Paramedic/RN

[UMSTUDENT]

So what is stopping more Paramedics from becoming a PA?

If you look at websites for the national associations of the NP and the PA you will see their accomplishments.

As far as the Paramedic vs Nurse with the nurse apparently the loser in your mind, you are comparing only the "well" educated Paramedic to the nurse which is one who has a degree with the prerequisites, correct? You are not comparing all the medic mill grads or the FFs who were forced to be a Paramedic, correct? You do realize that nursing is a vast profession with many different specialities and not all are based around "EMS", correct? Thus a nurse who specializes in chemo patients may not need the same education specialization as the RN in the ED. As well, RNs are very aware of their weaknesses and the need for more training and education when they come out of school. Paramedics believe they have it all mastered and they do in their one area of specialty. They (average) do not have the basis or foundation education to specialize and build upon as nurses do.

You do realize this also describes some Paramedics as well.

We already have nurses who go through nursing school and then specialize in EMS. Some even have their own credential in a few states.

If you read my earlier post you will see that "been there and done that". Paramedic education was at one time considered above that of an RN with very well established degree programs while the RN was still trying to emerge from the diploma error. Greed and ignorance took over and that concept went to hell by 1990. Nursing and many other professions flew past the Paramedic to establish their own professional standing and recognition. That is something the Paramedic still has not been able to establish because even the word Paramedic is not used by all states and all 50 states have their own defining scope and education for the "Paramedic". Plus, there are many more EMS levels still trying to define themselves. So if EMS does not actually know how to define a Paramedic, how can you adequately compare it to nursing which has a nationally established standard for education and testing? Also the majority of allied health care professions are also well established with high minimum national education standards and testing.

Nursing has already realized some of its weaknesses and it has taken a clue from the other professions which is why many employers seek out the BSN rather than the ADN. EMS still hasn't gotten the message to at least seek out the A.S. degreed Paramedic and many agencies have their own medic mills to crank out Paramedics faster.

Vent,

I agree with 100% of what you say. I realize these things too. I understand nursing does "more" than specialize in emergency treatment and also understand the educational things they've done right. Your last paragraph adequately sums up my disgust with our profession. A lot of my arguments are rhetorical, because I know better.

Our problems, in my opinion, come from the fact that we are not a homogenous group. We have "healthcare" practitioners and firemonkeys forced to become paramedics. One side wants one thing (progress) and the other wants the status quo.

As for the PA thing? I can speak for myself in that I think the Physician Assistant profession would be a viable option if I ever decided to pursue that direction, but I'm not addressing what PAs do. Be it PAs, NPs, advanced practice EMS providers, or physicians themselves I feel that much of healthcare, especially emergent care, could be completed in the home. I think EMS, or a component of EMS, is in a good position to accomplish this mission if we could get out sh!t together.

[Dustdevil]

Having been a paramedic for almost three years I am still having a problem finding huge differences between an RN and a well educated paramedic.

I'm not surprised.

Exactly how long have you been an RN?

[UMSTUDENT]

I'm not surprised.

Exactly how long have you been an RN?

Do enlighten me Dust. Really. I've seriously considered bridging to RN (a job I have little desire to do) just so I don't have to hear this completely illogical argument. I hear this all the time from nurses. "Well, you'll never understand because you didn't take our incredibly hard (yawn!) curriculum and succumb to our pat ourselves on the back mentality." Sense my sarcasm? I've sat in plenty of classes with nurses (my prerequisite curriculum was nearly identical) to know that a bunch of twenty something, settle on a gender appropriate profession, college chicks were not surpassing me in intelligence (I'm not sexist, but the reality is true. At least 75-80% of all nursing majors I met in school were female. Few had any real interest in healthcare).

What value does the nursing profession add to the healthcare environment? When you address this question, please do so from the perspective of a new graduate, floor nurse. Let me also reiterate that I've spent enough time with nurses in hospitals. In an employment atmosphere, and as a paramedic student. I'll know better when you're spewing BS. Give me clear, concise examples of "what" the nursing profession does.

