# Help Me get my Partner IV Certified.



## MedicPrincess (Jan 20, 2008)

My partner took the classroom portion of the IV class 5 weeks ago.  She is only required to get in 10 successful sticks, she has had 3 successful, multiple not.  I told her in the beginning I will not let her "practice" on children, Old people where I might only have 1 good shot anyway, or Critical Load-n-Go patients.

On her first attempt, as she went to stick the pt, I attempted to show her that she is going to want to secure the vein.  She looked right at me and said, "I took the class.  I know how to do this."  Ok then...go for it.  She tried, she missed, she got up front and drove while I did it enroute.

And this is how it has gone for the last 5 weeks.  She got 2 attempts on 7 patients yesterday.  Not because the other 5 fell into the above mentioned catagories, but becasue I have reached a point with her that I just don't really care if she gets her 10 sticks in.  

If I will point out where a great-easy site to get is, she will intentionally not stick the patient there.  And EVERYTIME she has not stuck the patient where I told her to, she has blown it.  So I have reached a point where if she wants to figure it out on her own, it WILL NOT be on patients I am siging my name to.

So, any suggestions?  She has actually "told on me" for not letting her attempt more sticks.  Our supervisor told me I must let her attempt on every patient that is not critical.  I respectfully told him I will not allow her to attempt on every single patient, until she decides to take my suggestions shen I tell her where to stick them.  He then told me I have to allow her to attempt more than once on the patients I allow her to try on.  I pointed out that per protocol we are only allowed 2 attempts, unless absolutely critical and I will not allow her to use the patients in our truck as a pin cushion while she does whatever she wants.  I offered to let him come ride on my truck until she gets certified and I will be happy to QRV all day or she can go work on a different truck until she gets her sticks in (or permanently!!!)....and that way she can stick all she wants under his liscense.  He declined.


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## disassociative (Jan 20, 2008)

Take her to the training room(if your service has one) and pull out the training arm. Focus your efforts on proper angle and technique as well as FEELING for the veins rather than going by site 100% of the time. It has been my experience; that most students that get on the rigs want to go for the first vein they see rather than taking their time and assessing. Furthermore, try not to open the back doors and throw her out as you are going down the road, everyone had to start somewhere. This one, unfortunately needs humility.
Hang in there princess.


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## Ridryder911 (Jan 20, 2008)

MedicPrincess said:


> Our supervisor told me I must let her attempt on every patient that is not critical.  I respectfully told him I will not allow her to attempt on every single patient, until she decides to take my suggestions shen I tell her where to stick them.  He then told me I have to allow her to attempt more than once on the patients I allow her to try on.  I pointed out that per protocol we are only allowed 2 attempts, unless absolutely critical and I will not allow her to use the patients in our truck as a pin cushion while she does whatever she wants.  I offered to let him come ride on my truck until she gets certified and I will be happy to QRV all day or she can go work on a different truck until she gets her sticks in (or permanently!!!)....and that way she can stick all she wants under his liscense.  He declined.



I would had told the supervisor if he/she wanted them IV certified so much, then she can start the remainder sticks on them (supv)... or they can respond and let them start on their patients as much as they want... sorry, no empathy if the person will not listen. 

R/r 911


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## bstone (Jan 21, 2008)

disassociative and Rid have the same icon. Interesting.

Good luck with the IV sticks.


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## IrishMedic (Jan 21, 2008)

its great to see that patient advocacy is strong out there, i think you're right, when i was a student getting my sticks we had to get 50 plus to be certified and well if missed a stick on a pt, i knew my limit's; your partner needs to be reminded she is doing it for pt care and not for herself....i knew if a pt needed an IV i had one shot....my medic instructors said i could try more, but if a pt needs one they need one...im not gonna mess it up or just try for the hell of it....she'll get it eventually but sounds like she is just gonna have to work out for herself she needs to listen, i use to critique everything i did looking for improvement and asking for as much advise as i could get on the road....i know i found it great when an instructor would say ok you did well on that one thing i wanna show you is........then they'd put on tourniquet and get me to attempt one on them....your doing a great job keep it up and dont lose the head......you can come ride with me anytime...


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## firetender (Jan 21, 2008)

Is there anything that prevents you from putting a statement in writing that you feel strongly that this particular student needs to go back to get more clinical exposure before you'll work with her?

