Nurses and 911 calls

[Ridryder 911]

I thought nursing bit off more than it could chew with NPs having only a semester of medical-model, now this? If the trend continues, there will eventualy only be different kinds of nurses. :roll:

Uhummm... apparently you know nothing about nursing. There are several hundred kinds of nursing (especially, specialty nursing), Second, only a semester of of medical model WTF ? Apparently, I must be going to the wrong school and the $50k student loan as well.

Before making an ass out of yourself (which you just did), be sure to research your statements.. NP programs are the minimum a graduate level, which is 2-3 years after... your 4 year BSN. Some are even PhD or DNSc level, which is the same or greater length college a M.D. has.

I don't believe in PHRN's, if your going to be a Paramedic be one... if your are a Paramedic and going to work in the hospital as a nurse, then go to nursing school. The curriculum, the methodology, the models, clinical emphasis are totally different.

R/R 911

[Callthemedic]

I did look at the curicculum, hell, I took some of it. I know NPs. I know paramedics that went to NP school. I think I have plenty of information

The programs I saw had about 15 hrs of medical-model type courses. I'm going by experience of how psychosocial nursing-model and medical courses are titled and how medical ones are. I have also brought this up with NPs, and looked at the curicculum and spoke with an NP student who was in my platoon.

It doesn't matter how long one attends school. The content of the curicculum is all that matters.

The only way I can judge other programs is by the course desciptions. They don't seem to describe the medical-model. My contacts say (about the medical-model training).....I am quoting...."it's a joke".

Isn't that really the point though. Nursing isn't medicine. Aren't they proud of that? I would have thought a nurse would like shunning the medical-model. My nursing instructors always belittled the practice of medicine saying it was "too simplistic".

So,

I've known students and NPs, I have been treated by an NP. I have researched the curicculum for masters programs.

How do I not know what I'm talking about?

[Ridryder 911]

Because you posting erroneous information. How could you take a semester of NP without being a RN/ B.S. /BSN first ? First semester of a nursing program ADN or even BSN is a lot different from advanced degree. In the first semester of general nursing, you are taught the general "basics".. nursing dx., etc.. This would be comparring the same as 1'st responder versus Paramedics education. Second, Paramedics cannot go to NP school without being an RN/BSN or at least be a RN with a BS. degree, or entering a RN/MS program prior to admissions. Then most require at least 5 yrs at a RN level/ You see they really don't care if you were ever a Paramedic. Believe it or not most health care professionals still don't recognize Paramedics as a profession yet. Second there is not a generic "medical model" as you described. Dependent on the "specialty" of the Nurse Practitioner program. Medical modules are sometimes intertwined into classes, not a totally separate class. Like medical school, they are imposed into areas. One must remember that the NP has alrady had at least 2 - 4 yrs of education prior to NP, not just starting out. My patient assessment module was 16 weeks long and the text is over 1100 pages & yes we covered it.. so an additonal 16 weeks in NP school or even medical school, would be to fine tune or review.

Again, please research more. Yes, there is psycho social modules, like in medical school, and P.A. school, etc . Dependent on the type of NP (yes, there are several types, like physicians they have specialties) from Psychiatric, Family, Neonate, Gerontology, Acute Care, Emergency, etc... the courses is all dependent on the specialty you choose. Advanced nurses, are more medical with a nursing perspective. That is why they have been documented to have a higher accuracy in medical dx., and fewer return visits regarding the same illnesses, as well as more holistic approach. Insurance companies have also noted this.

If I was to only review course descriptions, medical school, paramedic school, even aeronautic engineering would appear to be a breeze. Although, I can recognize that course descriptions are just that. One liners about the course content NOT the curriculum, which is a totally different thing.

I totally disagree with "curriculum" is all that matters.. that is the problem with EMS today. Uneducated, curriculum trained people. Even those people who went to EMT class for 2 weeks met the national curriculum standards. Every one meets the curriculum standards and we still test and have textbooks at a 6'th grade level.

R/R 911

[Callthemedic]

There is a HUGE difference between nursing and medicine. That's how nurses got their own licenses under the BON.

The difference between the nursing-model and the Medical-model is like night and day.

