Thoughts on RNs being allowed to challenge Medic exam?

[FiremanMike]

I can explain why; as @Carlos Danger so eloquently said, modified slightly for paramedicine:

Sure, maybe NRP or local state boards of EMS should grow a set and protect their turf the way the board of nursing has, but they didn’t.

It doesn’t change the fact that nursing school covers significantly more information than medic school.

 

[VentMonkey]

I highly doubt most nurses—with the exception of those holding a paramedic license—go to nursing school with an end goal of obtaining a paramedic license.

I think a lot of paramedics see nurses/ nursing (specifically the ER/ ICU specialties) as somewhat comparable to EMS. I think they’re missing a lot of the pieces of the puzzle between the two job types. A rather large disconnect, no hard feels.

Years of working alongside specialty RN’s still outlines the different roles, tasks, and priorities, but more importantly, the difference in the types of education and learning.

Not better, not worse, different.

Circling back to the OP, I don’t see a problem with a specialist RN (ER/ ICU/ prehospital) challenging an EMT or paramedic exam after hitting basic prerequisites. But a paramedic straight challenging an exam that tests all the fundamentals taught in nursing school…ehhh…a bit of a stretch.

 

[DrParasite]

I highly doubt most nurses—with the exception of those holding a paramedic license—go to nursing school with an end goal of obtaining a paramedic license.

I think that's a fair statement... also, I doubt most nurses go to nursing school with the end goal of becoming doctors. Or authors. or engineers. Also, you are making a statement that no one actually said, implied, or hinted at... Do many paramedics go to paramedic school with the end goal of obtaining a nursing license? I know some paramedics become RNs, but most of the paramedics who I know who did that didn't say day one of paramedic school that their end goal was to be a nurse.

Let's take a poll, out of the 5 or 6 of you paramedics who went to nursing school, did have the goal of becoming a nurse on day 1 of paramedic school?

Circling back to the OP, I don’t see a problem with a specialist RN (ER/ ICU/ prehospital) challenging an EMT or paramedic exam after hitting basic prerequisites. But a paramedic straight challenging an exam that tests all the fundamentals taught in nursing school…ehhh…a bit of a stretch.

Again, why not? an RN is a generalist in all of nursing (they know 20 percent of all aspects of medicine). a paramedic is a specialist in emergency medicine, particularly in the cardiac and respiratory system (they know 90%), but they don't cover other aspects (think 0-5% of the other aspects). So we can agree that the paramedic is much more knowledgeable in some areas, and much less knowledgeable in others. But the same can be said for the nurse.

Isn't the training different? are the job expectations different? in an ICU, doesn't a doctor still direct the nurse on what to do when a patient becomes unstable? it's not like the nurse is deciding what medications to give and at what doses, that comes from the doctor's orders, often with the doctor being right there in the room.

I don't know what the "fundamentals taught in nursing school" would consist of, but if it's being evaluated via a test, the test should weed out those that don't know it... right? And couldn't an experienced paramedic learn on their own, enough to perform at the level of an entry level nurse?

 

[VentMonkey]

Also, you are making a statement that no one actually said, implied, or hinted at...

My statements are my opinions and observations, much like yours.

Isn’t that the point of these discussions and forums? Also, I feel it’s at least relevant to this thread. Cheers.

I don't know what the "fundamentals taught in nursing school" would consist of, but if it's being evaluated via a test, the test should weed out those that don't know it... right? And couldn't an experienced paramedic learn on their own, enough to perform at the level of an entry level nurse?

I think you finally argued back your own (and my) point.

Very experienced paramedic here. I have the experience that @ExpatMedic0 referred to, but all these years later I still know what I don’t know here. Guess what that is? The basics of nursing fundamentals.

I would not feel confident, nor comfortable sitting in on the NCLEX as of today. Maybe I am just not that smart, I’m ok with that.

Paramedicine in and of itself is a specialty, I think we can all agree and, in fact, have at one time or another made mention of this.

Nursing has a multitude of sub-specialties. My understanding of the NCLEX is that it can and will elude to all forms of nursing.

