I read an article this morning from my hometown newspaper, about the future of nursing.

It's a quick read.  Anything in there that is applicable to EMS?


What do you think?

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Just to veer of course a little bit. In NYS, since the article is referring to; the RN has 10years to get a BS. There is no problem. It's not asking a lot from a practitioner to get more education at no cost to them. Many institutions in NYS pay for RN's schooling 100% when they do not possess a BS. Tuition reimbursement for Graduate and Post Graduate degrees for RNs.

The problem in NYS that is; most 911 Ambulance outside NYC is staffed by Volunteer EMTs. Paramedics are paid services; mainly contracted to local government. They're are over 16,000 local govts in NYS. NYC, is the exception. So, community residents staff the VAC. Many who volunteer as EMTs are professionals in other trades; some are students and others are retirees. It is hard to change the EMT standards when many residents in NYS depend on volunteers to respond to emergencies. If we make the requirements harder to become an EMT; the entire system could collapse. Many volunteer EMTs are seniors and students.

Paramedic is something NYS EMS can really change without real repercussions. There should be a timeframe for all Paramedics without a degree to get an AS. The govt should offer some type of tuition reimbursements or govt no interest loan for current Paramedics. All certificate programs must align with a college. The student to take all pre-requisities and then they are allow to enter into the Paramedic training phase if requirements are met. Colleges who have Paramedic as a major must not allow students to go non matriculate. If colleges want to align themselves with private training center who provides Paramedics can do so. Either ways, the Graduate Paramedic walks away with a Associates in Science in Paramedics. All this must be done within a certain time. Bachelors is a different avenue where it should prepare the Paramedic with Management and Heathcare Policies or Emergency Management. Masters in Paramedics is a direction it can go to, along with Doctorate.

It can be done for Paramedics but it will meet resistance. As for EMTs it's going to be hard to increase quality didactic and clinical hours. The local EMS will have trouble getting volunteers and staffing ambulances. Unfortunately, EMTs are considered a hobby by some, that's how many VACs advertise to recruit members but Paramedics is a career. Private Ambulances can contract services but then taxes goes up for the residents. It's easy to mandate but compliance is the challenge.

I'm not sure how well this image reproduces http://www.nhscareers.nhs.uk/images/table-diagram.jpg here's the link anyway. 

The first column shows ambulance staff in comparison with other disciplines. Its interesting where the highest EMS role fits with its counterparts. EMS in the UK hasn't broken into the advanced practice barrier. No Masters Degree Paramedic roles yet. 

Our Emergency Care Practitioner programme is not as successful as one might think, it really is a zip code lottery, with alternative destinations not in place or flimsy or with ridiculously strict admission criteria. 

There was a study conducted where our advanced practitioners were more likely to send patients to hospital due to an overabundance of knowledge with no experience. So patients were going in with overcautious diagnoses. 

Without experience in an admissions ward or emergency room, the advanced degrees just gather dust on a resume. As has been said before, EMS in the majority is used by patients that cannot access primary or urgent care elsewhere. 

Injury/Illness Prevention should be the start help people access the right care in the right place.  

More clinical---hmmm--the backbone of the diploma RN program....I did ICU clinical in my diploma program, while the BSN students observed!

Geri Jacobson said:

Paula Miller said:

So, if you

 want ALS to go that route, give them more courses in music appreciation, computer science, and creative writing and take them even further away from patients.  I'm sure it will help.  I'm just sayin'...


I only wish the BSN had time for music appreciation but a Bachelors of SCIENCE rarely does.  Today in the year 2012 it is very difficult to not be literate in computers so yes, a computer science class is necessary.  Creative writing came after 2 semesters of the required composition classes. If you still wanted to do more writing after those classes, more power to you. I am a firm believer in reading and writing  classes especially in today's texting iphone shortcut language. Writing is now like adding without a calculator for some.


40 years ago the diploma nurse was okay. The RN was viewed basically as a technician who performed tasks over and over. Technology was still very simple and few specialists were needed. RNs did x-rays, respiratory therapy and labs. Now within the past 25 years these fields have exploded with advancements. 30 years ago saving a 23 week preemie was not heard of. Nor was the ARDS patient saved. They just died. Then medicine advanced and LTAHs were on every corner for both adults and peds as we saved patients that were dying just a few years before. But, the long term care brought a need for more specialized treatment and technology.  Nursing no longer could sit back and be techs. They had to become part of medicine as professionals.   Also, nursing in the US is very behind other countries where the equivalent of the Bachelors is already expected and the LPN or LVN is a 2 year degree.


