Paramedic/RN

[UMSTUDENT]

Vent,

"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'm still seeing a lot of "you wouldn't understand." I refuse to accept this excuse. Other professions have to justify why they exist and what it is they provide that is valuable.

Nutrition?

Maybe impliment a nutritionist guidelines, but you seriously want me to believe this? I have never encountered a patient in the hospital environment that didn't have a detailed nutritional plan developed by a registered dietitian for a specific type of patient. Those with specific nutritional needs may have prompted a nurse/dietitian interaction, but that was rare.

Speech class?

Most of this thread still reeks of a lack of understanding. A speech class? English comp? You think I completed a reputable Bachelor's Degree without these same classes?

Decision Making

You want me to seriously believe that nurses are empowered solely with the ability to make cost benefit analysis of "quick" vs. "longterm" actions? Common Vent. You're doing exactly what I didn't ask for. I want precise measures of how these things are different in the nursing realm.

Again, I consider this protectionism. I'm not saying that paramedics should be nurses, but I am questioning the reported huge differences in scope of understanding. Even the things you address (insulin, nutritional needs) could be addressed by simply rearranging some of the curriculum (at least mine). The base education is there. Where I will agree is that, in general, the paramedic (not EMS) profession is ill equipped to handle these changes on a wide scale basis. Even if it functionally did not change what we do I would welcome an identical scope of education to the nursing profession to abate precisely this argument.

Edited January 19, 2010 by UMSTUDENT

[VentMedic]

Vent,

"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'm still seeing a lot of "you wouldn't understand." I refuse to accept this excuse. Other professions have to justify why they exist and what it is they provide that is valuable.

Nutrition?

Maybe impliment a nutritionist guidelines, but you seriously want me to believe this? I have never encountered a patient in the hospital environment that didn't have a detailed nutritional plan developed by a registered dietitian for a specific type of patient. Those with specific nutritional needs may have prompted a nurse/dietitian interaction, but that was rare.

Speech class?

Most of this thread still reeks of a lack of understanding. A speech class? English comp? You think I completed a reputable Bachelor's Degree without these same classes?

Decision Making

You want me to seriously believe that nurses are empowered solely with the ability to make cost benefit analysis of "quick" vs. "longterm" actions? Common Vent. You're doing exactly what I didn't ask for. I want precise measures of how these things are different in the nursing realm.

Again, I consider this protectionism. I'm not saying that paramedics should be nurses, but I am questioning the reported huge differences in scope of understanding. Even the things you address (insulin, nutritional needs) could be addressed by simply rearranging some of the curriculum (at least mine). The base education is there. Where I will agree is that, in general, the paramedic (not EMS) profession is ill equipped to handle these changes on a wide scale basis. Even if it functionally did not change what we do I would welcome an identical scope of education to the nursing profession to abate precisely this argument.

This post definitely demonstrates that you do not have a clue about the role RNs play in the hospital situation or what is involved in total patient care.

You also missed my point. I didn't say you did not have Speech and English since you already mentioned your education. What I said was Accountants have taken some of the same classes an nurses and all those you have mentioned. Does that make them a nurse also?

Do you want to work in prehospital or do you want to work med-surg in a hospital? If you want to be a nurse or "like a nurse" go to nursing school. Those of us who are Paramedics and also have obtained either nursing or RT degrees do understand the differences in patient care. I also had a 2 year degree as a Paramedic when I entered the EMS profession and thought I was "just like a nurse as well". I quickly found out how wrong I was when I started working in a hospital. I was not "like a nurse" or "like an RT" even though some of our skills overlapped.

I also gave you an example of how nurses function with a neuro patient which can also be applied to a cardiac patient or just about any type of patient. You just want to start a pissing match that the Parmedic is trained "like a nurse" and can not see any different.

You have a few science classes but NO core nursing classes and have not done 1200 hours of clinicals as a nurse. You have taken care of one patient at a time in the back of your truck. You have not had to care for a patient for any length of time or help them make the transition from ICU to Acute Rehab. If you or many of the other EMT(P)s had any of this training and knowledge, there wouldn't be the bashing of nursing homes and their patients on the EMS forums.

Go to nursing school if you want to be a nurse. Healthcare has advanced to where it no longer has to settle "like something" anymore. You must have the appropriate training and education to do whatever the patient requires.