Oh, and don't use a paramedic as a comparison. As I stated in response to VentMedic, I'm more than well aware that 60% of our profession is full of charlatan, cook book paramedics. We're definitely not an example of how best to defend your existence. Also, don't use small technical examples that a monkey could learn in a week (this is no better than me accusing nurses of being idiots when it comes to ECG analysis). I want you to provide me examples of far reaching, critical medical concepts that are achieved solely by the nursing profession and could not be duplicated by any other group of professionals. If these don’t exist (I can think of but a few) then cite me examples of economic pressures that make nursing a valuable profession.

My real belief is this: nurses (a basic RN, don't use this globally) constitute the worker bees of the hospital environment. The majority of their day-to-day interactions with patients could be duplicated by a different group of professionals; perhaps (gasp!) with less education! Don't get me wrong, the profession is needed and useful. I greatly admire the profession's push for higher education standards, increased pay, respect, and more autonomy. Bravo! I just believe that if you had to rank EMS' problems in order they would go in this order:

A) Poor, fragmented education standards. Low barriers to entry.

B ) No standard definition of "what" EMS is. No professional standards.

C) Lobbying efforts of the IAFF. The firefighting profession in general.

D) Lobbying efforts of the nursing profession.

I'm being serious. All I really want is a well written, believable manifesto of what I'm missing. No smart a$$ snipets of my writing and twisting it for a nice gut jab (Dust!). Answer my question. I'll read it. I promise. Also, if you provide studies, please try to get them from something other than a nursing journal, for which I believe there is more than questionable bias (talk about a celebration of how awesome you all are).

[UMSTUDENT]

I took the time to go back read all the posts in this thread. One thing I've noticed among the old timers is their ancient notions of current paramedic education. Yes, when referencing paramedic certificate mills, they're definitely right (and these definitely do still exist). A lot of the comments; however, are grossly inaccurate about legitimate community college programs and flat wrong about the really superb programs that I'm familiar with. Granted, I'm not knowledgeable about the entire country. I guess some of you live in areas with some sorry excuses for paramedic education.

[chbare]

Do enlighten me Dust. Really. I've seriously considered bridging to RN (a job I have little desire to do) just so I don't have to hear this completely illogical argument. I hear this all the time from nurses. "Well, you'll never understand because you didn't take our incredibly hard (yawn!) curriculum and succumb to our pat ourselves on the back mentality." Sense my sarcasm? I've sat in plenty of classes with nurses (my prerequisite curriculum was nearly identical) to know that a bunch of twenty something, settle on a gender appropriate profession, college chicks were not surpassing me in intelligence (I'm not sexist, but the reality is true. At least 75-80% of all nursing majors I met in school were female. Few had any real interest in healthcare). What value does the nursing profession add to the healthcare environment? When you address this question, please do so from the perspective of a new graduate, floor nurse.

This is not really a valid question because the entry level RN is not a terminal degree and significant opportunities for advancement exist.

Let me also reiterate that I've spent enough time with nurses in hospitals. In an employment atmosphere, and as a paramedic student. I'll know better when you're spewing BS. Give me clear, concise examples of "what" the nursing profession does.

Nursing does not do anything unique; however, nursing essentially filled a niche and no other profession has been organized or powerful enough to push nursing out of this role. Some of the allied providers have started to carve a niche and capitalize on specialized care, however. Look at respiratory care practitioner as an example of how this works. Modern respiratory care is basically in its infancy compared to other long standing professions such as nursing. However, respiratory just like nursing has aggressively advocated for its profession and pushed into a specialized role. My instructors constantly tell me that respiratory takes hints from nursing in how to manage the profession. There is even a big push for RCP's to operate with more independent practice utilising national guideline based therapy derived from current evidence based practice. This concept is already present in some facilities.

