EMT to Paramedic to RN

rmena

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Metaphysics...This might help.

First, like stated earlier, the models for paramedic and nursing are very very different. Add the stigma placed on both fields toward the other field and you have a crap throwing contest when the two fields should be working together. The nursing model, as I was told by an ER nurse, is very different from the "medical model" that is taught to PA and MDs. It is an supporting role and as there are a lot more fields than just emergency medicine, you are right, there is much more opportunity for employment and diversity. The Paramedic model is stabilize quickly and transport and goes more by the "medical" model. Of course you have the "para-gods" who think it is to question doctors, go beyond your scope because you read about it somewhere once, and be a self proclaimed bad *** but those guys don't last very long. They usually end up in court for doing something idiotic or their captain cannot stand their know-it-all attitude and get them fired for something else.

Second, the career ceiling myth. Many paramedics with a extra semester of fire school can work as firefighters/paramedics. In the fire world you have several ranks (ie, captain, lieutenant, battalion chief, etc) If you take your career serious and prove to be a good leader, and, and, and.... you may end up eventually as a battalion chief which varies in pay but is not uncommon to be a 6 figure a year job. So, in essence it is just like any career that has room for upward climb without extra schooling (although they may have changed the requirements of being a BC to needing a degree).

Third, the "you can do more than a nurse" idea. I don't really know where that idea came from. I think you may have confused the idea of having standing orders/protocols as having more freedom/more skills than a nurse. Consider flight nurses, they will run circles around your average medic with regard to skills and emergency medical knowledge and they are still just a "nurse". Yeah if you put an ICU nurse on the street (I have seen this before) they will not have a clue, but remember that in such vast careers like nursing a lot of your training as a nurse is more on site training. You get a little bit of everything in nursing school but you also get specialized training in whatever subarea of medicine you choose to go into.

Fourth, you will get as much intellectual working as a medic as you want. Yes, you will have protocols and scope and all those restrictive factors to your job, but there is plenty of intellectual challenges to every call. I have seen medics that can diagnose as good as some doctors and I have seen medics who only know the algorithms. Doctors are usually overwhelmed in the ER and will only have a matter of a couple minutes to make a diagnosis and decision, therefore, they will just end up treating to symptoms. If they have to start all over because the medic sucks at gathering information, the underlying problem is never even addressed. Quality care goes out the window. If you are a good medic and are able to think intellectually about the root disease process (ie go beyond the medic book in knowledge but not practice) you can paint a better picture for the doctor which will then be able to make a more informed decision. Don't believe this, ask my old man. He has been an ER doc forever!

Lastly, consider this as an alternative track. EMT -> Paramedic ->BS in emergency science while working (accumulating your exp. hours) and getting paid (a lot quicker than getting an RN) ->PA-C Schooling total ~ 6 years
 

Akulahawk

EMT-P/ED RN
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I know the new Sacramento City Fire Chief. He's currently licensed as a Paramedic and was an EMS Captain for a long time, most recently he served as a Battalion Chief before being selected for the job of Fire Chief. He's fairly young and still ran calls as a Paramedic, unfortunately now his job is primarily administrative. His current job will take him definitely off the street and no longer doing patient care.

He'll do very well in his new job and I'm sure he'll continue to press for advancements at his new Department.

His career path is pretty typical of FF/P's. Once you're promoted to the point where you no longer have to pull shifts on the ambulance, your patient contact will usually be limited to those few minutes between your arrival on scene and the arrival of the ambulance, or you play second fiddle to the transport medics if they arrive at the same time because it's a LOT better for the patient. Then the further up you go, the less and less patient contact you get.

I'm not saying that's all bad, just not good if you like the patient care part of the FF/P job.

Paramedic is educated more along the medical model. It's easier for the properly educated Paramedic to transition to PA-C than Nursing because they don't have to shift their way of thinking. Depending upon where you are as a PA-C, you can go pretty much anywhere in medicine but you will require a supervising Physician. The level of supervision can vary... now as a Nurse, after you've done some time, you can go to NP school and you may or may not require Physician Supervision but you may be required to have a collaborative agreement with one.

In other words, once you're a Paramedic, your options for doing patient care diminish as you advance in the ranks of Fire or EMS administration but as a Nurse or PA, you have the ability to find what you like to do and you can even change your focus later.

Either is a good way to go. I had a good time as a Paramedic and I hope that serves me well down the road.
 

rmena

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Just know that in any medical field, experience is your currency with the way the market is going right now.
 