How is it fair to assume that a paramedic with a “specialized care” mentality should be prepared to learn the bones of nursing?

Conversely a nurse who’s never worked ER, ICU, as a flight or CCT RN, why should they be permitted to sit for the NREMT/P?

Maybe if there was a a test created to bridge the 2 specialities (EMS—> ER RN), but i think that that nullifies the whole point of nursing school.

I think it was already mentioned, but the nurses going after their EMT or paramedic are not nurses without requisite knowledge in emergency or critical care. There’s no exam to shortcut a paramedic to specialist nurse, I don’t see the big deal.

Anyway, no firsthand knowledge of the NCLEX as I have no immediate plans to sit for it. Just my thoughts.

 

[FiremanMike]

Again, why not? an RN is a generalist in all of nursing (they know 20 percent of all aspects of medicine). a paramedic is a specialist in emergency medicine, particularly in the cardiac and respiratory system (they know 90%), but they don't cover other aspects (think 0-5% of the other aspects). So we can agree that the paramedic is much more knowledgeable in some areas, and much less knowledgeable in others. But the same can be said for the nurse.

Paramedics are "specialists" in a small subsection of emergency medicine. An experienced paramedic could probably crush a new grad RN in stabilizing a crashing patient. The problem is that this is where paramedic education ends. The nurses in the ED/ICU/Step down have to know how to stabilize and then start and continue all the things that come after that.

Oh, by the way, another thing nursing has taught me is that I didn't actually know 90% of the cardiac/respiratory system when I was a medic, I just thought I did.

Isn't the training different? are the job expectations different? in an ICU, doesn't a doctor still direct the nurse on what to do when a patient becomes unstable? it's not like the nurse is deciding what medications to give and at what doses, that comes from the doctor's orders, often with the doctor being right there in the room.

Ah the big misnomer that nurses just follow the doctors orders. I believed that all the way through nursing school and right up until I started working in the ED. There is a lot of collaboration between the nurses and the docs about the direction of care, and while the doc has the ultimate say, the nurses are often knee deep in guiding the care.

Besides, paramedics are just following doctors orders also. They're applying standardized treatment protocols, meds, and doses that their medical directors put in front of them.

I don't know what the "fundamentals taught in nursing school" would consist of, but if it's being evaluated via a test, the test should weed out those that don't know it... right? And couldn't an experienced paramedic learn on their own, enough to perform at the level of an entry level nurse?

I made it through the first semester of nursing school with an average level of effort, leveraging my previous knowledge and test taking abilities to get me through. I got a B, which pissed me off, but not enough to grab my attention. After that began our "specialty" blocks, with peds being first for me. "I'm smart AF and did fine last semester, I'll just keep this effort up." I got a 52% on my first exam - so bad that I was told I should just drop it and try it again to prevent an F on my transcript. That got my attention. That woke me up to the fact that I didn't know as much as I thought I did.

I'm not going to say that it's impossible to self-study nursing material and pass the test, but from my experience, it's a tall order.

 

[DrParasite]

Paramedics are "specialists" in a small subsection of emergency medicine. An experienced paramedic could probably crush a new grad RN in stabilizing a crashing patient. The problem is that this is where paramedic education ends. The nurses in the ED/ICU/Step down have to know how to stabilize and then start and continue all the things that come after that.

Oh, by the way, another thing nursing has taught me is that I didn't actually know 90% of the cardiac/respiratory system when I was a medic, I just thought I did.

Apologies, I think my numbers were confusing... Paramedics know 90% of the cardiac and respiratory treatment for emergency medicine, not 90% of the cardiac/respiratory system. Stepdown and ICU care isn't in emergency medicine, so I think we are in agreement there.

Ah the big misnomer that nurses just follow the doctors orders. I believed that all the way through nursing school and right up until I started working in the ED. There is a lot of collaboration between the nurses and the docs about the direction of care, and while the doc has the ultimate say, the nurses are often knee deep in guiding the care.

