# Clinical Preceptors



## EMT91 (Jul 4, 2012)

In conjunction with the poll, what do you as clinical preceptors allow your students to do? When you get a basic student on your rig, do you let him or her do anything? Do you quiz them and help them or do you feel they are a burden? What about I85 students?


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## DesertMedic66 (Jul 4, 2012)

All depends on the student. Some I will let them do everything that I do. Others wont do anything or very little. 

Regardless of how well they are doing they all get quizzed throughout the 12 hour shift. 

I've had to send one student home early followed by a call to his instructor. 

Then on their evaluation form I grade them on book knowledge, skills, communication, and how well they put their skills into an actual call.


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## EMT91 (Jul 4, 2012)

firefite said:


> All depends on the student. Some I will let them do everything that I do. Others wont do anything or very little.
> 
> Regardless of how well they are doing they all get quizzed throughout the 12 hour shift.
> 
> ...


What all do you do? I see you are a Basic, correct?


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## NomadicMedic (Jul 4, 2012)

I find out what their skill set is and then I put them to work. I expect basics to be able to do vitals, an assessment and ask pertinent history questions. Then we talk about the calls. What they should do and why they should do it. 

We don't have intermediates here... And since I'm not a Delaware FTO, I can't have a paramedic student here yet.


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## DesertMedic66 (Jul 4, 2012)

EMT91 said:


> What all do you do? I see you are a Basic, correct?



Correct I am a basic. If the student is doing well then vitals, 12 leads, IV prep, intubation prep, BGLs, oxygen admin, airway adjuncts, gurney operations, C-Spine, and everything that is in a basics scope. 

If they don't feel comfortable doing something then I will either have them watch me the first time so they know how to do it or I will guide them thru the process. 

If they are a wall flower I will say "hey grab a set of vitals". If they don't do it then I will ask why not after the call. If they still are a wall flower then they won't be doing anything on scene. 

I tell the ride outs that they are to follow me and do not leave my side. I had one call where she did not listen to that. She crossed 3 lanes of moving traffic during a MCI because her friend was in a car that was in the center divider. After that call we sent her home because her not listening was a huge safety issue.


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## Epi-do (Jul 4, 2012)

I love having students because it helps me to stay sharp as well.  When they first get to station, I have them go through the truck and ask the usual getting to know them sort of questions.  I ask them how class is going and what they are able to do up to this point.  After finding that out, I let them know what I expect of them, what I will allow them to do, etc.  

I offer to help them study, but know that you can only study so much, so I don't necessarily expect them to do so.  They are adults and know what they need to do to pass their class.

After each run, we talk about it.  I ask questions about what they think was going on with the patient, why they think that, if there was anything that could have been done differently and would it have made much of a difference, how they felt they did over all, and then discuss what they did well and what they could improve upon.


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## Melclin (Jul 4, 2012)

I like having students. A fresh face. Keen to learn. Someone to listen to me bang on about stuff. Extra set of hands. Whats not to like?

Obviously depends on the student. I usually try to have a chat at the start of the day about what stage they're at and what they wanna be doing.

*First years* mostly observe. Maybe a few skills, BP, chest auscultation, BSL etc. 
For the simple or stable patient, i'll have them sit in the back and do obs and ask a few questions while I watch from the airway chair.

*Second years*. 
Same as above. More sitting in the back with sicker patients. Doing interventions, critical thinking about pts.

Chat about jobs and pathophys during downtime, a little quizzing. Talk through the management of a job on the way. First crack at running their own job from start to finish for simple job types. Usually young people with extremity injuries.

*Third years *
Same as above. More detailed quizzing, more demanding in terms of ability to recall important knowledge. The tone changes from, "that s cool, I know you've got a lot to learn at the moment, keep at the study", to, "You've gotta know this stuff". Running jobs from start to finish with assistance for all but proper sick patients.


