Going to the Darkside

[Scaramedic]

I have not been here much lately, and it has been forever and a day since I was in chat. I'm sorry to Admin and the other Mods for not doing my time in the chatroom. The last six months have been really busy with work, life and preparing for today, my first day of pre-req classes for my BSN.

Yes I have fallen to the darkside. :twisted:

The temptation of better career opportunities, a temperature controlled environment, and of course higher pay have broken me. So for the next year I am taking the courses I need to take and some I am taking because it has been a long time since I have taken college level courses. Can you say Algebra!

My question is for the RN's on this site...

Any classes you would take prior to entering a Nursing program beyond the usual chems, biologies, math, etc.?

How challenging is it to go from Paramedic to Nurse mode?

Any other advice you might have would be greatly appreciated.

Thanks & Peace,

Marty

[itku2er]

RUN MARTY RUN.........just kidding hon........

WELCOME TO THE DARK SIDE...........well its like everything else in life you get out what you put in....I will talk to you some time when you are online or shoot me a pm and we will talk.

Terri

[Ridryder 911]

My suggestion is not to EVER tell anyone you were in EMS. It is far better to thought as equal playing field and many instructors either hold EMT's as higher or much lower with prejudice. Nursing and EMS are 2 different professions, and are nothing alike in instruction. Remember, you are in their world.... don't attempt to rationalize or compare your EMT training to nursing. Nursing is not medical model based teaching it is nursing and use the nursing process (which you will know by heart).

If possible take to brush up on research and writing skills, especially APA format, you will use it. Learn on how to manage your time well. I laugh at medic students whom complain, in nursing you will study at least 8 hours a day every day. Remember, you will complete those 2,000 page textbooks in those 8 weeks plus all those other projects and research papers, care plans, and clinicals. So the old adage "Is their life after nursing school ?" is correct. That is why RN's respect each other, we all had to go through it and still remember it. Kinda a right of passage. So time management is essential.

Good luck, and remember persistence is the key!

R/r 911

[chbare]

Scaramedic, welcome to the club. You should do fine.

Take care,

chbare.

[medic429]

I am right there with you scaramedic. I started taking my pre-reqs last fall. Good luck to you!!

Take care,

429

[Dustdevil]

Any classes you would take prior to entering a Nursing program beyond the usual chems, biologies, math, etc.?

I would advise you to take ALL of them prior to entering the nursing programme. Not because they will all contribute significantly to the educational process, but because it is ideal that you be taking NO other classes besides your nursing classes when the programme starts. Every other class you take simultaneously takes away from your concentration and study time for the nursing classes.

But, so long as you are intelligent, good at mental multi-tasking, and not working a full-time job and raising a family simultaneously, then you should do okay if you only have support courses like English, History, Sociology, etc... going at the same time. You will very definitely want to get ALL sciences and mathematics out of the way before hand though. That would include Psych/Child Development courses.

How challenging is it to go from Paramedic to Nurse mode?

Quite. How easy is it for you to play dumb? That is pretty much what you will need to do in order to reap the most benefit from the programme while reaping the least grief from your instructors. Rid is right. They will hold your experience against you. Even if they respect medics (which they usually don't), it will only result in you being held to a much higher standard. You have to put almost everything you know about medicine aside and re-educate yourself to a completely new perspective, or you will fail. Yes, your insight into human anatomy and physiology that you have achieved through years of experience will be quite beneficial to you. However, your insight into medical practice will be a hinderance to you because nursing is not medical practice, and their approach to patient care is completely different from a paramedic's approach. You cannot make any assumptions that because you did something one way as a medic, that it is also acceptable to do it that way as a nurse. I speak from experience, as this came back to bite me more than once in nursing school. Seriously dude, don't expect your EMS experience to be a significant benefit to you. It will hurt you as much as it will help you. In the end, it's a draw.