I did say ICU nurses, not ED right? I know ED nurses tend to have more standings orders to treat a patient, but most of the time I have brought a critical patient to the ER, the doctor is there. Yes, nurses do their assessment and communicate with the doctor, but the doctor is the one deciding on treatments.

Regardless, there is no disagreement that it's a collaborative effort, but as you said, the doc has the ultimate say.

Besides, paramedics are just following doctors orders also. They're applying standardized treatment protocols, meds, and doses that their medical directors put in front of them.

Is it really the same thing? the last sick patient I dealt with, the first time the doctor was consulted on the treatments was when the crew made it to the ER, 20+ minutes after we made patient contact. Drug dosages, drug choices, and administration routes were decided by the paramedic; Do nurses have that same level of independence? I've heard the same argument from other ER nurses, but the few times I was a patient, or my family was the sick patient, every time I needed something of a clinical nature, the first response was "let me check with the doc and get back to you."

 

[Akulahawk]

Ah the big misnomer that nurses just follow the doctors orders. I believed that all the way through nursing school and right up until I started working in the ED. There is a lot of collaboration between the nurses and the docs about the direction of care, and while the doc has the ultimate say, the nurses are often knee deep in guiding the care.

I can't stress this enough! There really is a LOT of collaboration between Medicine and Nursing. While the docs do direct the medical aspects of patient care, they have little to no say over the nursing aspects of patient care. I've been in the ED for coming up on 8 years now. I pay very close attention to my patients, their labs/imaging results, and the like and usually know that stuff before the doc does because I'm looking after 4 or so patients while the doc may have 20 or 30... so they depend on their experienced nurses to tell them that a given patient is ready for discharge, or alternatively, isn't ready for discharge, and why... It happens more times than I care to count, but I have suggested orders or alternative orders to providers based on what I know about the patient and that "suggestion" is followed.

 

[Akulahawk]

Is it really the same thing? the last sick patient I dealt with, the first time the doctor was consulted on the treatments was when the crew made it to the ER, 20+ minutes after we made patient contact. Drug dosages, drug choices, and administration routes were decided by the paramedic; Do nurses have that same level of independence? I've heard the same argument from other ER nurses, but the few times I was a patient, or my family was the sick patient, every time I needed something of a clinical nature, the first response was "let me check with the doc and get back to you."

Actually, it is. Your drug choices, dosages, routes are decided ahead of time by your medical director. You aren't the one that came up with the standing order on your own. If you're hearing "let me check with the doc" about something, it's because you're asking about something not anticipated within the current orderset. When I have a lot of medications available, especially PRNs for various situations, I have great latitude to determine the appropriate drug, the dosage, the route, and admin time without further consulting the provider about it. If a patient codes, ACLS stuff is a standing order unless a provider arrives at bedside to change something. About the only stuff I can't do is intubate as I'm not hospital credentialed to do that procedure.

 

[akflightmedic]

Dr.P, I am sorry man, but you truly do not know what you are speaking about. In both the ER and ICU, the RNs drive so much of the care. In many situations, we have standing orders/protocols as well that we can pick and choose from. We can even decide one medicine over another based on our assessments. We do not follow orders blindly or have to check for every little thing. And I, like others have stated, have directed the course for patient care, especially when a Provider knows us and our capability. The amount of dialogue and collaboration which occurs was completely mind blowing for me when I first started nursing. I have had doctors openly share their thoughts and potential plans and then look at me and say "what do you think?" The first time I was speechless. A nurse's opinion and suggestions are valued.

I have traveled to two different ERs where they said/claimed "this is a nurse driven ER"...and they were right. The amount of autonomy and decision making was significant. Doing assessments, placing orders, ordering meds, reviewing lab results and steering the care, many times before the Provider even had a chance to visit the patient. Go give them a verbal assessment and they would say "sounds great, keep doing what you are doing and advise if anything changes".

