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There are midwives who practice who are not RN's. There's a difference between a midwife and a certified nurse midwife... come to think of it, there's certified midwives (not RN), direct entry midwives (not RN), certified professional midwives (may or may not be RN) and certified nurse midwives. Just thought I'd throw that out there... This is some really excellent discussion! I would definitely agree that a lot of the misperception of nursing vs paramedicine comes from the attitudes that have developed within each specialty, with each disdaining the other through ignorance. Nurses are definitely independent thinkers (maybe not some of the SNF drones, but fortunately most of the ones I've met in that field so far have been very intelligent and good at what they do)and have to be in order to perform their job appropriately. Standing orders are standing orders, no matter what title you may happen to hold. I have standing orders to NOT EVER do CPR in my facility, because we're not a "skilled" facility. I also have standing orders to provide basic wound care since I have no nurse at night. Does that take all my thinking out of the equation? Certainly not, and if that holds true for me at the flunky level, it definitely holds true at higher levels. I think the perception that you are "autonomous" as a paramedic is one of the dumbest things I've encountered... it's where a lot of the cowboy medicine that is practiced without solid foundation comes from. Of *course* you need to make autonomous decisions based on the situation you are presented with... but at the end of the day you answer to the doc and if you gooned it up, the doctor will take away your ability to practice. Same holds true for nurses... you have to make critical decisions based on the information in front of you. Has anyone here been sick recently? What was your experience- who did you see? Who did the majority of your care? In my experience and that of close friends recently, it's been the nurse who does 90% of the care. The doctor may pop in to provide some of the puzzle pieces, but the nurse is providing care. That's autonomy if I've ever seen it... just autonomy with the awareness of physician involvement at the forefront instead of hidden away in the subconscious. Wendy CO EMT-B

Welcome! Tis a noble profession that you've chosen to pursue. You will need to become American Heart Association CPR certified, but many of the EMT programs include that in their curriculum. Not all do, but many do. So wait until you find a program. It can't hurt you to take an anatomy and physiology class. As you progress in levels of training, each level will teach you more about A&P, but I have found -having been an EMT-Basic, EMT-Intermediate and now an EMT-Paramedic - that none of the EMT level A&P classes are as in depth as an acutal college level A&P class. I always recommend becoming Nationally Registered as an EMT at any level. Most states require NREMT for reciprocity and initial licensing. At any rate, the answering to your question is no. You must attend an approved EMT program, complete the clinical and field internship, take a written and a practical examination to challenge any level of EMT test. For Indiana, if you go here, it will help you locate programs in the Indy area. Wishard has an ambulance service and if you contact their EMS educator, I am sure they will be happy to help you find a great class in the Indy area as well. I live and work outside of Indiana, but I was raised near Ft. Wayne. If I can be anymore help to you please let me know. Your fellow Hoosier! http://www.stvincent.org/education/ems/emtcert.htm http://education-portal.com/emt_certification_indiana.html http://degreedirectory.org/articles/EMT_Classes_in_Indiana_Which_Indiana_Schools_Offer_EMT_Certification_and_Training.html Just a few I found with a quick Google search.

There are a lot of variables, but in the US you'd be better off to go with a medic/medic system as opposed to a nurse/nurse truck as prehospital EMS is a very different animal than in-hospital EMS. The scope of practice and skill sets are much more finite and well defined, as well as the autonomous work environment. Am I, as a paramedic, the better choice to work an accident scene or significant acute medical in the field than an ER trained nurse? In my experience, yes, very much so. Is that because I'm smarter than the ER trained nurse? Not in any significant way. What I do bring as a significant advantage is a finite toolbox that I have practiced over and over bringing an efficiency of movement and confidence with not only pt management but the management of the scene and the resources available there. Now of course if you take a nurse that has been trained in these skills as well, then my whole point becomes moot, as we see often with flight nurses in the US. There is nothing magical about a medic cert that endows one with the skills mentioned above, only that here, that certification focuses on those skills throughout the education process as well as puts us in an environment to practice them endlessly. If your system is looking at simply staffing ambulances with hospital trained nurses over traditionally trained paramedics, then I'd say that that is not a good thing. In Kandahar I worked with a driver, a KIWI doc and an Aussie nurse. The doc was useless as he couldn't seem to get the point that he had hands of his own and that on an ambulance he was expected to use them. He also could either work a pt on scene, or load and run to the hospital, but seemed unable to come to understand that there are ways to do both at the same time. (THIS NZ doc, please don't extrapolate this to ALL NZ docs, or even docs in general, he just happens to be my only experience in this arena.) The Aussie nurse was awesome, but coming from Australia she already had a healthy respect for prehospital medicine and was simply a sponge when exposed to those concepts. But despite the fact that she was wicked smart and competent, she originally had almost none of the tools necessary to work prehospital, by her own admission I might add. The flip side of course is that given those tools and additional education specific to prehospital EMS her intelligence, commitment and common sense would have made many, many of the medics I've been exposed to look like a bunch of monkeys humping a like number of footballs. She was an inferior provider to me because she'd been dropped in my environment. Had I instead been put into hers I would have, and often did, feel like a complete poser, medically speaking. Two different worlds. Prehospital EMS is a pretty specific skill/education set. If those that will man ambulances are not trained/educated in it then I believe that system will suffer because of it. Dwayne