Oh, and don't use a paramedic as a comparison. As I stated in response to VentMedic, I'm more than well aware that 60% of our profession is full of charlatan, cook book paramedics. We're definitely not an example of how best to defend your existence. Also, don't use small technical examples that a monkey could learn in a week (this is no better than me accusing nurses of being idiots when it comes to ECG analysis). I want you to provide me examples of far reaching, critical medical concepts that are achieved solely by the nursing profession and could not be duplicated by any other group of professionals.

I know of no specific examples. The reality is nursing chooses to capitalize on concepts and spin them into unique aspects of nursing unlike other professions.

If these don’t exist (I can think of but a few) then cite me examples of economic pressures that make nursing a valuable profession.

Obamacare could be a big economic pressure. This is especially true in the primary care fight.

My real belief is this: nurses (a basic RN, don't use this globally) constitute the worker bees of the hospital environment.

Yes and no. The expansion of the allied health professions really makes this a blurry concept.

The majority of their day-to-day interactions with patients could be duplicated by a different group of professionals; perhaps (gasp!) with less education!

Most likely; however, like it or hate it, the nursing political animal aggressively pushes to ensure nursing continues to be seen as "unique."

Don't get me wrong, the profession is needed and useful. I greatly admire the profession's push for higher education standards, increased pay, respect, and more autonomy. Bravo! I just believe that if you had to rank EMS' problems in order they would go in this order:

Unfortunately, solid educational standards are lacking in many nursing schools. As I stated earlier in this thread, it almost seems we go into the realm of nursing erotica. The truth being, nursing has some fundamental problems to sort out IMHO.

A) Poor, fragmented education standards. Low barriers to entry.

B ) No standard definition of "what" EMS is. No professional standards.

C) Lobbying efforts of the IAFF. The firefighting profession in general.

D) Lobbying efforts of the nursing profession.

I'm being serious. All I really want is a well written, believable manifesto of what I'm missing. No smart a$$ snipets of my writing and twisting it for a nice gut jab (Dust!). Answer my question. I'll read it. I promise. Also, if you provide studies, please try to get them from something other than a nursing journal, for which I believe there is more than questionable bias (talk about a celebration of how awesome you all are).

It's more about the nursing political animal and special interest groups. This is the most powerful aspect of nursing. I have yet to see any group develop as powerful and as effective special interest groups as nursing. You want an example? Do some research on the DNP and independent practice concepts. In spite of resistance from the medical community (doctors), nursing has managed to force these concepts through and literally shove them down the throats of any who disagree. NP's have complete independent practice in some areas and the push for a primary care takeover seems to be the new writing on the wall. Agree or disagree, it is startling just how powerful some of these groups really are. Of course, this comes at the cost of neglecting the critically important aspect of "floor nursing" or patient care IMHO. If EMS had any sense, they would capitalize on this opening and push for proliferation into the hospital environment and home care environment. Of course, it's hard to do this when we are still fighting over what color of first out bag to buy.

I say this with the caveat that nursing may end up paying for their over aggressive actions somewhere down the line. I only hope the time to pay up holds off for two more years. Then, I can simply toss my nursing license in a lock box and say "I am not a nurse and I have nothing to do with that nursing profession stuff." It's all about flexibility and adaptability.

Take care,

chbare.

[UMSTUDENT]

chbare,

We essentially agree. Thank you for your honesty. Your emphasis on politics is exactly what I'm getting at. I also completely agree with you about EMS and taking advantage home healthcare opportunities.

I hate to say it, but nursing is a profession that has created its existence in the current rendition. Smart, really. Also, I've read about the DNP issues. Education creep is something of a side interest of mine; something of which I think the nursing profession is slightly guilty of in regards to the DNP.

Again, good for the nursing profession. I know that if we were even half as organized we'd do the exact same thing. I'd just like some acknowledgement of the truth.

[VentMedic]

What value does the nursing profession add to the healthcare environment? When you address this question, please do so from the perspective of a new graduate, floor nurse. Let me also reiterate that I've spent enough time with nurses in hospitals. In an employment atmosphere, and as a paramedic student. I'll know better when you're spewing BS. Give me clear, concise examples of "what" the nursing profession does.

