Paramedic or Nurse?

Many hospital licensed professionals have clinical ladders that are not necessarily related to being in upper management.

It is a way of giving RNs (RRTs, PTs, OTs etc) a chance to advance in steps to achieve a better pay grade, accepting more responsibility or more promotional opportunities. The steps can be achieved through obtaining more education in the form of a degree and/or more certs. It also can be obtained by cross-training for different units or doing special procedures. As well, one might have to achieve a certain amount of steps on the ladder to qualify for certain units or to do special procedures. Examples would be an ECMO or Specialty Transport. Rarely will these teams accept people who only meet the minimum standards and just exist day to day in their position. The same might go for those doing charge or lead positions and in roles as preceptors. Many RNs also continue to work on the same unit which may even be med-surg but through their educational accomplishments and completing job goals, they may enjoy a higher pay grade as well as bringing more to the care they provide to their patients than those who just exist at minimum.

Ok I understand what you're getting at. Sorry. I'll have to ask the GF about that cause I've not really paid too much attention to it to be honest. She'd be a good one to ask since she's a BSN on neuro IMC
 
Lucid you are wrong. Nursing will never step forward to bachelor's as a minimum. They still have hospital school programs that graduate RNs.

But that does not mean hospitals and specialty units or specialty areas such as Public Health and School Nursing can not require a BSN. The hospital programs are still associated with a college or will be accredited as such themselves to offer the requirements to meet the necessary standards. OJT went out with the early 70s.

This is one of Florida's hospitals that has its own nursing school which offers both the Associate and BSN.

http://www.fhchs.edu/academics/nursing

The nursing shortage is for experienced nurses, NOT for new graduates. If you are excited by emergency medicine pursue that, otherwise you are going to be in for a long road of doing jobs you don't want to do until you can get into a specialty like critical care or the emergency department.

That is true. However, right now the tough economy, many experienced RNs who have been raising families or chosen not to work because their SO made good money are back in the work force. Of course they will probably return back to "retirement" when the economy turns for the better. For new grads, you may have to wait for a hospital to offer a new grad program for precepting before being hired.
 
Neither of the hospitals where I work make any distinction in pay or limitation of scope along educational divides. I've worked with 30 year LVN ICU veterans as well as ADN charge nurses in ICU. Even ADN house supervisors. Not so much to make a point of disagreeing, but most of the time in the hospital, RN means RN. Now then if you go over to the east coast where a majority of the RNs are BSNs you may find you cannot get hired, or make at least $1/hr less with an ADN. On the other end of the stick, i've a friend here in austin who started working as a BSN, received her MSN and DIDN'T get a raise. Go figure. They pay nurses crap in austin!
 
On the other end of the stick, i've a friend here in austin who started working as a BSN, received her MSN and DIDN'T get a raise. Go figure. They pay nurses crap in austin!

Did your friend reqret getting the MSN and felt it was a total waste of time?

The same argument could be applied to EMS. College level A&P is not required for most Paramedic programs and the 2 year degree wouldn't be given a thought to several in EMS. However, if you were to take A&P or even get a degree while knowing the pay would not increase, would you consider it a waste?

However, I have not seen an LVN in any acute hospital situation in over 20 years and definitely not in ICU or the ED during that time.
 
I know of 4 LVNs that work in my ICU. Its a level 3 trauma center (but all of the traumas go to University, now (the level 1)). I don't think she regretted the education, she just got another job. The distinction that my instructors made from my ADN program to the BSNs was in "nursing management" courses. We had nearly as many clinical rotation hours as a BSN degree (which our accreditors actually dinged us on, go figure). Our reputation in the community is that Austin Community College nursing students come out of school, more prepared for clinical nursing than our BSN peer/graduates. I definitely plan on earning my BSN, but not until I am closer to stepping up for the MSN. There is a masters in flight nursing at Western Case, that i'd like to attend. From what i've seen online and with my alma mater, the bsn is really only 2 semesters away from my grasp. I just can't justify going for it right now as I already have a bachelor's and i'm more interested in getting my EMT-P.

