Paramedic Vs Registered Nurse

Discussion in 'Other alternatives' started by Thom, Aug 23, 2014.

  1. Thom

    Thom New Member

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    Hi guys,

    this may seem like a really dumb question, but apart from the obvious things, what are the main differences between paramedics and nurses.
    IE: What are the main differences in what a paramedic can or cannot do as compared to a RN?

    Are there things a nurse can do that a paramedic isn't allowed to, such as administer certain meds for example, whereas a RN may not be allowed to intubate (not sure)?

    i have just applied for paramedic degrees at both UTAS and UWS with RN degree as a backup. I'm thinking at this point paramedic is the way to go, but thinking RN may provide more specialist routes for long term career development?
    The NSW ambulance site is rather limited as to what specialities a paramedic can take.

    if we have any paramedics on here, I'd love to hear from you.

    cheers

    thom
     
  2. perthmale

    perthmale Regular Member

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    The main difference obviously is job setting. As a paramedic your first on the scene, working out of an ambulance etc. Dont fall into the trap of the intubation and trauma, as 80% of your job as a paramedic is actually routine transfer of patients between hospitals or from Nursing homes, or general pick up of patients, lots of psych, abdo pain, chest pain, assessment of these (within 10-15 min transfer times to hospital) etc. Generally the advanced paramedics are the one's doing the intubation as they form the rapid response teams. Burn out is high for paramedics, and many go into industrial/mining OHS/paramedic roles, as pay and conditions much better. RN, you need to be willing to do basic care of patients, but lots more career choice in terms of job roles, specialties etc, and employment prospects wider. Depending on specialty you do give more drugs, ICU/ED/CCU, but then these are medically ordered. If your unsure some uni's do offer double degrees in nursing and paramedicine, which may be a good option. In NSW nurses joining the ambulance service do less training time also.
     
  3. Thom

    Thom New Member

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    Thanks for the reply mate.
    Given where I live, on the Central Coast of NSW, and with having a family and mortgage etc, I'm pretty limited to where I can study. UTAS in Rozelle is my 1st choice for the Paramedicine. My 2nd choice is UWS at Campbelltown, although that will be a 2 hour commute each way for each day I would be there. All other options, mainly nursing degrees are aimed at getting me access to the Paramedicine degree. That being said, I can do the nursing degree a lot closer to home.
    Becoming a Paramedic, then going on to advanced care or any other speciality is my goal. Does this require much further specialist training or is related to time served as well?

    Many thanks.

    Thom
     
  4. depressedchild

    depressedchild New Member

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    I think a 2 hour commute is crazy! In my opinion, you are better off doing the nursing degree if you dont get the offer from UTAS. A nursing degree itself opens a lot of pathways and I think job opportunities are a little bit better seeing what is going on with paramedics atm. Plus, you can always do postgrad paramedicine after nursing. Not only will you be eligible for credit transfers, you will also be equipped with some nursing skills that can be applied to paramedicine.

    And yes, once you are a paramedic, moving on to more advance speciality will require further study. But you can have on the job training, funded by your employer if you are good.
     
  5. n33b

    n33b FIRST!!! Moderator

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    As a paramedic I think your scope of medical practice would be broader than an RN's. I imagine the role would involve far more diagnostic and management requirements than an RN would have to do, including taking patients' history and performing examinations routinely. As far as administering medication, I doubt you'd be administering as much as an RN would but you'd be prescribing more (e.g. things like morphine in severe pain or adrenaline in a cardiac arrest - don't need a doctor to prescribe this to administer it as a paramedic, whereas a nurse can't prescribe such meds).

    With intubation, I doubt you'd be doing this frequently as a paramedic and I'd think never as an RN. Patients will usually have this done by doctors in ED at the earliest. Not too sure about advanced training pathways for paramedics or RNs though. I'd think being an RN would offer more speciality pathways and possibly better career security in that sense, but I've heard complaints from both groups re: limited job positions, as with just about everything else these days...
     
