I've gotten into trouble regarding my thoughts on nurses in the prehospital environment before (unfairly I think). Before anyone has a go at me, I'm not having a shot at nurses and I'm not saying paramedics are better than nurses full stop or anything stupid like that. I'm essentially saying that the two roles are different enough to require significant cross training if you wanted to swap roles.
I quite like the idea of paramedic practice being a nursing specialty, however, we have a pretty good system that is moving towards being an even better system as it stands so I don't know that, practically speaking, another change would be good.
Also, as it stands now with the way nursing education is here, you couldn't put a nurse on an ambulance. University wise, the paramedic degree requires a much higher entry score than nursing, so it attracts a higher academic standard. There are a lot of people in the paramedic degree who wanted to do medicine and didn't quite make the cut, where as there are a lot of people doing nursing who are lucky to have gotten into university (I'm just talking about what I see around me at my own uni in terms of university entrance scores). Additionally, in the three years nurses spend at school, they don't ever seem to do a subject related entirely to proper patient assessment, Hx & Physical, and the idea of the primary survey being something more than a CPR checklist. Sure they do "obs", but there is a difference. For nurses in roles like the ED, they get taught later, mostly on the job and in the subsequent crit care qualifications as far as I can tell.
I'd also like to add that there are a lot of RNs doing the paramedic degree and they have all been surprised at how much different it is working in less controlled environments, with less time, hands and advice.
This will be an unpopular idea, but they have also commented on the difficulty of making clinical decisions when it is actually your decision (nurses words, not mine). Nurses often comment that they know what to do, they just need a doctor to sign off on it, but its a bit different when it really all falls to you (keeping in mind we don't have online medical control). Similar to the idea JP suggested in another thread the other day. I know nurses in America seem to have a more extensive scope than they do here and I know even here rural nurses, nurse practitioners and ICU nurses often have a lot of autonomy, but its an unfair comparison. They are nurses at the top of their game and I don't doubt their ability. But every paramedic out of uni has to be able to make these decisions, where as nurses have many years to learn, grow and gain experience in clinical judgment in environments that require less autonomous decision making. Those who are not suited to that sort of practice can excel in other areas. When you compare apples with apples and oranges with oranges: Paramedic grad to Nursing grad, Intensive Care Paramedic with Intensive Care Nurse; paramedics at each stage have a greater burden of extensive and focused patient assessment as well as autonomous clinical decision making (this is not to say paramedics are better or necessarily smarter, just that the focus of their role is fundamentally different). I think that the fundamentals of our respective educations need to reflect that.
Like I said, I like the idea in theory, because the most educational experiences I've had in my degree were my hospital placements. I think a year or two of doing rotations through various kinds of nursing before becoming a paramedic would be very beneficial. However, as I've said, you'd have to dramatically change the structure of nursing education if you were to do so.