Oh, and don't use a paramedic as a comparison. As I stated in response to VentMedic, I'm more than well aware that 60% of our profession is full of charlatan, cook book paramedics. We're definitely not an example of how best to defend your existence. Also, don't use small technical examples that a monkey could learn in a week (this is no better than me accusing nurses of being idiots when it comes to ECG analysis). I want you to provide me examples of far reaching, critical medical concepts that are achieved solely by the nursing profession and could not be duplicated by any other group of professionals. If these don’t exist (I can think of but a few) then cite me examples of economic pressures that make nursing a valuable profession.

My real belief is this: nurses (a basic RN, don't use this globally) constitute the worker bees of the hospital environment. The majority of their day-to-day interactions with patients could be duplicated by a different group of professionals; perhaps (gasp!) with less education! Don't get me wrong, the profession is needed and useful. I greatly admire the profession's push for higher education standards, increased pay, respect, and more autonomy. Bravo!

A skill can be duplicated but if the overall knowledge base is not there, it means little. RNs initially did and may still do skills from RT,Radiology, PT/OT and dietary. Nurses were also on ambulances long before the Paramedics. If you want economic reasons for cheaper, that would be a Paramedic. A tech that can do a few skills relatively cheaply or with their real job of Firefighting.

Disregarding the "cookbook" Paramedics, let's look at how statutes for EMS providers are written. They are generally a list, some states longer than others, of skills and meds. If it isn't on the list a lengthy process may have to be done for approval of that "skill". For some states, like Calfornia, it probably won't happened. Nursing (and RT) generally have open ended scopes of practice. The list of "skills" for the LVN is longer than that of a Paramedic although it has a different focus.

You are also focused on the "immediate" skill and result which will probably be the biggest hindrance to the Paramedic's usefulness in home situations. Just going door to door looking for an acute crisis so you can "read an EKG" is not the idea behind home care. Recognizing situations before they become a problem is the key. Would Paramedics be likely to check the feet, heels, bony prominences and other tissue areas such as the buttocks or sacral area? How about evaluating caloric intake and discussing their insulin with them to adjust it for diet and activitiy? How about positioning to prevent skin and joint stress? How much did Paramedics learn about taking a temperature or even the correct routes for certain situations? We could use sepsis as an example. Many Paramedics transport a "fever" from a nursing home and rarely dwell deeper especially if the BP is textbook "norm". They then bitch about lazy nurses that just want to get rid of patients and don't realize the assessment knowledge the RN might be relying on to make that call. Some in EMS don't realize the many types of assessments that are done each day by nurses and other professionals that don't just consist of looking for an obvious emergency. For home care, EMS also has to overcome the mindset of "BS" calls and ALS vs BLS to see the patient care aspect as a whole. They will also have to get over their fascination with L&S which is why many entered EMS. Few entered EMS to do glucose checks and assess BMs all day while discussing diets with patients. Few even realize the importance of that. It may be difficult be very difficult to expand the Paramedic much beyond "welfare checks" in the home care due to attitude. Also, welfare checks don't always address medical issues about to become problems because the Paramedic has limited assessment skills in that area and a very different focus.

You can not or should not get into "critical care concepts" as it pertains to patient care unless you have mastered the principles of patient care and that includes covering all patient needs from development, emotional, comfort and prevention as well as the emergencies. Thus, the nursing education does provide them with those concepts which gives them a better understanding to be effective patient care providers in critical care rather than recipe followers or skills robots. If you ever work with CCT and Flight teams, you will see how some Paramedics and RNs approach situations differently especially in assessment and communication. It is easier to teach "skills" than critical care concepts based on knowledge and experience.

If you had ever worked in a hospital environment you would see exactly what an RN, RRT, PT and OT bring to each patient. One could argue anyone could do the "skill" of walking a patient but few are going to understand how to assess and develop a care plan to correct or treat a gait problem. If you just "walk" a patient down the hall without extensive knowledge of movement, you have nothing for the patient to enhance their recovery. An uncorrected problem will then lead to more serious problems later and yes even for something that appears to be as simple as a gait issue. If a PT can prevent 2 patients/per month from having surgery, they have proven their worth from an economic stance.