Ok folks would like some advise if possible. The volly squad I am on is small (14 active mebers) so we are on multiple shifts with diffrent crews. What do you do if one of the crews you are on has a member thats just not gelling? The crew I am currently on during my 48 is awsome. The two women and me gel very well, work without having to say much and basically know each others roles and where to be and what to do. Well on this same crew is a 4th member who just seems off. Stands around at scenes until told what to do, stands in the background without much input, basically just in the way. I know this person can be a great EMT and will probably work out well in our crew but even after trying to help (training days, rig checks, that sort of thing) it seems everything goes in one ear and out the other OR total deer-in-headlights syndrom. I dont want to switch crews and my other crew member feels the same way but we are at a loss on what to do. What would you folks do? I do think she would be a great EMT if she puts her mind to it and hopefully she does.

You maintain your professionalism at all times. We deal with this in the Peds ICU unfortunately too often. Until the "parents" are charged, convicted and put behind bars, you will have to exercise your own restraint by focusing on the child and maintaining your composure around the "grown-ups" even if you know in your heart they are guilty. If you allow yourself to be sucked down to their level, you may give grounds for a lesser charge or even a dismissal on some technicality as well as putting yourself into the spotlight and subject to an investigation. Thus, put the child first and allow the justice system a chance to do its job. Or, give the inmates at the jail or prison an opportunity to show their "love" for child abusers.

Sure. With out knowing this person or the situation it’s hard to pass comment. The way I run things with the new members and cadets is tell them to take the lead while I provide supervision and support, tell her to ask questions if she’s stuck but at the same time warn them not to be offended if things start to turn pear shaped and I need to step in and take over. At the end of the call sit down with her, ask her how she went, ask about weak and strong points and ways to improve and then offer your feedback. I’m sure with some constructive feedback and extra training and support things will work out for the best. On the other hand: Does she really want to be in EMS and takes a strong interest or just she just want to help around the station with cleaning trucks and so on? There’s nothing wrong with taking a step back to provide a support role.

I too had a similar problem with one of my volunteer members. There’s not a great deal you can do, as a manager I just documented and wrote incident reports every time something went wrong and reported it to the regional clinician. Because it’s a volunteer service there really wasn’t many options in regards to having him dismissed because of discrimination and so on but I did suspend him from his operational role pending medical investigation, subsequently he is no longer an operational member and can not treat patients but still has full rights to attend meetings and trainings which he takes full advantage of to everyone’s dismay! The first step I recommend: You inform your OIC. and You approach him with your issues to define a cause to these problems - in the company of a mediator and have the conversation documented. It may be something as simple as lack of confidence that can be rectified with more education and training. Pending the outcome of this interview will dictate as to what action is needed next.

There’s no need to apologies, this is a forum of adult education were mature and up standing citizens voice there educated opinions and receive constructive criticism in a professional and well educational environment. Nah, it’s all good. I once was a Student Paramedic back in the day and made the switch to Nursing as we were constantly told that undergraduate high school leavers would never be accepted into the graduate program with AV because we had no ‘life experience’ and we’d be better doing nursing first then coming back to paramedics. I was also a little uneasy about the shear volume of first year students they accepted into the paramedic degree. (Not to mention the better pay, hours and work conditions compared to being a paramedic, have you seen what a RN Div One can earn on agency? It’s not to shabby at all) So I moved back to the country, found my self a hospital that paid for my training, paid me a full time wage, were crazy enough to pass me then gave me a scholarship to bridge into the nursing degree… I know deep down that I immensely want to be a paramedic but for the time being I enjoy nursing, it’s fun, challenging and I’m learning a lot. Anywho, enough about my life story… As I said in my previous posts, there two different courses. After all, what’s the point of having the same course for two different industries? Someone posed a question in a previous post what defining relevant paramedic education. I have no direct answer to that as I’m not a health sciences teacher nor am I a paramedic but like anything you need to assesses what previous qualifications, skills, education and experience these people have, you then need to implement a plan of action to over come these gaps in knowledge by both theoretical and practical education and possibly assess them on what there new scope of practise maybe as a paramedic with the aim of producing safe and competent partitioners. There was mention that Nursing and Paramedics are very different in regards to clinical environment, approach and support mechanisms – this is very true. How do we overcome this? More than likely with clinical supervision and guidance from an experienced practitioner in that particular speciality but at the end it all comes down to time and experience.

