Thoughts on RNs being allowed to challenge Medic exam?

ruralEMSgirl

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In my state of residence, RNs (and PAs) are allowed to challenge any level of the NREMT exam, up to and including the Paramedic exam.
As far as I could tell, no pre-hospital experience required. Meaning, a RN who's only prior training was nursing school and their current RN position, is allowed to test for their medic, and potentially become a licensed medic as a result.

I was honestly really surprised when I found this out- as an EMT who is currently in Nursing school, I've seen again and again just how different the nursing approach is from the pre-hospital approach. Not only that but this raises so many questions to me, as there is no required pre-training or EMS experience, they are allowed to just straight up test for and then become a Medic: how does an RN know how to perform various Medic-level skills and interventions that are not normally covered in nursing school? Moreso than the interventions/skills: how would an RN even learn to think like a medic?

What are y'alls thoughts on this? Is this a safety issue secondary to insufficient training requirements? Or is this no big deal as RNs (and certainly PAs) go through their own robust training? Is an RN/PA with no pre-hospital experience "safe" to operate in the field as a Medic?

(New to the forum so please delete if not allowed/ a repeat question.)
 

Summit

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Nobody would hire with zero relevant experience... but then medic pays way less so why would a PA or a RN bother?

If the RN is a flight RN, then the dual cert makes sense but there's your experience...

Outside of general EMS operations, there isn't much in the medic scope that an experienced crit care/emergency PA or RN isn't familiar with.

All that said, there is a good argument for relevant experience requirements and some ride alongs.

Now which state?
 
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ruralEMSgirl

ruralEMSgirl

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Nobody would hire with zero relevant experience... but then medic pays way less so why would a PA or a RN bother?

If the RN is a flight RN, then the dual cert makes sense but there's your experience...

Outside of general EMS operations, there isn't much in the medic scope that an experienced crit care/emergency PA or RN isn't familiar with.

All that said, there is a good argument for relevant experience requirements and some ride alongs.

Now which state?
https://www.healthvermont.gov/sites...EPRIP_RNPALicenseandExamApplication140514.pdf

It's a little wordy & visually cluttered, but here's what I read that led me to make this post, straight from the source! (above)

I agree with the points you made...I guess my big mental hang-up was just the wide array of different skillsets in different nurses, and
Based on what I read above, it seems like some 1 year old Med-Surg nurse could just go ahead and take the exams -> become a Medic -> suddenly be awarded a relatively high-stakes scope of practice in the field. It's that aspect that gives me pause.

Maybe the current system makes sense, maybe it's no biggie, but I would love to see the state tack on some additional requirements like ride alongs.
And also mandatory pre-testing psychomotor training- I'm envisioning something like the in-service a nearby agency made all medic providers attend. They practiced the higher-risk interventions.

I remember hearing they had a good working relationship with a nearby butcher, and their medics were practicing cricothyrotomies on recently deceased pigs.

I just feel like...medics go to school to become medics. They aren't going to nursing school, they go to MEDIC school. Surely they spend that year(+/-) of training learning necessary skills. I don't buy that clinical experience (even a great deal of it) is going to address any deficits in skills/clinical judgement for a provider.
 

DrParasite

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It's a fine question... why should an RN have to go through an EMTs education? or a paramedics? If they can pass the exams, that means they have the knowledge needed to be a medic right?

I know some RNs who worked as EMT-RNs, and they are awesome providers on 911 calls, as well as Paramedics who went to nursing school and now work as MICN; they are good at what they do.

I also know some who are downright scary; when you take the experienced RN out of the hospital, and put them on a moving vehicle, and expect them to do patient care where things aren't nearly as controlled as they are used to, they melt down.

Most EMS agencies that hire an RN as a newbie medic are still going to put them through the credentialing process, just like they would any other newbie medics, as well as pair them with an FTO until they are fully cleared.

Personally, unless you were an ER RN, or an ICU RN, or had some type of EMS experience, I would much rather you stay in the hospital. While I have no doubt there are some great providers, working in the field with much fewer resources in a much more dynamic atmosphere is much different than working in a hospital.
 