The Associates degree is not working anymore. The mere 1000 hours of clinicals are not working. The curriculum needs to be updated to meet the needs of a growing profession.

Nursing is so vast that 1000 hours will not cover even a small fraction of what a nurse needs to know.  The diploma nurse focused primarily on "med-surg" basics. Now schools are trying to expose students to every department including intensive care which was unheard of 30 years ago.  A solid BSN program will provide a broad foundation with a lot of knowledge but there is a lack of direction for specialization until this education is complete and there is successful entry into a new grad program.  Many BSN programs have links to externship programs for an addition 3 - 6 months of experience in a specialty unit or floor as an RN instead of a student. These have proven successful. 


The Paramedic education is still very focused on a limited field of specialization. Even the A&P, pharmacology and pathophys classes are abbreviated and tailored just for EMS. It keeps the EMS provider separate from all other health care professions which usually will have at least a year's worth of similar classes before being admitted to a 2 year degree program. The clinicals are also very focused and somewhat inconsistent between schools especially when it comes to oversight at facilities and agencies. But, the Paramedic still comes out of the program prepared as the diploma nurses were years ago with a focus on technician style training rather than the academics.


The specialties are also more intense today. Educating the patient is also now a priority which requires more informed health care professionals.  Who would have thought 30 years ago that you would need more education  just to teach an asthma inhaler? Now it is recommended for RNs who work in the ED and clinics to take the Asthma Educator certification. Even RTs are now required in some hospitals to take it.  I would recommend that Paramedics considering being community health providers to take it.  It is an eye opener and today with many deaths attributed to asthma, especially pedi, it is a necessary part of patient care. But then there are also COPD educators which differs from asthma. Wound care, SCI long term care, developmental health issues and of course diabetes with all of the specialize care that goes into it are all areas the require not only education but experience in maintaining and managing.  The RN is expected to be proficient enough to recognize when they need to call for someone who is specialized in a certain aspect of care. I do not see how a Paramedic with limited education in today's curriculum and very limited exposure to the day to day management of long term care issues can be expected to be proficient in just 2 months which is what some community health programs are suggesting as education.  Any other health care professional would not be so bold to believe they are qualified for such as endeavor after such a short period of time even with a Bachelors. I believe some of the other countries require a Bachelors and then graduate work for their Paramedics.  The care of the diabetic patient alone is very challenging and then when you have COPD or Asthma and wounds from circulation problems, you have a very complex patient.


I also have to ask of those who are advocates of Community Paramedics, what about the skills which some believe are the backbone of the profession?  Intubation, ACLS and IVs would take a backseat.  You could get the same stigma that home health  or LTC nurses used to have and still are thought to be the low life of nurses by EMTs and Paramedics.



Grrrrrowl!  Watch it, miss, in a few years he may be giving you orders!  To quote a paramedic I know, can't we all just get along?

Geri Jacobson said:

Joe Paczkowski said:

So because the California Business and Professions code lists the minimum training for physicians in hours, we're not degreed, or are you saying that it's hard to compare physician education to nursing because nursing has hours (which is directly, per code, translatable to hours) because there's a statute minimum in hours for physicians, but not nurses?

I'm not saying base science courses aren't important. I'm very much for foundational science courses. The point I'm arguing, again, is that those courses should be a part of the curriculum. That's exactly what I said earlier. I have no clue how you're reading that "foundational sciences should be a part of the curriculum and not a pre-req" as "foundational sciences aren't important." 

Yes, I'd like to see paramedicine be an associates degree. Personally, the EMT level should be somewhat near an associates degree and paramedic near a bachelors, but that's another discussion that requires a complete redesign of the levels from the ground up. However, whether the minimum training, by statute, is hours that are converted to units or units converted to hours is irrelevant, provided the requirement matches what is reasonably required to produce a competent provider. What I think would be more beneficial is to simply get away from the concept that the minimum should be treated by a maximum. Despite California requiring 4000 hours for physicians, I can't think of a single school in California that advertises their program by hours used, because it's irrelevant when it's a 4 year program.

Of course now I'm approaching this from a medical/medical student standpoint. You want to compare nursing to a non-health care professions (medicine is not another term for "health care" and nurses don't practice medicine, or else they'd be under the Board of Medicine) that's fine. I can't think I've heard once where a physician gave a darn about how he compared to a lawyer or some other doctorate level profession.