Given what you said, I don't think that's unreasonable. You are NOT doing your partner a disservice by submitting this to her instructor and then, if unheard, working up the food chain until someone listens to you. 

It is critical that when she's in the field with you she does what she's told. If she can't do that, then that is a clinical problem that should be handled by the instructors in a clinical setting. You are there (presumably) to ASSESS her skills, not teach her them. Your assessment is she needs more clinical. Period. (That's what I heard, anyway.)

If you're doing this as an official Training Officer, then boot her back to clinicals. If not, then refuse to work with her in that capacity. You have the right and the responsibility to protect the integrity of the care you render to your patients. 

That's one Grand dilemma, AND you'll get through it!


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## VentMedic (Jan 21, 2008)

Who does the initial classroom EMT-B IV training in your area?   Are they adequately prepared?  What is the total hours of training involved?  Does a clinical instructor monitor their ability/technique in a controlled setting such as an ED for the first couple of sticks before they are allowed to do the rest on an ambulance?


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## mdtaylor (Jan 21, 2008)

MedicPrincess said:


> So, any suggestions?



Either your skills as a precept are lacking or the student does not have enough confidence in you as a clinician to accept your instruction.

Perhaps you could sit down with your sup and approach it as "I want to be a better clinical precept but I am having trouble communicating with this particular student."


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## MedicPrincess (Jan 21, 2008)

> VentMedicWho does the initial classroom EMT-B IV training in your area? Are they adequately prepared? What is the total hours of training involved? Does a clinical instructor monitor their ability/technique in a controlled setting such as an ED for the first couple of sticks before they are allowed to do the rest on an ambulance?


 
This isn't a "student" still in school.  This is my regular, every shift partner.

The classroom training is done by the person in charge of training for our service.  It was an 8 hour class.  As for monitor in a controlled setting, no.  They get the class, and then are sent to their trucks to practice.

I make a "practice arm" out of an arm board and IV tubing.  Same thing I was given when I was first learning.  Gave it to her to practice technique and angle on.....found it in the trash.  

I am not a preceptor.  I have not been a Medic long enough to be a preceptor.  And as for not being a good one, I know I am not a great teacher.  I learn best by watching/then doing.  I do best with students who learn best the same way.   Now that being said, my EMT partner I had when I was with the county always disagreed, saying she had learned tons from me, it was just a matter of listening to what I was saying.  I don't know.

The problems with the partner and I are so much deeper than just the IV issue.  I could have an entire forum just on the issues between us.  I have requested a new partner.  Got shot down.  I will ask again....and again.  In the mean time I keep a journal, make sure I check and double check anything she does, do my job and part of hers, have really great FF we work with daily and use them to the fullest of their abilities, and stay out of it when someone calls her a "driver" and then procedes to tell her why they call her "driver" and not EMT.


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## VentMedic (Jan 21, 2008)

Unfortunately the Florida Statutes are very weak when it comes to EMT-B IV certifications.  Actually, that is one of many weak areas when it comes to clarifying training and education within the statutes.   If EMTs were to attend an IV class sponsored by a state vocational school or hospital that also trains LVNs, MAs and phlebotomists they would have monitored clincal rotations by the school's instructors or appointed preceptors.  In EMS, it is more often than not a random luck of the draw for the quality of clinical experience. 



MedicPrincess said:


> This isn't a "student" still in school.  This is my regular, every shift partner.



Your partner is an EMT-B, correct?



MedicPrincess said:


> Intresting you all feel the A&P classes and advanced airway classes should be taken prior to ACLS.  I have encouraged my EMT partner to attend an ACLS class, as well as the others that are offered to us (ITLS, PALS, Advanced Airway/RSI, ect), for the simple knowledge of whats to come when we are in that situation.
> 
> I don't expect for her to be able to interpret any rhythms for me, or perform the skills, but it is a comfort that she has a general knowledge base to be prepared for what I may be asking for next when we do finally have a code that isn't in Asystole/DOA/Signal 7.


http://www.emtlife.com/newreply.php?do=newreply&p=65512

You may be pushing her to be a "paramedic" while still an EMT-B.  She may know her education/training level limitations and comfort zone for her training.  140 hours of EMT-B and attending "cert" classes do not develop a secure foundation for working in the field. 

