Paramedic/RN

[Jwade]

Vent,

Agreed, on the state license issue! You are correct, good point! As with Nursing some time ago, many diploma RN's did not have a degree and still able to get a license. EMS just needs to get with the program and force out all of the medic mills, volunteers, etc.....I personally think they should all be 2-4 year degree programs such like the one I provided a few posts ago. There would be ZERO arguments anymore as to which profession has the more basic knowledge base! Did Oregon finally institute this requirement?

Now, again you make huge assumptions, which, any decent critical thinking course would frown upon as you well know! I am NOT defending the warm body interview style at all...The issue is and has been, you have mostly RN's with zero to very basic business / mgt background running these programs and making poor hiring decisions. This is a fact, not fiction. Trying to compare an MBA to a BSN MGT 101 course is ludicrous. Contrary to your statement, I personally would push for some upper division MGT courses as a track available to the BSN students. Giving someone a broad overview of basic accounting, finance, business law, HR, maybe stats, does very little to prepare someone to be a manager, much less a leader of a program / business / etc......I would make the educational track for mgt where an entire course in the aforementioned classes would have to be taken. This would be a gigantic step in the right direction.

Respectfully,

JW

Edited January 8, 2010 by Jwade

[spenac]

And the wheels on the bus go round and round, round and round.............

[ccmedoc]

There have been reports and studies showing a direct correlation to reduced mortality and morbidity with higher educated nurses (ADN vs BSN.

Something from the ACCN:

There is a growing body of evidence that shows that BSN graduates bring unique skills to their work as nursing clinicians and play an important role in the delivery of safe patient care.

* In an article published in Health Services Research in August 2008 that examined the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes. Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-rescue rates. The authors conclude that “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”

* In a study released in the May/June 2008 issue of the Journal of Nursing Administration, Dr. Linda Aiken and her colleagues confirmed the findings from their landmark 2003 study (see below) which show a strong link between RN education level and patient outcomes. Titled “Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes,” these leading nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death.

* In the January 2007 issue of the Journal of Advanced Nursing, a new study is titled “Impact of Hospital Nursing Care on 30-day Mortality for Acute Medical Patients” found that baccalaureate-prepared nurses have a positive impact on lowering mortality rates. Led by Dr. Ann E. Tourangeau, a research team from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to the hospital with heart attacks, strokes, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."

* In a study published in the March/April 2005 issue of Nursing Research, Dr. Carole Estabrooks and her colleagues at the University of Alberta found that baccalaureate prepared nurses have a positive impact on mortality rates following an examination of more than 18,000 patient outcomes at 49 Canadian hospitals. This study, titled The Impact of Hospital Nursing Characteristics on 30-Day Mortality, confirms the findings from Dr. Linda Aiken's landmark study in September 2003.

* In a study published in the September 24, 2003 issue of the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10 percent increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5 percent. The study authors further recommend that public financing of nursing education should aim at shaping a workforce best prepared to meet the needs of the population. They also call for renewed support and incentives from nurse employers to encourage registered nurses to pursue education at the baccalaureate and higher degree levels.

* Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level. These findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine that references studies conducted in Arizona, Colorado, Louisiana, Ohio and Tennessee that also found that nurses prepared at the associate degree and diploma levels make the majority of practice-related violations.

* Chief nurse officers (CNO) in university hospitals prefer to hire nurses who have baccalaureate degrees, and nurse administrators recognize distinct differences in competencies based on education. In a 2001 survey published in the Journal of Nursing Administration, 72% of these directors identified differences in practice between BSN-prepared nurses and those who have an associate degree or hospital diploma, citing stronger critical thinking and leadership skills.

* Studies have also found that nurses prepared at the baccalaureate level have stronger communication and problem solving skills (Johnson, 1988) and a higher proficiency in their ability to make nursing diagnoses and evaluate nursing interventions (Giger & Davidhizar, 1990).

* Research shows that RNs prepared at the associate degree and diploma levels develop stronger professional-level skills after completing a BSN program. In a study of RN-to-BSN graduates from 1995 to 1998 (Phillips, et al., 2002), these students demonstrated higher competency in nursing practice, communication, leadership, professional integration, and research/evaluation.