One thing I see medic-to-RN students do is go in with the attitude that, since they are already a medic, that becoming an RN will somehow make them a Critical Care guru. They blow off all the nursing fundamental instruction and focus themselves on the sexier aspects of patient care, thinking they don't need all those basics because they are going to be a CEN, CCRN, CFRN in six months anyhow. Consequently, they either drop out (or get thrown out) of nursing school, or end up as a sub-par nurse when they do graduate. Trust me, being a medic and an RN does not equate to being a specialty nurse. It just gives you a licence in two very, very different professions. After that, you are still going to have to do a lot of work to be a good nurse, regardless of your medic experience. Therefore, I reiterate that my best advice is to forget you were ever a paramedic and go in with the very real mindset that you are nothing more than a freshman nursing student learning a brand new profession that you have no experience with. It's hard to do, but that is how you will get the most out of nursing school.

Regardless, I have the greatest confidence that you will do very, very well, Marty. Just lay low, divest yourself of as many distractions as possible, stay focused on the curriculum at hand and you'll breeze through. Best of luck, Bro!

[UMSTUDENT]

I must say that I often make the comments in class that I feel that they (nurses) practice an entirely different medicine. I just finished the majority of a rotation in a local hospital and was often surprised at how differently they viewed a disease process.

My biggest problem with nursing is that they seem to perpetuate their reliance and subordinance to physicians. Even if they're intelligent and educated enough to know what is going on they'll literally create a giant mental wall to keep themselves from drawing conclusions. I can't even begin to explain the looks I get when I dare read a 12-lead and then talk to physician about it. That is entirely taboo.

One of the things I've definitely noticed is that general nursing education seems to focus more on the long-term care of a disease process, often making them ill-equipped to handle the hear and now of emergency medicine. They say stuff sometimes this is entirely inappropriate or just flat chronologically wrong.

An example:

I recently was working under a nurse when a fairly critical patient came in. She presented hot, clammy and diaphoretic, obvious dypsnea...pretty much in extremis. She complained of generalized chest pain and trouble breathing...at least on paper. She was tachycardic (~150) on the pulse ox and so the nurse ordered me to get a 12-lead because they were probably going to have to "push a drug to temporarily stop her heart."

Time! I'm already not impressed. My gut is not cardiac and just because her heart rate is 150 doesn't necessarily mean we’ll be pushing adenosine.

So I do the 12-lead and of course there are obvious p-waves of normal morphology. It was a perfect sinus tachycardia with occasional unifocal PVCs, normal axis and no ST changes. Sure, it could be reentrant or inappropriate, but hey she’s obviously febrile (treat the cause). I went to the physician we were working under, handed him the print out and gave him the "look." He's a cool guy and treats his students like he would a resident or medical student. So he walks back with me and does a quick assessment. The nurse is running around asking about possible cardiac causes and freaking out about getting a PE study. She keeps rattling off about there being at risk for a PE...something about her age.

Meanwhile the physician looks at me with the most disappointed look ever. He just seemed irritated. He listens to her lungs...totally junky. Patient is febrile and has severe trouble breathing. He orders a chest x-ray and CT that reveals a massive pneumonia. Consolidation in pretty much every lobe. The CT scan is pretty scary too. So he orders a gram of Vancomycin and Dexamethasone to open her up a bit.

Now once he had her hang the drip and push the steroid she was right at home. Once she was out of the acute stage she was entirely comfortable with her situation. I’m not confident that the nursing model of education is superior to a good EMS education utilizing the medical model. I’m a huge proponent that ER care, and healthcare in general, would work a thousand times faster if nurses would be taught to think and interact with physicians as colleagues and not slaves. There just seems to be a huge mental block. Granted, doctors can be assholes, but they work with them every day. The most successful nurses I worked with knew this and adapted in the interest of efficiency and patient care. They’re just very rare.

[Dustdevil]

Now once he had her hang the drip and push the steroid she was right at home. Once she was out of the acute stage she was entirely comfortable with her situation. I’m not confident that the nursing model of education is superior to a good EMS education utilizing the medical model. I’m a huge proponent that ER care, and healthcare in general, would work a thousand times faster if nurses would be taught to think and interact with physicians as colleagues and not slaves.