  6. depressedchild

    depressedchild New Member

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    I agree that being a paramedic will give you more scope of practice because from what I herd, they can also do IV cannulas without having a certificate. What is good about nursing is really the job security and pathways. You can always work your way up to be nurse practitioner which gives you the freedom to diagnose and treat certain disorders under the supervision of a doctor. In the end I guess there are pro and cons to both nursing and paramedics. It is hard to choose between the two both they are both similar yet different in so many aspects. To the OP, if u can, you should consider doing a double degree because they both go hand in hand with each other!

    seeing that applications is almost closing, what did you put as first preference? :)
     
    Last edited by a moderator: Sep 28, 2014
  7. charliebes

    charliebes New Member

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    My vote goes for paramedic career, as it carries a great scope as a profession. Apart from the carrying the patient to the destination it helps you work in extreme conditions. You can always choose nursing and complete your paramedic refresher course online .
     
  8. perthmale

    perthmale Regular Member

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    Are you joking? paramedics do not prescribe, they administer according to strict protocols. The job is very protocol driven, i.e. chest pain, aspirin, GTN, fentanyl etc. Assessment is no different to what an RN does in ED or ICU, physical assessment is also part of RN role. Working off protocols is no different to doctors prescribing and RN administering from medication chart, i.e. GTN, as the RN still needs to assess when to give GTN, i.e. is BP ok, is it chest pain etc. Actually 70-80% of a paramedic job is transporting patients, and this is what they tell all applicants. Paramedics can progress to become advanced paramedics, who have more advanced skills, i.e. intubation, but then that is akin to RN becoming a Nurse Practitioner, who can then prescribe etc. Paramedic career is more streamlined but then less options and burn out is high, horrific scenes and many mental health scenarios... Nursing can be more mundane but opens up way more career options.
     
  9. xxDanniixx

    xxDanniixx New Member

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    I would pick paramedic, it's just more interesting to me... But then again the choice is yours
     
  10. n33b

    n33b FIRST!!! Moderator

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    I really don't think it's that simple. You make paramedics out to be like robots... I feel like their role involves things doctors and nurses both do, only it's outside of hospital. More often would they take comprehensive histories and corroborative histories than a nurse would. (Have you worked with nurses much? You'd be surprised how many nurses will call you to review a patient with chest pain and then not know which side it's on or other associated symptoms or obs or... anything. Compare this with the Hx you get on paramedic's notes which go far beyond "patient has x, please review"). The same goes for physical assessments beyond taking obs. Maybe ED and ICU nurses are an exception, but still I doubt their diagnostic knowledge and practical skill-set would rival that of a paramedic.

    And why should nurses bother with clinical knowledge beyond what they need to provide basic care for patients? After all it's not likely that a doctor will take a nurse's word for the patient's history, examination findings or interpretation of investigations. And the nurse's obligation is only to inform the doctor and escalate to a clinical review or MET call when required. Compare this with a paramedic, who's all on his own until they reach the hospital and must make prompt decisions about the patient's treatment. Entirely different IMO.
     
  11. Kiwiology

    Kiwiology MSO Lawyer

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    Wrong.

    Paramedics today are more looking to a "community health focus" as the future of the profession. Less about driving to somebody on red lights, doing some treatment and taking them to the hospital. The system is evolving towards assessment, treatment and referral independent of the need to transport somebody to hospital. Most states in Australia have very liberal guidelines (incorporating standing orders) which allow for a large degree of autonomy and discretionary decision making based on clinical judgement.

    The day will come when Paramedics are registered and regulated under AHPRA (AU) and the HPCA (New Zealand). This will largely give them the same credibility as Nursing when it comes to choice and portability of qualifications.

    A number of double degree Paramedic/Nursing programs are available. At the moment Paramedics are fairly restricted in that they can only work for in the pre-hospital arena given they are not a regulated profession. In the future this is likely to change.

    Being a Paramedic is more interesting/diverse and allows for a much greater degree of clinical autonomy than being a Nurse. However, if I had to pick, I'd do a double degree Paramedic/Nursing or if that was not an option I'd honestly do a nursing degree first. You can always transition from Nursing to Paramedic but the other way around is quite difficult. You will gain a much broader exposure to general medicine as a Nurse that you won't as a Paramedic and I think this would be very helpful given that the Paramedic model is shifting away from "lights, siren, trauma, cardiac arrest" and more towards "Hmm, Nana has all these co-morbidities and has called us today because her family that cares for her is busy, and she doesn't know how to cope and these pills are all crushed up into the carpet because she has tried to take them herself but it hasn't worked and she stood on them and her GP can't see her today and if we take her to ED she is going to be ATS 4 and wait in triage for hours and hours and hmm what should we do to meet her healthcare needs most effectively and efficiently ....".
     