Also, my other hospital (a level 1 trauma center) has had an opening for an LVN in their ER for over 6 months. (just to make note that it is possible)
 
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Also, my other hospital (a level 1 trauma center) has had an opening for an LVN in their ER for over 6 months. (just to make note that it is possible)

Are the LVNs functioning as a nurse or as a tech? The LVNs that did not advance their education were allowed to stay but as PCTs which are CNAs with more skills. Or, if the LVN is working in the ICU, is the job description "exactly" like that of the RN for all meds and technology? Probably not.

There probably have been a few LVNs that have been grandfathered in the ICU and ED but they also have had over 20 years to prepare for the future as it was the 80s when LVNs were removed from many acute settings. I would not advise someone who wants to work in critical care to just go for an LVN education with hopes it would be possible. Even if they landed the job advertised that you mentioned, their future would always be unsure and that is not a secure feeling.

The problem with having LVNs in the ICU and ED is they would not be able to take patients with advanced technology such as the ICU ventilators, CVVH, do some of the neuro assessments or give many of the meds. Thus, they might be able to work in a very low acuity ICU that rarely has ventilator patients and ships out any very sick patient to a more capable facility. Even in some of the SNFs, an RN much oversee the LVNs assessments. We had a similar situation a few years ago when Paramedics were allowed to take patients in the ED. When the patient was admitted as ICU status but held in the ED, assignments had to be switched with the RNs so that the ICU orders could be initiated if the patient was held in the ED until an ICU bed was available.

The term ICU can be rather misleading as some RNs or LVNs might say they have ICU experience but the acuity in that unit might be that of what other hospitals might consider general floor patients.

The distinction that my instructors made from my ADN program to the BSNs was in "nursing management" courses.
Most of our BSN RNs are not looking into going for management positions. However, in nursing, "leadership" is stressed which is the reason behind some of the management courses which essentially are not managerial as they would pertain to a degree in Business Management. The RN has always been emphasized as the leader for care management of the patient and was to lead all other personnel in the overall organization of care or "supervision" to see that all orders and treatments are carried out. Now, in many places, nurses are working under managers from other specialities where education has evolved in other fields giving them a larger role in total patient care from a "leadership" standpoint.
 
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Just to chime in, I've seen LPNs on floors that function as actual nurses. I saw a few ALPNs on the neuro med floors. I don't know what the difference between an LPN and an ALPN is, and was never interested enough to ask, though.
 
Just to chime in, I've seen LPNs on floors that function as actual nurses. I saw a few ALPNs on the neuro med floors. I don't know what the difference between an LPN and an ALPN is, and was never interested enough to ask, though.

The ALPN - a title that can still be found at Florida Hospital for the LVNs who are granted a few additional skills and meds which the hospital must ensure their competency.

Here is FL's Nurse Practice Act that describes what is required for an LPN to administer certain meds and I believe specific assessments are also detailed as well.
http://www.doh.state.fl.us/mqa/nursing/info_PracticeAct.pdf

This will only be of importance if you go on to be an RN and will be working with LVN/LPNs on your team or patient care area.


Texas -LVN

http://www.bon.state.tx.us/practice/lvn-guide.html
 
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However, I have not seen an LVN in any acute hospital situation in over 20 years and definitely not in ICU or the ED during that time.
Vent,

Around here, I've seen a handful of LPN's that work in the ED. They usually work in the "Fast Track" area. As one explained to me once, she is able to do pretty much everything a RN can do, but isn't allowed to push IV meds... but she can start IV's and hang medicated IV drips.

Given that if a patient in "Fast Track" needs an IV for some reason, and definitely if they need IV meds, they get moved to the "regular" ED anyway, I don't see why an LPN can't work in that setting.

But yes - I haven't seen any real turnover of the LPN's... they've all been around for a long time, so it is very likely that they are grandfathered in and the hospital would probably fill their position with RN's if they were to leave.
 
Vent,


Given that if a patient in "Fast Track" needs an IV for some reason, and definitely if they need IV meds, they get moved to the "regular" ED anyway, I don't see why an LPN can't work in that setting.

A hospital ED is considered a higher level of care. The LPN works out great until there is a real emergency and all qualified hands are needed. That is not the time to be trying to figure out who can push what meds to take whatever patient.
 
