Paramedic to Nurse Program


I promised in an earlier post, Ambassador of Love, to talk about how I got my nursing degree.

I started the program with the intention of using it as a insurance both against injury and against overtime drying up. Before I finished the program I got my current second job as an EMS coordinator. Now, working 68 hours a week, I don’t have an hour left ito use my nursing degree. I won’t quit my medic job, and won’t quit the coordinator job, which is a state job with a pension if I manage to stay at it long enough.

Still, it is nice to have the R.N. in my pocket.

Here’s the deal on how I got it, and how you, as a paramedic, have a similar opportunity.

Excelsior College

If you are a paramedic, an LPN, a respiratory therapist or work in a few other select categories of health care, you are eligible to get a nursing degree from Excelsior College (the old Regents College).

Excelsior College

Excelsior is a fully accredited nursing program that utilizes the self-study educational model.

You do not have to go to a physical class.

You study on your own and take exams via computer at a Pearson testing center when you are ready. You pick the date and time from the many openings they have.

There are no clinicals.

You must however pass an extremely tough 3-day clinical Exam. (60% national pass rate).

If you have some college behind you, you may receive credit for the courses you have already taken.

I had to take the following 11 exams to get my degree.

Early Childhood Development

Anatomy and Physiology

Nursing Concepts 1-7

I also had to take a one credit information literacy course that took less than 1 day to complete.

In general when I was committed to studying I could knock off an exam a month. A&P took 2 months. I did most of my studying on duty, either sitting in the ambulance when posted on the street or at the ambulance bay when working in the contract town. I know people who have completed an exam every two weeks with intense studying.

People have passed the whole program in six months, most are expected to finish in less than two years. You must finish within seven. With two lengthy interruptions, it took me four years from first test to R.N. license. The beauty of the program is you can go at your own pace. If an interruption comes up in your life, you are not forced to drop out like you may be in a more traditional program.

Each exam costs (or did when I took them) from $225 to $290.

The exams require studying. I tried taking one exam without studying at all and I failed it. (I had already paid for the exam, but had lost interest for a time in the program. I received notice if I didn’t take the exam by a certain date (you have six months to take an exam after you pay for it), I would forfeit the exam fee, so I went down and took it with no success.

One nice thing about the exams is you get your grade as soon as you are done. Each exam is 160 multiple choice questions and you are given 3 hours to take it. I never needed more than 2. You hit the done button and your grade pops up. I love to see an A, but a C earns the same amount of credit.

I bought most of my textbooks used on Amazon. Some people pay upwards of $400 per course for study guides from various services such as the College Network. A friend lent me her study guide for one course and it was much easier and quicker studying from their guide than going through the texts myself.

When you finish all 7 nursing courses (I believe there are now 8 nursing courses), you are then eligible to take the CPNE (The Clinical Performance in Nursing Exam).

After you pass the CPNE, and have completed any other requirements, you get your degree and are eligible to take the NCLEX – the national nursing exam, which can range from 75 questions to 265. The exam cuts off when the computer decides you know the material. Once you pass the NCLEX, you are then eligible to be licensed in your state. In Connecticut, that meant filling out a form and paying the state $180.

Most states accept Excelsior College degrees. There are just a few that don’t or who have additional requirements. Check with the College before enrolling.

The Excelsior Program is for you if you work full-time and are a self-motivated student.

(All told the degree and associated costs (fees, books, exams, travel, seminar) totaled about $8,000.)


The CPNE (Clinical Performance in Nursing Exam) is a three day practical test held at various testing sites (hospitals) across the county. On the first day, you are tested on four lab stations (IV push, IM/SQ Injection, IV Drip Medications, and Wound Care). If you fail any or all, you get a chance to retake them the following afternoon. Fail one station twice, and they send you home.

On the second day, you have two PCSs (patient care situations). You have 2 Ĺ hours during which you receive your Kardex with assigned areas of care, get a report on the patient, review the patient’s chart, write a nursing care plan, implement it, and then write an evaluation and complete your documentation. You go over 2 1/2 hours you fail.

You will have to do vital signs, assist with mobility, record all intake and output, as well as demonstrate you are a caring person, and that you know all about hand-washing and asepsis. You will have to give medicine and perform several assigned areas of care and assessment (Neurovascular, Respiratory, Musculoskeletal, Skin, etc.). Throughout it you are judged by an impartial CA (Clinical Associate) who shadows you while constantly writing on her clipboard.

If at any point, you donít meet a critical element, you fail the PCS. I failed one of my PCSs because they didnít like my care plan, so I never even got to meet the patient.

You must pass two adults and one pediatric. If they donít have suitable pediatrics in the hospital, you get a substitute adult. You get one chance to repeat an adult failure and one chance to repeat a pediatric failure. On the last day, you do your PCS # 3 and then if necessary, PCS # 4 and # 5.

The exam costs $1900 not counting travel, lodging and missed work. If you fail an exam, you can retake it at a later date up to two more times, each at a cost of $1900. If you fail the third time, they boot you from the program. If you still want to be a nurse at that point, you need to look elsewhere.

