RN on ground ambulance?

[NysEms2117]

By me CCRN's or RN's are only used on few ground transports. Was wondering how it is in different parts of the country. If you could also include certificate requirements that'd be nice .

 

[SpecialK]

It's interesting you bring this up, as it has been an area historically poorly managed and with much confusion on behalf of the personnel involved.

Now it only happens in two circumstances

1. Either, the ambulance crewmember "happens" to also be a Registered Nurse, as some volunteer officers are. This is now restricted to EMT level only, it is no longer possible to gain ATP at Paramedic or ICP using a "recognition" process. An RN who wishes to practice at, for example, Paramedic level, will need to complete a specific Paramedic tertiary qualification so in essence, they wish to change careers. I have seen a few RN's who've changed but not very many considering the hours of work are much better for RNs than ambulance personnel and a pay is roughly the same.

There is a legal anomaly where an RN is a legally registered professional and can act within their professional boundaries of practice on their own volition (regardless of setting) whereas ambulance personnel have a strictly specified scope listed in the CPGs due to the lack of registration (coming soon hopefully!). What has been inserted in the last couple of editions is a registered practitioner may provide treatment within their professional jurisdiction but outside of any ambulance scope provided it is in the best interest of the patient and broadly consistent with "principles" of the CPGs (i.e. most effective and efficient treatment). A practical example would be an RN who is also an EMT inserting a urinary catheter or manipulating an NG tube, but not automatically gaining IV access as only certain RNs are proficient at this (a Practice Nurse, for example would pragmatically never gain IV access).

2. Or, when a transit nurse accompanies a patient to provide clinical care. This applies to some jobs undertaken by the Patient Transfer Service. Sometimes the transit crew also includes a Doctor but not very often; I've only seen it a couple of times and it's been air ambulance transfers.

 

[EpiEMS]

Naturally, this is one of those things that will differ by region and system. That being said, in NYS, I don't know of many places that use ground RNs - I believe Mercy Flight up in Buffalo has for their ground division?

For NYS, there's no bridging that I am aware of - though you can petition for advanced standing.

In CT, I'm not aware of any ground CCT that uses nurses, and I am not aware of any bridging above the EMT level (you can bridge to EMT by taking a refresher then the exam).

It's interesting you bring this up, as it has been an area historically poorly managed and with much confusion on behalf of the personnel involved.

I think this is true in the U.S., too, partially because of a lack of state-to-state consistency.

Here's results of an NAEMSO survey from 2008 that provides some context.

 

[TransportJockey]

I know there are some states like PA that use PHRNs (Prehospital RNs) in a paramedic-like role. Most other places they are only on ambulances for neo/OB/CCT runs.

 

[EpiEMS]

I know there are some states like PA that use PHRNs (Prehospital RNs) in a paramedic-like role. Most other places they are only on ambulances for neo/OB/CCT runs.

I think this is generally true. Doesn't CA have a bunch of different permutations of RNs on ambulances? (Paging @VentMonkey)

 

[Summit]

Some states use specialized PHRNs for 911.
Obviously states do CC transports in which CCRNs have role.

In some other countries, particularly parts of Europe, it may be normal to have specialized nurses on ambulances for 911 and/or there may no such thing as a paramedic, at least not in the American sense.

 

[NomadicMedic]

When I was in King County Washington, RNs staffed the CCT truck. Since privates were not allowed to have paramedics in King County, even a simple monitor and IV transport would go with an RN and EMT in the CCT truck.

Most of the RNs that were hired were ICU nurses, with standing orders very similar to the paramedic orders, however the nurses were not allowed to intubate.

Most, not all, other prive services outside of King County used paramedics.

 

[CALEMT]

I think this is generally true. Doesn't CA have a bunch of different permutations of RNs on ambulances? (Paging @VentMonkey)

Only place that I've heard of that's using a nurse for 911 calls is LAFD.

 

[VentMonkey]

I think this is generally true. Doesn't CA have a bunch of different permutations of RNs on ambulances? (Paging @VentMonkey)

Most other places they are only on ambulances for neo/OB/CCT runs.

Pretty much what @TransportJockey is saying in regards to California. While our particular service does in fact have ground critical care nurses that do respond with their paramedic and EMT to 911 calls when not assigned transfers, they aren't responding solely by themselves to 911 calls. This is a complete separate thing from PHRN's. Now, they do work along with the medics and are utilioas a second set of ALS hands as needed on these calls, which is under heard of in California. I could have sworn REMSA had PHRN's, but I could be wrong.