Also, I've been fairly consistent in comparing how minimum requirements are written in statute to medical school. Last time I checked, but medical school is not "trade school or votech." Since the only other field I've been discussing is nursing, I guess nursing school is now a type of trade school? Cool.

By the way, I'm in medical school now, so we can seriously drop the holier than thou, "Well, you're coming from an EMS background."

This part:

"foundational sciences should be a part of the curriculum and not a pre-req" as "foundational sciences aren't important." 

I have stated "prerequisites". I have stated a year+ for nursing of prerequisites. At no time did I say foundation courses were unimportant. I also pointed out some anatomy present in the UCSF med school curriculum to stress its importance. 

 You seem to want to discredit nursing education when I have agreed the Associates is inadequate which is why the BSN movement is making progress.  This is nursing's way of moving past the 2 year technical stigma toward a professional standing. The Associates was great 30+ years ago for advancement but by today's standard that is no longer true.  Your attempt at a belittling  "type of trade school" statement is neither new or insulting. You probably read or heard it in the many BSN debates which are occuring throughout the country.  


I have also shown to you that the RN is not 1400 hours in California as you thought. The LVN minimum is 1500+. 



This is also a quote from the UCSF med school link. I showed you the degree of Doctor of Medicine so you can not say I said doctors were not degreed. I also stated I dd not want to discuss doctors. You have been arguing with yourself on most points here about doctors.

Requirements for the Degree of Doctor of Medicine

  1. The candidate must have completed a total of 239 units with a passing grade including all required courses prescribed

I believe the school has the right to measure their degree in the acceptable units specific to their program as long as they are in compliance with the minimun stated in the statutes.


I also thought you were talking "medicine" since you kept referring to med school.  I stated there was no comparison. I again had asked that you not confuse the disciplines.  I did not try to say an ADN was equal to a Doctor of Medicine. 


It seems you got this discussion off track so you could brag alittle about being a "medical/medical student".  You are not a doctor yet.  If you are happy that I am now aware you are a medical/medical student, maybe the discussion can be brought back to nurses and Paramedics again.

Ok, sorry, I have been busy and haven't been on for awhile. I see that the direction has taken the normal course of healthcare professional discussion boards. By that, I mean it has degraded into a verbal battle of my profession is more important than yours, your education is not as hard as mine, so you are worth less, blah, blah, blah. Paula, Thank You! Why can't we all just get all, and realize that a diverse group of healthcare professions, with varying backgrounds and educational requirements are what our customers/patients desire and demand. Mutual respect, amongst the various professions is what our patient deserves, and it is what we deserve. I am not saying to abandon academic rigor or ignore evidenced based care, but quite frankly, I am tired of the condescending attitudes of some nurses towards EMS professionals (I am a RN, as well as a Paramedic), and the condescending attitudes of some physicians to nurses. Oh and lets not forget the arrogance of some EMS clinicians towards our hospital collegues! It has gotten better than it used to be, however, we still have a long way to go. I believe Skip started this topic to create an exigence and promote discussion over the "take aways for EMS" of this article that talks about creating the opportunity for RN's to obtain their BSN. It also talks about customer expectations (the AARP organiztion). I think this article clearly has a message for EMS leaders, educators, and providers as well, we need to set the bar higher. We had a great initial discussion, however somewhere along the way, we lost our way, please, let us find our way back to providing the best care we can to our patients, while realizing that we all must work as a team to provide this care

No one? Bueller? Bueller?

I'm all for a discussion, but the discussion has to focus on something real, not something irrelevant like calling "hours" something different because it sounds better, like units that are directly equatable to hours. Competency matters, not the number of hours one receives independent of competency.

Sir, It is worth stating that the pre-requirements listed for CCRN certification, once satisfied and verified, allows the nurse take a wildly difficult test. Real chemistry. Real math. Complex gas calculations. Pass that, keep up CE's, verify active practice...wear the letters.

Geri Jacobson said:

Chris Azevedo said:

Perhaps "nursing" doesn't give out titles, but there definitely are some titles for RN's who work in specialized fields and have specialized training--CFRN being one, and CCRN being another.  They are both exam-granted certifications.  In the same vein, the NR doesn't give out "titles" or have certification levels such as Critical Care Paramedic, Flight Paramedic, or Advanced Practice Paramedic, but there are such certifications which are attained by examination.

