Paramedic vs ER Nursing?

[answeringthecall]

Hello all,

Thank you for having me here!

I am a first year student (although I'm 26 and already have a humanities degree and some work experience) and have done the first year of both the Paramedic bachelors degree and a Bachelor of Nursing (in New Zealand).

As I can only stretch myself so far (damnit!), I am going to have to choose now which degree to continue with and career to pursue.

The only type of nursing I would want to do is Emergency Nursing. I am on nursing placement now in a general ward and find it quite boring. I love emergency medicine.

The advantage I see in Paramedic is that you get to make your own clinical decisions (in NZ, a Paramedic makes their own clinical choices within the scope of their level of practice - I don't know what it is like elsewhere. If an Advanced Paramedic needs to give midaz, for example, they do it - they don't have to ask anyone). You aren't sitting around waiting for a doctor to tell you to do something you already know you should do.

On the other hand, I really like the environment of the Emergency Department and the variety you see there (I was an ED receptionist for two years, so I know what I'm talking about).

I've pretty much decided to choose Paramedic to be honest, but I know people here have had all sorts of experiences in the medical field and I would love to hear some opinions and thoughts on the pros and cons of paramedicine vs ED nursing.

Thanks all :-)

[Kiwiology]

Depends which end of the R40 you want to be on.

In reality nursing is more established professional medically (but I think that's a common trait worldwide) and it will take probably a decade for the ambulance services here to catch up in terms of education, registration, funding, scopes of practice and pay - although from what I've heard, ambo pays better than nursing.

The ambulance service is also quite different; how many ambo's do you know who read medical journals or keep up with anything beyond what Tony Smith decrees? Do you see the ambulance services taking part in any randomised, double blinded clinical trials or publishing papers? How well do you think ambo police's CCE/CSR requirements?

You mentioned scope of practice and this was something I've gotten quite hung up on as I've been conditioned to somewhat autonomous practice much like you. Having had some very long discussion with our DHB nurse educators and ED staff about this my consensus is that it's not a big deal.

Nursing also has the travel opportunities that Paramedicine currently does not.

[Timmy]

I have exactly the same problem!

I've done my Diploma of Nursing and have a Certificate IV in Health (Ambulance) which is nothing exciting (similar to EMT B with basic pharmacology) I'm off to university next year to do my Bachelor of Nursing, going into the Nursing Degree already having a Diploma wipes a considerable amount of time so it's an easier option continuing with Nursing than going onto paramedics which is a four year degree.

I'm currently pushing around the pill trolley in a large aged care facility for fininical benefit, whilst not the most exciting job in the world and I don't necessarily enjoy having crushed up temazepam and risperidone in apple sauce spat back at me its good constantly being surrounded by basic pharmacology whilst waiting to further my education... Good news is I've got a large amount of shifts coming up in A&E!

But I do agree, there isn't much room as a nurse to initiate much without a doctors order which can be quiet frustrating. I find there are a lot more educational advantages in Nursing. I was reading the nursing journal the other day and it was saying we had something like 342 courses both at a local and tertiary level for nursing but I'm not sure how many paramedics have.

Once I finish my degree I look forward to doing a post grad diploma in emergency nursing then venturing onto paramedics (theres a pathway from ED RN to paramedics)

[scott33]

So what is the problem with doing both jobs? Lots of us do it.

[Kiwiology]

So what is the problem with doing both jobs? Lots of us do it.

How do you mean mate? To say "eh I'm sick of the street, I want to be a nurse" means another three years to do your Bachelor of Nursing - the two are very different, very separate, very established professions.

Edited December 4, 2009 by kiwimedic

[VentMedic]

So what is the problem with doing both jobs? Lots of us do it.

You have NY listed as your location. In the U.S. it is a little easier to do both where the Paramedic only requires a few hundred hours of training and the RN is still just an Associates degree for entry level.

[scott33]

You have NY listed as your location. In the U.S. it is a little easier to do both where the Paramedic only requires a few hundred hours of training and the RN is still just an Associates degree for entry level.

So not unlike your situation then?

The OP already has a degree, and has completed one year of both RN and paramedic degrees. She could probably get APL'd / credited for many of the duplicate requirements that she either has, or will gain if she continues with both paramedic and RN classes. It should also be noted that some bachelors degrees are only 3 years long in NZ

As for which one to choose...

Nursing is nursing - a job which will always be in demand regardless of where you do it. A job where if you get tired of one speciality, you can post to something completely different without changing your profession, title, or even your seniority in some facilities. It is also one of the few civilian jobs which can still facilitate certain visas for world travel assignments, unlike the paramedic (degree or not).

