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No urgent health care clinics in my area. Medicaid or Medicare actually had a form that if the ambulance crew determined that a patients "emergency" did not meet criteria for reimbursement that actually became a financial contract so you could pursue collections. I know many services would even request a deposit along with a signature if patient still wanted ambulance transport. You know the funny part is that I actually saw more poor people attempt to make payments even if only $5 month than those with good jobs but no insurance or where insurance, medicaid, medicare denied payment. Often I really think the poor only have their good name and they will do anything in their power to keep it.

No offence, but if that isn't enough motivation for you to get it done, then this simply may not be the career for you. If rote memorisation doesn't work for you (and it simply must on many medical topics), then what I find most successful is to not try to memorise it. Study the topic in-depth. Understand the underlying concepts so that memorisation of numbers is not necessary. If you understand (not memorise) the concepts of oxygenation, then you don't need to memorise the numbers. They come naturally as a result of your critical and deductive thinking. This is test taking 101. Memorisation doesn't equal education. Memorising the answer to every question doesn't tell you or us that you actually understand the concepts you have been presented. As an examiner, you're going to impress me a lot more by taking a moment to calculate the answer you give me, rather than spouting off some number you memorised, but don't understand. If neither of those work for you then again, this probably isn't the career for you.

I sense a little naiveness here. I don’t think a Registered Nurse is any more or less educated than a paramedic, merely you’re provided with industry specific education. The Bachelor of Nursing degree in Victoria is not based around emergency or pre hospital care, while it has some elements of life support and basic emergency care this is not its intended content. The aim of the graduate nurse from this degree is to be a competent practitioner in holistic nursing care, I see the nursing degree as the fundamental or baseline level of nursing with hundreds of educational opportunities and courses in the specific area of nursing I enjoy and dabble in after I graduate. If I want to work in an Emergency Department I can go off and study my Graduate Diploma of Emergency Care or Master of Nursing (Emergency Care), if I want to work in the Cardiac Unit I can go off and do further education in this field, same with community nursing, continence care, intensive care, acute nursing, diabetes and the list is endless. I’m sure you’re fully aware of how a Registered Nurse becomes a paramedic in Victoria. One must hold a Bachelor of Nursing, Graduate Diploma in Emergency or Intensive Care then complete the Graduate Diploma of Paramedicine. That’s 5 years of tertiary education plus experience compared to a undergraduate paramedic who has 3 years education. I’m not sure how much rural exposure you’ve had but we have a doctor shortage out in the sticks, in smaller rural facilities were there are limited/no doctors, nurses are often the only health professionals present during an emergency and depending on what level of training the RN has depends on what can be done for the patient. Depending on the facilities standing orders specific RNs can RSI, thrombosing, perform needle chest decompression, give front line medications and take any measure to sustain life within their scope of practice with out a medical order. We have an excellent relationship with the paramedics which is an essential part of the multi disciplinary team which ultimately contributes to a positive patient outcome. I’m merely a RN Endorsed Division 2 (shock, horror what would I know). I work casually in a small rural setting as well a regional hospital to support my way through my degree and I can tell you it’s no walk in the park. I mostly work weekends and nights were we have limited contact with a doctor. Sure I need to have a doctor’s order (direct or indirect) to give a medication or perform an invasive procedure but I can assure you the young intern/resident who has no interest in general medicine or surgery because they’ve been shoved out in the sticks as part of there rural cohort training and mope around all shift grumbling about not being at the Alfred or RMH, they makes quiet a number of mistakes and I need to know what’s going on in order to prevent being dragged in front of the coroners court. Most of the time they just okaying what I’ve suggested is best for the patient based on my clinical observation through out a shift, 9 times out of 10 they wont even come back to the ward to R/V the patient because there too busy waiting around for the next MET call. In certain ways nurses have a greater scope of practice, even though doctors must prescribe a medication I’m still responsible and accountable for giving it, this means I must be aware of the pharmacokinetics, pharmacodynamics, adverse reactions, interactions, contraindications – equally must a paramedic. The difference being you guys have… 40?? Drugs in your bag of tricks but we have a whole room full of medications. We can catheterise, deal with central/PICC lines etc etc were a paramedic would not know were to start. But on the other hand, as you say paramedics have greater flexibility in prescribing your own medications and doing what you like, per say. In conclusion please don’t short sell nurses because we all have our place and our speciality, I have great respect for ambos, your knowledge and skills and one day I hope to become a paramedic as well. But with a appropriate bridging program and education in the relevant specialist area I see no problem in a RN becoming and ambo or vise versa

I have to say I don't like the idea of using nurses in the prehospital setting. Here at least, a nurse and a paramedic are very different creatures. Paramedics have a greater scope and almost complete autonomy. They also have slightly more education than nurses although the more important point though is that it is different education. Paramedics here tend to be taught along the lines of diagnosis. Critical thinkers who can problem solve and apply their knowledge appropriately to figure out whats wrong with a patient and treat accordingly. In this sense, our training in more in the spirit of medicine rather than nursing. It has to be that way, because we don't have medical control: we sort of have to be watered down doctors. Nurses are the educated eyes, ears and hands of doctors, and while in practice, they are much more, their training is still based entirely around the idea that they are part of a team that necessarily involves direct medical oversight. Take away a nurse's support structures, other nurses, doctors, fancy gear and I think you've got problems. I've often heard nurses saying, well the doctor should be doing this and that and the other thing, but I wonder how confident they would be if the decision to paralyze and intubate or thrombilyse over PCI, decide on the amount of fluids that post-severe haemorrhage pt should get, leaving a pt at home after deciding that they aren't sick, actually rested on their shoulders. Most of my degree is about educated clinical decision making. When it comes down to (and correct me if I'm wrong), clinical decision making doesn't lay at the heart of nursing. (I have nothing at all against nurses, I'm just saying the fundamentals of their education are not suited to the requirements of autonomous care. I think it is also important to mention that nurses in American appear to have more education, a greater scope, and a slightly different role than nurses here). Also, I think prehospital care is different enough for it to be its own qualification. It would be a pain in the arse if I had to do a nursing degree and, sit on a ward for 3 years, do my ICU grads, and then start learning about prehospital care. You don't have to be a nurse first to be physio, or an OT or a midwife, because while they are related in some ways, they are different enough to have separate qualifications - so is paramedicine.

The weird part is i envy you a little.