Anyone can hand a patient a nebulizer and say breathe in but not all will be able to determine a care plan for that patient as to what device and medicine they qualify for at home. Few can identify the force and have extensive knowledge of over 40 different respiratory devices and medications to make that recommendation. The reason I became a Respiratory Therapist in addition to being a Paramedic was I realized how limited I was to helping a patient breathe. An albuterol neb and an ETT were my only options and neither are enough in some patients. For RT, if vent days are reduced even by one day, that is a huge savings as is every patient that intubation is provented. If the RN catches a problem early or prevents a problem such as an infection or decubitus ulcer, the savings are enormous. It is not about just being "worker bees". These issues are all well studied and well published as are those for justifying those with higher education and not just "techs".

If you only look at it as a "skill" from just "doing" the procedure, you are greatly shortchanging the patient and have not taught them anything about their disease or medication to prevent them from another ED visit or hospital stay in the very near future.

How many Paramedics can give meds about 30 different ways? Many are not allowed to access the long term vasular access devices. Nurses (and RTs) can be trained to insert a PICC just as they can other central lines for CCT and Flight. Both professions can expand to do just about anything they want because their professions have given them a consistent base education requirement for the medical directors of hospital units to use to their advantage especially with the open ended scopes. If they need people to "manage" an IABP and not just babysit it from point A to point B, they have both RRTs and RNs. If they need an ECMO specialist, both the RN and RRT can step up. But RNs and RRTs have the same capabilities of almost every skill listed in the Paramedic scope. They just have a different focus. If it is decided on day that RNs should intubate in L&D or CCT/Flight, they get the additional education/training and they intubate. The basic foundation is already there. But still, the primary thought is not just about the "skill".

Also, instead of reinventing the wheel, we could just utilize what we have and build from that foundation. RNs, NPs and PAs already have the focus for the long run in patient care for the home situations from their experience in discharge care planning, teaching and overall maintenance. EMS complains they are too stressed now. What if they had to do 12 house calls in 8 hours with a schedule to keep? The Paramedic was designed with emergency medicine as the focus. EMS still has not mastered that concept fully at this time. Why add on something else with a totally different focus to which they have few opportunities to gain experience in. Also, if they feel the value of "nursing care" is similar to yours, they would truly be ineffective in an environment which requires knowledge with a very different patient care focus.

But back to the general care, what about teaching patients and families to deal with life changing disabilities? How many Paramedics have done a plan of care for a 20 y/o who is a new AKA? How about instructing him on the care of his stump? And yet, there will be PT/OT involvement as well. It takes a team to put a patient back together physicially and emotionally so no one health care professional in the hosptial claims to do it all. That is something Paramedics have a great problem dealing with when they do work in an ED or even in the field. They may be able to fix treat some acute symptoms but they don't fix the problem and some may not have the ability to identify the problem except for a few emergent situations. Thus, a Paramedic working "as a nurse" in the ED may not have to ability to do a little more than just the "usual" assessment to get past the acute. Hopefully the doctor would do the assessment but many rely on RNs to detect issues before they become major problems. That happens all over the hosptial. A doctor who has 35 patients in the hospital to see will not be able to do a thorough assessment each visit.

You would just have to work in a hospital to see the value of each profession. You would also have to set aside the "skills" mentality and that everything is an emergency. Nurses and all the others prefer not to allow an emergency to happen for the sake of the patient. Nurses kick themselves, both before and after their supervisors kick them, for not recognizing something sooner that turned in a very serious problem quickly. Failing to do a further assessment for what might see like a minor temp change can be devastating to certain patients.