Edited January 19, 2010 by VentMedic

[UMSTUDENT]

This post definitely demonstrates that you do not have a clue about the role RNs play in the hospital situation or what is involved in total patient care.

You also missed my point. I didn't say you did not have Speech and English since you already mentioned your education. What I said was Accountants have taken some of the same classes an nurses and all those you have mentioned. Does that make them a nurse also?

Do you want to work in prehospital or do you want to work med-surg in a hospital? If you want to be a nurse or "like a nurse" go to nursing school. Those of us who are Paramedics and also have obtained either nursing or RT degrees do understand the differences in patient care. I also had a 2 year degree as a Paramedic when I entered the EMS profession and thought I was "just like a nurse as well". I quickly found out how wrong I was when I started working in a hospital. I was not "like a nurse" or "like an RT" even though some of our skills overlapped.

I also gave you an example of how nurses function with a neuro patient which can also be applied to a cardiac patient or just about any type of patient. You just want to start a pissing match that the Parmedic is trained "like a nurse" and can not see any different.

You have a few science classes but NO core nursing classes and have not done 1200 hours of clinicals as a nurse. You have taken care of one patient at a time in the back of your truck. You have not had to care for a patient for any length of time or help them make the transition from ICU to Acute Rehab. If you or many of the other EMT(P)s had any of this training and knowledge, there wouldn't be the bashing of nursing homes and their patients on the EMS forums.

Go to nursing school if you want to be a nurse. Healthcare has advanced to where it no longer has to settle "like something" anymore. You must have the appropriate training and education to do whatever the patient requires.

Still a lot of nothing. Honestly Vent I'm not saying that a paramedic is even remotely qualified to be a nurse-there are obvious differences in roles and responsibilities. I'm saying that the educational deficits seem small to me. You've still failed to give me specific examples of when and where, in the entry level educational process, this occurs. I'm of the opinion that much of it is on-the-job or clinical related. Again, something I believe could be easily integrated into a quality paramedic education.

I think your on the defense when I'm more on your side than you see. You seem to advocate compartmentalizing healthcare professions, which I'm not necessarily against. But what I don't agree with is a paramedic being clueless about what happens to their patient once they leave their hands, or not knowing how the continuity of care affects patient outcomes. A well educated paramedic should be capable of sitting in a room and not only understanding the job a nurse performs but vise versa. That isn't how it works in this country. Paramedics are often left out of overall healthcare considerations for exactly this reason. "Oh, those poor things don't know any better."

I worked on a hospital floor for almost two years prior to college. Of the over 1200 hours (yes) I did for clinical rotations, at least half or more were in hospital environents (and no not all in the ED). I've been in ICUs, flight environments, progressive care units, PICUs, etc. There were very few instances where I watched a nurse engage in anything that I didn't feel I had a very strong grasp of (w/ neonates and some aspects of LDRP the exceptions). Yes, I learned a lot. But it wasn't fundementals-ussually more procedural. Some of my best education on vents came from nurses. ECMO, IABP, and LVAD orientation was also done by nurses. In fact, the experience was often symbiotic. We didn't fight nor puff our chest at how different the professions were. I distinctly got the impression that we each learned something from the other. In fact, the only place I have ever encountered a nurse who was brazen enough to insult the paramedic profession was in the ED. The rest seemed to genuinely get that the profession had its values and distinct specialities.

So, yes I have been there. That is why I'm confident when I assert these questions. Healthcare is no different than any other service. There is a large propensity for fraud and waste. As Chbare said, a lot of it is political. It's creating a need for something from nothing.

[VentMedic]

But what I don't agree with is a paramedic being clueless about what happens to their patient once they leave their hands, or not knowing how the continuity of care affects patient outcomes.

How many Paramedics have been to ICU other than for a brief look during clinicals? How many have followed a TBI patient to and from many CT Scans? OR? Bedside drains? Step-down unit? Med-surg? Acute Rehab or SNF? How many who do "routine trucks" or BLS even know or care to know that their patient may have been a "cool trauma" at one time. How many take the time to understand the communication deficits of a TBI or just ignor the patient for the entire transport.

