ER Clinical Shifts. Anyone else have a hard time?

[PimpHandLooseNJ95]

Hey guys,

Little background im a paramedic student in NJ in a 2 year medic school program. the program is a hybrid program that consists of 6 consecutive semesters (summer also) that has online lectures and course work/case studies, once a week skill labs, and has clinical shifts in hospital in every semester with semester 5 and 6 consisting solely of field time. right now im in my third semester which is only clinical work in the ER and OR with anesthesia.

So this semester we have to do 88 hours in the ER and are now capable of giving drugs, ACLS skills, and 12 leads. I did my first 2 shifts last week and I feel really ****ty and down about everything. Its very hard to find any nurse that actually wants to let you do anything. When I come in to the ER to start my shift i usually go around and let the nurses know what skills im capable of doing but then it seems they never come to get me to do any of them. I do walk around the ER (small ER with about 20 beds and 5 nurses) and ask if they need any IVs started or any meds i can give but then i feel like im annoying them and i can tell they just don't want me around. its a fine line between asking too much to do stuff and then not doing anything because i didn't ask. Its very frustrating. A lot of the younger nurses are very stuck up and are quite nasty to me for no reason

There are a few nurses that will take you under their wing and teach you stuff but most just dont want to be bothered at all. I'll definitly meet all my clinical objectives this semester but im just not enjoying my ER time and not really learning much other than drawing meds, starting lines, and doing 12 leads. The ER is whole different environment than the field and i feel a lot of the work wont carry over. And i know everyone says "you get what you make of it" but im trying pretty hard and honestly not getting much from it

Did anyone else not enjoy or find their hospital ER time very frustrating or care to share their experience??

 

[mgr22]

Did I find my ER time frustrating? I hated almost every minute of it. In fact, I hated all of medic school -- lectures, rotations, tests, studying. Yes, I'm using the word hate. I know I wasn't the only one who felt that way.

I didn't go to medic school thinking I was going to like it. I went there determined to become a medic -- period. I did whatever it took, including lots of messy work in the ER that nobody else wanted to do. When a patient needed an emesis basin, I was right there. When another was impacted and needed -- not sure of the technical term -- disimpaction? I did it. On the ambulance, I filled the O2, did the checkouts, carried the equipment, lifted the patients, and picked up pieces of former people after they were transected by cars or trains.

I didn't dwell on who was nice to me and who wasn't. I treated every medical professional as if they were smarted than me, which they probably were. Those who persisted in rude behavior despite my best attempts to suck up -- well, I just didn't send them any Christmas cards and left it at that.

You sound like you mean well, just as I did, but I was 41 and you're only 22. I think it would have been harder for me to put up with all of the peripheral nonsense at 22, but I'm pretty sure my approach would have been the same: Be nice, be on time, do the best you can, know the medicine, take responsibility for your own education, and volunteer for the stuff that no one else wants to do. When it's over, you're going to feel so much better.

 

[DrParasite]

1) when I did my EMT hospital time, it was a huge waste of time. Just saying.
2) Medic clinicals are different. you should be ASSIGNED a nurse preceptor. This nurse should let you do all your skills. a good preceptor will actually send you to other when they hear a good patient come in, so you can do some cool stuff. Most don't know they have a student until you show up....
3) some nurses are better than others. I had a few absolutely horrible preceptors (the kicker is one was actually a medic too who worked FT as an RN), and some awesome ones who would push me into doing stuff and tell me "here, you do this" or even better, "ms. jones, dr P is an medic student, and he is going to be starting an Iv and stuff on you, if that's ok with you. here Dr P, go ahead."

Just remember, you need them more than they need you (and by that, I mean, they don't need you to be a student or a medic, but you need them in order to get signed off and become a medic). Keep your head down, keep your mouth shut, and once you finish your clinicals, you never have to deal with them again.