As far as certificates needed, it's the standard run of the mill alphabet soup (ACLS, PALS, PHTLS/ TCCC, MICN) along with any specialty certificates required in accordance with our CAMTS accreditation. These include CFRN, CCRN, and CEN, though I am told the CEN may not be accepted in the future in lieu of another cert.

Our CCT division is truly unique to California, if that says anything, but yes the rest of the state pretty much uses CCT nurses for non-emergent inter facility transfers.

Also, @NysEms2117 keep in mind, if a PHRN type role is something that may interest you later on once you're finished with nursing school, they'd probably want some experience. If flight, and/ or critical care are possible long term goals, any CAMTS accredited program will require a minimum of 3-5 years; they're upheld to this by the accrediting body itself, which is something some applicants fail to take into account.

 

[VentMonkey]

Indeed they do, or at least advertise as such:

http://www.remsa-cf.com/ground-ops.html

 

[NysEms2117]

Naturally, this is one of those things that will differ by region and system. That being said, in NYS, I don't know of many places that use ground RNs - I believe Mercy Flight up in Buffalo has for their ground division?

@EpiEMS Albany med has 1 ambulance staffed dual RN + driver, Think they are CCRN's and do super high profile transports.
@Summit is it a different certification for PHRN as compared to CCRN?
@VentMonkey this was kind of an interest gather(er) if thats a word, for me. I'm not sure HEMS is "part time" enough for me. I was trying to avoid just being a really medically smart EMT-B. I don't know if i can "strive" in a hospital setting, if i have to get experience in an ER or ICU then so be it i'm fine with that, just looking to get back into EMS with a BSN.

 

[VentMonkey]

is it a different certification for PHRN as compared to CCRN?

These certs aren't typically designed for fresh out of nursing school RN's. The CCRN TMK is nothing to fool around with. Nursing is a completely different concept than EMS in and of itself, and most RN's that cross pollinate--if you will--do so with a sufficient amount of time under their belt, and with good reason.

I keep referring back to my CCP course as it was filled with many different providers at different points in their careers, one of which was in fact a PHRN. She seemed to struggle the least, and was not a new grad.
https://www.hacc.edu/PublicSafetyCenter/EMS/PHRN.cfm
https://www.aacn.org/certification/get-certified

 

[NysEms2117]

These certs aren't typically designed for fresh out of nursing school RN's. The CCRN TMK is nothing to fool around with. Nursing is a completely different concept than EMS in and of itself, and most RN's that cross pollinate--if you will--do so with a sufficient amount of time under their belt, and with good reason.

I keep referring back to my CCP course as it was filled with many different providers at different points in their careers, one of which was in fact a PHRN. She seemed to struggle the least, and was not a new grad.
https://www.hacc.edu/PublicSafetyCenter/EMS/PHRN.cfm
https://www.aacn.org/certification/get-certified

ahhh. i think what i was getting stuck on is assuming the "CC" part of RN, included what EMS folks do. Now that i'm seeing CC equivocates more to ICU then EMS. I was presuming that CCRN's on ambulances go to the trauma calls as well. Are all CCRN classes broken down into 3 sections? (i know this is a bit down the road, but maybe i can take some pre-reqs and get them to dual count or something along those lines). I know thats more nursing, but in my personal opinion allnurses forum is nothing above useless.

 

[EpiEMS]

Albany med has 1 ambulance staffed dual RN + driver, Think they are CCRN's and do super high profile transports.

Interesting, didn't realize that. I would guess the driver is an EMT?

When I looked at Part 800 (NYS EMS code), it doesn't have any mention of RNs as ambulance staff. Article 30 of the Public Health Law, Section 3031 seems to address RNs (in ref.: "
Advanced life support system must....(2) be staffed by qualified medical and health personnel", where qualified personnel refers collectively to "physicians, registered professional nurses and advanced emergency medical technicians" (AEMT in the NYS sense means AEMT-I, AEMT-CC, and AEMT-P).

 

[VFlutter]

As far as certificates needed, it's the standard run of the mill alphabet soup (ACLS, PALS, PHTLS/ TCCC, MICN) along with any specialty certificates required in accordance with our CAMTS accreditation. These include CFRN, CCRN, and CEN, though I am told the CEN may not be accepted in the future in lieu of another cert.