A careplan(nursing) takes great pains to distance itself from any kind of medical-model diagnosis, EXCEPT for the name......Nursing Diagnosis. You are misleading people, along with the BON, to believe that nursing simply "blends" the Medical-model into the Nursing-model.

Compare this to a careplan:

This is the medical-model. It is clearly defined. The skill of differential diagnosis is gained through clinical rounds through ALL the medical subspecialties. There are 26. One general area of training can not prepare a person for differentials across the board.

I did a short search on ask.com and came up with this.

"The medical model differs from the psychosocial model in that the "disability" is viewed as "inside" of the person, rather than the result of barriers or attitudes of society (or employers). There are four key components of the medical model. They are:

1)Symptoms

2)Evaluation/assessment

3)Differential Diagnosis

4)Treatment (and prognosis)

Example of the Medical Model with a Clear Medical Disorder

Symptoms

You take you daughter, Jill to the doctor because she is not feeling well, she is coughing, complains of a sore throat, and just feels achy.

The symptoms are: Sore Throat, Achy, Cough, General Feeling of being sick.

Evaluation

The physician will take Jill's temperature, listen to her heart and lungs, look in her ears, nose and throat. The physical may also order tests. She may order a throat culture, maybe a blood or other ests.

Differential Diagnosis

The physician will use the information and data from the evaluation to make a diagnosis. Possibilities in this case are a cold, streep throat, or some other virus. "Differential" indicates the need for the physician to decide between two or more possible diagnoses.

Treatment (and Prognosis)

Depending on the diagnosis the physician will develop a treatment plan. The treatment may include medications, rest, change in diet, or other interventions. Once the physician has a definitive diagnosis, she will have an idea about the typical "course" of the illness and what is likely to happen to Jill (this is the prognosis). For example, if Jill has a cold, the physician can predict that in about a week Jill will be feeling better."

This is clearly not the psychosocial-model of nursing.

How many hours of clinicals in medical subspecialties do NPs do? For that matter, how many do they do period? I know how many hours PAs do. I have compared them. I made a thorough investigation so I could decide whether to throw away 2 semesters of nursing (the prereques for nursing won't transfer to the medical side). I made my decision based on the medical-model.

Now, the guys I know that went to NP programs. One quit when he saw that it was the psychosocial model all over again. One thinks the training is "a joke" but can't turn his back on the money and the power of the BON. Maybe that's a skewed example but it's the only one I have. I don't know anyone, including my NP who couldn't answer some simple questions, that thought NP school gave them enough medical training.

Meanwhile, I will take 4 years of real science courses and basicly the 1st and 3rd years of medical school curicculum then log hours in all the medical subspecialties in clinicals. I don't expect someone who is a nurse to think any differently than what they've been indoctrinated with from day one in nursing classes. I don't blame you a bit for your opinion, but do not accuse.

[Ridryder 911]

I will not continue to argue with such ignorance of specifics, as I expected, you were discussing basic nursing not advance practice or clinical nurse specialty. or even have the understanding of such. I was in a P.A. program, and quit because of the lack of speciality education or lack of. That is why they cannot practice medicine on their own licensure, where as NP's can.

Nursing care plans are usually only related to generalized nursing practice, by even addressing these, you have again proved my point.

I am in ACNP program extension and quite aware of philosophy, research, requirements. I am quite aware of comparative models of medical education levels and actually have really performed literately. scientific research, with comparison analysis, so google and "ask how" does not really impress me.

Just like the hundred others "I'm going to be a Dr. someday".. come back, I will be glad to discuss with you after you get into medical school.

Sorry folks for the hijack, and lame discussion...We now return you to your scheduled discussion...

R/R 911

[Callthemedic]

I will not continue to argue with such ignorance of specifics, as I expected, you were discussing basic nursing not advance practice or clinical nurse specialty. or even have the understanding of such. I was in a P.A. program, and quit because of the lack of speciality education or lack of. That is why they cannot practice medicine on their own licensure, where as NP's can.

Nursing care plans are usually only related to generalized nursing practice, by even addressing these, you have again proved my point.

Yes NPs can specialize.........in one area only. PAs can practice in any 26 subspecialties, well, because they are trained in them. IF you had gone to the trouble of getting into a PA program, you would have known that. NP licensure is only granted in one setting. If it is really true that they have more autonomy, that would be nice I think. If you are happy with it that's all that matters.

