Paramedic or Nursing?

[CJT]

Hey everybody before I get to my question I'll give my brief history in EMS. I'm a senior in high school. I've been an EMT since last august and I've been running since last November as a 3rd man on a micu. I'm planning on staying in ems once I graduate but I'm still thinking over certain things. I have been debating whether to go to nursing school or paramedic school. They both have pros and cons and that’s why I wanted some advice from people who've actually been in this field for a while. Since I'm a 3rd man I get to ride all the calls in the back including the als calls basically being a gopher/set of hands for the medic on these calls. Since I get to ride the als calls I learn a lot about different topics including cardiology which really fascinates me. Where I'm from once someone graduates from paramedic school they can go to physicians assistant school which which allows you to choose different specialties. One of the things I'm thinking is I might like to work as a physicians assistant and specialize in cardiology. If I did that I was thinking I might be able to volunteer as a paramedic a couple days a week. Where I'm from there is also a certification called a phrn (pre hospital registered nurse) this means if you go to nursing school and pass everything you're eligible to challenge the paramedic exam or take six weeks of classes and then challenge it. So I was thinking I might do nursing school to become a cardiac nurse, and volunteer as a paramedic 1 or 2 times a week. Which do you think would be the better side to pursue? I want to specialize and work in cardiology, but also I still want to stay pre-hospital some of the time.

I'd really appreciate any answers you guys can give me. B)

 

[TransportJockey]

I'd go with Nursing. THat's where I'm going after I get my medic. No point in staying in EMS, until it's seen as a real profession and not a part time hobby

 

[alphatrauma]

I want to specialize and work in cardiology, but also I still want to stay pre-hospital some of the time.

I'd really appreciate any answers you guys can give me. B)

Go to Med school and volunteer during your free time. If you want to "specialize" in cardiology, nursing is a waste of time... MDs/PAs specialize in cardiology, RNs specialize in telemetry. Huge difference.

Good luck with whatever you choose

 

[daedalus]

A cardiac nurse? Like a cath lab nurse or a CCU/CTICU etc nurse? The job of a PA and RN differ CONSIDERABLY. The PA practices medicine (on a team with other PAs and MDs, PAs work as a team). The RN practices nursing.

You should end up doing what ever your heart tells you too. From the sound of it, you want to really practice cardiology. You should be taking classes for entry into PA or Medical school, and working to obtain hours for PA school.

 

[Ridryder911]

Go to Med school and volunteer during your free time. If you want to "specialize" in cardiology, nursing is a waste of time... MDs/PAs specialize in cardiology, RNs specialize in telemetry. Huge difference.

Good luck with whatever you choose

Hey! Let's at least give accurate and correct information! Let's leave ignorance behind, okay? Let's at least attempt to be truthful. Apparently from someone that has never been past the ER doors.

As one, that has explored the education and role of all of them. I know the P.A. education is based upon the medical model. I can assure you that the P.A. is nothing more than a low paid physician and gets to take care of whatever the physician does not want to take care of or cases not needing that specialist. Hence, they are their assistants or may work in rural areas as the role of a physician sometimes . As well, the P.A.-C is required to take their board every 6 years along with CEU's although they may focus with a specialist have to be familiar with general medicine. Technically, they do not have a speciality rather associate with link with a specialist.

(Here's a little education) At least Nurse Practitioner have a specific speciality & oh yeah, they are board certified to practice within their speciality without a physician not alike a P.A. that has to be tethered to a physician. They will be required to have a Doctorate level by 2012. I have seen a major change of using NP's in lieu of of P.A.'s due NP's work upon their own license and malpractice.

I am not even discussing Clinical Nurse Specialist that are as well focused and specialized in an area. They perform research and usually are linked to Speciality Physicians and again usually will assist in performing research or conducting detailed care. As their graduate level and license will be focused in that area alone, not within general medicine alike the P.A.

Unless you want to go to medical school for 8 years, then 3 years for internal medicine, then another 3-5 years (that is if you are the upper 10% of your medical school to enter a cardiology fellowship) (non-interventional) and additional if you want to perform surgical procedures.

Now, to the question. If you want to be a nurse be a nurse. Yes, there are speciality areas but I only would recommend this if you want to be in the nursing career. If you want to be a Paramedic then be a Paramedic. You know the role and yes its a profession within itself.