* Data show that health care facilities with higher percentages of BSN nurses enjoy better patient outcomes and significantly lower mortality rates. Magnet hospitals are model patient care facilities that typically employ a higher proportion of baccalaureate prepared nurses, 59% BSN as compared to 34% BSN at other hospitals. In several research studies, Drs. Marlene Kramer, Linda Aiken and others have demonstrated that a strong relationship exists between organizational characteristics and patient outcomes.

* In the 2001 Employers' Survey conducted by the National Council of State Boards of Nursing, nurse employers expressed a clear preference for hiring experienced BSN graduates for nursing management and RN specialty positions.

* The fact that passing rates for the NCLEX-RN©, the national licensing examination for registered nurses, are essentially the same for all three types of graduates is not proof that there are no differences among graduates. The NCLEX-RN© is a multiple-choice test that measures the minimum technical competency for safe entry into basic nursing practice. Passing rates should be high across all programs preparing new nurses. This exam does not test for differences between graduates of different entry-level programs. The NCLEX-RN© is only one indicator of competency, and it does not measure performance over time or test for all of the knowledge and skills developed through a BSN program.

I am curious where you get the information about the basic education classes included in the BSN programs, if you have not gone through one yourself. Your "BSN MGT 101" reference seems to be a sticking point for you. If you believe the only difference between associates and bachelors degree is this, you are sorely mistaken..

There have been many reports issued that also state that a major determinate in good patient outcomes is education of the caregiver, not experience.

We could debate this all day, and the evidence to the benefit of BSN can be presented as well, I seriously doubt you will be swayed so the point is moot...

Source: http://www.aacn.nche.edu/Media/FactSheets/ImpactEdNp.htm

Edited January 8, 2010 by ccmedoc

[Jwade]

There have been reports and studies showing a direct correlation to reduced mortality and morbidity with higher educated nurses (ADN vs BSN.

Something from the ACCN:

I am curious where you get the information about the basic education classes included in the BSN programs, if you have not gone through one yourself. Your "BSN MGT 101" reference seems to be a sticking point for you. If you believe the only difference between associates and bachelors degree is this, you are sorely mistaken..

There have been many reports issued that also state that a major determinate in good patient outcomes is education of the caregiver, not experience.

We could debate this all day, and the evidence to the benefit of BSN can be presented as well, I seriously doubt you will be swayed so the point is moot...

Source: http://www.aacn.nche.edu/Media/FactSheets/ImpactEdNp.htm

CCMEDOC,

Good info, Thank you. I would have to read each study independently to verify the validity of the study and see what variables were excluded to reach their conclusions. It is often not what was included in the study which makes it valid, often times these are manipulated by leaving certain demographics out, as you probably already know being an MSN.

Again, I think you are taking my point out of context. In fact, even though I am NOT a BSN, in my MHA classes we have studied these programs quite extensively for reasons such as you provided in your post. So, I have a very in depth understanding of what these BSN Management classes are teaching, and they are a very basic level. I will qualify basic by saying they only teach a broad overview of concepts such as accounting, finance, stats, healthcare law, etc......Very few offer entire semesters of these classes as I stated would be a beneficial track if made available to the BSN students for those interested in future leadership opportunities. As it stands now, most are poor leaders being held back by a lack of formal education in this area. Of course there will always be outliers, but most in my experience tend to operate at two standard deviations below the mean. :-)

Just to clarify, I am certainly not against a BSN by any means, one must compare apples to apples in order to be swayed, for which, I am always open. Just not through a bunch of anecdotal evidence.

Respectfully,

JW

[maverick56]

WOW! I wasn't quite expecting the response. Guess it's a subject that stirred up some opinions, haha. Anyway, thank you all for your thoughts and suggestions, I really appreciate it. I know that if I were to go nursing, it would defenitely make the most sense to go for the BSN, especially with my science and technical background, I could do it in a year to year and a half (full-time). The big obstacle there is entry requirements - they're competitive programs and my GPA won't make the cut (I've looked into Michigan State and LSSU). I wasted too much time fighting my ADHD (and losing) rather than dealing with it the first time around.