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## abckidsmom (Jul 4, 2012)

I like having EMT students, especially if it's their first ride or two.  I love watching that deer in the headlights look go away after a couple of calls.

I usually let the student watch the first call, maybe take vitals if there's no pressure on getting them, and practice chatting with the patient on the way to the hospital.  I hate beyond words listening to someone who really doesn't understand what's going on go step-by-step through SAMPLE and not even digesting the information, so I usually just go through a logical H&P discussion, and talk about all the SAMPLE info I got through the chatting.

It's a rare student who takes over entire calls for me.  I usually save that for the preception.  Paramedic students are a little different, I will let them do BLS calls, and run the show on ALS calls.  I love to stop in the middle and explain how the answer to that question they just heard was a game-changer, now we're heading down ____ pathway, etc.

I love the brain stretch and extra chatting that comes with having a student.  Very rarely, I'm not feeling it, and I might come across and tired, but I hope never crabby and unfriendly.  I had a few like that and it was completely not cool.


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## JDub (Jul 5, 2012)

I realize the people in this thread represent a small portion of all EMS providers but it really makes me happy to see there are some people who enjoy having students.

When I did my EMT-B I was not so fortunate with my clinical preceptors. I got some good experience taking vitals and hooking up the monitor, however for 2 out of 4 ride outs I wasn't allowed to load or unload the stretcher into the ambulance even when empty because the paramedic said she had a student who almost dropped someone so students weren't allowed to touch her stretcher anymore. 

On my first ride out I asked if I could have someone help teach me where supplies were located at and they told me I could just look around myself which didn't help hardly at all because everything was inside tag locked cabinets and bags.

I was told not to bother asking SAMPLE and OPQRST type history questions because they had to ask the same questions and it would just be too bothersome. Finally I almost never got to talk to the crews because we were always in the ambulance and while I was sitting in the back I could barely hear or talk to the crew up front.

I love teaching people and I can't wait until I have a student riding out with me one day so I can try and help them learn. I'm glad to hear some other people are like that.


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## abckidsmom (Jul 5, 2012)

I will agree that students almost never touch the loaded stretcher. If I have a brand new any kind of partner, they don't touch the stretcher until they have demonstrated competence with it unloaded in practice. 

My stretcher spiel for new people includes all the stuff the stretcher can do, all the ways you can hurt yourself and your partner, and the ways you can drop a patient.


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## Melclin (Jul 5, 2012)

JDub said:


> I realize the people in this thread represent a small portion of all EMS providers but it really makes me happy to see there are some people who enjoy having students.
> 
> When I did my EMT-B I was not so fortunate with my clinical preceptors. I got some good experience taking vitals and hooking up the monitor, however for 2 out of 4 ride outs I wasn't allowed to load or unload the stretcher into the ambulance even when empty because the paramedic said she had a student who almost dropped someone so students weren't allowed to touch her stretcher anymore.
> 
> ...



I have a real issue with the way students are treated in our system. 

In short, people complain constantly about how students and new medics don't know anything but they are almost always the same people that never make an effort to teach. 

Oh boy, I feel a drunken rant coming on.

Students need to be made to feel part of the team. Because they are for starters, but its also an important confidence building exercise. There is way too much, "I'm the qualified medic and you are the scum that I ignore" BS that goes on. 

My experience as a student was that I would spend many hours sitting awkwardly around a coffee table listening to extensive rants about how utterly useless university students were (never specifically directed at me but it was hard to ignore the implications) but almost no time being taught anything. I pushed, sure. But you can only push so hard.

Don't act like you're God's gift because there is a student around. I make a point of telling student about all the F ups I've made. Especially after they just had their confidence shattered by a gruff triage nurse, messed up their first cannulation or buggered something up in one of the million ways you do when you're learning. How about the time I forgot a page about a closed cath lab and took a legit CP to a hospital with a closed cath lab, or the time I left the monitor at hospital and didn't realise until the day shift checked the truck. The times I felt like I was the worst paramedic ever to walk the face of the earth, the times I couldn't hit the back side of a barn with a 24g because my hands were shaking so much. We all need to get a bit more comfortable with acknowledging that we screw up from time to time and as a student, about 20 times a day. But thats okay, as long as you learn from it. We all should. And we all should feel comfortable admitting it so that we CAN learn from it.