Thus, most of us in the hospital strive to not have to demonstrate what heroes we can be. A day without and emergency means all involved in that patient's care are doing their jobs. It is not always about the "save" from a code but have many you save before they code. It is not about just one profession being better than another or more valuable. If that was the case, Physical Therapists would win without a doubt since their sign-on bonuses make both RTs and RNs drool. Radiology professionals who have their MRI and CT Scan certifications (additional) are being recruited with impressive perks.

I hate to say it, but nursing is a profession that has created its existence in the current rendition. Smart, really. Also, I've read about the DNP issues. Education creep is something of a side interest of mine; something of which I think the nursing profession is slightly guilty of in regards to the DNP.

Why? We have had doctorate degrees in nursing and many professions, not just health care, for decades and even centuries. The DNP just designates advanced training with a clinical doctorate. Actually, nursing is just starting to catch up by getting the DNP into their profession. Many of the other health care professions have already equaled or passed them in education. Physical Therapy has one and it is highly respected by the hospital administrators and insurers. What about all the other professions that require at least a Masters for entry? To teach at that level they must get a doctorate.

What about the nonmedical professions? My accountant has a doctorate. Are you going to tell a history professor with a Ph.D. that he is guilty of education creep? Have you never been on a college campus to see all the people with higher education it takes to mold the students for the future? Have you not noticed the education and credentials of those who are doing research that will eventually shape some of what EMS does as well as just about anything else? I have a friend who has a doctorate in music and I am amazed at the job offers he gets from research industries, including medicine, and companies from around the world. Universities have also been requiring higher education for their educators for centuries. However, EMS still has yet to recognize the difference between instruction or trainer and educator which is many EMS programs are in departments ran by nurses.

Edited January 18, 2010 by VentMedic

[VentMedic]

Let me give you another example of "critical care concept" and "patient care".

Take a neuro patient either CVA or TBI (as well as all the other types). In EMS these are both general terms without many specifics. Once they get to the hospital and the physicians do their job to determine damage and insert whatever devices, ICP monitor and EVD, the RN takes over with both the assessment and technical aspects. There is generally not much "skill" involved in the ICP monitoring and drains but they are attached to the patient which involves the assessment part. I can do most of the technical skills and have a fair amount of neuro assessment, definitely more than the average Paramedic because of my ICU and Acute Rehab experience, but even I know my limitations. The RNs in the ICU have expanded their knowledge base in that area more than I have since I have a different focus. There is also another understanding that must be dealt with and that is what part of the brain has been affected and how to interact with a neuro patient. There is a time for quiet and a time for stimulation. Verbal commands must be changed as appropriate to acknowledge motor, auditory, sight recognition and sensory. Not all patients will be able to communicate as one who does not have a brain injury and if you are not aware of all the various aspects of assessment for response, you may just right the patient off as "nonresponsive" to verbal.

This is also part of the development and assessment training RNs get in school that is later enhanced for their specialty. However, as these patients leave the ICUs, the med-surg, Rehab and SNF RNs also have the basic concepts for dealing with the physical and communication needs of the patient. But when they are unsure, they ask the specialists be it neuro, Speech or PT/OT about the specific needs of that patient to enhance the patient's recovery. They are not above carrying out the care plans of other disciplines for the good of that patient. This team approach is also a very unfamilar concept for the Paraemedic "who can duplicate" any skill and can do it all. Talking with a patient who has suffered a severe brain injury is something the few EMT(P)s have even given a thought to as evidenced with "BS" or "BLS" and even the "ALS" IFTs. So many EMTs and Paramedic fail broadening their knowledge base and just write off things that other health care professions find very valuable for a patient making a full recovery or at least having some quality of life.

This is just one example. There are many others as they pertain to cardiac, spinal cord injury and surgery, GI problems, pulmonary diseases etc. Each patient in each disease category will also have his/her unique set of issues that must be identified and not just "lady with a back drain and dressing that need changing". Again, total patient care to see that all the needs are met for the patient to have a successful transition out of the hospital and to prevent recurrent ED visits and lengthy hospital stays are the goals of the RN as well as all the other disciplines. Just giving a med or doing a skill is not "patient care".

