Clinical Experience- EMT vs CNA vs Phlebotomist

[L2014]

Hello!

 

As far as clinical experience goes, I know many schools don't require clinical experience but it is highly recommended. I am planning on getting a certification this summer to start logging hours. Does anyone have any advice on which would be best between an EMT, CNA, and Phlebotomist?

 

Thanks!

[EMEDPA]

emt>cna>phleb

[viking]

cna>emt>phleb I'm a CNA and an EMT and I can tell you that I've worked more and learned more as a CNA than as an EMT. The issue with EMT is that there can be too much sitting around waiting for the bell to ring. Thus a 12 hour shift might equal 3 hours with a patient. I can say definitively that as a CNA at a Post-op ICU my 12 hour shift is 100% with patients and nurses and docs learning.

[Timon]

EMT can be a lot of things. It's really where you're working. I put EMT in an ER over everything except RN, EMT-P and RT. The moral of the story is where you are getting your experience from not what alphabet cert you have. I put CNA in hospice or home caregiver below IFT EMT-B. I would also put CNA in a hospital outside of ICU or ER equal to an IFT EMT-B.

 

In terms of training, you learn more medical related issues through EMT-B versus CNA which is more nursing and bedside manner type of training.

 

Phlebotomy should be treated as an accent certification such as ACLS / PALS / NRP. Like the other alphabet certs just mentioned it'll open up opportunities to do more. If you want a job as an ER Tech it doesn't matter if you're a CNA or EMT, each hospital will have their preference. But some may require you to have that phlebotomy license as well. So pick one EMT/CNA and get your phlebotomy to accent those certifications.

 

Just throwing that out there.

[EMEDPA]

agree.

emt as er tech is awesome.

emt doing bs interfacility transports all day long, not so good.

cna as pt care tech in hospital is good. cna at nursing home doing bed baths and feeding folks, not so good. you will learn to work with people but very little about medicine.

 

as an er tech I was scheduled interchangeably with rn's after a few years and was trained to start iv's and push iv meds, draw blood, give injections, run all the lab equipment, do ekg's, splint, first assist minor surgery, give neb tx, etc

[Friction]

agree.

emt as er tech is awesome.

emt doing bs interfacility transports all day long, not so good.

cna as pt care tech in hospital is good. cna at nursing home doing bed baths and feeding folks, not so good. you will learn to work with people but very little about medicine.

 

as an er tech I was scheduled interchangeably with rn's after a few years and was trained to start iv's and push iv meds, draw blood, give injections, run all the lab equipment, do ekg's, splint, first assist minor surgery, give neb tx, etc

 

An ER tech giving meds... that must have been a long time ago ;)

 

As everyone has said, it really does depend on the unit you get on. Working the field as an EMT is dumb in my opinion, you're basically a glorified ambulance driver. Not very much quality pt care imo. I worked the past 14 months in the ED as a tech and I've learned an incredible amount, probably even more so than my Navy Corpsman training. CNA will probably afford you more job opportunities as most the floor units strictly use CNA and not EMT.

[EMEDPA]

worked as an er tech 87-92.

a field emt working 911 calls with a medic can learn a lot. a field emt doing bls transfers, not so much.

[Friction]

worked as an er tech 87-92.

a field emt working 911 calls with a medic can learn a lot. a field emt doing bls transfers, not so much.

 

Would've been two years old when you started as a tech, crazy that you've been in medicine for as long as I've walked God's green Earth. I agree you can learn a lot being paired up with a medic, but I still don't think you deliver very much pt care. At least not compared to an ER Tech.

[EMEDPA]

Would've been two years old when you started as a tech, crazy that you've been in medicine for as long as I've walked God's green Earth. I agree you can learn a lot being paired up with a medic, but I still don't think you deliver very much pt care. At least not compared to an ER Tech.

depends on the relationship of the medic and the emt. in many partnerships the responsibilities get blurred.

[SopranoKris]

I just finished my phlebotomy certification and I really enjoy it. I was a CNA back in the 90s and unless you want to wipe behinds and make beds all day long, do something else! I don't want to sound disparaging but being a CNA was a grunt job (worked at a nursing home). Doing phlebotomy, I work with patients all day long. I do morning rounds on the hospital floor, then work in the lab and go do stat draws in post-op and the ER. I love it! I'm making great contacts at the hospital and I'm hoping they'll allow me to learn to do IV starts soon. I have a lot of confidence in my skills. I'll be taking my ASCP exam in 3 weeks.