MMiz

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This is going to be an unpopular opinion, but I think that if you can pass the licensing exam and have the required hours internship hours, you should be able to be licensed in EMS.

Michigan didn't allow nurses or other providers to challenge EMS exams when I was going to school. I had a Nurse Anesthetist in EMT-Basic class with me. She was a rockstar in class and during clinicals.
 

mgr22

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This is going to be an unpopular opinion, but I think that if you can pass the licensing exam and have the required hours internship hours, you should be able to be licensed in EMS.

Michigan didn't allow nurses or other providers to challenge EMS exams when I was going to school. I had a Nurse Anesthetist in EMT-Basic class with me. She was a rockstar in class and during clinicals.
I agree. Getting licensed isn't the same as getting hired, or at least it shouldn't be. Let employers consider the pluses and minuses associated with each licensed candidate and decide who gets offers.
 

Akulahawk

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This is going to be an unpopular opinion, but I think that if you can pass the licensing exam and have the required hours internship hours, you should be able to be licensed in EMS.
I have no problems with this. However, I must say that doing internship hours should be a requirement of attaining a Paramedic cert. The reason I say this is actually pretty simple. An internship allows for an easily supervised learning experience for the person that's never done EMS before. For the PA and RN, it effectively becomes a transition course so that they can safely begin to do the job in the field. Once that's done, then any company would be able to hire and use the "new" Paramedics just like any "new hire." The internship process for the PA/RN would ideally also include modules for familiarizing the applicant with the various skills and policies/procedures typically used in the prehospital environment.

For the ED/ICU nurse, or a similarly experienced PA, the skills verification process itself should be very rapid as they're already familiar with most of the skills used by Paramedics.

One of the more interesting conversations I've had over the years was with the Chief Flight RN at Stanford Health (at the time) and it pretty much involved this topic. His personal opinion, which was shaped by his experience, was that it takes about 6 times longer to train a non-EMS nurse to the flight environment than it does for a nurse that has a couple years of EMS experience (Paramedic specifically). The "medicine" isn't the issue... the nurses know that VERY well and is about the same for EMS/Non-EMS nurses. It's the rest of it all that takes the extra time.
 

DrParasite

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A bit like making a firefighter an EMT or paramedic (can of worms now open)
actually, it's not. In your example, the hose dragger is completing a full EMT or paramedic class, taking tests along the way, and having documented their completion of any skills accomplished successfully. There is no "challenge", they are simply completing the class. It's not like someone is saying "well, since you spend a lot of time on an engine, you must know EMS. here, take this exam, and if you pass, we will give you a formal EMS certification." Two completely different scenarios.
 

akflightmedic

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Agree on the personality. These RNs are high speed ICU, ER, CVICU. They typically know their shyte, and are more than welcome to challenge and add the letters. I do like the requirement that FL has however, all Flight RNs must, and any RNs who wish to challenge, shall also complete an EMT course. That is a great class for them to get the fundamentals of radio ops, scene activity, body mechanics, stretcher ops, etc.

And no, I do not think the other way around is advisable. I used to; however, my personal experience has changed my opinion. Medics should not be allowed to challenge the NCLEX.
 

OceanBossMan263

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Why not? A nurse should have no issue on the medicine (actually, some may have trouble simplifying thinking to some of the medic-level questions, same as if a medic were taking an EMT test).

I also agree that a psychomotor exam and some sort of internship should be required. Internship can even be abbreviated, focused on demonstration of core competencies as opposed to a prescribed number of hours.
 

DrParasite

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And no, I do not think the other way around is advisable. I used to; however, my personal experience has changed my opinion. Medics should not be allowed to challenge the NCLEX.
Why not? if the NCLEX is the deciding factor on in a person can be a nurse, if a medic has attained the knowledge to become a nurse, why should they not? If the medic doesn't have the required knowledge, shouldn't the NCLEX weed them out? And if it doesn't, wouldn't that indicate a failure of the NCLEX exam to properly evaluate if a person has enough nursing related knowledge to do the job?