Vent as far as I'm aware, in Texas, LVNs have to have additional training to hang blood, or work with narcotics. In ICU, I have seen LVNs take ventilated patients, stroke patients, hemodynamically unstable patients; i have never seen an LVN take a CRRT patient, but as an RN i'm not even allowed to take those patients until I take another class, same for IABPs. I also do know of one LVN new grad, who used to work as a CA on our floor who was invited to come into critical care (if she started RN school), SO, i suspect, Vent, that you are correct in that No new LVNs will find a place in our ICU anytime soon.
 
Vent as far as I'm aware, in Texas, LVNs have to have additional training to hang blood, or work with narcotics. In ICU, I have seen LVNs take ventilated patients, stroke patients, hemodynamically unstable patients; i have never seen an LVN take a CRRT patient, but as an RN i'm not even allowed to take those patients until I take another class, same for IABPs. I also do know of one LVN new grad, who used to work as a CA on our floor who was invited to come into critical care (if she started RN school), SO, i suspect, Vent, that you are correct in that No new LVNs will find a place in our ICU anytime soon.


I posted TX LVN's practice. In the ICU there will probably be an RN responsible for the medications an RN gives and a Respiratory Therapist may not be allowed to leave the ICU if a ventilator is on the patient. If it is an RN taking the patient, the RRT may leave the ICU for some situations without a relief RRT taking over. Some hospitals do not even allow LVNs to suction tubes and some subacutes allow them to oversee ventilators that are classified as homecare vents.

For IABPs, at least as an RN you do have that capability whereas the LVN does not.

When considering to be a Paramedic, one should see if the state's scope of practice will meet ones goals or if one will be limited with very few opportunities for growth. Of course, we could again use California as an example of a very limited state for the Paramedic.

Over 20 years ago, LVNs had a good standing in some ICUs but it was decided a mere 1 year of training/education was nowhere near enough for that environment just like the CRTT vs RRT. RT still has a few grandfathered 1 year "techs" in the profession but rarely are they allowed to do critical care. However, both the LVN and CRTT students logged some serious hours in the classroom and clinicals during that year.
 
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RN - better pay, benefits, job opportunities, schedule, advancement, etc....
 
Did your friend reqret getting the MSN and felt it was a total waste of time?

The same argument could be applied to EMS. College level A&P is not required for most Paramedic programs and the 2 year degree wouldn't be given a thought to several in EMS. However, if you were to take A&P or even get a degree while knowing the pay would not increase, would you consider it a waste?

However, I have not seen an LVN in any acute hospital situation in over 20 years and definitely not in ICU or the ED during that time.

If one seeks additional education only for career advancement purposes, and the new degree doesn't result in promotion, advancement, or compensation, then it was a waste. It serves no purpose. Perhaps a different degree would have been of greater benefit. If one seeks additional education for their benefit and enjoyment, and also to be a more proficient provider, then it was well worth the investment.
 
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If one seeks additional education only for career advancement purposes, and the new degree doesn't result in promotion, advancement, or compensation, then it was a waste. It serves no purpose. Perhaps a different degree would have been of greater benefit. If one seeks additional education for their benefit and enjoyment, and also to be a more proficient provider, then it was well worth the investment.

So you actually believe the additional classses in A&P, clinical assessment and leadership are a waste?

Some do not want to change careers but enhance the knowledge for the career they are in. There are people in healthcare who aren't torn between the FD and healthcare to where they seek out a totally different career like nursing. There are also FFs that get Masters degree in something that compliments their FF careers and learn something new everyday to use in their current profession. This prevents burn out and keep their chosen career fresh. Too many only work a "job" for the money and have no interest in the job itself. Thus, they feel they know it all and there is nothing else to learn. Those are the ones that stay on the bottom rung of the ladder and just exist with a title or patch doing only the minimum required and little else.
 
How about environmental engineer or vertebrate paleontologist?

For career longevity, better avrage pay and benefits, and lots of openings, go with the RN (don't do LVN unless forced to for money reasons). Be prepared for burnout.
If I had it to do all over again I would have gone back to school to get my degree in environmental engineering, not nursing, then reenlisted in the USAF as an officer.
 
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