 

I don't know about your area of the country, but around here, the waiting list to get into an EMT program is unreal. Even then, once you get through...good luck getting a job. I know this varies by city/state, but it's something to consider before pursuing a particular track.

[Timon]

Good luck on the ASCP. It's worth paying for the practice tests from their website. Probably one of the hardest tests I've taken including all of my prerequisite classes and other alphabet certs.

[cnguyenle]

I'd say phleb, you might pick up on what some of the lab tests do and are for, have patient contact, dont have to do "grunt work" as stated above, and wont have to find a EMT job that has a hit and miss for patient contact/care. But thats just my opinion :P

[Friction]

I'd say phleb, you might pick up on what some of the lab tests do and are for, have patient contact, dont have to do "grunt work" as stated above, and wont have to find a EMT job that has a hit and miss for patient contact/care. But thats just my opinion :P

 

I think this is very good advice. If you can get direct patient experience working as a phleb and learn the lab testing aspect, and avoid the grunt work, you'll probably get a lot out of the job. While I don't necessarily think its as good as ER tech experience, I think it can be very useful in the long run. While I know a decent amount being an ER tech, I certainly don't know as much as a lab tech/phleb would know about how and why tests are run.

[Timon]

I think this is very good advice. If you can get direct patient experience working as a phleb and learn the lab testing aspect, and avoid the grunt work, you'll probably get a lot out of the job. While I don't necessarily think its as good as ER tech experience, I think it can be very useful in the long run. While I know a decent amount being an ER tech, I certainly don't know as much as a lab tech/phleb would know about how and why tests are run.

 

Thats why you get both. A lot of sites require an ER Tech to do a 12 lead and have a phlebotomy license. A lot of CNA and MA jobs require a phlebotomy license as well. Knowing the tests, testing errors, and the significance behind those tests will really increase your understanding of what's going on. I started my first job ever in healthcare as an ER tech 5/152012. In that short time ive learned exponentially moreso then the other techs i work with.

 

Its because I pay attention and had the education that allows me to understand and fill in the gaps and ask appropriate questions. Like for example if someone comes in tachycardic, temp of 101, and lab results come back with 20k WBC count, 10% banding you know this guy is septic and for every hour antibiotics are withheld mortality increases by 3%, Or if someone comes in and has a high BUN and Creatine you know there's probably some type of renal failure, or if someone comes in with a HCT of 8 and Hemoglobin of 25 with a complaint of general weakness you know they probably need a transfusion. Or if someone has a potassium of 3.0 they're probably going to be an ICU patient and needs k-light or dialysis, or if its at 8 they're probably going to give kayexalate and to have that bedpan, flexiseal, or commode ready.

 

Having both really puts you ahead of the game. Not to mention you get to increase your scope of practice because of the dual cert / licensure. Having multiple certs has really allowed for me to spend more time learning and less time doing grunt work because when I see something I'm not familiar with I ask about it and learn from it then act accordingly in anticipation for what may be needed to help the RNs and Docs do their job.

[cinntsp]

I think this is very good advice. If you can get direct patient experience working as a phleb and learn the lab testing aspect, and avoid the grunt work, you'll probably get a lot out of the job. While I don't necessarily think its as good as ER tech experience, I think it can be very useful in the long run. While I know a decent amount being an ER tech, I certainly don't know as much as a lab tech/phleb would know about how and why tests are run.

