Nurse vs paramedic

[Handsome Robb]

id go for the medic career. most state have a aramedic to rn corse that isn't as bad as youd think.

The base knowledge is similar but that's about where the similarities end.

One of the biggest things I have learned throughout my clinical time for school is that Paramedicine and Nursing are two totally different beasts. I felt useless during my ICU rotations, we just don't have that type of education. In the ER one could argue that paramedics might be a better fit than nurses but the nursing union says otherwise. Also most paramedics I know don't like having to wait around for someone to tell them what to do.

Comparing Nursing to Paramedicine is like comparing apples to oranges, just like Linuss said.

My program completes an "equivalent" a college level A&P course, but that's not the norm.

 

[Tigger]

The base knowledge is similar but that's about where the similarities end.

One of the biggest things I have learned throughout my clinical time for school is that Paramedicine and Nursing are two totally different beasts. I felt useless during my ICU rotations, we just don't have that type of education. In the ER one could argue that paramedics might be a better fit than nurses but the nursing union says otherwise. Also most paramedics I know don't like having to wait around for someone to tell them what to do.

Comparing Nursing to Paramedicine is like comparing apples to oranges, just like Linuss said.

My program completes an "equivalent" a college level A&P course, but that's not the norm.

I'd argue that the base knowledge is no where needs to be for paramedics and is probably quite far from the nursing side of things. I can't figure out why this is however. As is mentioned frequently in these discussions, RNs are limited in both their autonomy and skill set. In most cases paramedics can provide many more interventions than a Nurse. Yet if a medic course requires a semester of A and P it's considered above and beyond. Wouldn't it make sense to provide our pre-hospital providers with a core understanding of the human body since they're responsible for so much more? In many cases it seems medics "do" more with less education than nurses do. The positions are really not that similar, but they both require a detailed understanding of the human body. Shouldn't we be getting that?

 

[MS Medic]

I keep hearing you guys talk about this piss poor education background for medics and this new info for me. Like I said earlier, we are required to take the same A&P classes nurses and then move on to patho and disease process ect. Can someone give me an idea of what the "average" (i guess for a lack of a better word) education for medics is.
I have heard horror stories about a medic school run by Acadien that teaches pharmo by box color and farms the students to pass registary but I always thought that was an exeption to the rule.

 

[systemet]

I got in to this debate with a nurse a few months ago. She thought she had more schooling because she had a 2 year degree, until I clarified that Paramedics also have 2 years of education, just more specific in nature. Her fallback defense? "Well, I also have pre-reqs"

My response? "Cool, so doing spreadsheets on a computer makes you a better healthcare provider?"

People who argue that they're better than someone else based on the level of their education are asshats. It doesn't matter if they're MD/PhDs who're dual residency trained, nasa astronauts, or an RN with an Associate's.

It's not worth arguing with them. If someone's actually educated and competent, they don't usually need to point it out every five seconds.

RN's do a longer educational program than paramedics in most parts of the world. It undoubtedly prepares them better to be RNs. I imagine it makes them pretty poor welders on average.

I have a friend who has a PhD in English Literature. They're definitely more educated than me. Does it matter?

I don't regret becoming a Paramedic, but I know I probably won't retire from it. I am saving some money so I can go back to school full time and earn another degree, such as my PA or RN. RN DOES give more options in where you can work when your body decides it no longer wants to. Even if that means working 3 days in a hospital and 1 day on an ambulance for my 'fix'.

As hey, field work is just that awesome.

I think this is a good attitude.

 

[systemet]

I keep hearing you guys talk about this piss poor education background for medics and this new info for me. Like I said earlier, we are required to take the same A&P classes nurses and then move on to patho and disease process ect. Can someone give me an idea of what the "average" (i guess for a lack of a better word) education for medics is.

I think this varies greatly with geographic region inside the US, from what I've heard, and can vary greatly outside of the US.

Some of the European systems require that you first have a BSN, work for a year or two in the ER or ICU, then complete a year or two of specialty nursing training to be a paramedic. Interestingly, many of these systems don't RSI.

From some of our members from Australia and New Zealand, it sounds like their new paramedics that are working at something between an intermediate and an ALS level are educated to a Bachelor's degree standard, and they complete a further year of two of training to get to the higher "Intensive Care Paramedic" level.

The UK system is a little confusing to understand, but it sounds like they now have entry-to-practice programs at the Bachelor's level as well. (Correct me if I'm wrong, anyone). They also have a fairly novel "Paramedic Practitioner" level, that I believe has a Master's degree.

One of the Canadian provinces has a two year diploma for BLS providers, followed by another year to upgrade to an ALS level, and a further year to upgrade to a true critical care level that includes real education on ventilator management, x-ray interpretation, management of invasive lines, and enables them to independently manage more complicated pieces of technology like IABPs.