I think the biggest thing I'm taking from this whole thread is that those of you who have followed the medic route and enjoyed it don't regret the decision, even if you're making less etc. Having spent so much time fighting what I want vs. what I "should" do, it's nice to hear "real adults" talking that way. I think ultimately, I know that I'm dragging my feet on the nursing business because it's not really what I want - I just don't want to deal with my dad seeing that as the end result. If the genius child who drives him nuts isn't going to be an engineer or a doctor, she should at least be a nurse and make a living... But that's another issue altogether.

It's great to see all the info and emphasis on education in general though, as I am a firm believer in always continuing to learn new things and challenging myself. You all put a professional, intelligent, educated light on the EMS field - kudos!

I have never really understood the fascination with being a flight medic. In the area I work in, we rarely use the helicopter due to our proximity to a level one trauma centre. On the few occasions that we have had to call the helicopter to a scene, the pt. was treated and prepped for transport by the ground crew. All the helo team did was load and go.

When it comes to inter facility transfers, it was the RN that performed the majority of the interventions. ie Neonates.

Must be the prestige and the helmet.

Haha, maybe for some. For me, it just makes sense coming from 6 years working in air assault and MEDEVAC.

P.S. As far as leaving the state for either education or work - I intend on getting out of Michgian ASAP!! That won't likely be for another 18mo or so (so I can finish up the medic course), but I won't be job hunting around here long term.

[Jwade]

WOW! I wasn't quite expecting the response. Guess it's a subject that stirred up some opinions, haha. Anyway, thank you all for your thoughts and suggestions, I really appreciate it. I know that if I were to go nursing, it would defenitely make the most sense to go for the BSN, especially with my science and technical background, I could do it in a year to year and a half (full-time). The big obstacle there is entry requirements - they're competitive programs and my GPA won't make the cut (I've looked into Michigan State and LSSU). I wasted too much time fighting my ADHD (and losing) rather than dealing with it the first time around.

I think the biggest thing I'm taking from this whole thread is that those of you who have followed the medic route and enjoyed it don't regret the decision, even if you're making less etc. Having spent so much time fighting what I want vs. what I "should" do, it's nice to hear "real adults" talking that way. I think ultimately, I know that I'm dragging my feet on the nursing business because it's not really what I want - I just don't want to deal with my dad seeing that as the end result. If the genius child who drives him nuts isn't going to be an engineer or a doctor, she should at least be a nurse and make a living... But that's another issue altogether.

It's great to see all the info and emphasis on education in general though, as I am a firm believer in always continuing to learn new things and challenging myself. You all put a professional, intelligent, educated light on the EMS field - kudos!

Haha, maybe for some. For me, it just makes sense coming from 6 years working in air assault and MEDEVAC.

P.S. As far as leaving the state for either education or work - I intend on getting out of Michgian ASAP!! That won't likely be for another 18mo or so (so I can finish up the medic course), but I won't be job hunting around here long term.

Maverick,

Have you checked into Wayne States CD2 BSN program? This is a 1 yearish ( 16 months) BSN program for students with a previous Bachelors and all prereqs completed. I have had at least 5 friends of mine go through this program when I lived in Detroit, and all were successful and anecdotally stated it was not really all that difficult. Granted, most had previous medical experience as well.

Wayne State University / CD2 BSN Program

Again, Follow your heart!

Good Luck,

JW

Edited January 9, 2010 by Jwade

[ccmedoc]

Again, Follow your heart!

Good Luck,

JW

I think this is the most important issue..if you want to be a Paramedic, and concentrate on flight..then you should. You need to have your full energy into whatever you choose, and make it yours..I love working as a Paramedic, and do it quite often in the cities around here. To do nursing because other people think you should or for a paycheck will make you miserable..

JakeEMTP has the attitude of a lot of ground medics that have never been on a flight. I would not discourage you from vacating MI, I will be leaving in the next couple of years myself. It is a mess up here and I don't see it getting better any time soon..

Good Luck and enjoy whatever you do..If you choose an accelerated BSN program, they are not difficult, but very busy..expect a significant time investment.

[VentMedic]

Now, again you make huge assumptions, which, any decent critical thinking course would frown upon as you well know! I am NOT defending the warm body interview style at all...The issue is and has been, you have mostly RN's with zero to very basic business / mgt background running these programs and making poor hiring decisions. This is a fact, not fiction. Trying to compare an MBA to a BSN MGT 101 course is ludicrous. Contrary to your statement, I personally would push for some upper division MGT courses as a track available to the BSN students. Giving someone a broad overview of basic accounting, finance, business law, HR, maybe stats, does very little to prepare someone to be a manager, much less a leader of a program / business / etc......I would make the educational track for mgt where an entire course in the aforementioned classes would have to be taken. This would be a gigantic step in the right direction.