True, but I think your missing my point about the fundamental focus of the paramedic vs nursing undergraduate education, which was really my original point. Most of those skills listed their are quite advanced and are not predominantly things that graduate nurses do. I keep saying, I'm not having a go at nurses and people list skills and talk about how wonderful nurses are. I concede that I was unaware of the extent of the scope of advanced practice nurses in some settings, however, that is not terribly relevant to my main point which was basically if you are looking for an affective way to educate prehospital professionals, the best way to do that is begin with prehospital qualification, because of the specific skill set required. I happily agree that good ICU/ED nurses would make great paramedics, but as I said, to require prehospital professional to be great ICU nurses before they can step onto an ambulance is an overly round about and unnecessarily long pathway to EMS (with the corollary being that a nursing undergraduate degree by itself is by no means equivalent or superior to a paramedic degree when it comes to prehospital care, which is a common argument in the states where the prehospital qualifications are inferior, and I wanted to provide a picture of a system where that was not the case). Some of the things I said "dissing" the average grad nurse was my attempt to explain to the Americans that a BSN in Australia is not equivalent to an American BSN which is a higher qualification as far as I can tell. Of course not, but to be far I didn't really suggest that. I have obviously touched on the a nerve that many nurses and paramedics have (students like me included) that involves raising ones temper when people assume a much lower level of practice that you actually have. It appears some of what I have said has been the equivalent of calling you an ambulance driver, and I do apologise for not being more familiar with the extent of higher levels of nursing practice. However, again, this was not fundamental to my point about the fundamentals of the undergrad education. Also, importantly, I often make a point of the fact that I'm a student. I don't claim to be coming from a position of any particular expertise and my point was primarily about something that I am familiar with, which is the nature of the paramedic and nursing undergrad education. I do however, maintain that almost every nurse, some of them quite highly qualified and experienced, that are now doing my degree have said that it is a much different ball game - that it is much harder than they thought when its all on them and them alone, especially without the support structure of the hospital. You can take or leave my undereducated and under-experienced opinion, but that is a pretty common sentiment from people who have actually made the switch. I was also on placement with two experienced paramedics, who were originally ICU nurses and wanted to return to nursing, who were complaining angrily of the re-certification requirement on the grounds that they do more as paramedics than they ever could do as nurse. So I feel my opinions are not totally baseless, but your're right, I know very little about the nursing field, but I never really said I did beyond the graduate component. No it isn't. But I can see how you would think that looking back on some of my posts. I apologise for my obtuse use of language and broad generalizations. Yes it is that way in America, but things are a little different here. I take your's and Vent's point about a false sense of autonomy, but I do think that depending on the extent to which you are willing to defend your decisions, we have more autonomy here than perhaps you realise. I think the point here is the difference between guidelines and protocols, while some here argue the difference is only the name, others feel that they can basically do whatever they want if they can justify it, and that is different to a lot of American systems, which is what you appear to describe. I don't of course want to start a pissing match about who can do more because it is evident that, one, I already did that without intending to and I don't want to continue it, and two, I obviously don't know enough about nursing to do it. What I will say however, is that I think the above paragraph shows a bit of a misunderstanding about some of the aspects of a lot of Australian paramedic practice. I don't know your background, so I obviously can't say for sure, but the above does sound like an odd interpretation of Australian practice if you are aware of its specifics, so I'd like to humbly and tentatively suggest the possibility that you may be more unfamiliar with modern paramedic practice here than you realise. Forgive me if I have misinterpreted your words, and that you are actually the CEO of Ambulance Victoria, which could be somewhat embarrassing on my part . Midwives absolutely do not need to be nurses first - http://www.med.monas....au/bmidwifery/ I can see that I have offended you and, as I said, I do apologise. I was wrong about a number of points but I also think you misinterpreted the main point of my post perhaps because of its inadvertently offensive nature....This feels familiar . Oh and the creatures remark...I just assumed that all health care professionals ate noisily from horse troughs and made abhorrent noises and gestures when displeased. Is that not the case of nurses?