There are other systems that choose to staff their ALS ambulances with one or more physicians. It sounds like the Germans often use physicians for critical pediatrics. I believe they form the ALS tier of the French SAMU.

I think the South Africans have a degree level paramedic, as well.

------------

My personal opinion, having a little less than 3 years of total training to become a paramedic, was that a lot of things could have been taught better, and that the situation would be vastly improved if the training programs were improved by a year or two.

Unfortunately whenever you put forward this viewpoint on a forum like here, you immediately here how little money everyone makes, and how no one would be willing to accept the extra training time until the pay increases, which won't happen until we get more educated.

I have heard horror stories about a medic school run by Acadien that teaches pharmo by box color and farms the students to pass registary but I always thought that was an exeption to the rule.

After posting on here for a while, it has been pointed out to me that there are some US programs that are as short as 6 weeks of didactic for paramedic. This floored me.

 

[MS Medic]

Unfortunately whenever you put forward this viewpoint on a forum like here, you immediately here how little money everyone makes, and how no one would be willing to accept the extra training time until the pay increases

As I've stated in other threads, I feel that more education isn't the silver bullet for EMS it keeps getting made out to be, atleast here in the U.S.A. A large bulk of the education I did receive was essentially useless to me. In the field, I can assess and diagnose a pt but can't do anything about it. In other instances, I have no way to apply knowledge beyond a theoretical point. Then on arrival to the hospital, after giving a C/C, the staff ignores EMS and that is if they listened to anything at all, so all this info gleened during assessment isn't good for anything other than filling out a report that will only be read by the service QA and billing.

While I think a 6 week course ought to be criminal, I also think requiring a degree without fixing other things in a broken system puts an undo burden on EMS personnel, especially with the current cost of education.

 

[systemet]

As I've stated in other threads, I feel that more education isn't the silver bullet for EMS it keeps getting made out to be, atleast here in the U.S.A. A large bulk of the education I did receive was essentially useless to me. In the field, I can assess and diagnose a pt but can't do anything about it.

I think it could be argued that the same thing probably happens to a lesser extent in the ER. The physicians may be able to identify some esoteric pathology, but their actual course of action is to punt the patient to another service.

There's obvious limitations in the prehospital environment. But some of these are being pushed back. For good or bad, ultrasound is starting to appear in some environments. While a lot of the point-of-care technology is some combination of too expensive / too delicate / too inaccurate / too slow, it's also making it's way in there. As these things develop we'll probably have a greater role in identifying pathology, and initiating treatment.

One role that's been discussed a lot is screening for sepsis using prehospital lactate measurement, although this benefit might be restricted to systems transporting to either busy / congested ERs, or those with long transport times.

The word "diagnosis" is loaded with all sorts of badness that get physician's mightily upset, but if we accept that you or I may occasionally identify the root cause of someone else's medical problem through luck or sheer genius, I think this is valuable when it happens. I can't say that it's been that often for me.

In other instances, I have no way to apply knowledge beyond a theoretical point. Then on arrival to the hospital, after giving a C/C, the staff ignores EMS and that is if they listened to anything at all, so all this info gleened during assessment isn't good for anything other than filling out a report that will only be read by the service QA and billing.

Don't take this the wrong way, because it's not intended as a slam, but I feel like sometimes we need to be honest with ourselves about what we're doing.

I can't speak to anyone else's experiences or competency, but for me, I know that on a given day, even a fairly poor ER physician is going to be able to assess and examine a patient much better than me. They're going to have seen most presentations more often, they're going to have experience with real-life examples of most of the zebras that might be hanging around, and they're going to consider a much wider list of differentials, including things that I haven't even thought of.

I think what we can bring to the ER is a description of the circumstances in which the patient was found, information from bystanders and neighbour's about how the current situation developed, or what happened in the days prior. We can also be useful in describing how the patient's presentation has changed, especially if we fixed a problem, or have given analgesia. That's stuff that the physician isn't necessarily going to be able to get via physical exam or history taking.

I'm not saying that I haven't been in a situation where I've pointed out something that's been missed, but it's pretty rare.

If you're having issues where they're not looking at your 12-leads, and tossing them in the garbage, then they're just being stupid. But this really shouldn't be happening anymore -- because this represents the loss of valuable information that may affect the patient's treatment.

While I think a 6 week course ought to be criminal, I also think requiring a degree without fixing other things in a broken system puts an undo burden on EMS personnel, especially with the current cost of education.