 

Phlebotomists don't know how or why tests are run. They draw blood. The exception may be some point of care testing(i.e. finger prick glucose, etc). Even lab techs(MLT) don't know much of the why. Medical laboratory scientists aka medical technologists are the ones with the deep lab knowledge(other than the pathologists). MLS(ASCP) and MT(ASCP) are the credentials to look out for. :)

[Friction]

Phlebotomists don't know how or why tests are run. They draw blood. The exception may be some point of care testing(i.e. finger prick glucose, etc). Even lab techs(MLT) don't know much of the why. Medical laboratory scientists aka medical technologists are the ones with the deep lab knowledge(other than the pathologists). MLS(ASCP) and MT(ASCP) are the credentials to look out for. :)

 

I'm sure this is very much dependent upon the state, because here in AZ the phlebs are also lab techs, at least within the Banner Health system. I'm sure they have some inclination of what is being run and why, or at least I hope so. To Timon: I work as an ER tech, do both 12 leads and draw blood/start IV saline locks (not sure how that legal for an EMT/CNA), and I couldn't tell you the majority of tests that are being run and why, except for maybe trop and a few others. If I had more time I would certainly be asking though :)

[cinntsp]

I'm sure this is very much dependent upon the state, because here in AZ the phlebs are also lab techs, at least within the Banner Health system. I'm sure they have some inclination of what is being run and why, or at least I hope so.

 

It's not dependent upon the state because these are national certifications handled by the ASCP. You may just be confused by various titles. Lab tech is an often misused term that actually refers to MLT, essentially the associate's level lab personnel. MLTs are used in some places but many larger institutions have phased them out in favor of MLS', the folks that have a bachelor's or higher, have attended a CLS program, and are qualified to interpret lab results/develop QC/etc. Now...some MLT and CLS programs do also teach phlebotomy as part of the curriculum so it's possible you have some MLTs drawing blood as well(MLS usually don't unless it's somewhere rural/small). You may also be seeing folks trained in point-of-care CLIA-waived testing that are being called "lab techs."

 

MLTs and to a greater degree, phlebotomists, don't receive the same depth of education. Knowing that a troponin is being run as a cardiac marker is not the same thing as understanding the physiology behind it, how it should be interpreted, etc. Hopefully that helps clarify things.

[ToppDog]

True, but in many instances phlebotomists do more than just obtain the samples. They may work as "lab assistants" which would give them a considerable amount of exposure to the inner workings of the reference lab & hospital lab environments. In such a case, there is a ton that a phlebotomist can learn by working directly with the various tech's & pathologists. In the same way that you described tech's sometimes being trained to draw blood, phlebotomists are sometimes trained to do some of the tasks that tech's are trained to do.

[Friction]

True, but in many instances phlebotomists do more than just obtain the samples. They may work as "lab assistants" which would give them a considerable amount of exposure to the inner workings of the reference lab & hospital lab environments.

 

I agree with both of you, but this is kind of what I was getting at.

[dreatx]

I'm an EMT-P in a medium city in a 911 service. We run basics, as well. The thing an EMT job allows is decision making. If I hand over a patient to a basic, that person assesses them and treats them, based on their training, not on what they are told to do. Additionally, the basics need to be able to recognize situations they can't handle, and fast. I think that learning to think that way would be a great preparation for being a PA. Also, the basics get to experience what it is to be truly accountable for their medical choices. As an EMT, you can easily find yourself in front of the call review board, explaining why you took the actions you took. Working, with that in mind, seems like another good prep for life as. PA.

[SopranoKris]

Phlebotomists don't know how or why tests are run. They draw blood. The exception may be some point of care testing(i.e. finger prick glucose, etc). Even lab techs(MLT) don't know much of the why. Medical laboratory scientists aka medical technologists are the ones with the deep lab knowledge(other than the pathologists). MLS(ASCP) and MT(ASCP) are the credentials to look out for. :)

 

That's not necessarily true. My phlebotomy program required that we learned what all the lab tests are testing for. I got my certification through a college, not a fly-by-night med asst. school or a weekend phleb class. When I did my externship at the hospital, I knew more about testing that some of the phlebotomists that have been on the job for years, because my training was so thorough. It pays to do your research before you choose a school to get your training!

[Timon]

That's not necessarily true. My phlebotomy program required that we learned what all the lab tests are testing for. I got my certification through a college, not a fly-by-night med asst. school or a weekend phleb class. When I did my externship at the hospital, I knew more about testing that some of the phlebotomists that have been on the job for years, because my training was so thorough. It pays to do your research before you choose a school to get your training!

