True, but as well nurses usually are not specialized when exiting school. Very few know how to turn on a monitor as much as read an ECG, thus the reason for the intern/externship programs. At one time the new grad would work in less critical area such as step down ICU for a while then apply to ICU extern and be trained within the speciality area and take courses along the way. Now, we are seeing more and more new grad's being directly placed into speciality areas.
We only have a couple of hospitals in our area that will take new grad RNs into the Critical Care Program. But, the additional education is 6 - 40 hour weeks in the classroom, 6 weeks of shadowning a CCRN in the unit, 6 months of being under the watchful eye of an assigned preceptor and 6 more months of a probationary period. Then, if they want to join a specialty transport team, they will need two more additional years of experience in the unit after that all the initial training to apply and then the serious training begins which can take over another year. This allows time for additional education and to gain competency in skills. Example: RNs on either the Pedi or Neo team will need at least 10 intubations (RRTs as the primary intubator need 100 to apply and 25 more after accepted to the training program). At least 10 UAC/UVC insertions are needed. Then even with all of the required skills competencies and additional education, they will still need to be with a preceptor for 5 to 10 transports depending on prior experience and finally the direct approval of the medical director who also may determine if they are allowed to start the training in the beginning. This still is all with a base RN (RRT) education of 2 or 4 years. You can't imagine how excited some Flight programs are to get RNs that have done specialty transports as they can also adapt very easily to doing 911 HEMS as well.
Compare that to some of the new Paramedics who may have some of the eduation or classroom training with few to no prerequisites to establish a foundation for medicine. As well, many of the necessary skills which are the "technical foundation" of the profession are not being obtained such as intubation. Then, when some companies only require 5 rides, that pales in comparison with the number of patients a nurse must see after he/she has gotten more hours of education/training just for entry into a Specialty AFTER nursing school than some Paramedics get in their entire program or orientation by their employer. Then, some in EMS wonder why there is criticism for certain skills and Paramedics not being allowed to have access to many of the medications that might allow them to do better critical care transport or facilitate certain procedures in the field. You can also see how difficult it might be to compare the education and skills of the Paramedics that do apply for Flight where the experience and scope will vary. You can easily see this from a Paramedic that worked as a Southern CA with a very busy service for several years with a very limited scope but now wants to do Flight or CCT in say Oklahoma or another progressive area. As you have probably read on the forums, not everyone is aware Paramedics are even allowed to transport IABPs in some areas. You can talk to California Paramedics about certain drips and all they can say is "MICN only".
You can criticize RNs all you want but still, the number of patients and patient hours they get when they do enter critical care training AFTER they have a 2 - 4 year foundation of general knowledge is impressive. Yes, nursing school doesn't teach everything indepth but they do have enough pathophysiology to where explaining pharmacology actions, perfusion concepts, pressor interactions, ventilation theory and even O2 delivery a little easier. Myself and other instuctors usually don't have to resort to fire hose examples in explanations and try to avoid misleading the new RNs by saying "lido numbs the heart" or "CPAP pushes the water".
Unfortunately, ACLS and PALS can also foster some of the bad knowledge when people get their instructor cards too soon. Or, they have no experience especially with kids. Some Paramedics even get very offended when they are not allowed to become NRP instructors "to complete their set" of instructor certs for their alphabet soup. Yes, CPR (BCLS) has instructors that teach without ever doing CPR on a real person but that is purely a "skill" and doesn't require much critical thinking. The critical thinking requirement is what ACLS and PALS are also becoming very weak in but then effective CPR is now the emphasis.
BTW, have you looked lately at the competencies the NPs and PAs are going through in some areas in addition to the increasing educational requirements? Very impressive and not just in the specialty areas. The additional post grad programs for specialization, especially for the PAs, are gaining a lot of recognition and their grads are highly sought after.