I walked into my clinical auditor's office about two months ago and basically told him I stepped outside the guidelines, I got it wrong and it probably caused significant harm to the patient. I was in his office for over an hour. Never once did I feel like I was "in trouble". I suffered no negative repercussions. I learned a lot from our discussion. I will feel comfortable admitting fault in the future and undoubtedly I will be back in his office at some stage learning more from my mistakes. I feel proud of him and the local part of our system for allowing that kind of culture, but unfortunately the system as a whole is not as forward thinking.   

We complain constantly that we don’t get paid enough. Educating students is part of our role. How about we start earning the money we get paid before we ask for more. 





Eurrghh. END RANT...for now.


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## abckidsmom (Jul 5, 2012)

Amen. 

The reason the stretcher operation thing is such a trigger for me is because when I was a 19 year old just getting started, I dropped a lady one time. Freak accident caused by poor communication between me and my partner an failure to keep two hands on the stretcher at all times when rolling it. 

That day sucked. It has stuck with me, though, and has made me a more careful provider over and over again.


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## JDub (Jul 5, 2012)

abckidsmom said:


> Amen.
> 
> The reason the stretcher operation thing is such a trigger for me is because when I was a 19 year old just getting started, I dropped a lady one time. Freak accident caused by poor communication between me and my partner an failure to keep two hands on the stretcher at all times when rolling it.
> 
> That day sucked. It has stuck with me, though, and has made me a more careful provider over and over again.



I completely understand the caution with a loaded stretcher, hell I still get nervous when I unload a stretcher with someone on it. However, I didn't much appreciate being yelled at for loading the empty stretcher back into the ambulance at the end of the call at the behest of the EMT on the crew who supervised me while I was doing it.


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## abckidsmom (Jul 5, 2012)

No, I totally let the student do anything they want as long as they are either competent or teachable. 

Looking at the poll, it's obvious that it's skewed by the people who care about EMS. I'm glad that this is a place populated with people who welcome students.


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## EMT91 (Jul 5, 2012)

How many of you have let a basic or intermediate student put in a npa?


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## DesertMedic66 (Jul 5, 2012)

EMT91 said:


> How many of you have let a basic or intermediate student put in a npa?



I have let students do it. One of the instructors at my college will actually let students place an NPA in his nose. 

I also let them do OPAs.


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## Veneficus (Jul 5, 2012)

I let students do anything within their scope of practice.

Generally I follow the example of my teachers and try not to let them do anything that carries undue risk of them hurting themselves.


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## EMT91 (Jul 5, 2012)

I have not yet had the oppurtunity to place one in a patient. And ven I replied to your statement in the pain thread.


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## Shishkabob (Jul 5, 2012)

I like students WAY more than I do new-hire, newly-minted Paramedics.  



I let, and in fact encourage, students to do anything and everything in their scope.  I love NPAs, so if a patient is to get an airway adjunct, I get the student to do one.


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## Medic2409 (Jul 5, 2012)

On the flip side, the thing that probably pisses me off most is those Medics that whine and moan about students.

My response is generally to remind them that once, they were students also, brand new to the field, just exactly like the ones they're pissing and moaning about.

It usually does no good, but makes me feel better!


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## MexDefender (Jul 5, 2012)

I had a great experience on my clinicals, our local service is known a lot of burnouts and as the firefighters say a requirement to be a paramedic is to be fat. I had a really energetic paramedic who was really different from the other paramedics I saw that day, her EMT-B was kind of crabby sometimes but they both let me go through the SAMPLE OPQRST spike a bag and a bunch more that was really helpful in gaining confidence. It was the same way when I went on another clinical at a rural area ambulance service which almost no calls but they were also energetic and really trying to instill some of their knowledge and experience into me and I couldn't ask for a better learning experience. 

