can also factor in the hundreds of smaller departments that would love to be able to staff a full time ALS rig with a paid crew but even at today's wages its not happening for many.

 

[46Young]

Good luck with organizing. Most employers across the board want to keep EMS salaries as low as possible. Who's going to advocate degrees if it'll mean a pay increase? Meanwhile, many in the profession are transient as it is.

 

[SerumK]

Level1pedstech I appreciate your thought out posts.

Who's going to advocate degrees if it'll mean a pay increase?

Worked for OT, PT, RT, PA, and RN... each stood up as a profession and decided it and then worked for it. The process took YEARS. Why is EMS so different?

Meanwhile, many in the profession are transient as it is.

That's what I'd call a symptom.