The fact that you are requesting a new partner and keeping a journal on her every move makes for a less than ideal learning environment for her.


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## MedicPrincess (Jan 21, 2008)

VentMedic said:


> The fact that you are requesting a new partner and keeping a journal on her every move makes for a less than ideal learning environment for her.


 
Not a journal of "her every move." However, when we are preparing to make a decision of intubation vs. CPAP and she cannot figure out what the CPAP looks like...I do note it.  (And before you ask...Yes....I have gone over every single piece of equipment on our truck with her, at some point she needs to have her own initiative to take another look at the stuff we don't use to often.)  Or when I have to tell her to stop hitting on the patient long enough to help get him on the backboard...or when I have to ask her to stop showing a FF how the electrodes will make great pasties and help with the pt that is working hard at coding......or when I have tell her for the unknown number of times to STOP TEXTING while responding to the hospital and she would have seen that car that is pulling out in front of her.....


And I could have been more specific about the ACLS class....I have worked 2 jobs for the last 2 months....I wouldn't encourage this partner to attend anything except maybe an EMT refresher....I was referring to my partner at the other job I had.


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## triemal04 (Jan 21, 2008)

> she cannot figure out what the CPAP looks like


First offense=remedial training (assuming a new employee).  Second offense=termination.


> I have to tell her to stop hitting on the patient long enough to help get him on the backboard


Suspension, termination for a second offense.


> I have to ask her to stop showing a FF how the electrodes will make great pasties and help with the pt that is working hard at coding


Suspension followed by termination the next occurence.


> I have tell her for the unknown number of times to STOP TEXTING while responding to the hospital


Immediate termination.  As in the moment you arrived at the hospital.  Hopefully followed by a loss of her EMT cert and revocation of her driver's licence.  Though that's just a dream I suppose...

If any of these things are remotely true, especially the last, then it is beyond time for you to take this to your supervisor.  At this point your partner has gone beyond being a danger to herself and is now putting the public (not to mention the profession) at risk.  Stop worrying about "helping" her with her IV skills and instead begin to worry about her basic EMT skills, not to mention her common sense skills which also seem to be lacking.

This is not an issue to let slide anymore, and the longer you go without taking any sort of action the worse things will become, and you will being exposing yourself to further problems and liabilities.  It's never fun to be the one to tell someone that they are not cut out for this and that it's time to seek a different line of work, but there is no alternative in this job.  Step up and do what's right.


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## oldschoolmedic (Jan 21, 2008)

*Hmmm*

Maybe, just maybe, a brand-new paramedic shouldn't be in a precepting position at all.

Take your little notebook, and your partner, and go see your supervisor. This way he gets both sides of your "differences" at the same time, not just you coming in and venting about her.

The training officer should be in there as well, since you are casting aspersions about the quality of his trainng standard.

Hopefully, the four of you can work this out before someone gets hurt. Until then, "Life's rough. Just put on your big girl (or boy) panties and deal with it!"


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## MedicPrincess (Jan 22, 2008)

> This is not an issue to let slide anymore, and the longer you go without taking any sort of action the worse things will become, and you will being exposing yourself to further problems and liabilities. It's never fun to be the one to tell someone that they are not cut out for this and that it's time to seek a different line of work, but there is no alternative in this job. Step up and do what's right.


Done that already.  Was in a nutshell told to make sure I have on my big girl panties when I come to work.  Took it to our Ops Mgr....he gave it back to our supervisor.

Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.


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## mdtaylor (Jan 22, 2008)

MedicPrincess said:


> Done that already.  Was in a nutshell told to make sure I have on my big girl panties when I come to work.  Took it to our Ops Mgr....he gave it back to our supervisor.
> 
> Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.



Maybe it's time you took your 'big girl panties' to an employer worthy of them? Is that an option?


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## MedicPrincess (Jan 22, 2008)

You know that saying "There is no job Utopia...."  Well everything else about this employer is great....it is my unfortunant circumstance that I happen to have possilby the most apathetic supervisor ever created.  He ran the previous service for 10 years prior to them - for whatever reasons -  not getting the contract to provide EMS service for the county.  He then was hired as a supervisor with the new service.  With his salary and bonuses he would get for keeping the previous company under budget, this new service is paying him about 1/3 of what he was bringing in before. 