I've always had male PCP's my whole life and have had mixed results with them. Some are easy to talk to and be honest with and other's not so much. My actual PCP in the practice back in MD was an ass who would spend <5 minutes with you, and when I got my diagnosis of a genetic disorder from Johns Hopkins, he didn't believe it and actively tried to challenge the diagnosis. There was a younger doc in that practice who was the pediatrician but would see young adults too who was very very good and thorough and picked up on the joint problems I was having in one visit with him, while 10 years with the other PCP revealed nothing. As for women's issues, no way in hell would I have a male doctor check out down there. I appreciate that there might be some good male OB/GYN's out there, but I just would not be comfortable with them examining me. From my experience, the older population does seem to have a problem with female doctors. Mostly I think this is because when they were younger, women just weren't common as physicians. Elderly gentleman seemed to have an even bigger issue because often questions of prostate and male urogential problems would come up and it was viewed as improper for them to discuss this with a perhaps younger woman. When my grandfather was still alive, he was a WII and Korea veteran and very set in his ways, we had to take him to a psychopharmacologist to get his dementia and anxiety medications situated and she happened to be a female doctor just out of residency (the type you want in such a fast changing and evolving field) and he just sat there and asked her if it was past her bed time yet and told her that little girls shouldn't play dress up in men's clothing. Granted he was in the middle stages of Alzheimer's at the time and just a crochity old man, but still he just had zero respect for her. Took him to a urologist who was a man in his 50's and he answered the doctors questions with absolute respect and honesty. All in the same day too... it amused my aunt and my mom and just confused me completely. I do remember when I ran with a male partner and it was a male, I would ask if the patient would feel more comfortable with him doing the exam and some would say yes. I've also been on calls as a basic where the female was not comfortable with the male medic placing the 12-lead cables so they stepped out of the room briefly and I placed the leads and did the 12-lead for them and then they came back into the room and the patient was much more at ease. In EMS and medicine in general, patient comfort should be one of the higher priorities. After the critical points of course. The patients and their families call us at what could be their worst time in their lives and their stress and anxiety level is already very high, we do not need to add to this by making them uncomfortable. Sometimes the gender issues are unrealistic to resolve on scene, but when possible, taking that extra step to see if the patient would be more comfortable with a provider of their own gender might go a long way in opening the communication between patient and provider and provide essential links and information to patient care.

1) Paramedics have a different scope but not necessarily broader. For instance, how many can insert foleys, NGT's, titrate inotropes, infuse blood products, administer antibiotics, set up, start, run and discontinue dialysis (including CRRT), access central lines, insert PICC lines, initiate ventilator weaning protocols, manage invasive pacemakers, manage invasive monitoring lines (arterial, Swan Ganz etc)? Just to name a few "skills" beyond intubation. The majority of the aforementioned activities require some degree of "critical thinking" abilities. 2) If as a nurse you are unable to do this you won't last long in an intensive care or high acuity ER environment. Nurses don't stand around and wait for the doctor to come when a patient is coding. 3) Pretty bold statement to make based on hearsay and your own very minimal experience and limited knowledge. It actually only shows your ignorance of what it involves to be a nurse especially in a critical care unit or ER. I can guarantee you that there are many Doctors who have ignored a nurse's advice and caused harm to a patient or on the other hand listened to what a nurse said and prevented a serious event as a result. Do you think Doctors aren't human and don't make mistakes or write orders incorrectly? 4) Another example of ignorance since "educated clinical decision" making is the foundation of nursing. It is obvious that your whole perception of what a nurse is and does it to mindlessly follow Doctor's orders. 5) So following this philosophy I should not be able to be a Flight nurse as I was educated and trained in Australia? (Don't tell my bosses that, I have them bluffed!!! ) 6) I agree with Ventmedic about Paramedics having a false idea of autonomy. They all operate under standing orders or protocols (Doctor's orders! Every program has a Medical Director for that very reason). Many different units have their own version of standing orders and protocols just the same that nurses can initiate and use without having to ask the Doctor for each specific order. Autonomy exactly the same. The Doctors are not always readily available in the units either. How many medic programs have to call for online medical control to give an extra dose of Morphine over the protocol amount (just for example!). Really no difference just looking at it from a different perspective. Doctors orders and the protocols that paramedics follow are really the same thing except in the hospital they are individualized to a patient and not a broad disease category. Nurses in the ER will often triage and start treatment with standing orders before a doctor has even seen the pt. (For example with chest pain). Is that not exactly the same thing that a paramedic does? That is just one example. 7) Actually a midwife is a nurse with further education. You can't be a midwife without being a nurse first. I am not attacking you personally here. I am just a tad offended at the statements made when you obviously don't really know what you are talking about. Oh and p.s......Paramedics might be "creatures" but nurses aren't!!!

wow...not even any views yet...

Yeah I guess it is rather late...I'm curious and impatient and figured we all had to be creatures of the night like me.