As I said before, I personaly know NP ex-students as well as NPs that agree with me about the curicculum. As to why the careplaning and contrived psychosocial etiology of disease was in their advanced programs and not yours, well, who knows.

Look, you've obviously worked hard to get where you are. The BON is strong and the fact that they have so little to do with medicine is a great advantage. More power to you. It doesn't mean I won't get angry when they say......."we can't be regulated by the AMA, we don't practice medicine"...then pull this paramedic gig out of their butt. Can't nurses just be nurses and be happy with that?

I could write more but it is not worth arguing really.........not really, right? The differences between nursing and medicine are obviouse to us but others that haven't experienced them don't know. This is on the OP though.

[flight-lp]

Yes NPs can specialize.........in one area only. PAs can practice in any 26 subspecialties, well, because they are trained in them. IF you had gone to the trouble of getting into a PA program, you would have known that. NP licensure is only granted in one setting. If it is really true that they have more autonomy, that would be nice I think. If you are happy with it that's all that matters.

As I said before, I personaly know NP ex-students as well as NPs that agree with me about the curicculum. As to why the careplaning and contrived psychosocial etiology of disease was in their advanced programs and not yours, well, who knows.

Look, you've obviously worked hard to get where you are. The BON is strong and the fact that they have so little to do with medicine is a great advantage. More power to you. It doesn't mean I won't get angry when they say......."we can't be regulated by the AMA, we don't practice medicine"...then pull this paramedic gig out of their butt. Can't nurses just be nurses and be happy with that?

I could write more but it is not worth arguing really.........not really, right? The differences between nursing and medicine are obviouse to us but others that haven't experienced them don't know. This is on the OP though.

Acute Care, Adult Health, Anesthesia, College Health, Community Health, Emergency Nursing, Family Health, Gerontology, Holistic Nursing, Neonatology, Obstetrics/Gynecology, Oncology, Pediatrics, Palliative Care, Perinatology, Psychiatry, School Health, Women's Health.

So much for only one specialty......................

[Callthemedic]

Either I wasn't clear, you don't understand, or you are misleading people that don't know.

Graduate nurses can not go through one program that grants them a license under the BON in all of those.

I was comparing it to a type of medical training anyway and it's not. Nursing is a unique field. There is no comparison really. That's the strength of nursing. Nurses regulate themselves because the training is non-medical. Only nurses can regulate the unique nursing practice.

That makes perfect sense now and it made perfect sense when it was concieved.

The question is, can it cross-over into medicine?

I think nursing practice and medical practice are too far apart to be blended somehow.

This is not a question of skill, dedication, IQ, or breadth/depth of training, nurses go through all of that. This is a question of medical training.

[Spock]

WOW! I agree that Callthemedic is out to lunch.

Back on topic--Pennsylvania has a PHRN certification. I hold both PHRN and NREMT-P (even though PA is not a Registry state completely) certifications. I was an EMT-P before I completed nursing school so all I had to do was fill out a form and I got a second state EMS certification number. Nurses that want to get the PHRN must complete the EMT course and then challenge the paramedic exam (National Registry). They also must get the county medical director to authorize the application. ACLS, PALS, and either TLS courses are required. After passing the state exam, they must precept with the local EMS service to get command priviliges.

Scope of practice is the same except a PHRN may perform any procedure or administer any medication allowed under his/her nursing license as long as the service medical director authorizes it. The reason for this is legal. EMS is under the Dept. of Health and can't infringe upon the Board of Nursing. Paramedics are certified while nurses are licensed.

I use my PHRN number with the two services I run with. I used to run with a hospital intercept team and had to use the

EMT-P number because PHRN wasn't in the job description. PA requires 18 hours of con-ed each year so I have to have 18 hours for each number. I kept the EMT-P number for sentimental reasons but am rethinking that.

Would I want to run with a brand new PHRN? No more than I would want to run with a brand new EMT-P. We all start somewhere and should try to mentor the inexperienced. We don't let a new medic or PHRN run without an experienced medic for a good 6 months.

Live long and prosper.

Spock

[basic2be]

Well said Rid.