So essentially, he just doesn't care...and says so just about every shift.  And dealing with a problem, and making people upset, is not anywhere on his agenda at all...thats to much conflict.  Its time for him to go....but thats MUCH BIGGER than me...I really do love just coming in to work, getting into my truck, running my calls, and moving where ever dispatch feels as though they need us today.

We are only 4 months into a 5 year contract with the county.  Bugs, complications, and a weeding out process is expected.  I just wonder how long it will take.

This service has a ground and an air division.  I am extremely intrested in the Air Transport side, once I get enough expierience....a long time away....and the correct alphabet after my name.


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## EMT19053 (Jan 22, 2008)

MedicPrincess said:


> Done that already.  Was in a nutshell told to make sure I have on my big girl panties when I come to work.  Took it to our Ops Mgr....he gave it back to our supervisor.
> 
> Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.



When she does sink herself, hopefully, you and/or the patient are not on the same boat.:sad:


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## firetender (Jan 22, 2008)

There are few things more frustrating than having an almost-dangerous partner and an unresponsive, next-highest authority to help you deal with it.

Documenting what you are experiencing is important in case YOU catch some hell on a call for her behavior. Don't neglect it. 

And if the Owner of your company will not respond to a personal request for a private, confidential meeting because you feel un-responded to by your Supervisor and feel it is a disservice to the system and perhaps danger to patients to MANDATE you as a trainer, then it's REALLY time to find a new company. Problems like these will not get better.

If you get the chance to sit with the Head-Honchos, present them with your documentation and ask them to place it in your file. Record that you gave it to them and keep a copy. This is now "on the record". The next step is to gently ask how the company will handle this information if your partner causes harm and the company goes to court.

It's really NOT about getting her bounced. Bottom line is the partnership is not serving anyone and if you feel it hinders your ability to render the care you're contracted to. You have the right and responsibility to ask her to be moved to another partner.

All this is based on -- and I'm asking you to really look at this -- if you really beleive she could be or is a danger. If not, and you can weasel your way around minimizing her patient contact, tough it out, it's just one ca-ca head partner in a career that I'm sure, will have many.

Experiences like this are not unusual and this really is your learning time to figure out what works best. Sorry you have to go through it in extremis so early, but it WILL give you good a good foundation to work from when things like this come up again.


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## Jon (Jan 23, 2008)

From my read, I don't think the issue is training-based... this seems to be an attitude issue with the subject who doesn't want to listen or improve themselves. The subject seems to repeatedly demonstrate that they don't want to let Princess assist them. As for new providers teaching - isn't the saying in Medical School "See one, Do one, Teach one". By teaching, we complete the cycle and solidify our understanding of the topic. I see no problem with a "newer" medic (who was a student for a year or two and doing IV's for that whole time) teaching someone else how to do IV's... IV is a "monkey" skill... you can train anyone how to do it (the military trains EVERYONE)... no different than boarding/collaring. (Generalization).

I think that Princess needs to do something about this person... if they are acting in a way that could be offensive to other EMS/Fire service members and/or the general public, than they don't belong on the ambulance. We all drive a rolling billboard and represent every EMT and FF everywhere.

If the person is exhibiting behavor that puts YOU and YOUR PATIENT at risk (Texting while driving class I/II/III) they need to be unemployed, and you need to NEVER work with them again. Your life is more important than your job. Communicate that to your boss and ask him HOW he will keep her out of your ambulance so she doesn't impact your safety


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## VentMedic (Jan 23, 2008)

I think there is more than one side to every story.   The partner is not on the forum to defend herself.  Or, maybe she is and doesn't want to slander anyone or the company's training since we do now know where this is taking place from previous posts by MedicPrincess.  It would be too easy for the people being discussed here to find out that they are the topic of the day. EMS is a rather small community especially in Florida. Things posted on the internet have a way of biting one in the butt if restraint is not exercised on some issues.  

Since this is a public forum there are some issues here that would be better benefited if they were hashed out in the company's office with all persons present to represent their own point of view.


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## MedicPrincess (Jan 23, 2008)

Vent-  your right.  The whole point of this thread was to get ideas to help me to better teach her....not let loose my frustrations that don't really matter that much anyway.

So, try to bring it back around....