There are only a few states that have pre-hospital nursing and personally, I find it a foolish thing. There is nothing in nursing core courses to prepare you for prehospital care. In fact, the NCLEX (RN) exam cannot even ask any cardiology or trauma type questions as they are a speciality. One will focus after nursing and become a speciality and yes, that can range from cardiac to psychiatric. Alike the general EMT or Paramedic is not prepared to work within the hospital arena, it is not their function or role.

You can do both, just alike I did. I have a formal education in both. They require different education as they are different professions and each role has a specific function.

Get a guidance counselor and look at your options. Where do you really want to work in and focus upon?

R/r 911

 

[Scott33]

You can do both, just alike I did. I have a formal education in both. They require different education as they are different professions and each role has a specific function.

I agree, do both. Get the best from both worlds, and whereas both roles are traditionally different, they can often compliment each other.

 

[JPINFV]

(Here's a little education) At least Nurse Practitioner have a specific speciality & oh yeah, they are board certified to practice within their speciality without a physician not alike a P.A. that has to be tethered to a physician. They will be required to have a Doctorate level by 2012. I have seen a major change of using NP's in lieu of of P.A.'s due NP's work upon their own license and malpractice.

Don't NPs in most areas have to have a collaborating physician? If so, how does collaboration and the supervision that PAs work under differ?

 

[CJT]

You can do both, just alike I did. I have a formal education in both. They require different education as they are different professions and each role has a specific function.


R/r 911

I think my first step will definitely be to get my paramedic certification. I've been involved in pre hospital care for little while but I love doing it already. After I do that I'm thinking I'll probably get my bsn. I don't want to flip flop but I've been thinking about doing critical care nursing for a while also. I think if I get my bsn after I do my medic school it will benefit me a lot. With a bsn I would be able to advance to np and specialize if I ever choose to. Or I could decide to work as a nurse on a smaller scale depending on how I feel about everything. I want to do medic 'cause it's something I believe I will truly enjoy. I want to do nursing because I've talked to nurses in emergency departments and other areas of hospitals and it sounds like something that I would enjoy as well. Do you have any other thoughts?

 

[Ridryder911]

Don't NPs in most areas have to have a collaborating physician? If so, how does collaboration and the supervision that PAs work under differ?

Actually many states allow the NP to work either under the contact of a Physician or as more and more states are allowing they can be independent (I believe at this time about 20+). I know of three NP's (all with DNSc) that have their own clinic. In my state the NP only has to have a "contact" physician to be able to advise them and possibly refer to if need be. They have prescriptive rights and can only work within their speciality. That is why many obtain family medicine so they can diversify.

Even the ones that are associated with speciality physicians are increasing in number due to they receive graduate and post graduate education within their speciality and focused areas.

The P.A. program is usually associated with the medical school and I believe why it is still familiar and popular. I am seeing more and more NP's utilized with speciality physicians as their sole focus of education is within their speciality unlike the P.A. program. i.e. Acute Care, Psychiatric and so on. Each state has their own Board of Nursing that regulates the details and may vary.

Alike NP's each state of course has their own regulations but from what I understand most P.A.'s have to be in contact with a physician that agrees to be medical control for the P.A. and be < than an hour away and or per direct communications (phone). They have to be reviewed on scheduled basis

I have researched both physician extender programs and both are very similar and I respect either one.

Insurance companies are beginning to see the benefits of using NP's as well with better diagnostic ratios and patient satisfaction. Many believe it is because of the holistic approach rather than strictly medical and the empathy that should be considered. As well many of these NP's are being used in the rural and remote areas.

R/r 911

 

[Veneficus]

JP,

a friend of mine in this program sent this to me:

http://www.nursing.pitt.edu/academics/dnp/curriculum_dnp/acnp_bsn_dnp.jsp

I have to say after seeing the curriculum, my opinion of the position has degraded several notches. I was even told that no "real" biochemistry or molecular biology is even required.

Despite the year of research, from the 3rd year, it looks like a "mini clerkship" is held in higher regard than physical and natural science, along with ever pervasive organizational management classes.

My good friend and I are under the agreement that NP is basically a clinically based education not meant to be a substitute for a physician and while many practice independantly or in critical care environments it is largely for "routine" healthcare that doesn't require a physician or in capacities where physicians would not be economically viable.

We also had a brief discussion on whether or not a nurse calling oneself a "doctor" was a "backdoor" medical route similar to testing out of a class or a betrayal of the nursing profession.

But after our chat, I can honestly say I don't feel my position will be in any danger. If some want to refer to themselves as "doctors" from academic degrees, let them.

