Is an RN considered a higher level of licensure than a Paramedic?

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Permalink Reply by Joe P. on June 24, 2009 at 9:25pm

Paramedics, more often than not, are not licensed by the board of medicine. You could always compare scope. Why is it that RNs can monitor a lot more critical care drips on CCTs than paramedics?

...and yes, in terms of physical therapy, DPTs and physical medicine and rehabilitation specialized physicians (of course which is higher? PM&R physicians or DPTs?) trump RNs. Of course EMS and physical therapy are different specialties. Can we keep to comparing apples to apples?

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Permalink Reply by Duncan Hitchcock on June 24, 2009 at 9:41pm

Licensure is a matter dependent on the state. In Florida a Paramedic is not licenced. They are certified. THey are not independent practicianers. They can only function as a Paramedic under the license of a physician. The Paramedic follows those protocols as determined by the Medical Director (a physician) only to the extent as they allow.

As an RN certain aspects of the practice of nusring, those that relate to the provision of medical procedures, interventions and treatment are also dependent on the orders prescribed by a physician. But other aspects of the nursing practice are an expectation with the nursing practice.

Being both a Paramedic and an RN there are delineations that must be realized between each set of expectations, roles and responsibilities. I much prefer the freedom alotted me as a Paramedic by our Medical Director in our specific agency. My training as an RN is different in many aspects than my training as a Paramedic. One example is in pharmocology. As an RN more time is spent on learning about all the different types of medications, their effects, side effects, contraindications, ontoward reactions, long term impacts, etc. As a Paramedic my training prepares me to respond to emergency situations, rapid patient assessments, immediate life sustaining interventions based on the presenting conditions, stabilization, packaging and transportation to a higher level of care.

A common misnomer is that the nurse we see in the ED is the same nurse that we see on the floor or the nursing home or ICU. They all start with the same basic education but specialization requires future training and education to work in specialized patient care areas.

I have always said and will continue to say that becoming an RN made me a better Paramedic and that being a Paramedic made me abetter RN. The basic training is different with different emphasis. But the shared commonality is patient care.

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Permalink Reply by Skip Kirkwood on June 24, 2009 at 10:04pm

Different, for sure.

I don't know if there is such thing as a hierarchy of licenses.

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Permalink Reply by Ben Waller on June 24, 2009 at 10:44pm

Nurses are not typically licensed by a board of medicine, either. They're usually licensed by a board of nursing.

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Permalink Reply by TravisS on June 25, 2009 at 12:36am

The semantics of this discusion tend to lead to a big pissing contest. If I'm in a hospital or ER, I treat the RN's as equal members of the health care team. Sometimes I have to use my 'big boy' voice and direct eye contact to get them to acknowledge my requests for their time or for a complete report, but they're usually pretty compliant. Outside of the hospital, I have a legal obligation to take control of the scene. Once 911 is called and I arrive on the scene, it is MY scene and I am legally and ethically responsible for the care and treatment of that patient. Usually the RN's on scene are just happy to see me and hand off the problem. There have been a few instance when a care home nurse has been concerned when I have upped the O2 on a hypoxic patient from 1.5lpm to 6. Sometimes you just have to politely smile, nod your head, pretend you don't understand English, and continue on with patient care. The only person who outranks a paramedic on scene is an MD or DO. We aren't allowed to take orders from an RN, PA or NP. Of course you still need to be respectful and utilize all resources available to you on scene, but when all is said and done, it's your cert on the line.

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Permalink Reply by Justin on June 25, 2009 at 1:28am

My point was physical therapy is a separate field from nursing(much like nursing is a separate field from EMS), but they have a "doctorate" now a days. My analogy was purposely set up like that because the argument is that since nurses have more education, even though it is in a different field(nursing not EMS) they are a higher level of licensure. Comparing a paramedic to a nurse isn't really comparing apples to apples. You are changing the scenario to include critical care transport RNs and that's not what I was really trying to compare, I meant more of just a RN in a general setting(nursing facility, school nurse). An interesting question I think is, what exactly is nursing? They seem to be able to do almost anything and call it nursing. They can do EMS and call it nursing(flight nurses, pre-hospital RNS) and they can practice medicine and call it nursing(Nurse practitioners, CRNAs). I'm not complaining about any of these jobs, I'm just not sure exactly what uniquely separates nursing as a profession from all of these different roles it fills.

