Paramedic programs for RN-EMTs

[hogwiley]

I think bridges/challenges are good for certain people but they're not for everyone.

I agree, the problem is that how are you supposed to know which people they are for and which they aren't.

I'm not against a bridge course from RN to Paramedic, as pointed most of a Paramedic course would be redundant for an RN. How much of it is redundant is the issue. My Medic course is a year and 6 months long without a break(added on to EMT school which was 5 months). Are you telling me a year, and 5 months would be redundant? One RN in my Paramedic class(who has struggled mightily) would certainly disagree with that statement, as would one of our instructors who is an RN as well as a Paramedic.

 

[TacomaGirl]

^^ I wholeheartedly agree.

 

[STXmedic]

I've seen ICU RNs crash and burn in the ER, which is a lot more controlled environment than a pre hospital setting.

Most of the ICU nurses I know that didn't like the ED after ICU were because of patient load more than anything. Going from 1:1 or 2:1 to sometimes 6:1 can be overwhelming. Their patient care of the individual patient is generally still stellar, though.* That wouldn't have any crossover to prehospital ability in my opinion. You can throw out the mass casualty example if you'd like, but I'd put money on most paramedics handling the same incident in a sub-par manner also. It's not something heavily touched on in school, and is a very low frequency event.

An ICU nurse with several years experience, in my opinion, would do fine in an accelerated transition program. I'd take many of the ICU nurses I know and work with them on the box tomorrow, and they'd still probably outperform many of the medics I already work with.

*Assuming they weren't already :censored::censored::censored::censored:ty nurses in the ICU

 

[Carlos Danger]

I mean I spent more than 2 weeks just learning and proving my competency in advanced airway procedures alone, nevermind all the other things Paramedics do that RNs have no formal training in.

When I worked as an ICU nurse the ONLY skill that I didnt do in the unit that I did as a paramedic was intubate. But considering that many paramedics graduate their program with only a handful of live intubations, and that ICU nurses are generally very familiar with the process of intubation (assisting anesthesia and / or intensivists), that simply isn't as big an issue as you'd think. Also consider that many of the things that a paramedic needs to know how to do, ICU nurses do much more often than paramedics.

The only real difference is the environment. But ICU nurses tend to be very comfortable dealing with sick patients, and they tend to be flexible and adaptable. I've know many ICU nurses who became flight nurses, and most made the transition very smoothly and easily.

 

[TacomaGirl]

Great post Remi. I think the one's that aren't cut out for the accelerated course, will weed themselves out. You just cannot 'wing it' in my opinion.

I cannot speak as a medic, because I am not one. My respects to their skills and amazing work; however, I agree that the major difference is the environment and I would add AUTONOMY. Hospital the environment is controlled and an order must exist for every move. In the field, there is much more autonomy and therefore some skills get to be used/practiced that might not in a hospital setting.

 

[STXmedic]

I cannot speak as a medic, because I am not one. My respects to their skills and amazing work; however, I agree that the major difference is the environment and I would add AUTONOMY. Hospital the environment is controlled and an order must exist for every move. In the field, there is much more autonomy and therefore some skills get to be used/practiced that might not in a hospital setting.

In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.

 

[Carlos Danger]

In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.

Exactly.

 

[hogwiley]

Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?

If its not an issue then they should be able to handle being the lead medic on every ALS call from day one and cruise through their internship. Trauma calls, MVAs with entrapment, Pediatric calls, none of it should be a problem for em. That may very well be the case for all I know.

Again, the RN in my class and the lab instructor who is an experienced Paramedic and Emergency Room Nurse(I forgot to mention shes currently a NP) think the jobs are completely different and require a different mindset and skillset, so its apparently something not everybody agrees on.

 

[hogwiley]

In the ICU environment (and ER, though I'm not sure if to the same extent), the nurses function in the same way as a paramedic. They both work off of standing orders. The nurses can typically address problems in the same manner as paramedics. If something falls out of the scope of their standing orders, they talk to the doc, just like a paramedic. The ICU and ED nurses operate with very similar "autonomy", they just have a physician closer than a paramedic, who has to call one. Paramedics can't do whatever they please and claim autonomy; they still usually have to talk to a physician to go outside of their scope.