I have been in the EDs, the ICUs, the med-surg floors, the Acute Rehabs and subacutes to know the interaction between EMT(P)s and patients. I have also listened to patients talk about their transport experience. I have listened to EMT(P)s bitch about transporting such a BS patient from a subacute at 0300. I have also tried to get EMT(P)s to see their patient as a human being rather than a vegetable wasting their time when they could be doing a cool EMS call. This is over 30 years and in many locations. I get an ear full when we fly into a place that requires us to be transported by ambulance. The EMT(P)s compliment us on what a cool job we must have and then procede with a rant about BS calls from nursing homes not realizing the patient we will be picking up will eventually end up as a "BS" nursing home patient even though today he is a cool flight team patient.

So no, don't tell me that all EMT(P)s know all the painful procedures and even more painful recovery that a patient experiences after the ED.

A well educated paramedic should be capable of sitting in a room and not only understanding the job a nurse performs but vise versa. That isn't how it works in this country. Paramedics are often left out of overall healthcare considerations for exactly this reason. "Oh, those poor things don't know any better."

Sitting in a room is not the same as actually working in a patient care situation everyday.

You have not taken the same nursing classes. If you want to use your own reasoning there is not reason an RN can not do exactly what a Paramedic does. They also have the same classes. It shouldn't be too difficult to pick up a couple of skills and believe it or not there are RNs that do just that and become successful MICNs, PHRN, Flight and CCT RNs. However, most are not so arrogant to believe they are "just like a Paramedic" as soon as they leave school be it with an ADN or BSN. Not knowing what you don't know is what will get you in trouble and that seems to be your situation.

You seem to be only for advanced education for yourself and use only yourself as an example. You fail to recognize that this is not true for all of EMS and nor is it true that all of your clinical hours are spent at a patient's bedside in various situation in the hospital for any length of time. There was a program in Georgia that was attempting to incorporate more critical care experience but as of right now there hasn't been any word of their success.

In fact, the only place I have ever encountered a nurse who was brazen enough to insult the paramedic profession was in the ED. The rest seemed to genuinely get that the profession had its values and distinct specialities.

Did it ever occur to you that the ED RN sees more of the Paramedic's acutal skills and patient interaction with the patient so they are better to form an opinion than the ICU RN who may see you and your RN partner only for a CCT or Flight transport but will more than likely be giving the report primarily to the RN? Or, they might see you for a little clinical visit where they are told to play nice with the students. However, consider yourself fortunate as a Paraemedic student because the RN students don't get the kid gloves treatment on med-surg or the ICUs as they are expected to have reviewed much of the material before class and actually participate, not just there for the view.

Some of my best education on vents came from nurses. ECMO, IABP, and LVAD orientation was also done by nurses. In fact, the experience was often symbiotic. We didn't fight nor puff our chest at how different the professions were.

Symbolic because they knew you were not to actually learn about these devices but rather to see them. You had an overview of ECMO and not an orientation since a Paramedic will not be doing ECMO in the U.S. anytime in the near future. If you do participate in transport, there will be an RN, RRT or Perfusionist doing the ECMO. For IABP you also may have been given just enought info to babysit the pump from point A to B and not actually manage one. There is a difference. The same for the LVAD. I also love to hear when a Paramedic says they "learned" ventilators and procede to pull out an ATV for a critically ill patient.

You also wouldn't want to get into a peeing match with all an RN has seen as an "overview" or has actually participated in. As I said before their list of "skills" is very impressive and what they have seen for procedures and equipment is even more impressive.

So, yes I have been there. That is why I'm confident when I assert these questions. Healthcare is no different than any other service. There is a large propensity for fraud and waste. As Chbare said, a lot of it is political. It's creating a need for something from nothing.

So nurses are not worth anything? I think that is rather insulting considering you have not worked as a nurse.

What do you suggest? We replace all RNs with Paramedics? There was a reason nursing did away with the LVN in the acute care setting as did the RT do away with the "tech". How many Paramedics want to do total patient care which includes many of the things Paramedics avoid and give up doing EMS? We have had a lot of Paramedics get their RN patch through Excelsior just so they could avoid doing "nursing stuff" during clinicals. Many were found to be useless in the hospital and now just have an RN patch to add to their Paramedic. Thus, many states have refused to accept the Excelsior or they require over 700 hours of clinicals doing nursing care. Now, you don't hear about Paramedics scrambling to take that course.