 

I agree. I did mine through UCI Medical Center. We learned everything accellerated but very detailed. Had to memorize all the clotting factors, coagulation cascade, additives and their mechanism of action, what test for what tube and what the test was testing and why it was ordered, etc. We did nearly 300 VPs in 2.5 weeks inpatient and outpatient settings and had to observe arterial punctures. Had to do finger sticks and VPs on all demographics (new born, peds, adult, geriatric, bariatric, etc. Most of our draws were on chemo / dialysis patients so every stick was a hard stick for the most part. We also had to use all of the point of care testing devices. Glucose tollarence tests (1hr to 3hr). Did special VPs for research and serology (like 20 yellow tubes for eye drops). It was a great experience. When I speak with other phlebotomist they tell me they had a hard time getting VPs and didn't nearly have the depth of training we got.

[cinntsp]

That's not necessarily true. My phlebotomy program required that we learned what all the lab tests are testing for. I got my certification through a college, not a fly-by-night med asst. school or a weekend phleb class. When I did my externship at the hospital, I knew more about testing that some of the phlebotomists that have been on the job for years, because my training was so thorough. It pays to do your research before you choose a school to get your training!

 

I agree. I did mine through UCI Medical Center. We learned everything accellerated but very detailed. Had to memorize all the clotting factors, coagulation cascade, additives and their mechanism of action, what test for what tube and what the test was testing and why it was ordered, etc. We did nearly 300 VPs in 2.5 weeks inpatient and outpatient settings and had to observe arterial punctures. Had to do finger sticks and VPs on all demographics (new born, peds, adult, geriatric, bariatric, etc. Most of our draws were on chemo / dialysis patients so every stick was a hard stick for the most part. We also had to use all of the point of care testing devices. Glucose tollarence tests (1hr to 3hr). Did special VPs for research and serology (like 20 yellow tubes for eye drops). It was a great experience. When I speak with other phlebotomist they tell me they had a hard time getting VPs and didn't nearly have the depth of training we got.

 

You don't know what you don't know. That'll become clearer once you're both actually in PA school and doing phys, clin lab, hem/onc, and so forth. Knowing that a CBC is run on a purple top is irrelevant. Knowing what tests are components of the CBC is more helpful. Knowing how to use a CBC along with a few other labs to differentiate between various anemias, CA, infection, etc. is what's important. That is not taught in phlebotomy programs because it is irrelevant to them. That's where the MLS and to a lesser extent the MLT comes in. If you have clin lab guys in your programs you will see the difference. My point wasn't to bag on phlebotomists; I was just clearing up the differences between the lab-related professions for Friction and anyone that may be interested in one of these careers.

[Timon]

I agree with you most programs teach you just tubes to tests. What I am saying the program I went to taught the significance and purpose of those tests. We shared the didactic with the CLS going through the program. Granted we didn't go through all the tests but the more common ones we were going to run. So we knew when we pulled a EDTA tube for a CBC it was to check for anemia and sepsis versus drawing a A1C for diabetes management (since an A1C is looking at the number of RBCs that are glycosylated vs a CBC is counting what type of each cell is in the blood and if there's banding).

 

Ya we didn't go through differential diagnosis for every test as to which specific type of anemia etc or which exact type of infection but we covered a lot of the more common diagnoses.

[cinntsp]

I agree with you most programs teach you just tubes to tests. What I am saying the program I went to taught the significance and purpose of those tests. We shared the didactic with the CLS going through the program. Granted we didn't go through all the tests but the more common ones we were going to run. So we knew when we pulled a EDTA tube for a CBC it was to check for anemia and sepsis versus drawing a A1C for diabetes management (since an A1C is looking at the number of RBCs that are glycosylated vs a CBC is counting what type of each cell is in the blood and if there's banding).

 

Ya we didn't go through differential diagnosis for every test as to which specific type of anemia etc or which exact type of infection but we covered a lot of the more common diagnoses.

 

That was my point: a measurable knowledge gap. Everyone knows what a CBC and A1C are "for" but there is way more to lab values and thinking clinically than that. Not to mention laboratory theory, which can also be important when practicing medicine. Friction's post that I originally replied to equated phlebotomists to MLS/MLT, which is totally inaccurate. Again--not bagging on phlebotomists--just pointing out that there are tangible differences between the professions and that implying some point of care tests and learning what an A1C is for gives a person a wealth of lab testing knowledge is a bit far reaching.