This is a high stress test. You can be just fairly prepared and sneak through or you can be highly prepared and fail. It has a 60% pass rate nationally (I am guessing that means each time taken). Look at it this way. If you have average preparation then you have to reach into a box of ping-pong balls. Six are marked pass, four are marked fail. The better prepared you are, the more ping pong balls that say pass on it. But due to the nature of the exam with so many automatic failures, the best you can probably hope for is 9 Pass balls and one fail.

I spent three months studying for the exam, including traveling to Atlanta for an excellent three day seminar on how to pass the exam.

I went though all my course work without having to miss a day of work, and because I do well on written and multiple choice tests, it was pretty easy for me. The CPNE is the one drawback to this program. I have worked as a full time paramedic for 16 years. I have vast clinical experience. For that, they credit me so I didnít have to do any clinicals, but I had to do the CPNE. They make the CPNE so rigid because they have to certify that you know what you are doing. They donít want the guy who slept at the Holiday Inn Express last night to have to easy a chance to slip through without being exposed.

I was lucky and got through on my first try. I would hate to go through the program and then fail the CPNE on all three attempts, which happens to some people.

Had I known how hard I would have to study for the CPNE and how stressful it would be, I might have thought twice about the entire program.

But in the end, it worked out for me, so I am glad I did it. I now have some degree of injury and future employment protection. As I said, I hope to keep working as a paramedic, although there are days when I feel the aches of age and wonder how long I can stay at this.

Good luck to anyone taking the Excelsior program. If you have any questions, please feel free to contact me.


  • Rogue Medic says:

    Some friends of mine did that. Two of them went on to medical school. Both are hopeless overachievers. One is Vince of Living La Vida Vince. I thought about it, but I know that I am not motivated enough to do a good job of this.

  • medicthree says:

    Thanks for this breakdown. I am very interested in this program. Would you recommend this program over say, a local online AS-RN program? The cost is about the same, but the local program does practical clinicals as well. I’m not convinced I need them as most of the skills are part of life already. What are your thoughts?

  • totwtytr says:

    Thanks for posting this. A friend of mine is looking into this and the information is timely. I sent her a link to the post.

  • quickmedic says:

    Thanks for this post!!!

  • Paramedic Bill says:

    How readily accepted are the programs by state certification boards, and by employers? and since you mentioned it, specifically Connecticut? Where are the CPNE’s held?

  • medicscribe says:

    Thanks for the comments and questions. I apologize if I accidently deleted anyone’s. I am still learning how to moderate comments and my site was attched by a spammer so I was doing some mass deletes and hope I didn’t screw up.

    Excelsior is accepted by most states. Be certain to check with your state before applying. There are a couple states that require Excelsior grads to do supervised internships after graduating. Some of this information is available on the Excelsior web site. But again, in general, in Connecticut and the vast majority of states, the program is accepted and a R.N. is a R.N. In Connecticut Excelsior is specifically mentioned in the state regulations as being accepted.

    As far as how do employers look on it, it would depend on the employer. If you are a seasoned paramedic and looking to work in an ED as an RN, they would likely hire you before an inexperienced graduate of a traditional nursing school. The EDs around here have several nurses with EMS backgrounds who went thtough the Excelsior program. Most employers have their own training programs they put nurses through.

    The CPNE is held all over the country. The closest locations for Connecticut are in upstate New York and I believe possibly Long Island. I took it in Utica, New York. There are sites in Georgia, Texas, Michigan, Califonia. Once you are ready to take the CPNE, it can be up to six months before it is scheduled. Mine was scheduled within a month because I said I was available to do it on weekends or during the week. You do have some flexibility in when it is scheduled.

    The trick to the CPNE is learning what they want from you. There are seminars you can take which are very valuable in teaching you how to pass it. A friend of mine who is also a paramedic went through it at the same time I did, so we did much of our studying together and that was very helpful. The College does have an electronic forum for people to chat and ask questions and you can set up phone appointments for free with the faculty to go over any questions.

    As far as this versus a local on-line program, you would have to answer that based on your own needs. What I liked about Excelsior was everything (with the exception of the CPNE) was on my schedule. I studied when I wanted, I took the exams when I wanted. As far as the nursing skills, many paramedic skills translate, the rest can be learned or taught once you become an RN.

    When you take the CPNE, they give you a huge binder (now on CD) which lays out all the skills you need to learn. When you go though the actual clinical you will not do IVs, foleys or anything invasive other than an IM injection. You might have to give meds through a feeding tube or do a sterile dressing, but that can be learned easily enough. If I had questions, I’d just ask an ED nurse to show me.

    I’m happy to answer any questions you have.

  • Matt says:

    I had to burn through an A&P class for a deadline, and I did the Excelsior exam in three weeks, but I had to study four or five hours a day almost every day. It was sort of miserable during it, but then when I took the exam, I felt glad that I had done it in so short of a period instead of wasting a semester. I didn’t know that Excelsior offered this program, and now that I have a little experience with them, this sounds very appealing.

    In other news, one of the ED nurses told me today that she found some program where RNs can bridge to paramedic in two weeks. Not sure how I feel about the underlying assumptions of transferability there.

  • Nice Post ! Good information

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