Joe P. said:

Paramedics, more often than not, are not licensed by the board of medicine. You could always compare scope. Why is it that RNs can monitor a lot more critical care drips on CCTs than paramedics?
...and yes, in terms of physical therapy, DPTs and physical medicine and rehabilitation specialized physicians (of course which is higher? PM&R physicians or DPTs?) trump RNs. Of course EMS and physical therapy are different specialties. Can we keep to comparing apples to apples?

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Permalink Reply by Justin on June 25, 2009 at 1:31am

It doesn't seem like their should be, but I've heard it come up a lot. When I asked one of my supervisors a question about a nursing facility doing CPR on a person with a DNR and if I was allowed to respect the patients wishes and not run the code when I took over care(I'm a paramedic, they called 911), he told me no because a nurse is a higher level of licensure and I should do whatever he/she says.

Skip Kirkwood said:

Different, for sure.

I don't know if there is such thing as a hierarchy of licenses.

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Permalink Reply by Justin on June 25, 2009 at 2:04am

Also, you are right I was mistaken as to which board licenses EMS personnel. It appears it is different between each state. Regardless, a paramedic still practices "emergency medicine" as delegated by a medical director and a nurse practices nursing.

Joe P. said:

Paramedics, more often than not, are not licensed by the board of medicine. You could always compare scope. Why is it that RNs can monitor a lot more critical care drips on CCTs than paramedics?
...and yes, in terms of physical therapy, DPTs and physical medicine and rehabilitation specialized physicians (of course which is higher? PM&R physicians or DPTs?) trump RNs. Of course EMS and physical therapy are different specialties. Can we keep to comparing apples to apples?

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Permalink Reply by Nathaniel Davis on June 25, 2009 at 2:07am

As with so many discussions on here, this will vary state to state, however...

As both an RN and a paramedic, let me weigh in a bit. Mr. Hitchcock covered most of what I planned to say already. In the hierarchy of licenses, I would say that RN vs. P is an unfair comparison to both fields. While a lot of the fundamentals are the same (A&P, illnesses, pathophysiology, etc), your basic RN and Medic are trained incredibly differently. Generally, medics worry about stabilizing life threats, while RNs worry about the "big picture" (ie discharge planning, home care, and what's going to happen days/weeks/months down the road). This isn't to say one is better than the other, just that they are different.

More to the point of your question, is one a higher level? I'm not going to get in to the semantics that come with licensure vs certs. My non-lawyer response would be that neither is "higher". They are two different fields, and while I hold and encourage others to obtain both, it is because the training is complementary, not higher. The quick thinking, crisis management of an EMT-P is invaluable as a nurse, and the "wide-angle lens" thinking of a nurse makes the EMT-P more effective. Both have their places, and in the ED, the RN wins. In the field, the EMT-P is the top. Neither is "better" or "higher", both are just different.

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Permalink Reply by TheCannulator on June 25, 2009 at 8:33am

As an RN and Paramedic I've come to the conclusion that EMS has one of the biggest inferiority complexes known to man. Always worrying who's the boss.

If EMS was EMO, it would have no arms left to cut.

There is no relevance to the comparison. Both roles overlap and are in fact complementary and at the same time are separate.

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Permalink Reply by Lady O. on June 25, 2009 at 12:17pm

I think you've summed it up quite nicely.

TheCannulator said:

As an RN and Paramedic I've come to the conclusion that EMS has one of the biggest inferiority complexes known to man. Always worrying who's the boss.

If EMS was EMO, it would have no arms left to cut.

There is no relevance to the comparison. Both roles overlap and are in fact complementary and at the same time are separate.

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Permalink Reply by Jerry on June 25, 2009 at 3:28pm

For an interesting read, go to the NREMT website (NREMT.org) and read Bill Brown's commentary on the differences between Licensure and Certification. One of the differences has to do with "rights." In Oregon, the Health Division can only revoke you after they go through a legal process and you have "hearing rights." Hummmmmm...

Nurses often raise this issue; it is not an ISSUE unless you or your organization permit it.

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