Where does any of this fall in the nursing world?

It is my understanding the NREMT is not the test used by every state nor is every level issued by each state the same. It is also subject to change in the near future as I have noticed a new level "AEMT" being talked about by the CCT EMTs.   The Community Paramedic in Minnesota is now a new level or title which was created with an additional 120 hours of training.   The NCLEX is the test used by nursing for the vocational and Registered Nurse in the US.  Those are the two levels recognized in the US for licensing. After that you have the Advanced Practice Nurse licensure.


There are some credentials handed out by testing in nursing and then those that are most recognized t/o the profession required additional hours of training. Usually those doing the interviewing for certain positions will be able to sort through the handed out alphabet and those which required a little effort.


For example, the AACN issues the CCRN certification.

Eligiblity includes:

Practice as an RN or APRN is required for 1,750 hours in direct bedside care of acutely or critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application.

  • Eligible hours are those spent caring for the patient population (adult, pediatric or neonatal) of the exam for which you are applying.


You must repeat the same requirements for each age group you wish to test for.

For Med-surg nurse certification:

  • Have practiced the equivalent of 2 years full-time as a registered nurse.
  • Have a minimum of 2,000 hours of clinical practice in the specialty area of medical-surgical nursing within the last 3 years.
  • Have completed 30 hours of continuing education in medical-surgical nursing within the last 3 years.


For Rehabilitation nurses CRRN: (CARF will know the difference for credentials in a unit or facility.)

  • Within the five years preceding the examination, completion of two years of practice as a registered professional nurse in rehabilitation nursing; or

  • Within the five years preceding the examination, completion of one year of practice as a registered professional nurse in rehabilitation nursing and one year of advanced study (beyond baccalaureate) in nursing.


The above certifications are recognized nationally but do not require additional state titles, certication or licensing. 


Certifications which can be obtained in just a day or two at a seminar or liked ACLS or ABLS are recognized for what they are which is additional training certs which anybody can take without prior experience or even a specific title or license. These are usually just used for CEs and sometimes to fulfill the requirements of continuing education mandated by certifications such as CCRN.


Advanced Practice Nurse or Nurse Practitioner requires extra education and is recognized by the state with a designated set of practice regulations.  It is not a level an RN can just test out for with an ADN degree.  The APN is usually in 4 different areas: Nurse Practitioner, Certified Nurse Anesthetist, Clinical Nurse Specialist and Certified Nurse Midwife.  The RN must achieve the higher education and pass the appropriate certification through the American Nurses Credentialing Center (ANCC).

For California, this is how we defined Advanced Practice Nurse:



California also has the MICN (Mobile Intensive Care Nurse) certification which is county specific by the EMS authority in that county. Other states may have a PHRN  or  EMS- RN (Nevada) which is issued by their state BON. These titles are specific to that state are a region and not national.


Just like EMS, you must look at the source of the certification or title and whether it is national, state or local.  EMS also has hazmet, tactical, wilderness, CCT EMT and many other types of specialty certifications. I honestly don't know how many of these are recognized by their state licensing board. I believe in California these are all extra certs of special interest and you do not need to apply to the EMSA for another title or certification.


I am aware of one state, Tennessee, that does have a Critical Care Paramedic level but it requires no additional college education in the form of a degree such as an Associates. It consists of modules which are hours based in training and apparently can be done in less that a month.  Maybe someone here from that state could give a better explanation of how that works. 

But the requirements to take the tests are very different. If someone actually has a year or two of experience in a critical care unit such as what the CCRN requires, the CFRN is easier and when interviewed, that person will be able to draw from experience rather than memorization of a Q&A book. Those conducting interviews for nurses will be familiar with the requirements of the certifications and can usually direct their questions to weed out the alpabet or vanity letter collectors. On the other hand if they say they took the class for certification to gain more knowledge and admit they realize it does not make them an ED RN, they will gain respect for having some initiative for learning. 


But, the FP-C and CCP-C do not have any work experience requirements nor is a prep class required. There are some Paramedic schools which offer the 80 hour CCEMT-P course to their new grad Paramedic students and will advertise it makes them eligible to also take the FP-C and CCP-C tests. This is all without any work experience as a Paramedic or in an ICU.