If a medic can successfully complete the RN internship hours (just like an RN who wants to test to be a medic), why should they not be given the title?
 

CCCSD

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Why not? if the NCLEX is the deciding factor on in a person can be a nurse, if a medic has attained the knowledge to become a nurse, why should they not? If the medic doesn't have the required knowledge, shouldn't the NCLEX weed them out? And if it doesn't, wouldn't that indicate a failure of the NCLEX exam to properly evaluate if a person has enough nursing related knowledge to do the job?

If a medic can successfully complete the RN internship hours (just like an RN who wants to test to be a medic), why should they not be given the title?
Then anyone who self studies enough to pass any final for any educational program should be granted that status?
 

MMiz

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Then anyone who self studies enough to pass any final for any educational program should be granted that status?

That's essential what Western Governors University does. You can complete an undergrad degree in a month if you can pass the tests.

The degree isn't prestigious, but it's a degree.

It's on the individual employer if they accept the degree as worthwhile.
 

FiremanMike

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Why not? if the NCLEX is the deciding factor on in a person can be a nurse, if a medic has attained the knowledge to become a nurse, why should they not? If the medic doesn't have the required knowledge, shouldn't the NCLEX weed them out? And if it doesn't, wouldn't that indicate a failure of the NCLEX exam to properly evaluate if a person has enough nursing related knowledge to do the job?

If a medic can successfully complete the RN internship hours (just like an RN who wants to test to be a medic), why should they not be given the title?
Because the nclex merely scratches the surface of nursing. In order to sit for the nclex a nursing program must attest that the student has passed each section of the national curriculum, which is where the bulk of learning and testing occur.
 

Bullets

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In order to sit for the nclex a nursing program must attest that the student has passed each section of the national curriculum, which is where the bulk of learning and testing occur.
Isnt that how NR works? You have to complete an accredited program before you can sit for the test.
 

akflightmedic

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I can only write from my perspective, so this opinion is what it is. I know I am smart and capable. I am the guy who never studied for anything, sailed through high school honor classes, blasted some college courses in pursuit of one day being a doctor, before being seduced into EMS. Became an EMT after penciling the NR Exam in about 45 minutes, and then promptly enrolled in Paramedic school. A program that was less than 6 months in length, which often had the instructor saying, "if you see this, you give gray box, you see this, give purple box". I learned what I could from the program but knew there had to be better and it would be up to me to find it. I was 19 when I sewed on my NR Paramedic patch.

I left good old SC and moved to Florida. Wow, huge learning curve for me. Went to work for an all-ALS service, double medic truck, no fire, county service that had National recognition a few years prior. They were progressive, aggressive, and huge supporters of education. I quickly realized my cookbook recipe education was not going to fly for very long. I had to dig deep to self-learn, became an instructor and started teaching to assist reinforcing my knowledge base. Then I decided I wanted to become a flight medic. I took the courses required, but could not break in the field in FL. So, to realize my dream, I made a move to Alaska. Holy Cow!! Another huge knowledge gap...remote, rural, frontier...those are the only descriptors. I did my first chest tubes there, administered blood, delivered high risk babies, RSI my butt off. It was freaking amazing, however again, required tons more of education along with experience.

As some of you know, I jumped from flight service to flight service, went to work for DOS in Philippines, then onwards to the world of DOD contracts in Afghanistan, Iraq, parts of Africa. I then turned all that into a rather long successful business venture. Again, knowledge and experiences I never had before. Diagnosing and treating, no medical top cover, prescribing meds, ABX, suturing, prev med, occ med, crisis counseling, Nutrional counseling, on and on. Then I sold the business, cashed out, and entered personal life turmoil which flipped all I had known upside down.