A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known. And while having to triage in the field doesn't happen regularly, it is something you need to know how to do WHEN it does arise, and you never know when that might be.

A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio. Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.

 

[Handsome Robb]

That's exactly why they need a transition course...you just answered your own rhetorical question.

Let's be realistic how much time have you spent on extrication operations in school, EMT or Medic? Same goes for troubleshooting. I think it needs to be a two way street, personally. There should be a medic challenge for RN but until we have the education to support it we can't do much about it.

 

[STXmedic]

I am absolutely in agreeance that there should be some sort of field internship. It's a different environment that they are not accustomed to. So yes, they should have x amount of hours under a preceptor. Ideally, their employing agency would provide that anyway. That's not always the case, so I wouldn't be opposed to a certain amount of hours being required after the transition course. The same thing would be done if they changed floors in the hospital.

 

[Summit]

Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?

For those who are going into field paramedicine, they will get their field internship from their FTO on their service. They are not going to be thrown into a lead 911 medic with an EMT partner with zero orientation. They don't do this to fresh medics either.

Why do these accelerated bridge courses REALLY exist? Few ICU RNs are interested in switching to paramedicine and the few who are typically have field experience as an EMT. Most RNs in these courses are either interested in being a flight RN or are already employed as a flight RN looking for the dual qualification.

A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio.

When the crap hits the fan for 911, it isn't the lone wolf paramedic for most calls in the US (yes, I know rural is different, I did rural and I do WEMS). It's usually two paramedics, the 6 firefighters EMTs, and a cop or two on that street corner doing compressions, defibrillating a patient, starting an IO, pushing some drugs, and dropping a tube. That is high intensity, high pressure, but not high complexity.

Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.

The only urban EMS patient movement issues that are technical (vs physical) challenges are vehicle extrication (you have FF help) and convincing altered patients to get in the ambulance. Now wilderness, water, technical, snow, and high angle rescue, there is a challenge.

 

[Carlos Danger]

Look, if most ICU RNs can easily transition to Paramedic with a minimum of training, then why not have them prove their competency by doing a field internship under the supervision of an experienced Paramedic?

Again, the RN in my class and the lab instructor who is an experienced Paramedic and Emergency Room Nurse(I forgot to mention shes currently a NP) think the jobs are completely different and require a different mindset and skillset, so its apparently something not everybody agrees on.

A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known. And while having to triage in the field doesn't happen regularly, it is something you need to know how to do WHEN it does arise, and you never know when that might be. A Paramedic in the field has none of that. All they might have with them is a single EMT basic who will do what they tell them(with varying competence), a cell phone and a radio. Not mention having to figure out how to get a patient onto a cot and into the ambulance, which can be an ordeal itself.

Look man, you are seriously exaggerating how difficult it is to learn to put people on stretchers.

 

[STXmedic]

Alright, you just proved with those statements that you don't know the first thing about ICU nursing, and you are also grossly romanticizing the challenges of working as a paramedic.

The truth is, the types of crap-hits-the-fan calls that you refer to are uncommon, unlikely to be encountered in a internship, and because of that many paramedics don't handle them stellarly, either. Also it just isn't that hard to learn to put someone on a cot and get them in the ambulance. And after that, the protocols are the protocols....nothing magic about pushing drugs in the ambulance vs. in the ICU. Don't make it into a bigger thing than it really is.

This. And the bolded portion is what I'm taking away from this as well.

 

[Summit]

A few big differences though. One being in addition to having a physician close by IF needed, they also have other experienced ICU nurses, RTs, NPs and PAs, a pharmacy, Hospital security, are in a safe well lit climate controlled indoor setting where family can quickly be ushered out of the room, where weather and traffic isn't a factor and transport decisions don't have to be made, where the patients medical record is usually on hand and their medical problems and history are already largely known.