Have you ever followed a patient from the ED to Radiology to ICU, to the OR, back and forth to Radiology, CT Scan, IR, MRI, Nuclear Med, Step down unit, med-surg, Acute Rehab or SNF? This course may take some patients a year and each step will be an important one that is dependent upon their nuring care. Nurses will always be there to help coordinate the many, many other professionals that will come and go from that patient's bedside.

Edited January 18, 2010 by VentMedic

[UMSTUDENT]

Vent,

Good response. I still feel like it comes with a bit of predetermined bias about what is and isn't taught in a good paramedic programs. My patient assessment class was almost 6 months long, Monday-Thursday. The majority of the class was taught by a combination of PAs and physicians. We were taught to do entire assessments of the entire body, not just from an EMS standpoint. There was a realization that many of our graduates may work in industrial settings or overseas. So yes, I do have training in recognizing and classifying ulcers. Yes, I was required to memorize cranial nerve exams (right down to corneal reflexes-cotton ball included). We had individual exams on every major system. I had to know Kehr's sign, Cullen's Sign, Grey Turner's, etc. Normal lab values, etc. I’m just pulling some of the things you mentioned.

Respiratory standpoint? Yes, I know and can describe in detail a V:Q mismatch, shunting, partial pressures, anatomical vs. physiologic dead space. Communicating adequately with a patient? Yep. Mental health, including death, dying, and disability, was a major portion of my education.

So when you write about these things I get frustrated. I'm not one of those paramedics. As for the DNP, trust me when I say I see the value in a terminal degree (I attended a Carnegie Research Extensive University), but I was writing specifically about the DNP as an entry point to advanced practice. It is my understanding that this is being considered, though not currently required. When will the nursing profession simply come out and say it. They want an entry pathway to independent medical practice separate of traditional medical education.

[VentMedic]

Vent,

Good response. I still feel like it comes with a bit of predetermined bias about what is and isn't taught in a good paramedic programs. My patient assessment class was almost 6 months long, Monday-Thursday. The majority of the class was taught by a combination of PAs and physicians. We were taught to do entire assessments of the entire body, not just from an EMS standpoint. There was a realization that many of our graduates may work in industrial settings or overseas. So yes, I do have training in recognizing and classifying ulcers. Yes, I was required to memorize cranial nerve exams (right down to corneal reflexes-cotton ball included). We had individual exams on every major system. I had to know Kehr's sign, Cullen's Sign, Grey Turner's, etc. Normal lab values, etc. I’m just pulling some of the things you mentioned.

Did your assessment classes pertain primarily to emergency situations or long term maintenance and care? What treatment plan and preventitive measures were you able to impliment from your finding for those that were not an "emergency"? Could you regulate their diet? Give insulin? Restrict their fluids? Were you able to obtain lab values at scene? It is great that you do have knowledge of these things but there is still the implimentation of what to do with the data you collect and formulating a care plan beyond 15 minutes.

Being taught by physicians is not unlike any other profession and that includes nurses. The physician will just teach at your level and may teach differently for an RN, RT or med student.

Respiratory standpoint? Yes, I know and can describe in detail a V:Q mismatch, shunting, partial pressures, anatomical vs. physiologic dead space.

Gee does that make you a Respiratory Therapist also?

Yes, that is good to know but what are you going to do about it beyond the 15 minutes you are with the patient. There is the "emergent" and then there is the weeks of care it takes to correct some of these situations and not to have other systems compromised which treating another.

Communicating adequately with a patient? Yep. Mental health, including death, dying, and disability, was a major portion of my education.

Many other majors including Accounting can take prerequisites in Psychology and Death and Dying so it is not just unique to your class. However, you may take one that is again very specific to EMS. Other majors have also been requiring at least two semesters in English Comp for the writing, a semester of Speech for talking and a semester of literature for reading.

Again, for the short term it is very different than do a plan of care for a hospice patient and their family. You know you will be out of the sight of the deceased and their family in a few minutes. You also appeared right before the death or just after. You are not with the patient and the family for many 12 hour shifts trying to answer complex questions about death. The patient is essentially dead to you upon arrival or after you drop them off at the hospital.