As far as fraud, right now with the monitors in place, Medicare is seeing that we don't waste alot by extending hospital stays with causing more injury from improper care. They do hit the hospital in the payment.

You have criticized higher education for nurses from the BSN to the DNP. You argue that the Paramedic is a good as any RN. I don't know exactly what your angle is.

So you think advanced education for RNs and other allied health professions promotes fraud? Have you even looked at how the petitioning is done for reimbursement based on education and expertise or the studies that higher education does promote savings in the hospital? I DID give you example of that from different profession. Are you also calling educated RRTs guilty of fraud because we promote shorter ventilator stays? How about the doctorate PTs? Are they guilty of fraud by promoting a higher level of rehab to have a patient become a productive citiizen again?

You seem to want to tear down all other professions because you are still held to the standard of the weakest link in EMS. Get your own yard in order before telling other professions their education is worthless or they are quilty of being frauds or committing fraud.

Edited January 20, 2010 by VentMedic

[chbare]

I still think we need to look at the nursing aspect realistically. While some programs may have 1,200 hours of clinical experience, many do not. In my area of the country, nursing students receive less than 1,000 hours total. The programs near me only require one clinical day a week. I went to a program in a different part of the country where I had about 1,000 hours total. These are all accredited programs. Also, many programs across the nation are ADN programs based out of community colleges, therefore nursing is not always the perfect of example of pushing for the highest level of education. I respect nursing and as a nurse, the profession has taken me many places; however, if we continue to use nursing as an example, it is only fair to recognize the pitfalls of this profession.

Regarding the DNP; yes there is a big push to transition all programs into this newer level by 2015. However, the problem with the DNP is the fact that there is a massive push for these nurses with less education than physicians to take over the physician role in some areas of health care. In several states, NP's already have independent practice. This means no physician supervision, no collaboration and no chart reviews. In essence, they are a physician and are pushing to bill the same as physicians. So, a provider with less education is taking on the role of providers who have more education. This is in essence the same stuff we see in EMS?

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

In addition, only 50% of candidates passed the new DNP exam that was partially based on the USMLE step III exam.

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

In conclusion, better education is absolutely a must for EMS; however, nursing has many things to sort out before being the best role model of a profession IMHO.

Take care,

chbare.

[UMSTUDENT]

Vent,

I've obviously struck a chord. You've shown what you really think of the profession in general. You used my "sit in a room" figure of speech as an indication of what I believe nurses do. You talk about the "kid gloves" treatment of paramedic students.

You yourself have no idea what you're talking about. Your experiences are from what? Late 80's...early 90's? Do you live in the Deep South or some impoverished area of this country where paramedic education is completed in trailers? Jeez man.

Symbiotic and symbolic also have nothing to do with each other. Interesting as symbiosis is a biological term that should be well understood by a nurse.

You talk about how paramedics gripe about nursing home patients and how "B.S." the care is in these places. Common Vent. If the pinnacle of nursing education is to ship out patients to conduct borderline Medicare fraud (to readmit after X number of days) or because they've noticed a mild change in mental status, you've got to be kidding me. Most of these nurses couldn't tell you what the patient's normal mental status is (They don't care. Too busy gabbing at the nursing station). Doesn't help that there is a huge influx of non-English speaking, Caribbean nurses because of the artificial nursing shortage.

Remove yourself from flight RN/RRT/whatever badge you’ve collected and think about the typical nurse right out of school. Not so many are spectacular. I’ll also say it again: I’m not saying nursing is useless. They’re just not that different than us. All I’ve heard is a bunch of stuff about compassion and “total care” that seems to have come from a Johnson & Johnson nursing commercial. You talk about following patients? What practical skills are you talking about? That a human being, a nurse (they’re super special and empowered with special skills of reason), is capable of realizing that there are multiple facets to healing? Are you implying that paramedics can't feel for another? That we're all cold, heartless idiots?

“I’m sorry sir. You’re a traumatic brain injury patient who needs to go to Cat Scan. Unfortunately I’m incapable of finding the room. For that matter sir I have no idea what a Cat Scan is. But why am I talking to you? I probably don’t even realize that you have severe, long lasting neurologic deficits because I’m a stupid paramedic and not an awesome nurse.”

“Miss I can’t empty your urine because I’m incapable of understanding the implications of urine output and overall renal function. I’m just a big dumb paramedic.”