I want to help you understand a little about the ICU that you haven't gotten to understand in your career as a PCT/volly MFR with a year of ED tech and medic school. I don't mean that as condescending, just that your career hasn't provided you with ICU experience to contrast with your fledgling view of paramedicine.

In the 911 emergency patient, there is usually an algorithmic or semi-algorithmic approach to 1 maybe 2 major problems with very limited treatment options aimed at stabilizing and transport, because that is all you can do with limited knowledge of the patient and typically short periods of care.

Yes, in the ICU, there's the availability of an intensivist, a RT, a pharmacist, a RN, and specialists and imagery and lab and... but 90-95% of the time it is just the assigned ICU RN.

The reason you need those extra resources in ICU is because compared to 911 EMS, the ICU setting is definitive care addressing more complex patients with multiple complex problems in more complex ways over longer periods of time covering sometimes multiple critical periods. (We won't distract by talking about procedural care). The paramedic does not deal with those complexities. If the RN only had the paramedic's limited formulary, they would have less use for an ICU pharmacist. If the RN didn't have to run 12 drips, the pacer, the IABP, CRRT, and read the PA cath, they wouldn't need the RT to help with the vent (there is little most RT do, apart from intubate, that the ICU RN doesn't do).

Yet you see these resources and assume that the ICU RN couldn't hold their own in the ICU if the other providers were busy. What you haven't thought about is that situations occur all the time that put the ICU nurse on their own in bad situations longer than you might think, longer than the transport time for most urban EMS. Here, they have algorithmic solutions to sudden emergency situations just like EMS.

 

[hogwiley]

I'm not really basing my comments on working as an EMT(both volley and paid if it matters) or working in the ED, or working as a PCT, or Paramedic school, none of which makes me any sort of expert on the matter. I'm basing my comments on what RNs themselves have told me, including those that have been Paramedics. (Including an RN I'm engaged too).

Obviously not everyone agrees and you make valid points. I still don't think its going to hurt some of these RNs to take a Paramedic course, abbreviated or not. More knowledge and training is usually a good thing no? If they want to be a flight nurse bad enough it shouldn't be THAT big a deal, and its not like there is a shortage of RNs wanting to fly.

 

[VFlutter]

More knowledge and training is usually a good thing no?

Repeating the same material, usually at a much lower level, does not mean more knowledge and training. After taking college Anatomy w/ lab, physiology, pharmacology, and pathophysiology (All separate 4-5 hr courses) with literally thousands of pages of textbooks I am skeptical there is advanced knowledge hidden in a paramedic textbook, which thinks it is adequate to cover all of those courses in one book, that I missed. Besides that after an EMT-B course there really isn't that much to cover.

I totally agree there should be extensive ride along time but you will not convince me that taking an entire paramedic course is needed or beneficial.

 

[TacomaGirl]

I totally agree there should be extensive ride along time but you will not convince me that taking an entire paramedic course is needed or beneficial.

Not to mention the cost of re-taking redundant material.

 

[RALS504]

Eastern New Mexico University- Roswell has an RN to Paramedic bridge. It involves 3 wks of didactic training in Roswell, online course work, & then a local internship at your location. I have only second hand knowledge of this program, but the RNs in this program steak highly of it. Pre-reqs are RN or RRT & EMT-B license. Their affordable tuition & programs are top notch. If you need a online refresher or an Associates or BS Degree in EMS online they offer that as well.

see page #11:

http://www.roswell.enmu.edu/documents/ems/hybrid_paramedic_application.pdf


http://www.roswell.enmu.edu/

 

[EMT4EVA]

Hi JakeyJake,

Have you checked with Creighton University in Omaha, Nebraska? Here's their main number:
(402) 280-2700

I am an RN who challenged the EMT exam in my state -- looking to go into flight nursing which where I live requires you to be licensed as a paramedic and an RN. I know of one program out in the midwest, which allows ICU nurses to take an intensive paramedic course in two weeks, but I don't know of any others. I would be willing to travel out of state for this. Does anyone know or have heard of any such programs?