Nursing also has several other certifiations which you may not be familiar with that requires another 1 - years of education and experience such as for wound care.  Again those who are interviewing candidates for those jobs will know the requirements of the credentials.  Nursing is very familiar with letter collecting so if you use something on your resume, you will have to back it up in the interview. 


I believe every profession should know the differences in their credentials. There is a difference between one that tests your knowledge from actual education and job experience and one that is handed out without those requirements even if the tests are similar. Sometimes assumptions are made incorrectly that someone with CEN, CCEMT-P or FP-C are job ready to dive right in.  I have interviewed Paramedics for an ED Technician position who had CCEMT-P and FP-C but had never spent any time in an ICU nor had they seen a patient on a mechanical ventilator or IABP.  They also had never managed a patient with multiple pressors and much of what they were tested on were not even in their state scope of practice even at the expanded level.
Scott Lancaster said:

So, Kind of like the FP-C / CCP-C exams... Have the experience, take a wildly difficult test, with real chemistry, real math, complex gas calculations, pass it, keep up on the CE's...wear the letters??

p.s., Haven taken both, and working with RN's with the CFRN, CCRN, CEN certs along with FP-C the exams are very very similar.


Rob Nash said:

Sir, It is worth stating that the pre-requirements listed for CCRN certification, once satisfied and verified, allows the nurse take a wildly difficult test. Real chemistry. Real math. Complex gas calculations. Pass that, keep up CE's, verify active practice...wear the letters.

"Perhaps, If they check (which they don't)... There are a lot of Flight Paramedics out there who get their CCRN and CEN within 6 months of becoming an RN. By the book, maybe not."


I do not advocate lying on any piece of paper about experience or title even if it is on just a certification exam. That should also be picked up by the interviewer if they are using the cert as a basis for hiring.

The CCRN application process also states:

The name and address of a professional associate

must be given for verification of eligibility related to

clinical practice hours. If you are randomly selected

for audit, this associate will need to verify that you

have met the clinical hour requirements.


The CEN is a certification from a different agency and only requires an RN license. Again, an interviewer should know the different requirements for certs.


I am sure there are also situations where a Paramedic holds the FP-C or CCEMT-P cert but works for a very rural service with very few calls or in an area with a limited variety of calls. The rural hospital RN with a CCRN definitely is disadvantaged especially when applying for a Flight position. Major hospitals with high acuity units will often treat new hires the same as new grads and tailor their orientation and preceptoring around their pass experience or lack of regardless of the certification.


There are also some Flight Paramedics who have become RNs that must get the required 3 years of critical care experience as an RN before assuming the Flight RN title.


"knowledge of current ACLS, PALS, NALS, & ITLS/PHTLS standards"

To be successful in critical care, much more is needed than just the resuscitation certs. Preventing a patient from getting to the point of requiring ACLS with knowledge of medication, technology, disease processes and physiology should also be stressed.


 "However to get into a CICP or CCEMTP course (the real ones) there is an experience requirement to get in, and in many cases spots are competitive."

Since CCEMTP is trademarked by UMBC, I take it to mean that is one of the real ones you are referring to.

On the UMBC website the experience is still only recommended and not required.

"Recommended minimum of one (1) year as a paramedic."

Yes it is probably very competitive to get spots since there are many Paramedics wanting CCT or Flight jobs and the course is about the only way for a Paramedic to get some critical care knowledge. The course is also very short even at 120 hours.


"I don't understand why they would want that type of position, unless they were looking at RN school and where interested in that aspect of care."

There are many reasons why they want to work in an ED. Some just like the pay, benefits and hours better. Some don't want to be firefighters or aren't able to be firefighter due to the very competitive nature.  Some realized the private companies change owners and contracts occasionally creating discord in future stability and advancement opportunities.  Some also know with several Paramedics on every scene and with the Fire Department Paramedics usually being the lead, private Paramedics will not get to utilize many of their skills which may even be starting an IV.   Some go into the ED for more medical knowledge and interaction with other health care professionals and even the patients. They may get to do the skills they wouldn't do on a daily basis and may do them many times over and over such as phlebotomy, IVs, EKGs and setting up equipment they normally would not see on an ambulance. They may get to see diagnostic exams which they wouldn't see on an ambulance and even get to venture into other departments to follow up with patients and their care post the ED.


RNs are often responsible for the Paramedic working in the ED to see their charting and medications are co-signed. Also, assignments must be changed when a patient assigned to the Paramedic gets drips or technology attached that is beyond the scope of a Paramedic working in the ED. 