My classmates had less fortunate experiences with the local service.


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## abckidsmom (Jul 5, 2012)

EMT91 said:


> How many of you have let a basic or intermediate student put in a npa?



Student always manages the airway as long as theres enough help/conditions allow for supervision.


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## NomexMedic (Jul 5, 2012)

I love to see students, so long as they are humble and their to learn.


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## GorillaMedic (Jul 9, 2012)

I have to echo the sentiments above…I don't get how paramedics can piss and moan about students. We all were students once, and I think we can all look back at great clinical preceptors who helped us become the medics we are today.

I love teaching and I love having students on my truck. At the beginning of the shift I try to feel out where they are at in their confidence and skill level, and then I let them practice their skills to the extent I'm comfortable with their competence.

I try to let them do CPR if the opportunity arises (we use LUCAS devices so this is increasingly rare), start IVs, take vital signs, etc. The only thing I'm not comfortable with a student doing is intubation, simply because the ambulance is not a very controlled environment and the risk to the patient is pretty high. Our paramedic students all get plenty of OR intubation time.

My attitude is that the better clinical time my students get, the better quality new-hire paramedics will end up on my streets.


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## NomexMedic (Jul 10, 2012)

GorillaMedic said:


> I have to echo the sentiments above…I don't get how paramedics can piss and moan about students. We all were students once, and I think we can all look back at great clinical preceptors who helped us become the medics we are today.
> 
> I love teaching and I love having students on my truck. At the beginning of the shift I try to feel out where they are at in their confidence and skill level, and then I let them practice their skills to the extent I'm comfortable with their competence.
> 
> ...


Couldn't have said it better myself!  Great words sir.


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## AnthonyM83 (Jul 10, 2012)

For EMT students, it depends on the student.

If they have a great attitude and are intelligent and I see potential, I might literally talk the entire shift and put 110% into trying to teach them as much as humanly possible in one shift. I'll treat them pretty similar to a new-hire trainee, but with less stress. Of course, there are times when I've been tired or had personal issues going on, so haven't been the best. But I always try.

I also do try to mold their ride-along to their goals. If they want to be doctors, I introduce them to doctors. Same with firefighters, nurses, etc. I'll try to connect them with other EMTs on similar career paths, but who are further along than them. 

I'll also try to find their strong and weak points. For some, I know getting them to speak up and take charge will serve them best. Others, talking about theory/book material will serve them will, because they're already good with their hands and thinking on their feet.


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## nekogirl (Jul 11, 2012)

Just the thread I was looking for! I do my first ride along for clinicals this Friday!! It's a 12-hr shift so we can try to get our 5 patient contacts in.  We get three ride alongs to try to get those done.  

I just looked at the preceptor form that they fill out on me and it is a bit scary!  The form sort of implies that we need to accomplish an Assessment, Vitals, SAMPLE and PH...basic stuff but when we talked about the ride alongs in class our instructor didn't mention this at all.  In fact, he said what we do is entirely up to the preceptor, which makes sense to me. 

I'll be honest, I'm nervous about it.  Because I just did my first sign offs for stuff and I don't think I was good enough to get signed off but did.  I was signed off on Assessment and CPR (which I feel confident with.) But it's the Secondary Assessment section that I don't feel as confident in because honestly, our class hasn't had that much practice or instruction in it.  We have gone over the Scene Size-up, General Impression, and Primary Assessment many times and I'm feeling pretty confident in those...but we hardly have done vitals or OPQRST, and we just learned what SAMPLE and PASTE were this last week! 

Also, I know that our class is the first class since all the major changes in BLS CPR and even the recent changes in EMS so even when we get a one of the Paramedic students in to help us who are EMT-I or EMT-B they are still doing "old protocals" compared to what we are learning right now so it's a bit odd.

