FNP/Paramedic in the ICU

[762513]

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Hey Everyone,

So I'm a DNP FNP student. I decided to go the FNP route for a few reasons: the tuition is 100% free with my military benefits, only one of two programs in my state to be covered, and I wanted to have flexibility in my role. I am also a Paramedic with National Registry and State License and critical care endorsement. I do not actively work on the rig anymore, because 15.00 is not very enticing when you can make 38.00 an hour, however I worked pre-hospital for a decade, and I think it's fair to say I still have (rusty) skill set in that area.

My thought has been to keep my Paramedic current as I have for many years as a way to transition into an ICU role. Does anyone have any knowledge or experience in this area? Will being a Paramedic/DNPFNP be looked at favorably by intensivists?

I would appreciate feedback from people who have been there.

Thanks!

 

[deleted6669]

I would assume so. I am an emergency med PA and have gotten several jobs, including solo coverage rural jobs, specifically because of my prior medic experience. folks like the fact that you know how to manage an emergent airway and run a code, start your own lines, deal with all manner of badness, improvise, etc.

 

[762513]

I think I will keep it refreshed. It's just an expense of time and money, wanted to check if people thought it was worth keeping. Thanks for your input.

 

[BreathDeep]

It might be a small point, but could see you being popular during codes, especially if there's a shy intensivist or two who don't like to, or just aren't that good at, running them. Same goes for rapid responses.

At my hospital we have four intensivists, all of them extremely talented physicians. Unfortunately even though two of them are very good during codes, the other two leave much to be desired. They mean well and all, but as soon as things get hairy they turn into frazzled and disjointed messes. I would take the NP who was an experienced paramedic to run the code 10/10 times.

 

[ChrisNP87]

I'm not sure if that will help you in the near future. I know Northwell Health is requiring all NP's who do not possess an acute care degree/certification, like those who are primary care based (FNP, ANP, & PNP), to go back to school for a post master's certificate or they'll be let go. This program is about 12 credits and can be completed in about a year. I'm sure your experience as a medic has helped you tremendously in your practice in regards to codes, intubation, and critical care drug administration but the credentialing agencies want master's and doctoral prepared acute care (ENP/AGACNP/CPNP-AC/etc.) NPs in the hospital setting and primary care NPs in the outpatient settings. Unless you plan on using your EMT-P for work or volunteer purposes there is almost no reason to keep it, as an NP is above an EMT-P in the hospital setting. Good luck to you!

 

[762513]

I'm not sure if that will help you in the near future. I know Northwell Health is requiring all NP's who do not possess an acute care degree/certification, like those who are primary care based (FNP, ANP, & PNP), to go back to school for a post master's certificate or they'll be let go. This program is about 12 credits and can be completed in about a year. I'm sure your experience as a medic has helped you tremendously in your practice in regards to codes, intubation, and critical care drug administration but the credentialing agencies want master's and doctoral prepared acute care (ENP/AGACNP/CPNP-AC/etc.) NPs in the hospital setting and primary care NPs in the outpatient settings. Unless you plan on using your EMT-P for work or volunteer purposes there is almost no reason to keep it, as an NP is above an EMT-P in the hospital setting. Good luck to you!

I would like to volunteer with my paramedic in the future. I'm also a ICU RN going for my FNP and yes I am popular in codes. Being able to actively help with intubations is a bonus, recently I helped with a bedside crich.

Im speaking with the head of our intensivist about doing my residency with him. I think it's more pallatable if I hold a Paramedic license as he knows I am at least familiar with a slightly broader skill set.

 

[Boatswain2PA]

Re: paramedic/RN running codes vs MD/PA/NP running codes.

Paramedics/RNs, and other non-provider types generally stick with the ACLS protocols.

A MD/PA/NP who routinely runs codes should practice well beyond the ACLS protocols. No need to do a pulse check, and therefore drop their MAP to zero, every 2 minutes when the EtCO2 is 25. PEA arrest? Grab that ultrasound. The list is long.

That being said, being prior military/medic/firefighter/cop often gives you the ability to control your OWN pulse when the Fits hitting the Shan, and can make you the go-to-person.

 

[762513]

Re: paramedic/RN running codes vs MD/PA/NP running codes.

Paramedics/RNs, and other non-provider types generally stick with the ACLS protocols.

A MD/PA/NP who routinely runs codes should practice well beyond the ACLS protocols. No need to do a pulse check, and therefore drop their MAP to zero, every 2 minutes when the EtCO2 is 25. PEA arrest? Grab that ultrasound. The list is long.

That being said, being prior military/medic/firefighter/cop often gives you the ability to control your OWN pulse when the Fits hitting the Shan, and can make you the go-to-person.

Agree. Believe it or not recently we were doing a bedside crich during a code and by ACLS protocol we stop compressions for pulse checks every 2 minutes. The physician was busy cutting and I made the decision that a pulse check was pointless until we establish an airway, and simply continued doing CPR until we did. The patient was coded for 15 minutes a total of 4 times and left the hospital a week later with no neurological deficits. The point is that sometimes the Physician is doing a procedure and someone else must step in.

 

[BreathDeep]

Re: paramedic/RN running codes vs MD/PA/NP running codes.

Paramedics/RNs, and other non-provider types generally stick with the ACLS protocols.

A MD/PA/NP who routinely runs codes should practice well beyond the ACLS protocols. No need to do a pulse check, and therefore drop their MAP to zero, every 2 minutes when the EtCO2 is 25. PEA arrest? Grab that ultrasound. The list is long.

That being said, being prior military/medic/firefighter/cop often gives you the ability to control your OWN pulse when the Fits hitting the Shan, and can make you the go-to-person.

Very true. This is why I actually love my hospitals set up -- Two RT's and an ER RN show up and run the show initially, RT intubates while the RN (or other RT until the RN arrives) runs through ACLS, and once the ED and ICU MD arrive they can stand back, take in the whole clinical picture, and then act accordingly without having to also direct us through an algorithm we know anyway. It lets them spend more time thinking about the "why" behind the code and how to appropriately intervene while us worker bees handle the standard details. Having the two physicians on hand also allows more focus intensive interventions (placing central lines and such) while ensuring that if things turn south again you still have someone competent at the helm. Might be a bit overkill having 2 physicians, 2 RT's, and an ICU and ED RN, but since its implementation our codes are thing of beauty compared to the out of control dumpster fire they used to be.

 

[Boatswain2PA]

Very true. This is why I actually love my hospitals set up -- Two RT's and an ER RN show up and run the show initially, RT intubates while the RN (or other RT until the RN arrives) runs through ACLS, and once the ED and ICU MD arrive they can stand back, take in the whole clinical picture, and then act accordingly without having to also direct us through an algorithm we know anyway. It lets them spend more time thinking about the "why" behind the code and how to appropriately intervene while us worker bees handle the standard details. Having the two physicians on hand also allows more focus intensive interventions (placing central lines and such) while ensuring that if things turn south again you still have someone competent at the helm. Might be a bit overkill having 2 physicians, 2 RT's, and an ICU and ED RN, but since its implementation our codes are thing of beauty compared to the out of control dumpster fire they used to be.

Great way of doing it. This also helps with downstream care. The EP can head back to the ED, while the intensivist can just admit the pt to the ICU without needing additional briefing from theEP.