 

[Gurby]

...are now capable of giving drugs, ACLS skills, and 12 leads. ... Its very hard to find any nurse that actually wants to let you do anything....i usually go around and let the nurses know what skills im capable of doing ... ask if they need any IVs started or any meds i can give...and then not doing anything because i didn't ask.

I know you need to get things signed off, but running around being a skill monkey is a huge waste of time IMO. You'll have plenty of time to do all those things in the field. None of the skills you're practicing are all that difficult or important anyways (aside from airway management in the OR, which is extremely important, difficult, and you will not get nearly enough experience with).

The thing you absolutely must get as much exposure to as possible during your rotations, is medical decision making. You have the rest of your career to practice IV's, but you may not have such unfettered access to physicians in their natural habitat ever again. Spend more time sucking up to the doctors rather than the nurses. Try to be there whenever the doc's go to see a new patient and absorb as much as you can. Try to emulate their demeanor, the way they assess different patients, try to think about what questions you would ask or what you would do for a patient.

The fact that you think the field is so different from the ER makes me feel like you are missing what's important. As a paramedic you are doing the exact the same thing the doctor does in the ER - say hello, see what's going on, come up with a plan. You are just doing an abbreviated version is all.

Your priority should be sharpening your assessment skills, interacting with lots of patients and learning how to tell 'sick' from 'not sick'. If I'm your partner or preceptor I don't give a single **** if you have trouble starting IV's or if you can't draw up a med, if your actual medical knowledge and diagnostic skill is good.

 

[VFlutter]

Do not take it personal. Some people are better preceptors then others, try to find the good ones and let the bad ones do their own thing. Also remember that some of these people may be preceptors for EMS students, Nursing students, and also new hire RNs so they may have someone with them almost every shift which can get them burnt out quick. As far as the younger nurses many of them may still be learning how to do their job and perfect their skills so they may not be interested in trying to teach something they aren't experts at.

As someone else said do not be afraid to help with me menial tasks like helping someone to the bathroom or with a turn. I know you are there to do skills but do not forget that is a huge time consuming part of a RNs job and helping out will make the nurse more apt to get you for the "cool stuff".

Just be persistent and let them know you are there to help with anything, but would like to get IVs and Med pushes, and hopefully it will work out.

 

[luke_31]

Gurby hit the nail on the head. Focus on learning how to do a proper assessment of a patient similar to how the doctor does their assessment. There is a difference between how a doctor and a nurse assesses a patient. See if you can figure that out. Look for opportunities to assess the patients as they come in and try to get a procedure or two done while doing your assessment. Help out with everything in the ER, not just the stuff that you need to work on. When I did my clinicals many moons ago, I helped with many procedures that weren't relevant to what I needed to do or know. The nurses and techs in the ER noticed that I did more then just what I needed and would come get me for the interesting patients and let the doctors know that I was a paramedic student and needed practice with a procedure that they were about to do. By being there and helping with all the crappy tasks that need to get done, you will be able to do more and have a better experience.

 

[DrParasite]

The fact that you think the field is so different from the ER makes me feel like you are missing what's important. As a paramedic you are doing the exact the same thing the doctor does in the ER - say hello, see what's going on, come up with a plan. You are just doing an abbreviated version is all.

which is odd, because medic students are almost always assigned to nurses, and very rarely to doctors......

I would love to follow a doctor for an entire busy shift and pick his brain for why he did a particular treatment, assessment, or intervention.

 

[Tigger]

which is odd, because medic students are almost always assigned to nurses, and very rarely to doctors......

I would love to follow a doctor for an entire busy shift and pick his brain for why he did a particular treatment, assessment, or intervention.

In some places. As usual, you've seen one place, you've seen one place. More than half of my ED clinicals were with an assigned physician, and the rest of the time we were free to interact and shadow them if we weren't looking to get skills signed off.

 

[Old Tracker]

Great timing for this question. I'm going through AEMT, not paramedic, but we're fixing to start clinicals, so the advice is more than a little welcome.