Are there any ideas that can help me to better teach this person....or any person in general....


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## VentMedic (Jan 23, 2008)

I don't believe you mentioned how long your EMT-B partner has been in EMS.  EMT schools are not all the same and educational quality varies as does the clinical experience the student receives.  Also, if she got the same (2 weeks) or less time in orientation that you got, that is not a good start for anyone in an entry level position.  Even if she has been in the profession for awhile, different companies are known for forming bad habits. 

I would suggest that SHE go to the training officer for a review or find an IV class through the local community college, hospital or vocational tech school (state is fairly inexpensive).  There are IV classes offered for the LVN, MA and EMT.  They may give her a different prospective or view on the technique. She may also feel that she is not being judged in another class.  Some of the classes offer clinicals for the sticks. If not, a different instructor might give her the confidence that she doesn't feel now to be successful at starting an IV.  I'm sure if there is tension between the two of you as partners, attempting to teach/learn will be difficult.   

Is the IV certification required for her EMT-B job?  
Has she talked about going on the Paramedic school?
What are her ambitions?

You have told us about what your ambitions are for her but not what she wants.


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## MedicPrincess (Jan 23, 2008)

VentMedic said:


> I don't believe you mentioned how long your EMT-B partner has been in EMS. EMT schools are not all the same and educational quality varies as does the clinical experience the student receives. Also, if she got the same (2 weeks) or less time in orientation that you got, that is not a good start for anyone in an entry level position. Even if she has been in the profession for awhile, different companies are known for forming bad habits.
> 
> I would suggest that SHE go to the training officer for a review or find an IV class through the local community college, hospital or vocational tech school (state is fairly inexpensive). There are IV classes offered for the LVN, MA and EMT. They may give her a different prospective or view on the technique. She may also feel that she is not being judged in another class. Some of the classes offer clinicals for the sticks. If not, a different instructor might give her the confidence that she doesn't feel now to be successful at starting an IV. I'm sure if there is tension between the two of you as partners, attempting to teach/learn will be difficult.
> 
> ...


 
She actually has not been in EMS very long at all....Has had her cert for about 6 months, only working as an EMT for about 3 1/2 now.  

IV certification is not required.  It is supposed to be an asset, another tool in the EMT's bag 'o tricks.  

She is planning on starting Medic school, I believe they start in May.  I really do hope she does well.  

It is not a secret how I feel about new EMT/new Medic partnerships.  As a new Medic I am so busy trying to figure out how to apply all this new information and these new skills to the patient in front of me that doesn't fit any "textbook" description of anything, it becomes extremely difficult to effectively teach a new person their job too.  Everyone knows, school only teaches the core knowledge you need to know.  It does not teach how to actually work on the street, nor prepare you for everything that comes your way.  When things are going from bad, to worse, to Dear God...that is not the time to have both people on a truck trying to figure out their next move....or have one person trying to figure out the next move for both people.


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## VentMedic (Jan 23, 2008)

I think you have just thought it through.  Relax and let both you and your EMT partner get comfortable in your new career paths.  Help your partner to be a good EMT-*BASIC* first.  The rest will come as both of you gain experience in your new roles.

Good Luck!


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## MedicPrincess (Jan 23, 2008)

VentMedic said:


> I think you have just thought it through. Relax and let both you and your EMT partner get comfortable in your new career paths. Help your partner to be a good EMT-*BASIC* first. The rest will come as both of you gain experience in your new roles.
> 
> Good Luck!


 
So then the next question is....how do I do that? By encouraging her to get comfortable in her BASIC skills...it comes across as though I don't want her to advance at all. She has taken ITLS, the IV course, and is getting ready to take our Advanced Airway/RSI Class.

I am all for EMT's getting good at being an EMT before moving forward. When I started out, I was on a BLS truck doing NH transports. I spent the first 6 months "practicing" assessments on all my patients. I think that helped me tremendously when I did get a full time slot on an ALS truck....and then into Paramedic school. I often hand over my stethoscope and tell others to listen..."Old people have really neat breath sounds."

Either way....in order to well and succeed in Medic school and then in the field...she is going to have to get good at her Basic stuff....crawl before walk right?


On a side note.....What is the "Relax" thing you speak of??  I finally quit chewing the inside of my lip on EVERY call....now its just those Dear God calls.....I thought I had acheived this Mythological "Relax" you speak of...