Respectfully,

JW

You are looking at "management" from the only perspective you have been taught with is probably very different than the health care leadership model BSN and BSRTs get. Our pertain to a health care setting and with direct patient care that covers leading and organizing many different services for the good of the patient. If the nurse wants to get more into health care administration and less with patient care they can go the MHA or MBA route. The management in these "lower" degrees is still geared toward patient care. BSNs are needed because the RN has traditionally been the higher educated clinician who was responsible for the whole patient. However, if you attend a multidisciplinary meeting, most allied health providers will have a Masters and are quickly gaining more respect from the MD and Hospital Administrators since legislators and insurers are impressed with their evidenced based research for patient care and have shown that professions with higher education can cut costs in the long run.

This must be the "basic" management course that you are referring to.

NUR 4828 CON-NURS 3(3,0)

Nursing Leadership, Management and Role Transition:

PR: Admission to the BSN program, successful completion

of the first four semesters in the nursing curriculum, and

concurrent enrollment in NUR 4945L Directed Practice;

NUR 4637; NUR 4637L; NUR 4257. Professional development

and role transition of baccalaureate graduates entering

professional nursing practice focusing on principles of

leadership and management applied to health care settings.

Except for a couple of community and public health classes, the RN to BSN candidate can choose from several patient care based electives to enhance his/her clinical knowledge. However, I would not dismiss the importance of community and public health nursing. That is a huge issue right now and it has the potential to shape the way health care is delivered in the out of hospital setting. NPs and PAs as well as RTs are already very involved in the legislative processes for out of hospital settings that will directly influence their professions.

If a nurse wants to get more education for management as it pertains to running a nursing unit, there is an MSN with a management track. If the nurse wants to run a health care company or participate in corporate nonclinical level management, then he/she would get the undergrad requirements to enter an MBA program or anothe graduate business degree. Again, management in the direct patient care setting and dealing with patient as well as "leadership" issues is a different specialty and you should already know this since there are MBAs with varying tracks for different specialties as well as MSA (accounting), MST (taxation) MSBM (sport business management), MS (human resources) or whatever your specialty.

Nursing is a very expansive profession and the BSN is just one step that really is an entry level for patient care and one the gives the RN more credibility with focus to the broader picture of things to come in the clinical setting and the future. The ADN provides only the core courses with their prerequisites much like the RTs are now seeing how outdated their A.S. degree is for achieving their goals and providing a better educated clinician at beside. We're still learning what OT, PT, SLP, Athletic Trainers, Radiation Therapists and a few others have already mastered.

Edited January 9, 2010 by VentMedic

[JakeEMTP]

.

JakeEMTP has the attitude of a lot of ground medics that have never been on a flight.

Not so much an attitude, more like a random thought. I just don't see it as we don't utilise the helo very much. I have been on a HEMS for a couple of weeks as an observer. I do have some clue as to what goes on. I wouldn't make such a statement blindly. I just don't see it. Perhaps in more rural areas there is more too it. But here (as I stated originally) the Helo is used more for inter-facility transports where the flight RN does the majority of the work.

I aplogise for making my opinion known.

[VentMedic]

Not so much an attitude, more like a random thought. I just don't see it as we don't utilise the helo very much. I have been on a HEMS for a couple of weeks as an observer. I do have some clue as to what goes on. I wouldn't make such a statement blindly. I just don't see it. Perhaps in more rural areas there is more too it. But here (as I stated originally) the Helo is used more for inter-facility transports where the flight RN does the majority of the work.

I aplogise for making my opinion known.

Even from a scene response there are major differences. Some FD and SO HEMS just fly the patient from the scene in a swoop and run manner. Others may have RNs, RRTs or well educated/trained Paramedics that can begin a stabilization process beyond that of the local ALS. Also, the better trained/educated ground crews may not have a need to call a helicopter if they have more protocols to stabilize a patient and not have to call a helicopter for airway or BP management where the time of HEMS response and distance to hospital by ground might be the same or longer.