I don't pretend to know everything about EMS. But, I must be familiar enough with the transport professions to determine who is right to transport our patients from one facility to another. Sometimes just seeing a patch is not near enough. Even RNs who are on CCT or Flight may not have expertise in every aspect of critical care but you can usually tell by the questions asked whether they are comfortable taking the patient. This they have learned to do from Critical Care experience and knowing what it is like working 12 hours with a patient that might have needs beyond your education/training comfort zone. But, hopefully there will be others to give you a hand. If you don't know what you don't know or what to expect, you can get yourself and the patient into some trouble on a transport.  Therefore, I make it my business to ensure those transporting our patients are comfortable whether it is just for a routine test as another facility or if it is to a specialized center. The doctors expect a safe transport for their patients.   I think EMS also evaluates the abilities and credentials of a facility if they have protocols which allow them to transport to the "most appropriate" rather than just the closest although that is also still utilized.


I don't believe I have talked "down" about your professon. Nurses  know you can not place someone from a SNF or Rehab unit into the ICU or on an IFT with an IABP. This is why we have float staffing policies in place. Even with a extra cert to their name they must still meet the facility's competencies and level status.  In reality the best person for the care of a patient during an IFT transport must be considered and egos must be put aside. When time is critical you can not always teach a whole course in critical care at the bedside in front of the patient and their family. As I have stated before, nurses interviewing nurses will have a good insight on who got their credentials just for the sake of getting a credential and who really has a critical care background. Usually those who are upfront about their background may be given the most opportunities for a solid education to make their transition into a higher acuity unit more successful.


Scott Lancaster said:

If someone actually has a year or two of experience in a critical care unit such as what the CCRN requires

Perhaps, If they check (which they don't)... There are a lot of Flight Paramedics out there who get their CCRN and CEN within 6 months of becoming an RN. By the book, maybe not.

CFRN is easier and when interviewed

Not what I've heard, but to each their own - I've been told by people with all 3 that the CFRN is a combination of the other 2, with flight physiology thrown in. 

the FP-C and CCP-C do not have any work experience requirements nor is a prep class required

No, but there is a prep. course available although I never took it. From the BCCTPC website: "This certification process is focused on the knowledge level of accomplished, experienced paramedics currently associated with a Flight and/or Critical Care Transport Teams. The questions on the exam are based in sound paramedicine.  The candidate is expected to maintain a significant knowledge of current ACLS, PALS, NALS, & ITLS/PHTLS standards. This exam is not meant to test entry-level knowledge, but rather to test the experienced paramedic's skills and knowledge of critical care transport"

But ya, they don't check either.

Nursing also has several other certifiations which you may not be familiar with that requires another 1 - years of education and experience such as for wound care

Thanks, I know about many of them. I work in a Academic Medical Center under the Office of Professional Nursing, in a nursing department.

There are some Paramedic schools which offer the 80 hour CCEMT-P course to their new grad Paramedic students and will advertise it makes them eligible to also take the FP-C and CCP-C tests. This is all without any work experience as a Paramedic or in an ICU.

Correct. I actually teach a 120 hour CICP course, and yes some take the FP-C exam after finishing. I do not recommend it, but some do. However to get into a CICP or CCEMTP course (the real ones) there is an experience requirement to get in, and in many cases spots are competitive.

They also had never managed a patient with multiple pressors and much of what they were tested on were not even in their state scope of practice even at the expanded level.
Yes, very true. However there are also RN's who have worked in small community ICU's that don't keep really sick people who meet the requirements and have passed the CCRN. When they come to interview with us, their lack of true experience is noticeable.

I have interviewed Paramedics for an ED Technician position who had CCEMT-P and FP-C...

I don't understand why they would want that type of position, unless they were looking at RN school and where interested in that aspect of care. A true ED - Paramedic position, sure...We have many medics in my area who work in-hospital with full scope / expanded scope of practice and those jobs are really good. Some RN's don't like it much, having medics take patient assignments seems wrong to them in some ways. 

I guess my point is, I'm am not a nurse (although I work along side them everyday) so I don't talk about their education or certifications with much authority. I don't talk down about that profession, and I would really appreciate it if people didn't talk down much about mine. Yes, prehospital medicine has it's problems without argument, so does nursing.