I find it completely ironic that you are telling us how it is inside the units, when you are not even doing this type of work. Collectively, we are not all going to BS you or anyone else about the scope we operate under. And no, it is not just the ER that performs like this. I am currently at a facility where some of the units have this type of practice as well. Ever been inside a true CVIUC? One that has multiple patients on VAD, CRT, and 15 pumps all at same time? Dr.P you often bring up valid, informed opinions/statements, however you are way out in left field with your current perspective/opinion. Maybe in the bubble you have operated in, some of the places have been this way. But as a whole, this is not how it is. If I wrote about my current job you would probably call BS flag...cause it absolutely destroys your perception.

This is again all about, you do not know what you do not know. I shared my nursing school experience, however once out in the real world and seeing what we can do, to what level, and how heavy we are relied on, on how much involvement we have in directing patient care has been a huge eye opener. It completely changed everything I thought I knew about nursing from my early paramedic years. I was wrong for so long.

 

[FiremanMike]

Apologies, I think my numbers were confusing... Paramedics know 90% of the cardiac and respiratory treatment for emergency medicine, not 90% of the cardiac/respiratory system. Stepdown and ICU care isn't in emergency medicine, so I think we are in agreement there.

I understood what you meant, my point stands.

I did say ICU nurses, not ED right? I know ED nurses tend to have more standings orders to treat a patient, but most of the time I have brought a critical patient to the ER, the doctor is there. Yes, nurses do their assessment and communicate with the doctor, but the doctor is the one deciding on treatments.

ICU nurses have arguably the most autonomy of all, especially at night. The have the longest list of PRN meds and the most flexibility to use nursing judgement to use them, hold them, or titrate meds already being administered.

Is it really the same thing? the last sick patient I dealt with, the first time the doctor was consulted on the treatments was when the crew made it to the ER, 20+ minutes after we made patient contact. Drug dosages, drug choices, and administration routes were decided by the paramedic; Do nurses have that same level of independence? I've heard the same argument from other ER nurses, but the few times I was a patient, or my family was the sick patient, every time I needed something of a clinical nature, the first response was "let me check with the doc and get back to you."

You are incorrect, the first time the doc was consulted was 2 years before that run when they wrote out the standing orders that you are allowed to follow, which clearly dictated the drug choices, drug dosages, and administration routes.

 

[DrParasite]

You are incorrect, the first time the doc was consulted was 2 years before that run when they wrote out the standing orders that you are allowed to follow, which clearly dictated the drug choices, drug dosages, and administration routes.

That sounds a lot like cookbook medicine... if you see X, do y.... might be how it's done by you, it's not really how it's done by me... we have standing orders (like everyone else) and guidelines from our medical director, but it's left up to provider discretion as to which order is appropriate, and which one to use. Its rarely only one option, it's choose which one you think is best for this patient.

If nurses can initiate treatments paths, administer medications, without talking to a doctor, than TIL. And for the record, I have never been inside a CVIUC, so I have no idea what occurs.

And for @akflightmedic, @Akulahawk, and @FiremanMike, I am not a nurse, so I will differ to you guys who work in a hospital. My experience based on what I have seen is much more limited than you, so maybe my time in the ICU (which was mostly clinical time) was not accurate. I'm man enough to admit that I might be wrong here, and my perceptions and observations do not reflect the full scope of what nurses can do. To anyone who was offended, I do apologize.

For the record, I think the nursing profession has a much better partnership with doctors than paramedics have with doctors. the treating doctors respect the opinions of the nurses much more than many online medical control docs have with paramedics.

 

[akflightmedic]

"let me check with the doc and get back to you."

Dr. P, I cannot even tell you how many times I have used this line as my only escape from an annoying patient, an annoying family member, or simply a way to interrupt the patient/family monologue so I can get to the 1000 other tasks running through my head.

Legit, many times I know the answer. However, I have zero desire to engage, it is irrelevant, or I simply do not have the time to cater to all their demands, questions, theories, suggestions, "well Google says", etc. And I even use it to escape people who are medical or I suspect are medical, because they are often the most annoying.

 

[VentMonkey]

I would be curious to gain insight from bridge program nurses who bridged with their paramedic license and/ or experience.