While I wholeheartedly agree with that final conclusion, I am not so sure about that observation about education models. Again, nurses are not doctors, and should not be educated in the same matter, or with the same goals. Same with paramedics. You seem to have missed my point that nursing school does not -- and was never intended to -- produce specialists in any discipline, including critical care. Because you or I know ACLS like the backs of our hands after only 6 months of tech school (yes, I know you and I are personally way beyond that, but this is just for instance) doesn't make us any smarter, any better, or our education more viable. It just means that our education was more focused on a specific comfort zone while the nurses' education is intended only to give them a very, very broad foundation upon which to build a specialisation later in practice. Obviously, medics don't come out of school knowing more than nurses. They only come out knowing different things. Unfortunately, in most medic schools, they come out knowing a lot about very little. Comparatively, nurses come out knowing a little a bout a lot. That is because paramedicine is, in and of itself, a specialty. Nursing is not a specialty. Specialisation is something that comes through years of study and practice. And let us not fail to recognise that the model of medical education is more akin to the NURSING model than you think. Physicians too are educated with a very broad foundation, only specialising and getting into serious treatment mode after graduation, just like nurses. Ask Doczilla or ERDoc how comfortable they were with specialised practice immediately after graduation from med school. Yes, they had brains full of eight years of theory and foundation, but I assure you that they were scared to death at the thought of actually being the one everybody was looking to for action until well into their residencies.

Now, turn your scenario around. Come out to an independent practice environment like mine, or like the oilfield, offshore, and other industrial medics out there. Ninety-nine percent of them are absolutely lost when it comes to providing primary care. They suck. They have no idea what the inside of an ear or eye is supposed to look like. They don't know the normal temperature ranges for patients. They wouldn't know a heart murmur if they heard it on a loudspeaker. They don't know stage 1 HTN from stage 2, or what to do about them. They haven't the slightest concept of microbiology and think that the way to choose antibiotics is by strength. Conversely, the RNs come out here and do very well. They don't have to be taught microbiology or the pharmacology of any medicine that isn't on the ACLS list. They excel at putting the results of an H&P together into an intelligent assessment and viable plan while the paramedic is still scratching his head trying to figure out which end of the otoscope to look into. So, I suppose that makes paramedic idiots whose education should be more in-line with the nursing model, right? No, what this means is that...

[align=center:719ec46225]THEY ARE TWO COMPLETELY DIFFERENT PROFESSIONS WHICH CANNOT AND SHOULD NOT BE LOGICALLY COMPARED.[/align:719ec46225]

This is an prime example of exactly what I am talking about when I say that you have to get the paramedic out of your head when you go to nursing school. If you go in with that attitude that you already know more about adenosine than a nurse (yes, you probably do) you will end up tuning out the greater part of what you really need to learn in nursing school to be a competent provider.

And incidentally, I watched two ER physicians do the very same thing that nurse in your story did a few months back. Septic patient and they were reaching straight for the adenosine. Luckily, cooler heads prevailed.

[chbare]

"THEY ARE TWO COMPLETELY DIFFERENT PROFESSIONS WHICH CANNOT AND SHOULD NOT BE LOGICALLY COMPARED."

Dustdevil, + 5. If people would realize this fact, we could finally put the RN/Paramedic debate to rest.

Take care,

chbare.

[UMSTUDENT]

I totally and completely agree with you on most points. I whole heartedly understand that the professions are grossly different, which is why I made the comments of the two seeming to be "different types of medicine." I simply don't agree with the mental block and medical culture that surrounds the position of a nurse in the diagnostic process. IMHO they are just as capable as we are to do our job given the right direction and education...likewise with the right education a paramedic could easily function as a nurse.

I mean, I don't know about most paramedics, but I know the difference between essential (primary) and secondary hypertension. I know the stages. I was taught how to use an ophthalmoscope and otoscope. I know what the tympanic membrane looks like. I know where the light reflex should occur (5 and 7). I know how to do a comprehensive HEENT assessment. I know the difference between a gram-negative and gram positive bacteria and I'd say I have at least a general knowledge of the more commonly used antibiotic therapies and their utility given the strain of pathogen. So it frustrates me that these things are believed to be out of our realm.

In the end though, I guess these things all fall back on education or lack thereof. EMS could have a very bright future with the right direction.