Lpn vs medic school

[Akulahawk]

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...

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.

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]

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]

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]

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.

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]

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]

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

There's just something ironic nurses complaining about encroachment.

 

[Akulahawk]

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?

There's just something ironic nurses complaining about encroachment.

Just a little irony there...

 

[usalsfyre]

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]

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.

 

[JPINFV]

^
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]

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...

^
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]

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

 

[Katy]

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.

 

[8jimi8]

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]

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]

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.

 

[8jimi8]

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.

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.

 

[Shishkabob]

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

 

[8jimi8]

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.

 

[jjesusfreak01]

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.