My instructor just told us to ask the preceptor what they expect from us and go from there.  I am just going to be honest and do my best.  If I don't know how to do something I'll ask and speak up.  If I'm asked to do something and I haven't a clue what to do I'll be honest and ask if I can watch the preceptor do it the first time and then try it on my own after that.  

You think that will work?  I don't want to get in the way and I certainly don't want to be a wall flower either.  I want to challenge myself and use what I'm learning and have learned this far but I don't want to put anyone's life at risk for that experience either.

I hope my preceptor is cool with students otherwise, I am the type of student who will let my Program Director know whether that preceptor was professional and helpful or rude and made me feel uncomfortable. Honestly, I don't care what you have going on personally in your life, it's not my issue and it should be my problem either it should left at home, not work. We are adults. Because if you are taking it out people at work then that could mean patients aren't getting the best care either. Besides, I am spending my personal time on this ride along and the preceptor is getting paid to do their job still.  It's not like I'm just there for my health. haha! 

It should be a great experience for both of us, at least that is how I see it.


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## GorillaMedic (Jul 11, 2012)

nekogirl said:


> Just the thread I was looking for! I do my first ride along for clinicals this Friday!! It's a 12-hr shift so we can try to get our 5 patient contacts in.  We get three ride alongs to try to get those done.
> 
> I just looked at the preceptor form that they fill out on me and it is a bit scary!  The form sort of implies that we need to accomplish an Assessment, Vitals, SAMPLE and PH...basic stuff but when we talked about the ride alongs in class our instructor didn't mention this at all.  In fact, he said what we do is entirely up to the preceptor, which makes sense to me.
> 
> ...


Take heart! Every one of us felt challenged on our first clinical. Just go in with an open mind, be willing to jump in and work, stay humble/teachable, ask a lot of questions, and don't judge_ anyone_. You'll do fine.


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## EMT91 (Jul 15, 2012)

Just yesterday, I did a ride along and I loved  my preceptor, he made sure that after every call he would ask what questions I had, what things I noted etc. really involved me with patient care.


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## leoemt (Jul 17, 2012)

We didn't do ridealongs, we went to Haborview instead. While I thought the Harborview experience was great I was a little upset that we were told we weren't supposed to touch patients, um it is a teaching hospital how are we supposed to learn (apparently a prior med student paralyzed a patient)?

Me and my partner were fortunate that we had a ER Tech that took us under his wing. He showed us around and explained things to us that other students didn't get to see. We also had some cool nurses that encouraged us to observe procedures. 

I remember one patient that was a sexual assault victim. The EMT's bringing her in were concerned for her privacy (as they should be) and asked us to step out of the room. The patient told them "no I want them to stay if their students they might help me someday". 

We also got lucky and got to observe a neuro consult. An IFT had come in with a patient complaining of a headache. The hospital did a CT Scan and diagnosed her with a brain tumor and sent her to Harborview. The neurologist approached us and asked if we were the EMT students. When we said yes he told us to follow him. He explained the CT images to us and let us observe his initial diagnosis of the patient. It was all above my head but definately something interesting to learn. 

Me and my partner were the only EMT students that actually got to do some patient handling. We had a female who was struck by a car and our ER Tech had us help log roll her while the nurses stripped her and checked her posterior. 

I feel my class was fortunate in that we got to go to Harborview for our precept time. I wish we could have done a little more like vitals but I was thankful for the experiences we did get. 

I do wish we could have also rode on an ambulance as well though. Would have been nice to see ambulance ops on a real call. I would trade in my Harborview time for anything though. 

We got lucky. I hope that in the future when I have students I will remember the EMT's, medics and ER staff that helped us out at Harborview and will be a good preceptor myself.


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## Handsome Robb (Jul 17, 2012)

I like students, if they are willing to learn. 