So when you write about these things I get frustrated. I'm not one of those paramedics.

It is not about being one of those medics but understanding the difference between emergent care and total care for the long haul. You can "emergently" correct one lab value but does that fix the problem? You can give a diabetic glucose but does that fix the problem? Can you identify the problem or even care to for fixing that patient's glucose fluctuations? For Paramedics that do Flight, they sometimes struggle with the "act quick" before assessing all the data to see if quick is correct. Thus, they are still only thinking on a very short term when they are picking up a patient who is now on a very long term treatment. You can not just do piecemill or patchwork treatment as what might have been sufficient in the field.

All the allied health professions take basically the same prerequisites and some of the same assessment classes as well as the usually Psychology and Death and Dying classes. However, they then specialize and go more indepth into their own specialty. RT takes many of the classes the RN does but no RT says "I'm just like a nurse and can do everything a nurse does." We can do many of the "skills" but we don't do the same care plans from the same assessments. We do a multidisciplinary care plan with the RNs to combine the skills and knowledge of both professions. A Physical Therapist with a Doctorate has many higher sciences than the RN and many different assessments with several overlapping skills. However, I have yet to hear any PT say "I can do what a nurse does or I am just like a nurse".

A lot of Paramedics have attempted nursing school with the same attitude you have and have failed miserably because they would not accept there were many ways of approaching patient care based on different assessment or even the same one. They were very caught up in "treat it now" without realizing long term consequences. It is like the argument about "why not have Paramedics start antibiotics in the field?". But, which ones and what organ should we sacrifice must be considered but the Paramedic may only be concerned about here and now issues. Nothing wrong with that but for the long term they must see the whole spectrum of patient care and how every action may bring a reaction and one that might not be desired.

You are trained as a Paramedic for prehospital emergent situations. Unless you have been through the RN or even RT program and have worked in that profession, you may not fully understand what they do or know. I would never hold against a nurse in a nursing home that can't read a 12-lead ECG but who is responsible to the care of 25+ patients who are always on the edge of breaking. If these nurses did not do a good job there would just be a constant shuttle between the NH and the hospital. For some in EMS to complain about 1 patient out of 200 per shift being shipped demonstrates a lack of understanding what the care of these patients is about. I don't believe any Paramedic could walk into that job and accept responsibility for 25 patients but yet they view the NH RN as the scum of the earth as it pertains to the nursing profession and not even worthy of the EMT-B's courtesy.

All the health care professions just have a different focus toward a similar goal. I personally would want someone who has genuine expertise at the bedside and not someone who is just comparing a few classes or skills and believes they are just like a nurse without the actual education, training and experience.

As for the DNP, trust me when I say I see the value in a terminal degree (I attended a Carnegie Research Extensive University), but I was writing specifically about the DNP as an entry point to advanced practice. It is my understanding that this is being considered, though not currently required. When will the nursing profession simply come out and say it. They want an entry pathway to independent medical practice separate of traditional medical education.

Are you also going to tell the other professions that the Masters and Doctorate are ridiculous? I doubt of PT would agree with you about their doctorate.

Even at a doctorate, that is less education and training than an MD. A doctorate is not that difficult to get if you put a little effort into it and this something I do know about.

I applaud the NPs for their clinical DNP (starting as a requirement in 2015 I believe) because the Masters was not enough for the advances in medicine. A Bachelors in not even enough for RN or the RRT especially in critical care.

Some also think anything more than 1000 hours of training is too much for a Paramedic and the Associates degree is just absurd. We have a poster from Oregon on another forum who complains about it constantly. He also stated something I didn't know about Oregon in that the Associates in not necessarily required upon entry and that you can still work if you promise to get it in a few years. I haven't personally confirmed that but that is disappointing if true and sorta gives me a different opinion about Oregon if they are still bending over for the lowest denominator.

Edited January 19, 2010 by VentMedic