As the dean here often says "Anyone can get a medical degree, but very few of them will ever truly be doctors."

 

[JPINFV]

Oh, I don't feel threatened at all by the rise of mid levels. Anything that can increase access to health care, especially primary care, while decreasing costs without sacrificing quality should be embraced. That said, I don't think it's fair to say that NP collaboration is completely different than PA supervision.

 

[VentMedic]

JP,

a friend of mine in this program sent this to me:

http://www.nursing.pitt.edu/academics/dnp/curriculum_dnp/acnp_bsn_dnp.jsp

I have to say after seeing the curriculum, my opinion of the position has degraded several notches. I was even told that no "real" biochemistry or molecular biology is even required.

Despite the year of research, from the 3rd year, it looks like a "mini clerkship" is held in higher regard than physical and natural science, along with ever pervasive organizational management classes.

My good friend and I are under the agreement that NP is basically a clinically based education not meant to be a substitute for a physician and while many practice independantly or in critical care environments it is largely for "routine" healthcare that doesn't require a physician or in capacities where physicians would not be economically viable.

We also had a brief discussion on whether or not a nurse calling oneself a "doctor" was a "backdoor" medical route similar to testing out of a class or a betrayal of the nursing profession.

But after our chat, I can honestly say I don't feel my position will be in any danger. If some want to refer to themselves as "doctors" from academic degrees, let them.

As the dean here often says "Anyone can get a medical degree, but very few of them will ever truly be doctors."

The fact that it doesn't rerquire certain classes does not mean someone can not take specific classes. Often people will take calculus even if just basic math is required just because of their goals. It is only those that want the minimalist's way of doing things that go only by the basic standards. And, we all know every university is exactly the same. Ever wonder why some move to a different location to find a school that meets their needs?

I don't know if you are speaking as a Paramedic or whatever but you do seem to have an issue with people achieving higher education and using the titles their degree allows them to use.

There are few doctors that are "intimindated" by physician extenders. Paramedics seem to be the ones who can not understand why they are not considered physician extenders by the true definition. They are also upset when they find out their skills and protocols are extended in out of hospital or in hospital situations to many different providers. Again, it is probably just insecurity on their part or a lack of understanding between "skills" and "education".

After I finish my Ph.D. sometime next year, I can also use the term "doctor". Those that are so insecure with a title need to find the root of those insecurities and address them as they do tend show up in one's professional being. If one can not acknowledge another person's academic acheivement regardless of the field, that person has a problem, not the profession using the title.

Back to the degree requirements. If one has looked at the Paramedic degree offered at community colleges, you will find it has be "dumbed down". College level A&P is replaced by the abbreviated coloring book or Reader's Digest overview. The two semesters of college pharmacology is now just a 2 credit Pharmacology for EMS. That is a sad statement when other professions are developing foundations to move to higher degrees while EMS is lowering what degrees it does offer. Of course, that doesn't mean those going for a degree in EMS can not take the regular college level A&P to be better prepared.

 

[BlazercatMedic]

EMS will never go away so job security is not really an issue, but the compensation still is. Of course all healthcare professions have suffered compensation cuts and hold backs due to the economy and the increse in cuts to insurance claim pay outs. It may soon be time to seek employment outside of medicine all together. Something new is always coming along that offers better opportunities and financial benefit.

What if you had been the guy created GOOGLE?

 

[Ridryder911]

JP,

a friend of mine in this program sent this to me:

http://www.nursing.pitt.edu/academics/dnp/curriculum_dnp/acnp_bsn_dnp.jsp

I have to say after seeing the curriculum, my opinion of the position has degraded several notches. I was even told that no "real" biochemistry or molecular biology is even required.

Despite the year of research, from the 3rd year, it looks like a "mini clerkship" is held in higher regard than physical and natural science, along with ever pervasive organizational management classes.

My good friend and I are under the agreement that NP is basically a clinically based education not meant to be a substitute for a physician and while many practice independantly or in critical care environments it is largely for "routine" healthcare that doesn't require a physician or in capacities where physicians would not be economically viable .

I will allow your own statement state for itself. I am really surprised and saddened by this. I was hoping the M.D'iety would not affect you. So in a nut shell; its okay to see someone else than a physician if it is an area that can not afford you? Yeah, we can see why the public opinion is changing.

R/r 911

 

[Juxel]

I'm going to refrain from saying too much as there's a lot that could come spewing out of me right now. I'm a nurse practitioner. Suffice it to say that I teach at a Big Ten medical school and the "molecular biology" that is taught there is not a comprehensive class by any stretch of the imagination.