Also, @NysEms2117 keep in mind, if a PHRN type role is something that may interest you later on once you're finished with nursing school, they'd probably want some experience. If flight, and/ or critical care are possible long term goals, any CAMTS accredited program will require a minimum of 3-5 years; they're upheld to this by the accrediting body itself, which is something some applicants fail to take into account.

I hope that CAMTS removes CEN as an accepted "Critical Care" certification as it does not compare to CCRN or CFRN.

Illinois has PHRN as well. It requires the alphabet courses and states it is designed for experienced RNs but does not state a specific requirement. It is a 24 hr class with ride alongs.

There are a few RNs in my area that work on ambulances and function the same as paramedics. Most were prior flight RNs who no longer fly. Not really sure of the details but I was told all it takes is the medical directors approval for an RN to work under that role.

 

[NysEms2117]

Interesting, didn't realize that. I would guess the driver is an EMT?

When I looked at Part 800 (NYS EMS code), it doesn't have any mention of RNs as ambulance staff. Article 30 of the Public Health Law, Section 3031 seems to address RNs (in ref.: "
Advanced life support system must....(2) be staffed by qualified medical and health personnel", where qualified personnel refers collectively to "physicians, registered professional nurses and advanced emergency medical technicians" (AEMT in the NYS sense means AEMT-I, AEMT-CC, and AEMT-P).

from what i can gather they aren't EMS, "my" rig is the CCT EMS rig. They do super complex hospital transfers if i gathered my information right, and didn't completely muck it up. example: patient is critical in schoharie county(middle of nowhere, next to albany county), that local level 3 or w/e rank hospital calls them, since it's a bordering county, and they go take them? I also think they can be registered legally, because they have an EMT on board(?) i'd have to check the wording exactly, i'd presume they just call for orders at that point. I know they ride in something with pretty red and blue lights though because i've seen it before. However, idk if i'd like just putzing around all day waiting for somebody to call

 

[NysEms2117]

I hope that CAMTS removes CEN as an accepted "Critical Care" certification as it does not compare to CCRN or CFRN.

i was just looking at that, was debating looking seriously because they "Recommend a lot", but nothings mandatory other then passing the NCLEX.

 

[VentMonkey]

I hope that CAMTS removes CEN as an accepted "Critical Care" certification as it does not compare to CCRN or CFRN

I am told this is what is to replace the CEN endorsement:
http://www.bcencertifications.org/Get-Certified/CTRN.aspx

Are they are critical care topics in the CEN exam that you're aware of, Chase (e.g., hemodynamic monitoring, ABG's, vent management, etc.)?

 

[VentMonkey]

i was just looking at that, was debating looking seriously because they "Recommend a lot", but nothings mandatory other then passing the NCLEX.

@NysEms2117 because you're my pal I think I can say this with fairly unabashed restraint. Going through a 2-4 year nursing program, and then directly back into the field/ EMS kind of defeats the whole purpose of nursing school in the first place.

Also, as I mentioned earlier in regards to experienced nurses taking these exams (many of whom still struggle), I equate this to brand new paramedics asking me how to study for the FP-C, or CCP-C.

Can they study, take, and pass these exams? Sure, but what good will it serve them without any sort of fundamental knowledge and understanding behind them? I took my FP-C seeking to enhance my knowledge in the long run, which I have/ am, but only after being a street paramedic for several years.

I think the same, or similar, can be said and applied to taking any or all of these specialized, or advanced nursing certifications. Again, the CCRN, and CFRN are nothing to take lightly, but good luck, brother; you know where to find me.

 

[VFlutter]

I am told this is what is to replace the CEN endorsement:
http://www.bcencertifications.org/Get-Certified/CTRN.aspx

Are they are critical care topics in the CEN exam that you're aware of, Chase (e.g., hemodynamic monitoring, ABG's, vent management, etc.)?

I do not believe the CEN has any critical care topics and I do not see anything listed on the content outline. The CTRN does have critical care topics listed in the outline and I am told is pretty similar to the CFRN.
http://www.bcencertifications.org/BCENMain/media/CEN/2016-CEN-Content-Outline.pdf

i was just looking at that, was debating looking seriously because they "Recommend a lot", but nothings mandatory other then passing the NCLEX.

If you want to take the CEN to fluff your resume then go for it. It does not require experience to take the exam. Nothing against it in general and I am sure it is still a challenging exam however if we are talking about critical care transport it does not include critical care topics as mentioned like vents, swans, IABP/VAD, etc.