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## firetender (Jan 24, 2008)

MedicPrincess said:


> It is not a secret how I feel about new EMT/new Medic partnerships. As a new Medic I am so busy trying to figure out how to apply all this new information and these new skills to the patient in front of me that doesn't fit any "textbook" description of anything, it becomes extremely difficult to effectively teach a new person their job too. Everyone knows, school only teaches the core knowledge you need to know. It does not teach how to actually work on the street, nor prepare you for everything that comes your way. When things are going from bad, to worse, to Dear God...that is not the time to have both people on a truck trying to figure out their next move....or have one person trying to figure out the next move for both people.


 
No need to defend yourself, Princess. 

You've got two things going on here. One is the quote above. Most likely, that's the core of this whole dilemma. On that level, I don't think the system that you are working in cares to either see or listen to your point of view. 

Your point of view is valid: You don't need an anchor that pulls you down, you need a partner whose focus is to be of support to you as the person who has the ultimate responsibility for the patient. 

If your system can not respond to these concerns, all that means is you do not fit in it and it's time to find something more appropriate to who you are. I think many people here would agree there are systems that are designed to handle this kind of stuff differently.

The second thing is your partner. If what you describe is accurate, she has an attitude that makes it highly unlikely that you could teach her anything. It may be she just doesn't jibe with you, or it may be that she doesn't want to be taught or it may be, though quite capable in other areas of her life, she's just out of synch with THIS work.

None of that matters. You percieve it as a threat to good patient care. 

Maybe here's what you really need to look at, though. Is this situation REALLY impacting your ability to offer professional care or not?

If it is, then you have little choice but to deal with it, and quickly, and also be willing to lose your position if it blows up in your face, which it could.

If it really doesn't, then the attitude needing adjustment is your own because all you're doing is torturing yourself, and maybe her, too.

At this point, I'd say honestly look at this and rate the danger to patient care because of it on a 1-10 scale. And then, whatever the result, take action in proportion to that result.


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## VentMedic (Jan 24, 2008)

Firetender,
What this is coming down to is two people on a truck with very little experience in their current professions.  

MedicPrincess: just got her EMT-P a few months ago, got a two week training with a new company

EMT-B partner:  EMT-B for 3 months

How spectacular of an EMT-B were you with only 3 months experience?  

That adds up to a very stressful situation without the personal/professional drama adding to it.  I will repeat: the personal and professional conflicts between these two people should not be aired on a public forum nor should people or a company/representatives be criticized if they are not there to defend themselves.   This could go unfavorably against MedicPrincess if not with this job but future job prospects.

I would agree that both need new partners but not for the "bashing" reasons but for each to get a more experienced partner so that they are both given a chance to succeed in their chosen professions.


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## firetender (Jan 25, 2008)

Okay, then. The disparity clearly lies in the fact that it is not appropriate for an inexperienced paramedic to be responsible for the preceptorship of an EMT who is just starting invasive procedures on live patients in the back of an on-duty ambulance.

Princess' partner is NOT a paramedic, she's a student. In her capacity of student, she should be a "Third Man" assigned to a qualified Training Officer until she's cleared in the field to work in the capacity of being a partner. As it stands now, she's not a partner and it is the system that is causing her to be a liability because it is blurring her role. As a partner, she is not there to practice, she is there to render care as part of a team.


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## KEVD18 (Jan 26, 2008)

there is never a set of circumstances where putting a brand new medic with a brand new basic is a good idea. i cant think of one conceivable way thats going to work.

a new medic shouldnt be allowed to work with a basic at all. new, experienced, veteran, it doesnt matter. new medics should train and precept under experienced medics

its not entirely your fault. its your systems. its broken. 

you need to sit down and have a come to jesus talk with your partner. make it clear it no uncertain terms whats wrong with your partnership and what you want to do to fix it. dont beat around the bush. tee it up and drive it home. make sure she gets it and give her the oppurtunity to respond in kind. its a give and take process. neither one of you leaves the room till your both on the same page. sometimes that meeting goes from that room to the supps office where the "we will never work together again" meeting happens. sometimes things get worked out but the point is that things have gotten to a point where a real solution is needed and since your company doesnt seem willing to participate, its up to you two to sort it out.


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