My Ph.D. is in molecular biology and that just happens to be one of the courses I teach. Just because the medical schools call a class "molecular biology" and the nursing programs don't doesn't mean nursing students aren't getting the same or close to the same information.

 

[daedalus]

Hey! Let's at least give accurate and correct information! Let's leave ignorance behind, okay? Let's at least attempt to be truthful. Apparently from someone that has never been past the ER doors.

As one, that has explored the education and role of all of them. I know the P.A. education is based upon the medical model. I can assure you that the P.A. is nothing more than a low paid physician and gets to take care of whatever the physician does not want to take care of or cases not needing that specialist. Hence, they are their assistants or may work in rural areas as the role of a physician sometimes . As well, the P.A.-C is required to take their board every 6 years along with CEU's although they may focus with a specialist have to be familiar with general medicine. Technically, they do not have a speciality rather associate with link with a specialist.

(Here's a little education) At least Nurse Practitioner have a specific speciality & oh yeah, they are board certified to practice within their speciality without a physician not alike a P.A. that has to be tethered to a physician. They will be required to have a Doctorate level by 2012. I have seen a major change of using NP's in lieu of of P.A.'s due NP's work upon their own license and malpractice.

I am not even discussing Clinical Nurse Specialist that are as well focused and specialized in an area. They perform research and usually are linked to Speciality Physicians and again usually will assist in performing research or conducting detailed care. As their graduate level and license will be focused in that area alone, not within general medicine alike the P.A.

Unless you want to go to medical school for 8 years, then 3 years for internal medicine, then another 3-5 years (that is if you are the upper 10% of your medical school to enter a cardiology fellowship) (non-interventional) and additional if you want to perform surgical procedures.

Now, to the question. If you want to be a nurse be a nurse. Yes, there are speciality areas but I only would recommend this if you want to be in the nursing career. If you want to be a Paramedic then be a Paramedic. You know the role and yes its a profession within itself.

There are only a few states that have pre-hospital nursing and personally, I find it a foolish thing. There is nothing in nursing core courses to prepare you for prehospital care. In fact, the NCLEX (RN) exam cannot even ask any cardiology or trauma type questions as they are a speciality. One will focus after nursing and become a speciality and yes, that can range from cardiac to psychiatric. Alike the general EMT or Paramedic is not prepared to work within the hospital arena, it is not their function or role.

You can do both, just alike I did. I have a formal education in both. They require different education as they are different professions and each role has a specific function.

Get a guidance counselor and look at your options. Where do you really want to work in and focus upon?

R/r 911

This post is a slight bit disappointing to me, Rid. The PA is trained in the medical model, and there is no such thing as a comparison between NP and PA. While it is true that the PA career is a physician dependent position, this is exactly where their profession wants to be. They have no desire to function independently from their supervising physicians. Alike, PAs can indeed specialize. There are residency programs and fellowship programs for PAs in most subspecialties of surgery and medicine. It is not fair to elevate NPs on a pedestal when they are trained in advanced nursing practice, vs PAs who are trained to practice medicine in a team atmosphere.

Listing of PA-C residency programs (one year in length, certainly no replacement for an MD, but PAs can indeed specialize)
http://www.appap.org/index1.html

 

[daedalus]

The fact that it doesn't rerquire certain classes does not mean someone can not take specific classes. Often people will take calculus even if just basic math is required just because of their goals. It is only those that want the minimalist's way of doing things that go only by the basic standards. And, we all know every university is exactly the same. Ever wonder why some move to a different location to find a school that meets their needs?

I don't know if you are speaking as a Paramedic or whatever but you do seem to have an issue with people achieving higher education and using the titles their degree allows them to use.

There are few doctors that are "intimindated" by physician extenders. Paramedics seem to be the ones who can not understand why they are not considered physician extenders by the true definition. They are also upset when they find out their skills and protocols are extended in out of hospital or in hospital situations to many different providers. Again, it is probably just insecurity on their part or a lack of understanding between "skills" and "education".

After I finish my Ph.D. sometime next year, I can also use the term "doctor". Those that are so insecure with a title need to find the root of those insecurities and address them as they do tend show up in one's professional being. If one can not acknowledge another person's academic acheivement regardless of the field, that person has a problem, not the profession using the title.