“Well sir. The doctor finished that in situ pinning. Your femur should be all better now. Here’s five dollars and a cane. Have fun! Oh, what is that? You need physical therapy? Ah, I’m sorry sir. I’m just a paramedic. I thought you’d be all set!”

[chbare]

No, Vent is correct about some of the paramedic programs that are currently in operation.

Take care,

chbare.

[VentMedic]

I still think we need to look at the nursing aspect realistically. While some programs may have 1,200 hours of clinical experience, many do not. In my area of the country, nursing students receive less than 1,000 hours total. The programs near me only require one clinical day a week. I went to a program in a different part of the country where I had about 1,000 hours total. These are all accredited programs. Also, many programs across the nation are ADN programs based out of community colleges, therefore nursing is not always the perfect of example of pushing for the highest level of education. I respect nursing and as a nurse, the profession has taken me many places; however, if we continue to use nursing as an example, it is only fair to recognize the pitfalls of this profession.

Were you ready to dive right in without any orientation, precepting or any type of additional training as a new RN? Probably not. The orientation can be very extensive for some hospitals especially if they recognize their nursing program at the local college sucks. However, if you read the posts and talk to some Paramedics, after two shift or at little as 5 supervised calls, they are on their own regardless of whether they graduated with a 2 year degree or from a 3 month wonder mill. I believe on of our local FDs puts the Paramedics on the streets right away if they did their ALS engine sleepovers at their station.

Regarding the DNP; yes there is a big push to transition all programs into this newer level by 2015. However, the problem with the DNP is the fact that there is a massive push for these nurses with less education than physicians to take over the physician role in some areas of health care. In several states, NP's already have independent practice. This means no physician supervision, no collaboration and no chart reviews. In essence, they are a physician and are pushing to bill the same as physicians. So, a provider with less education is taking on the role of providers who have more education. This is in essence the same stuff we see in EMS?

http://www.forbes.com/2007/11/27/nurses-doctors-practice-oped-cx_mom_1128nurses.html

In addition, only 50% of candidates passed the new DNP exam that was partially based on the USMLE step III exam.

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

Forbes? Both of those articles have been circulated extensively out of fear of what the DNP actually is. They have been bashed and thrashed on every forum. The AANP published their own statement defining the work "doctor" and "doctorate" because of these articles. The DNP has been around for over 15 years. It is just when it was announced that this would become the new entry level that some took notice.

http://www.aanp.org/NR/rdonlyres/105556AC-24FC-4FFF-A9EE-08CDC6DB1BE5/0/DNPGROUPLETTER608wcopyrightandattribution61908.pdf

If there was really an issue with nurses in the NP role, do you not think that an organiztion as powerful as the AMA would not have put an end to this 5 years ago when the new standard was announced?

In conclusion, better education is absolutely a must for EMS; however, nursing has many things to sort out before being the best role model of a profession IMHO.

As stated before, nursing has taken an active role in cleaning up their profession first by changing from diploma to degree. This was actually done well after the Paramedic and their degrees appeared but has definitely advanced faster than the Paramedic which no longer advocates for degrees as it had been done in the 70s.

Nursing has taken a stance with the LVN and have stated they need to advance at the very minimum of the ADN to function in acute care settings. Period. No whining or exceptions. Those LVNs at our hospitals who did not want to advance could be moved to a nursing home or if they wanted to stay in the hospital, they could work as PCTs for about the same money.

Nursing recognizes the ADN is not enough and will often prefer and encourage the BSN. Since they are lagging in education (along with the RRT), they will be an expectation of promoting the BSN until the majority of RNs have the degree. Then, it will be a smooth transition to make it the entry. This was also done prior to the diploma change as the schools started linking to the colleges. RT promoted the A.S. degree for almost 20 years until almost every RT had the degree when the transition was made.

Nursing appreciates the CNA but does not cater to the CNA when it comes to their own professional agendas. They encourage the CNA to take part in a hospital's tuition assistance to advance to RN. EMS still makes excuses for the EMT-B to remain the lowest level and accepts all excuses for not taking a few hundred more hours to be a Paramedic.

Nursing does not accept other CNAs being the primary instructor for a CNA class. EMS allows minimally educated to teach even less educated (by 110 hours). The RN classes are taught by a minimum of a BSN with it usually being an MSN with Doctorate oversight. Paramedics with a Paramedic cert teach Paramedics.