It's no secret that NZ Paramedics are moving away from the BLS SJA volly days of old (they do still have them) and into the Australian, British, and Canadian model of degree-based entry for practice. It sounds like it will be a good system to be part of in the years ahead.

On the down side - both jobs can be equally tiring, thankless, messy, smelly (not just RNs that deal with number 2s), often underpaid, and always have the potential to be on the receiving end of physical abuse.

For the OP, I can't advise you to chose one from the other. As I said, if you could do both I would certainly advise it. You don't need to do them at the same time, leave it a couple of years between courses. If you can't - it's your call.

Good luck anyway.

PS, Say "hi" to my Mother if you see her...she lands in Auckland at 1:40pm today as she is spending christmas with my Sis in Whangarei.

Edited December 4, 2009 by scott33

[scott33]

Once I finish my degree I look forward to doing a post grad diploma in emergency nursing then venturing onto paramedics (theres a pathway from ED RN to paramedics)

Or you can do what Timmy is doing if NZ have a similar conversion course in place.

[celticcare]

Hi, New Zealand RN here, also EMT and EMD. *I am using the terms EMT purely for the fact of that its an American forum*. I like the original poster, have desire for Paramedic *our Intensive care scope* career and future. However, I am going to say get RN first, with the base of being an RN and working in the field as a nurse, it will set you up alot clearer for being a medic.

I disagree with the comments that Nurses have limited scope, remember we do have clinical nurse specialists and nurse practioners, who like EMS staff, were once Basics, then intermediates and then medics.

We are bringing in cross converstion and post grad registration/qaulifications for RN's to become medics. Honestly become an RN first, get your degree and a new grad year under your belt then look at becoming a paramedic. You will have an established course that frankly here in NZ we don't have for medics. And will always have a qualification you can travel on, Paramedics at this stage you are limited, RN you can have the world as your oyster.

ED nursing isn't easy to get into though and you will have to work your way into it, which is better trust me.

Send me an E-mail if you want any more information, I started my training at the same institutes as you

Scotty

RN/ACLS (L6)/EMD/EMT

[melclin]

I think you have to ask yourself which you enjoy more and what your personality predisposes you too. I thought about doing the Nursing/Paramedic double degree, but eventually thought - Why? In what world do I want to be a nurse? What in, essence, floats your boat when it comes to EM?

Even if I don't get to play around with the complex knowledge and management like an ICU nurse might (for the time being anyway), while the decisions paramedics make are on the simple end of the spectrum, at least they are their decisions. Depending on where you work, nurses have lots of different scopes, and they certainly seem to have a lot more scope in the states than they do here in Victoria, but when it comes down to it, except maybe for sometimes in the ICU, as a nurse you may know what to do, they may know how to do it, but when it comes down to it, its not really your decision.

I like that the role of the paramedic is that of a doctor, nurse, RT etc rolled into one, and I like the idea of the challenge that it represents. I like the idea of un-familiar and uncontrolled environments and the challenges that they represent.

All of this is based on very little experience and maybe I'm getting things wrong, but central to the idea of being a paramedic as far as what I've been learning here at uni is asking whats wrong with my patients and what is the appropriate course of action to take - and it seems like that really isn't the primary role of ED nurse, and most nurses really. If that's not the process that attracts you, then maybe nursing is better.

Career progression wise, I don't know about NZ, they seem to be about 10 years behind us (thanks to St John?), but I see plenty of career paths for paramedics here:

- the 'basic' ambulance paramedic and IC qualifications & practice, then there's flight work for both of those;

- further education (masters, PhD) in in epidemiology, public health, clinical practice, education, emergency management (are some that are offered by my uni);

- being a part of the adult or paediatric retrieval teams with the major hospitals;

- with MICA and flight educations, then there is HEMS work;

- the paramedic practitioner (in the same vein as nursing practitioners) is starting up here and is somewhat more advanced in the Queensland and very much more so in the UK;

- there's work on standby in mines, oil rigs etc and the pay is pretty good I hear, boring though (in a similar vein there is also starting event first aid businesses, which seems lucrative;

- international pt retrieval for medical travel insurance companies (which sounds like the best gig ever);

- teaching, academia and research in the universities or as past of the clinical standards/education division of whatever service you work for (Clinical Instructors and Clinical Support Officers here);

- health care administration either within the ambulance service and elsewhere.

It doesn't seem that much different to nursing to be honest, with the exception of being more enjoyable . If you really want to be a nurse, you can go back to uni for two years while you're still working.

Put it this way - There are a lot of nurses in our paramedic degree; there aren't many (none, that I know of) paramedics in the nursing degree.