Back to the degree requirements. If one has looked at the Paramedic degree offered at community colleges, you will find it has be "dumbed down". College level A&P is replaced by the abbreviated coloring book or Reader's Digest overview. The two semesters of college pharmacology is now just a 2 credit Pharmacology for EMS. That is a sad statement when other professions are developing foundations to move to higher degrees while EMS is lowering what degrees it does offer. Of course, that doesn't mean those going for a degree in EMS can not take the regular college level A&P to be better prepared.

Vent and I had a disagreement on the Doctorate for NPs a while ago. I can still say that I am very disappointed in the DNP curriculum, as it seems like it backed far far away from basic medical science. The patient contact hours required for the DNP program is equally as disappointing.

Though I may have may reservations, I think that Vene has the best mindset. "Many can have a medical degree but few will ever be doctors".
I like that one, thanks.

Oh boy this forum is starting to sound like SDN...

 

[Veneficus]

I will allow your own statement state for itself. I am really surprised and saddened by this. I was hoping the M.D'iety would not affect you. So in a nut shell; its okay to see someone else than a physician if it is an area that can not afford you? Yeah, we can see why the public opinion is changing.

R/r 911

I was under the impression that because of the lack of renumeration and other factors reducing primary care physicians in rural and underserved populations that some other form of provider would have to be utilized. I am not the one who coined the term "mid level provider." But I was quite shocked at the NP requirements, compared with both the MD and CRNA which seem to be more scientifically based in this particular case.

We have argued long and hard here that "experience" was no substitute for formal education, considering the amount of clinical vs. formal basic science in this program, it would seem hypocritical to hold medics to a standard of basic science and turn a blind eye to another provider whos "clinical time" was a majority of the degree doesn't it?

Or is nursing somehow due a special exception?


Vent,

I think you misunderstood my statement or i was not clear. I have no problem if people with academic degrees want to use whatever title they have earned.

The quote from our dean I believe specifically refers to the social position of "doctor" as opposed to somebody who has earned an MD but does not meet the what has become expected as the role in society. I am sure the same can be said of providers in any profession at any academic level. But I do appreciate what she says and how she says it.

 

[daedalus]

I was under the impression that because of the lack of renumeration and other factors reducing primary care physicians in rural and underserved populations that some other form of provider would have to be utilized.

I am under the same impression...

I thought that PAs and NPs were created specifically to address the current shortage of primary care medical doctors. What is to argue here?

 

[Ridryder911]

This post is a slight bit disappointing to me, Rid. The PA is trained in the medical model, and there is no such thing as a comparison between NP and PA. While it is true that the PA career is a physician dependent position, this is exactly where their profession wants to be. They have no desire to function independently from their supervising physicians. Alike, PAs can indeed specialize. There are residency programs and fellowship programs for PAs in most subspecialties of surgery and medicine. It is not fair to elevate NPs on a pedestal when they are trained in advanced nursing practice, vs PAs who are trained to practice medicine in a team atmosphere.

Listing of PA-C residency programs (one year in length, certainly no replacement for an MD, but PAs can indeed specialize)
http://www.appap.org/index1.html

Actually majority of the P.A.-C is generalized practitioners. Yes some P.A.-C. may become specialized and may work beside a specialist and or may never received any fellowship programs. Where as NP's are automatically specialists within their scope or license. One has to choose a speciality and focus within that area if they want to increase their speciality they have to expand their education and take board certifications as such. In other words a neonate cannot work upon an adult vice versa. After receiving their B.S. or BSN and required work experience they then can choose the speciality from family medicine to neonate, acute care, geriatrics, family practice.

Be careful attempting to compare educational programs between the two. Really do not know how the medical model are recognized in some courses. There are still P.A. programs that only still produce an associate degree level and or Bachelor degree where as the NP is at least graduate and maybe PhD level. Yes, alike EMS programs they are increasing their level of education. Many of the graduate levels are more difficult to enter than some medical schools. As one that had started both, I stopped the P.A. program and entered the NP because I appreciate the NP approach of holistic medicine. I much rather treat the whole patient instead of just the traditional approach.

Again, I have researched both intensely. There are great and very little differences in many of their philosophies. I never heard of any (both professions) ever describe they were a replacement for physicians but may fill the void and provide the same if not better services.

R/r 911
http://www.universities.com/edu/Ass..._at_Abraham_Baldwin_Agricultural_College.html
http://www.pct.edu/schools/hs/bpa/
http://www.mdc.edu/medical/academic_programs/physician_assistant/physician.htm