You still are using the exceptions rather than the overall broader picture as examples to justify your points. 2 outstanding RNs who have no problem being a flight nurse without any critical care unit experience is not the norm considering there are over 3 million licensed RNs.  I know alot of exceptions to the norm also and have seen changes especially for NPs.  There have been outstanding NPs who went through the short diploma programs  but at some place in time the bar should be raised and the appropriate standards in place to represent the profession as whole and not just one or two outstanding individuals.

 "In practice, I don't see the need,"

I wish I could get you to see where experience managing 2 critical care patients with multiple drips and several pieces of technology attached to them for a 12 hour shift every working day in a critical care setting with access to other professionals and rounds with doctors explaining the whys and hows could be of benefit to someone seeking a career as a Flight RN.



ALL health care professionals work under a doctor in some way either by protocols or as their Medical Director. Both the RN and the ED tech in the ED work under the Medical Director of that ED. The Medical Director signs the protocols for both. The doctor writes orders for technicians and nurses. If there is a Respiratory Therapist in the ED they may initiate their own protocols per their own Medical Director and not the ED Physician.  Radiology also works under the protocols of their Medical Director which is why all the checks and balances are done. But, the ED Nursing Supervisor is still responsible for you and that your scope of practice is adhered to. You are also not exempt to the medication rules for that facility nor are you exempt from the credentialing and training requirements mandated by the hospital as you would be on an ambulance. CNAs and Transporters are also part of "nursing staff" with the differentiation coming from licensed status and how your license is recognized.


I would say it is more like "some" and not many who are striving to advance the education of EMS. I still don't know where Skip actually stands since it seems the BSN is not that well received here. Nursing has been around for a long time and ever since the degree at the ADN level become widely accepted in the 70s, the leaders in nursing starting preparing for the next step in education since they realized it may take many decades to get to the next level. It has taken 50 years to get past the 35% mark for the BSN. In the US it seems Americans want instant gradification rather then using the example of our neighbors and European countries where the ADN would be an LPN or "aide" of some type. I believe this holds true for EMS as well. But, I do believe the US should establish a more consistent education standard before putting the words Advanced Practitioner and Critical Care in their titles when the training and experience varies so much.  In Nursing, Advanced Practitioner usually refers to someone with at least a Masters degree. For Paramedic it should be more than someone who has a 1000 hour cert and an extra 2 - 3 weeks at a CCEMTP course. In Australia, the Critical Care Paramedic has the equivalent of a Bachelors and beyond along with many hours of extra training. The ECP in the US is also the equivalent of a Masters or similar to the US PA or NP with a specialty in emergency or prehospital medicine.

Scott Lancaster said:

This is very true, although it is not based on any evidence or study. I know a couple of RN's who transitioned with less then 3 years of ICU and are stellar providers (both had numerous years as flight paramedics prior to their RN). In practice, I don't see the need, but people smarter then me have made a 'rule'...


This actually isn't allowed in my area, they have to work under the MD, but they can report to the charge RN for assignment. Normally in my area they are part  of the nursing staff. But I know this differs from state to state.



Sorry if I took it that way, but in re-reading your prior posts I still feel that someone without personal experience in the field is making judgements about it. I respect opinion, as long as it's not projected as facts. Believe me I know there are problems in my profession, we are where nursing was in the 60's (little white hats, subservient to others etc) but many are trying to change that. Adding in college level A&P, Micro, Chemistry is a great place to start and I highly recommend it. I really think times are changing in EMS, but change is painful and takes time. I'm only in my little corner of New England, and don't have the national voice of Skip and others - but they are trying.

Without actually knowing what state you are in or your actual job title it is difficult to make any comparison. It appears you still want to get into a superiority pissing match rather than comparing education, experience and licensing.  That is not the intent of my posts.

In the hospitals and in other health care professions, advancement has been made through education and the skills followed.  Some technicians who failed to increase their education were left behind either by their employer or their state licensing board.

But for your example of the "charge Paramedic" in a cath lab, it is not that uncommon in some areas for a "charge" person to be someone other than an RN but the other licensed staff will work under their own license and Medical Director. By not actually working in a hospital it might be difficult to understand all of the different licenses, Medical Directors and heirarchy.


"I'm not talking about the exceptions, just the reality in my area. There are only 16 CCT paramedics in my state"


The exceptions  were in reference to the 2 RNs who became flight nurses with less than 2 years of experience. 


You seem to have a very controlled sector and this is truly not the norm everywhere.


 "In New England, all CCT is hospital based providers currently."

Is this true for all New England states?

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