So, with my world spinning, I made future plans for myself several of which would necessitate having RN behind my name. It was the "easiest" path for me to follow, as I knew I did not have the time or mentality to pursue any higher-level provider degree. With my three year no-compete in effect, I returned to college and began nursing school. I chose to do the full brick and mortar program as I wanted to not short change myself in any way. Could I have taken the medic to RN route, yep I would have skipped the first semester only, and by doing so, missed out on building rapport with my classmates, but also receiving exposure to many elements of that first semester which I have never been exposed to. By completing that first semester, the state also automatically granted a CNA license. I then took a job in a local ICU as a CNA so I could have real time exposure to ICU level Nursing to further assist me down the road. That first semester gave me exposure to feeding tubes, Gtubes, wound care, much of the basic crap which I have no desire to ever deal with, however knowledge that is sometimes needed, even in the ER.

Nursing school sucked. I truly was bored majority of the time, I did skip lectures often, and yes, I absolutely had enough knowledge to just challenge the exams. I spent more time hosting study groups, teaching my cohorts, and drilling them for practicals and exams. Nursing school barely scratches the surface of actual nursing, and it mostly prepares one to be a MedSurg nurse at best. I was almost kicked out on two different occasions, because I am that guy who will push the envelope, challenge instructors, and always demand to know why or more. For the record, most do not like that. I was even banned from class exam review my senior year due to my frequent challenges backed by facts, so I had to schedule 1:1 reviews. :) Despite all these hurdles, I do not regret doing the program the way I chose to do it. Once graduated, I sat for NCLEX and it shut off on #75. Not bragging, just facts.

I apologize for the lengthy surface background; however, I think it is needed to potentially understand my perspective. Once I had RN, I went straight to an ER, have never worked a day in any other unit. I did ok in the ER, I thought I was doing great, but I did have some awesome preceptors. I thought I did not need this orientation period or preceptor. I was slightly cocky on some things for sure. The only reason I improved is because of who I am. I looked around and saw other Medic to RN staff, and they were mediocre at best. They struggled or they simply were indifferent. RN was just a pathway to better money. Sadly, those clowns in my area helped foster a mindset that the Medic to RNs sucked. They were not wrong on most. LOL

After 5 months or so in the ER, I started travel nursing. Talk about jumping in the shark waters!!! During my travels, I have met many Medic RNs, some good, some bad. Not every Medic education is the same, so that does directly correlate to nursing competency initially. I would absolutely be concerned with any RN in a critical care capacity overseeing my care, knowing they only had challenged the exam. I did yield benefit from nursing school that has been relied on by me in various ER situations. No school, then I would not have had this prior exposure and then I would either burden my already burdened coworkers, or I would provide substandard or neglect care.

As I said, for many, many years I was shoulder shrug to the difficulty level of nursing, and I did sign up a few times early in my paramedic career for Excelsior. I wanted to fast track because how simple it was to be. I absolutely have the intelligence, the experience, and personal drive to accomplish becoming a RN simply by "testing out", however what I did not know was all the smaller nuances, skills not taught in medic or nursing school which impact the level of care and flow of care I provide. There are so many to list, I simply do not have the time. But I think even you yourself have stated in the past, or implied, "you don't know what you don't know". Again, I have no factual peer reviewed studies to back any of this up, just a well-informed guy sharing how he went about it all, and what he thinks of it all. I would be a way less nurse had I not endured the trials and tribulations of nursing school, with all of its clinicals, and then subsequent new hire orientation period.

I feel as if no matter what is stated, you will not be convinced otherwise, and the only way you might even come close is if you yourself choose to attempt it and then report back. The unfortunate part of the study is you can only choose one path personally, so then the results themselves are still technically flawed, right? To each their own I guess, however this old man took the long route and does not regret it.
 

CCCSD

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As a Medic who started that route, the oft derided CNA part was such a key base and I never looked down on it or them. Those skills learned are still in use 30 years later when providing austere care.
 

Summit

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Medics training creates a specialist
Nursing education creates generalists (who then specialize)

It is far easier for generalists to specialize than it is for specialists to become generalists.
 
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