I guess this is a major issue in the US. I paid the equivalent of about $3,000 US / year for two years for my paramedic, and about the same for my EMT. I also did some university, and paid between $4,000-$6,000 / year. I imagine in the states those numbers would be much higher.

If it cost $20,000 / year to take a four year Bachelor's degree, then, yeah, there's definitely an issue there. But, at the same time, we really can't call ourselves professionals and having it mean any more than the professional in "professional hair dresser", if we don't start demanding that our paramedics have a baccalaureate.

 

[MS Medic]

That isn't a slam. Your absolutely right about the ER report. I wasn't whining that they should pay more attention to me (although I see where my statement can be interpreted as such), I was merely pointing out that there are other things that should worried about than if we have a degree or not when it will make little if any difference how we go about our job.

 

[Scott33]

The UK system is a little confusing to understand, but it sounds like they now have entry-to-practice programs at the Bachelor's level as well. (Correct me if I'm wrong, anyone).

Commonly a paramedic-specific 2 Year Diploma or 3 year bachelors degree. But this is not mandatory in the whole country as yet - I am sure it will be some day. Some existing 'old school' NHS techs, and non-degree medics, can use the open university as a means of 'bridging' to a degree.

http://www3.open.ac.uk/study/undergraduate/qualification/x08.htm

 

[MedicSansBrains]

In Texas you must have Intro to A&P to have an accredited EMT-Intermediate or EMT-Paramedic program.

Also, an EMT-Paramedic certification is just steps away from an Associates of Applied Sciences (AAS) in Emergency Medical Services. Of course in order to issue an Associates Degree requires the educational institution to be an accredited college i.e. community college.

With an AAS in EMS you can be a Licensed Paramedic (in Texas). As it goes in Texas there are 4 levels of certification in EMS with the aforementioned being the highest

EMT (Formerly EMT-Basic)
Advanced EMT (Formerly EMT-Intermediate)
EMT-Paramedic
Licensed Paramedic

The above are given/determined by the Texas Department of Health.

To become an EMT-Paramedic you have to earn a level II certificate. A Licensed Paramedic has an AAS in EMS as aforementioned.

The difference between these two levels of certification is that an AAS in EMS requires some "peripheral" classes including

-College level Math/Algebra
-English & Composition
-Speech Communications
-"Culture" Elective i.e. Art History, Philosophy
-Elective

Also, Licensed paramedics are required to have

-PALS Certification (Pediatric Advanced Life Support)
-ACLS Certification (Advanced Cardiac Life Support)
-PTLS Certification ( Pre-hospital Trauma Life Support)

The certifications above are all AHA (American Heart Association) certifications.

Besides the inherent wealth that the extra education offers and the certifications I'm not aware of many employment/advancement advantages between a EMT-Paramedic patch or a Licensed Paramedic patch besides the cool factor and prestige. (In Texas of course..)

That being said the employment space is really policing up on the type of education required to practice as an EMT/Paramedic. As my professor said "It used to be that all you had to have was the paramedic patch and you'd get hired. Now, they're looking into where you got your education from."

I know that here in Central Texas there are a few EMS systems that have outright changed their hiring policies to exclude all paramedics with paramedic schooling from anything other than an accredited college.

The field of paramedicine is progressing but it truly is the lack of a national level of policy making that keeps us from making these changes non-variable.

However, I'm not so sure how appropriate that is in EMS. Here in Austin we are comfortable in saying we have one of the most progressive EMS systems. Austin Travis County EMS (ATCEMS) pioneered the "pit crew" technique along with many other innovations in EMS and other progressive systems have picked it up like wild fire. Likewise, ATCEMS has been able to pick up innovative practice from others.

I think that is in no small part due to the autonomous nature of EMS systems in their policy and procedure. If you have a well funded system with good people and a progressive medical directors office you have a lot of leverage in improving care. I'm not sure how a strong national regulatory agency would fare on the side of progress in patient care. It almost always does the opposite.

EMS in many areas can do advanced surgical and airway procedures while others can't. I think that a national regulatory push would bring things to a mean requiring the laggers to come up a little and the advanced systems to come down. Then again I guess the scope of practice always relies upon your medical director anyways. Although, states do have legislative influence in this area. If anyone has in depth analysis on this side of things I would appreciate such knowledge.

Back to the original post of "RN vs. Paramedic" there is little similarity in the type of medicine practiced, the environment it's practiced in, and the employment standards and practices.

The education is also different. An RN must have at least an Associates Degree in Nursing (ADN). This is a national requirement and is highly regulated. The degree must be administered by a regionally or nationally accredited college with an accredited nursing program.

