Regulation of prehospital nursing practice: a national survey

In 1988, the National Flight Nurses Association and ENA published a revised joint position statement advocating that registered nurses (RNs) "should not be required to certify as Emergency Medical Technicians (EMTs) at any level before assuming a nursing role in the prehospital environment." The position endorsed a collaborative role with emergency medical services agencies, regulation of prehospital nursing by state nursing agencies, and additional educational requirements in areas unique to prehospital emergency care. This study examines the existing state of affairs in the regulation of prehospital practice of RNs throughout the United States.

Data were obtained by review of written state rules and regulations pertaining to certification of prehospital care providers and by telephone survey of state emergency medical services agencies nationwide.

All 50 (100%) of the states were contacted. In 44 of the 50 states (88%), no certification in prehospital nursing exists. As a result, most states require that RNs become EMTs at some level as a prerequisite for prehospital practice. Of these states, 36% (16/44) allow RN substitution to meet ambulance staffing requirements without additional certification requirements. Of these states, 61% (27/44) require RNs to complete the entire EMT curriculum to obtain certification, whereas 39% (17/44) allow challenge examinations in combination with varying other educational requirements. Nursing "certification" for prehospital practice exists in 12% (6/50) of states.

As a nation, we are far from actualizing the recommendations stated in the ENA and National Flight Nurses Association position.