Nursing has minimal hours of education and on the job experience before they allow testing for many of their certifications. EMS allows weekend certs such as the "CCEMT-P" and then puts these medics on a CCT for the higher reimbursement rate.

Nursing does a background check for licensing which is something EMS is still not doing in all states. CA just started and it was amazing what they found. CA also made all the RNs who held licenses for more than 20 years go back through the finger printing process for their renewal.

You can bash nursing all you want but for the number of nurses there are and the many specialities they have, I think they have done a very good job at legislating for their future. That also includes the states that now are petitioning for nurse to patient ratios such as CA and I believe NJ has done. Even with the diversity, there are many fundamentals and standards they do agree upon. For EMS to share one common thought even about patient care is a rare occasion.

for all of its faults nursing is still a proud profession and is always seeking ways to improve patient care and the total outcomes.

[VentMedic]

Vent,

I've obviously struck a chord. You've shown what you really think of the profession in general. You used my "sit in a room" figure of speech as an indication of what I believe nurses do. You talk about the "kid gloves" treatment of paramedic students.

You yourself have no idea what you're talking about. Your experiences are from what? Late 80's...early 90's? Do you live in the Deep South or some impoverished area of this country where paramedic education is completed in trailers? Jeez man.

Actually in many parts of the country the Paramedic is still taught in the back room of the FD or ambulance service and not in a college. TX still only requires 624 hours to be a Parmedic. And yes there are still 3 month mills to crank out Paramedics. If you listen to some in EMS you would think that is too long.

You talk about how paramedics gripe about nursing home patients and how "B.S." the care is in these places. Common Vent. If the pinnacle of nursing education is to ship out patients to conduct borderline Medicare fraud (to readmit after X number of days) or because they've noticed a mild change in mental status, you've got to be kidding me. Most of these nurses couldn't tell you what the patient's normal mental status is (They don't care. Too busy gabbing at the nursing station). Doesn't help that there is a huge influx of non-English speaking, Caribbean nurses because of the artificial nursing shortage.

When was the last time you were responsible for 25 - 30 patients at one time with maybe just one CNA? Do you think you could get to know everyone very well in 8 or 12 hours while passing out 300 meds and doing 20 dressing changes? Do you not know how quickly the mental status of a brittle elderly person can change from day to day?

Do realize the nursing home has to justify each transport and is subject to a Medicare inspection at any time? Do you realize that if a nurse is found guilty of fraud he/she loses their license and goes to jail? Do you realize that many EMT(P)s flap their jaws about fraud but yet most are afraid to take a legal stance even though there are avenues to do so? Yeah some talk big but cower in a corner when asked to put up the proof.

Unless the nurse is from Puerto Rico, they may be required to take the ENGLISH NCLEX exam. What about the EMT(P)s that do supposedly speak English but can not put a sentence together?

Remove yourself from flight RN/RRT/whatever badge you’ve collected and think about the typical nurse right out of school. Not so many are spectacular. I’ll also say it again: I’m not saying nursing is useless. They’re just not that different than us. All I’ve heard is a bunch of stuff about compassion and “total care” that seems to have come from a Johnson & Johnson nursing commercial. You talk about following patients? What practical skills are you talking about? That a human being, a nurse (they’re super special and empowered with special skills of reason), is capable of realizing that there are multiple facets to healing? Are you implying that paramedics can't feel for another? That we're all cold, heartless idiots?

“I’m sorry sir. You’re a traumatic brain injury patient who needs to go to Cat Scan. Unfortunately I’m incapable of finding the room. For that matter sir I have no idea what a Cat Scan is. But why am I talking to you? I probably don’t even realize that you have severe, long lasting neurologic deficits because I’m a stupid paramedic and not an awesome nurse.”

“Miss I can’t empty your urine because I’m incapable of understanding the implications of urine output and overall renal function. I’m just a big dumb paramedic.”

“Well sir. The doctor finished that in situ pinning. Your femur should be all better now. Here’s five dollars and a cane. Have fun! Oh, what is that? You need physical therapy? Ah, I’m sorry sir. I’m just a paramedic. I thought you’d be all set!”