  12. Thom

    Thom New Member

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    Thanks for all the replies everyone.

    Is anyone who who replied to this thread an NSW Paramedic, or are these Nurse or other out of job perceptions?
    i was hoping for the joint degree, but the nearest one is CSU at Bathurst, and with living on the Central Coast it's just too far away. I was thinking of doing the nursing degree then trying to find a conversion course, but being 35 in April, taking time out to study at my age is hard enough.

    So so far I am waiting to hear if I have been accepted to UTAS for the paramedic degree as of yet, but have been accepted to Nursing at Newcastle (Ourimbah campus). I have had to defer till the 2016 intake though due to finances. Pesky mortgage etc!
     
  13. Syn

    Syn Regular Member

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    Agreed with n33b. ED nurses are no exception! They take simple obs at the start then hand the patient off with a one-liner, such as abdo pain, chest pain, etc... no history, nothing else. Half the time the triage nurses can't even spell. I don't think nurses can even read ECGs (which I believe paramedics can, atleast to a minimal extent). I remember a nurse with almost 30 years experience, asking me about a neonate's unremarkable ECG.

    I'm going to stop myself there, because I can go on and on about nurses, and that will just hijack this thread. I think the main difference is that a nurse's job is basically as a technician, they give out drugs, take obs, change catheters, take tea breaks, and first sign of a deteriorating patient, they escalate it (as they should). A paramedic on the other hand, I believe, has to think about the patient a lot more, and has to triage and treat them on the spot. They have to be prepared for anything from a mild case of indigestion to a horrendous MVA. Most of the time they are all alone (alone as in without a doctor) in the field, and have to make life saving decisions on the spot, and administer treatments on the spot. One huge difference I found in ED is that the paramedics are extremely adept at inserting cannulas, whereas nurses won't even go anywhere near them. In fact, I believe nurses need some sort of specific qualification to do cannulas, which most do not have.

    Personally, I would definitely have gone with Paramedicine over Nursing, if that was a choice I had to make.
     
  14. chinaski

    chinaski Regular Member

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    [offtopic]Oh boy…[/offtopic]
     
  15. Kiwiology

    Kiwiology MSO Lawyer

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    [MENTION=8781]Syn[/MENTION], as an aside you'd be surprised, Paramedics are now taught to do full 12 lead ECG interpretation; STEMI +/- mimics, axis deviations, bundle branch blocks, electrolyte disturbances, all sorts of things, some are even thrombolysing STEMIs autonomously. Many nurses are also incredibly competent at interpreting ECGs, particularly in CCU and ICU where Doctors are a bit harder to come by and you have to think for yourself a wee bit more than in ED which is (generally) flush with medical staff to ask for immediate help.

    I shall leave this here otherwise we're going to get into a measuring match but I thought you would be interested.
     
  16. chinaski

    chinaski Regular Member

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    "Autonomously" is a bit of a stretch in this context. Pre-hospital thrombolysis programmes are not new, but they don't exist with ambos working independently. Rather, they work as a part of an integrated team, which also includes doctors who provide supportive interpretation of ECGs (which are transmitted to them) prior to the clinical decision being made to lyse.
     
  17. Syn

    Syn Regular Member

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    Yes, as far as I know, I don't think they can make the decision to thrombolyse themselves. In my rural experiences, I've found that ambos generally send the ECG to the local cardiologist's phone, who then makes the decision to thrombolyse or transfer to a cath lab, or sit and wait, depending on many number of factors, not just based on the ECG itself.
     
  18. chinaski

    chinaski Regular Member

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    Correct. The protocols for PHT are pretty clear. This is not to under-represent the role of the ambos in this process; merely to point out that they are not autonomous practitioners.
     

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