I always tell them at the beginning of shift that this ridealong is what they make of it. If they want to jump in and learn I'm happy to help, if they want to be a bump on a log sounds good to me, if they want to be a skills monkey go for it but you can bet I'll be pushing those students in the direction of doing assessments. 

I don't gain anything by precepting students, in fact it generally makes my job more difficult but I'm still happy to do it but I'm not going to force a student who doesn't want to learn to participate. 

Students don't touch the gurney, period. It's a company policy that started after a student was injured during a lift. Technically they aren't allowed to carry gear either but I'll let that one slide.


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## xrsm002 (Aug 5, 2012)

My preceptor wants me to "run" the call I thought I was doing this I would be the first person on scene form my general impression, get information from FD who usually get on scene before us, then I start thinking what I will be doing for the patient.  I'm a paramedic student so I'm assuming this is what my preceptor means by run the call. Unless he doesn't want me to ask him questions


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## 281mustang (Aug 6, 2012)

It seems most preceptors on the site are superior to preceptors IRL. 

On my second to last rotation as a Medic student my preceptor cut me off as soon as I start interviewing the patient on the first call and gave me 'the look.'

I got chewed out when we got back to the station and was told that "under no circumstances are students to address the patient on scene", and if I wanted to assess them or get a hx to do it on the way to the hospital.





That was the one negative student eval I received.


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## Veneficus (Aug 6, 2012)

281mustang said:


> It seems most preceptors on the site are superior to preceptors IRL.
> 
> On my second to last rotation as a Medic student my preceptor cut me off as soon as I start interviewing the patient on the first call and gave me 'the look.'
> 
> ...



It has been my observation that the more of a jerk the preceptor is, the more questionable their abilities as a provider.


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## the_negro_puppy (Aug 6, 2012)

I have only recently received my Medic qualification and recently worked with a student as their direct supervisor for the first time. It was a strange feeling, and slightly scary. We have Paramedic students at university that can fill in shifts as casual employees with a Medic supervisor. Having never worked with them before its difficult to gauge where they are at. Also as the qualified officer we are responsible and accountable for patient care, so if the students does something wrong or omits to do something we can also get in trouble. We work 2 up either Medic/Medic or Medic/Student

I enjoy teaching as part of the job. Its far better to work with a student (say over 6 weeks) than 1 shift.


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## 281mustang (Aug 6, 2012)

Veneficus said:


> It has been my observation that the more of a jerk the preceptor is, the more questionable their abilities as a provider.


 In my experience the worst of the worst cook book Medics either tended to be ****s or extremely lackadaisical in regards to any preception and pretty much gave me free reign over nearly everything. 

The Medic I referenced in the above post got extremely pissy when I politely asked to do an IV attempt after he already failed two attempts. His response was "If I missed twice a student isn't going to hit a vein, don't ever ask to do procedures. If I'm okay with you doing something you'll know." He later told me I 'disrespected' him with my question.

Whenever I got a stick as a student that a previous Nurse or Medic missed the provider was always cool about the situation. Fella definitely seemed to be self conscious of his skill set/knowledge base.


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## Veneficus (Aug 6, 2012)

281mustang said:


> In my experience the worst of the worst cook book Medics either tended to be ****s or extremely lackadaisical in regards to any preception and pretty much gave me free reign over nearly everything.
> 
> The Medic I referenced in the above post got extremely pissy when I politely asked to do an IV attempt after he already failed two attempts. His response was "If I missed twice a student isn't going to hit a vein, don't ever ask to do procedures. If I'm okay with you doing something you'll know." He later told me I 'disrespected' him with my question.
> 
> Whenever I got a stick as a student that a previous Nurse or Medic missed the provider was always cool about the situation. Fella definitely seemed to be self conscious of his skill set/knowledge base.



I think anyone who has been doing IVs for any length of time knows there are days when you cannot stick the broad side of a barn. 

a new set of eyes and hands is definately a good idea.


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