You are only talking about "skills" again. Finding the CT Scan room? Get real! Do you not think about assessing the neuro patient to determine if the change warrants a CT Scan? Yes, that is the RNs call to make.

Dumping urine? What are you going to do with the information?

You believe all there is to Physical Therapy is handing someone a cane? Do you honestly think you are now a Physical Therapist as well as an RN? Do you even know how many clinical hours they must complete?

I think you just proved my point as to what you do and do NOT know about total patient care. You've got one big chip on your shoulder and not that much experience. You also have failed to mention anything about EMS and what the Paramedic should be focusing on rather then trying to take over nursing, PT, RT and the Dietitan's job with all the expertise you acquired from your one Nutrition class. You also may actually have been one that didn't spend enough time doing routine transports to know what some of the threads on the EMS forums are about or what the attitude is amongst those who don't do 911 calls.

[ccmedoc]

I have read this last part of the thread, and I really don’t know what can come from this discussion. The education of a nurse and a paramedic are different. Maybe in the community college the pre-requisites are the same or similar, but the core classes are different. As far as I know, ADN nurses do not need chemistry courses, but require a biology/microbiology course. I think this is not required for AAS paramedic yet is it, it wasn’t for mine. I think these go a long way to understanding the base of disease and treatments, certainly from an outcome standpoint. Most nursing pharmacology courses are much more in depth than the paramedic curriculum, if you attended the same course as nursing, count yourself lucky and in the majority.

Paramedic training, education if you are lucky, focused on emergent, short term care and taught in a very medical model. Find the problem, focus on the problem, and fix the problem. Nursing is a more holistic assessment and treatment process, and brings into this process a lot of psychosocial and less tangible factors than medicine. I think you can assume, and you would be correct, that the nursing model incorporates many aspects of the medical model; plus the additional factors of home situations, recent lifestyle changes, ability to care for oneself, support systems, etc. None of which would be taught in any paramedic program I have been associated with, although they are all proven to affect the healing process significantly. The additional education in psychiatric nursing is far beyond anything you will see in paramedic school; community health is non-existent in any programs I have seen; geriatric medicine is a specialty barely touched upon in paramedic education, but what percentage are the elderly in your patient logs? Pediatric education is severely lacking in the paramedic education, but is a primary course in nursing; how many pediatric clinical rotations were in paramedic school? There is a depth and breadth of education issue, I believe, at the heart of the question at hand. Nursing education is much deeper in detail and wider in breadth than that of a paramedic. Simply a difference in curriculums and focus; the intent was never to have a paramedic perform long-term care, as far as I know.

As far as skills; monkeys can learn skills and perform repetitive tasks, but thinking through the technology and how it is going to affect the patient is certainly dynamic and an exercise in critical thinking. During all the “clinical” in the ICU, CCU, Stepdowns, med/surg, etc; how much time did you spend actually caring for a patient, talking to the patient and their family, assessing the treatment plans, adjusting the plans accordingly, conversing with the physicians and students and interns…..

I still believe that there is a big difference between the “education” a paramedic attains and that of a nurse. Most paramedic programs are based on training that, like it or not, is based on cookbook type medicine. The average paramedic school graduate doesn’t not have the education that an average nurse has, and I can also pretty much guarantee you than a well educated paramedic would not have anywhere near the education or training that a well educated and trained ICU, CCU, or other intensive care based nurse would have, unless they were also the latter. This, of course, would start the micturation competition you were not looking for.

As both a very educated paramedic and a fairly educated nurse, I can assure you there are differences between nursing and paramedic. Both have their place in the health machine, and are two totally different animals.

In fact, the only place I have ever encountered a nurse who was brazen enough to insult the paramedic profession was in the ED.

Although I don’t think nurses should insult a profession they possibly know little about, if the nurse worked in the ED for any length of time, the insult was likely warranted. You say you are educated to a much higher level than most paramedics (medically I assume); she sees most paramedics. Most medics are the same way towards nurses and they are both way off base.

I still think that comparing a paramedic education to a nursing education is ludicrous, and I also know this discussion will be going on long after this thread is closed, regrettably…

If you don't want to be a nurse, don't. There are already too many disgruntled practitioners out there that are only in it for a paycheck. This can make for very poor patient care and you will be very miserable....I guarantee it.

Edited January 20, 2010 by ccmedoc