Did/ do they feel the curriculum missed was a non-factor? I realize requirements can vary by state. My state did it for like 2 years, but I have yet to come across one personally.

 

[FiremanMike]

I would be curious to gain insight from bridge program nurses who bridged with their paramedic license and/ or experience.

Did/ do they feel the curriculum missed was a non-factor? I realize requirements can vary by state. My state did it for like 2 years, but I have yet to come across one personally.

My bridge program skipped the STNA requirement and in lieu of the first clinical rotation at a nursing home which taught basic assessment, we had a "transition to RN" class which was pretty silly.

I don't feel I missed anything with the missed clinical, but to be honest I wish I had taken the STNA. The basic patient care skills aren't something you typically do, and while I'm comfortable now, I had to have people show me what the hell I was supposed to be doing.

 

[FiremanMike]

That sounds a lot like cookbook medicine... if you see X, do y.... might be how it's done by you, it's not really how it's done by me... we have standing orders (like everyone else) and guidelines from our medical director, but it's left up to provider discretion as to which order is appropriate, and which one to use. Its rarely only one option, it's choose which one you think is best for this patient.

I’ve been chewing on this since you posted it.

As a medic, I also have a fairly “open” protocol and a medical director that encourages critical thinking.

With that said, one of hardest pills I had to swallow later in my EMS career is that we’re all pretty much cookbook medics. For the most part, the most appropriate treatments have been determined since the inception of EMS and the standard of care is fairly well known.

In the paramedic scope of practice, we have a relatively narrow list of meds that we can give and those medications can really only be given for a small number of reasons. Accepted standard of care combined with a litigious society in modern times pretty much dictates that if you see x and don’t do y, and a bad outcome occurs, that’s going to be on you entirely.

Sure, there is some leeway, but it’s not as much as any of us pretend it is.

 

[ExpatMedic0]

After 20 years in EMS I'm finally on my way out. I have a 2 year exit plan. To a career where the minimum requirements for licensure is a masters degree or doctorate.There are many reasons for this, but the topic of this thread and the attitude of some in it will add another tally to my exit list
In terms of the cookbook stuff, I think everyone has best practices and clinical guidelines, even doctors.
The Paramedic program and the RN program are booth rooted in 200 level community college education with similar program hours in many areas. In my home state of Oregon, both require a degree for licensure and both AAS degrees have mostly the same pre recs. To my knowledge an RN cannot challenge our state paramedic license, nor can one challenge the NREMT. That being said the fact a nurse can challenge the paramedic exam in some select states is just a direct reflection of our professions inability to move forward, advocate for itself, and failure to meet it's agendas of the future. It's also a reflection of the power Nursing has. Nursing has power in healthcare and we don't.
I've worked as a paramedic in several other countries, currently in Canada and I say without a doubt we are the most underpaid underpowered and underappreciated in the USA. It's no wonder we all move onto nursing, PA school, Fire or something else.

 

[FiremanMike]

After 20 years in EMS I'm finally on my way out. I have a 2 year exit plan. To a career where the minimum requirements for licensure is a masters degree or doctorate.There are many reasons for this, but the topic of this thread and the attitude of some in it will add another tally to my exit list

The attitude of some in it? You mean those of us who went to both nursing school and medic school and say that nursing school is much harder?

Whatever man, congrats on your new career!

 

[ExpatMedic0]

Thank you!
Keep on nursing people back to health and best of luck to all.
I'll see myself out.

 

[FiremanMike]

Thank you!
Keep on nursing people back to health and best of luck to all.
I'll see myself out.

not sure what field you’re going into, but sounds like you just completed a program in something.

Just wondering how you’d feel if folks here were insistent that their education was essentially the same as yours and they should be able to just be able to test out of it? You’re sitting there thinking “hey wait, I just finished that, I have a valid perspective and I don’t think that’s correct”, but then the folks who had never completed your program doubled down that they definitely could, threw some straw men in there, then deuced out with some fairly hefty condescension on their way out.

Would be wild, wouldn’t it?

 

[akflightmedic]

My guess is on CRNA...