An ADN program has pre-requisites including

-Microbiology
-Anatomy
-Physiology
-Statistics

In Texas, the length of an accredited ADN and AAS in EMS are theoretically the same. In fact the AAS in EMS is longer by a semester (Who's counting anyways). While it's true an AAS in EMS doesn't require Microbiology and only requires a compressed "Intro to Anatomy & Physiology" course I'm not sure how much bearing that has on providing treatment in the field.

EMS education is much more focused on practice and skills because an EMT is expected to practice on their own outside of direct supervision of an MD. Of course they are operating under an MD and do rely on them and contact them frequently when needed but they don't have an MD standing over their shoulder while they administer an advanced airway or cut into someones throat (doesn't hardly happen but you know).

It does hurt my feelings when someone, especially a nurse, talks down to or disregards EMS in the light of all this. The truth is that a Paramedic in a busy and progressive county practices more "medicine" than 90% of nurses, under more uncertain conditions, with less resources. However, I would never talk down to a nurse or consider their role in patient care less critical or their education less pertinent or in-depth.

Also, let's not forget that, in my area at least, starting RN's make on average 50% more than Paramedics. Both have similar length in schooling however, an ADN is hands down less intense than a good AAS in EMS program.

Anyways, rant on an old thread is done and maybe it'll help someone have a more in depth understanding in the differences between RN and Paramedic education, employment, and practice.

 

[Ewok Jerky]

Holy crap. Nice first post!

 

[VFlutter]

CRNA maybe...

On average PAs make around $20K more a year in my area depending on where they work. PAs working in specialty areas make substantially more than Hospitalist PAs. Personally, I make the same if not more than some Hospitalist PAs working as a Staff RN with overtime and Bonus pay.

Skills wise, A paramedic can do more than a nurse. If a nurse can read an ECG, its because she learned to do it on her own. A nurse cannot intubate. A nurse cannot perform surgical procedures such as an emergency tracheotomy, thoracic decompression, chest tube, needle crichothyrotomy.

If you judge a profession solely on the ability to perform procedures, that your are horribly undereducated and under-trained for, then Nursing is certainly not for you. Take the Ego out of it. How often do you perform surgical airways, decompressions, chest tubes, ect? I assists with most of these procedures daily and likely see more in a month then you will in your entire EMS career. If It wanted to preform the procedures myself I would go to Medical school not become a paramedic. I enjoy my job and it does not bother me that I am not the one putting the plastic between the cords.

And I don't think I'm too shabby at reading EKGs..

Most skills past an IV/pushing meds in the hospital setting are handled by doctors and their assistants.

That statement is just idiotic. What "most skills" are you refereeing to? MDs spend 5 mins a day with a patient and nothing more. Nurse assistants can not do anything except for the most basic tasks and do not assess the patient in anyway. Have you ever worked in a hospital?

Knowledge wise, it depends where you get your schooling but as far as practical job related knowledge goes its pretty much the same. Sure you can say a nurse spent more time in a pharmacology class or took microbiology, but lets be realistic, after a year no one remembers any of that stuff unless they strive to maintain it on their own.

I use the information learned in my pharm and micro class every single day.


OP, I would suggest shadowing both fields and see what you enjoy the most. Advice on forums should be taken with a grain of salt because RNs and Medics understand very little about each other and have many false misconceptions. Personally, I think nursing is the way to go. I think I received a great education, have a rewarding job, and am financially stable. I could work 3 days a week and still support myself easily.

 

[TacomaGirl]

Perception, opinions and finally your decision. I am not an EMT nor paramedic and after 10 yrs critical care in the hospital setting (NICU/PICU/ICU/ER), I decided to get into prehospital. I have been very successful thus far with the minimal training provided by my employer. I don't feel any less or disadvantaged for being a nurse, nor made to feel that way by them. There is a bit of pay discrepancy between the two. About $10/hr diff where I work. I didn't become a nurse for the money but I sure in hell expect to be compensated adequately for my responsibilities and skills. I have no regrets in becoming a nurse.

 

[joshrunkle35]

Also, be aware that nursing is a very broad field. Emergency nurse's jobs are very different from other fields and departments. So, for example, I was very turned off from nursing while doing clinicals in EMT/medic in the hospital...but it took a while to realize that is only one type of nursing, and also, one area of the country.

I would do nursing, keep working hard somewhere that will pay for school, and do nurse practitioner while you work.

 

[TimRaven]

Just a minor correction, but PHTLS is a NAEMT cert, not AHA.

Here in SF Bay Area, most Paramedic schools require college level A&P, current EMT-B cert, 1,040 hours clinical work (does not limit in EMS, can be CNA or CMA).
The school itself is 12-14 months long, with three full days a week. Tuition is anything between 3,000 - 12,000 depending on state and federal fund. (government funded schools are much cheaper)