VFlutter

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It really depends what kind of "rush" you are into. To me there is nothing better then managing a crashing patient on CRRT, IABP, 6+ Drips, etc or an open chest post CABG patient. It is intensely intellectually challenging. I will take that over lights and sirens any day.
 

Summit

Critical Crazy
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It really depends what kind of "rush" you are into. To me there is nothing better then managing a crashing patient on CRRT, IABP, 6+ Drips, etc or an open chest post CABG patient. It is intensely intellectually challenging. I will take that over lights and sirens any day.
Indeed

you on the unit now?
 

VFlutter

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Indeed

you on the unit now?

Yep, been in the unit for a couple of months now. M/S ICU that takes pretty much everything. Neuro, cardiac, etc. Only thing we don't do is advanced neurosurg and cardiothoraic surg
 
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Carlos Danger

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For me, however, there are personal drawbacks to nursing, namely as a paramedic you can generally DO more than a nurse, you often have more training in some areas, and you can also work in an emergency room alongside nurses at some hospitals.

As a paramedic your scope of practice is generally very narrow. In nursing you can practice in all sorts of areas.

When I worked in the ICU the only skill I couldn't do there that I could on the streets (as a paramedic) was intubate. But there were all sorts of things I did and saw in the ICU that I never did in the streets.

Plus, I need the adrenaline rush.

You will quickly become bored and disappointed with EMS if you need an adrenaline rush.

Same with the ED - it is mind-numbingly busy and monotonous.

I do worry that being a paramedic won't provide the intellectual challenge I need out of a job over the long term. I could be wrong. I hope I am.

Being a paramedic can be intellectually challenging, especially if you work for a truly progressive system.

IME, one of two things happens to really smart, motivated paramedics: they either get bored and move on (which can happen much more quickly than you'd expect), or they find a way to keep feeling stimulated and interested and challenged, and they thrive. That's a lot easier to do in some systems than others, but individual personality factors are obviously critical as well.
 
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Emergency Metaphysics

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Thanks

Metaphysics...This might help.

First, like stated earlier, the models for paramedic and nursing are very very different. Add the stigma placed on both fields toward the other field and you have a crap throwing contest when the two fields should be working together.

Thanks for this. It is helpful. I work with nurses right now and they haven't really come down either way on whether they are in love with paramedics/EMTs or not. They are, however, nurses who have sort of found their nice, quiet corner of the field to camp in and prefer to remain unnoticed and static. I'm not like that at all.

One of the reasons career diversity is so important to me is that I need constant challenge and growth, but I'm also 36. I've already had a career. I'm considering medical school, but there are other things I want to do first.

I'm curious if 36 is too old to be an EMT full-time/Paramedic full-time ... I guess I'm feeling old and non-traditional. So, with that, I worry about how long a career I could actually have in EMS, and whether I should instead go into nursing or P.A. work.

Thoughts?
 

Emergency Metaphysics

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I don't know about Fire

I know the new Sacramento City Fire Chief.

His career path is pretty typical of FF/P's. Once you're promoted to the point where you no longer have to pull shifts on the ambulance, your patient contact will usually be limited to those few minutes between your arrival on scene and the arrival of the ambulance, or you play second fiddle to the transport medics if they arrive at the same time because it's a LOT better for the patient. Then the further up you go, the less and less patient contact you get.

Thanks for this. I've heard the fire-paramedic idea before, but the hang-up for me is that I have a mild case of asthma. That's fine for being a medic as I'm fit, run, bike, swim, can do half-marathons, etc. So, I'm in shape, but for fire departments I believe my asthma would be an automatic disqualified. After all, do you send the guy with asthma with his rescue inhaler into a burning building? I'd do it. But I don't think they'd let me. :)
 

Akulahawk

EMT-P/ED RN
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Thanks for this. I've heard the fire-paramedic idea before, but the hang-up for me is that I have a mild case of asthma. That's fine for being a medic as I'm fit, run, bike, swim, can do half-marathons, etc. So, I'm in shape, but for fire departments I believe my asthma would be an automatic disqualified. After all, do you send the guy with asthma with his rescue inhaler into a burning building? I'd do it. But I don't think they'd let me. :)
The point wasn't to point you toward being a Firefighter/Paramedic... but rather to simply show you the typical career course of the FF/P in that typically as you promote within the department, your patient care contact decreases because you promote away from doing that stuff. Promoting away from patient care wouldn't make me happy...

Some guys would be very happy to promote away from patient care and still be able to earn the "Paramedic" stipend.
 
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