# not assertive enough? advice please



## brandnewemt (Jan 19, 2012)

Hi all,

I just finished my EMT-B course a month ago. When going on calls, my biggest issue seems to be that I'm not being assertive enough. The problem is, I'm worried about overstepping and pissing off those who have been doing this much longer than I have. I'm confident in what I've learned, yet I find myself fumbling around at the simplest things. Does anyone have any advice on how to overcome this? I'm only 3 calls in, but I'd like to resolve this issue ASAP.

Thanks!


----------



## NomadicMedic (Jan 19, 2012)

Are you responding with another EMT? With a medic? Why do you feel you're not being assertive enough? I suggest that you tell your partner you want to lead some calls. You can't do it unless you do it.


----------



## lawndartcatcher (Jan 19, 2012)

I'd say ask the folks you're working with - tell them "I'd like to step up on some of these calls but I don't want to step on toes".

Some folks will be fine with this, and some won't. At least you've laid it out for them. A good mentor will encourage new folks to step out of their comfort zone.


----------



## BLS Systems Limited (Jan 19, 2012)

Its a fine line between being assertive and being aggressive and its a wise person that knows the difference.  If in doubt, be assertive by asking questions.  Don't blow your cool, try not to fumble too much and always review what you did to see whether there would be changes to the process next time.  If you see a difference between the waqy you were taugt versus what you see in the field, don't be afraid to ask why there is a difference and/or why your partner chooses that specific method.


----------



## Veneficus (Jan 19, 2012)

brandnewemt said:


> Hi all,
> 
> I just finished my EMT-B course a month ago. When going on calls, my biggest issue seems to be that I'm not being assertive enough. The problem is, I'm worried about overstepping and pissing off those who have been doing this much longer than I have. I'm confident in what I've learned, yet I find myself fumbling around at the simplest things. Does anyone have any advice on how to overcome this? I'm only 3 calls in, but I'd like to resolve this issue ASAP.
> 
> Thanks!



Are you being told you are not assertive enough or is it how you feel?

If you are being told, tell those people to "F*** off" and ask them if that is better.

If it is a self assessment, I can tell you that confidence comes with comfort. I'd be more worried after 3 calls if you thought you were an expert than you being afraid.

You are still very new at this, give yourself some time to get all of the stuff in your head into an order of importance and action.

Very few patients are actually textbook as you learned them. If it feels like you can't figure them out right now, you are probably where you should be. It gets better with more patients. 

Also, something not often expressed in medicine is that we become better providers from the sum of our experiences. That includes close calls and mistakes. 

In my not always humble opinion, a provider who is once bitten and forever shy is a far bigger diservice to future patients than one who is bitten but tries again.


----------



## swampwolf (Jan 19, 2012)

brandnewemt said:


> Hi all,
> 
> I just finished my EMT-B course a month ago. When going on calls, my biggest issue seems to be that I'm not being assertive enough. The problem is, I'm worried about overstepping and pissing off those who have been doing this much longer than I have. I'm confident in what I've learned, yet I find myself fumbling around at the simplest things. Does anyone have any advice on how to overcome this? I'm only 3 calls in, but I'd like to resolve this issue ASAP.
> 
> Thanks!



Hi Brandnewemt~ I'm a newbie as well. I have gone on 4 calls so far since finishing my basic class. I'm still pretty nervous but eager to learn. I feel confident about my "textbook" knowledge, but I'm overwhelmed by it at the same time. I feel like I have so much info in my head that when I'm on a call, I try to dial in to what's going on, but I forget the stupidest stuff, stuff that I KNOW is in my brain but somehow I don't recall it in the moment. 

For the rest of the forum, please tell me that, with experience, all this information swirrling around in my head will fall into order...Did or does anyone else feel the same way when starting out?


----------



## Veneficus (Jan 19, 2012)

swampwolf said:


> Hi Brandnewemt~ I'm a newbie as well. I have gone on 4 calls so far since finishing my basic class. I'm still pretty nervous but eager to learn. I feel confident about my "textbook" knowledge, but I'm overwhelmed by it at the same time. I feel like I have so much info in my head that when I'm on a call, I try to dial in to what's going on, but I forget the stupidest stuff, stuff that I KNOW is in my brain but somehow I don't recall it in the moment.
> 
> For the rest of the forum, please tell me that, with experience, all this information swirrling around in my head will fall into order...Did or does anyone else feel the same way when starting out?



If you are lucky, you will have a teacher or mentor who instructs and guides you how book knowledge applies to the "real world."

You will then become a competent and confident provider.

If things don't go so well, you will learn what to do, but always be at a loss for why.

That leads to ignorance and arrogance. 

It is much easier to be calm and collective when you are proactive rather than the constant uncertainty of being reactive.

But as I said to the OP, at this stage in the game, you sound like you are right where is expected.


----------



## mycrofft (Jan 19, 2012)

Communicate with your coworker. That is how division of labor and coordination of action are initially devised. If your mentor/coworker won't communicate, at any point working on ambulances, it's time to ask to talk to your supervisor.
If you are on orientation they ought to have a full crew with you riding extra and doing stuff as directed and observed. If you are on orientation and expected to act as a full half of a team, then your company either has problems, or you really impressed them. If you are off orientation, then you and your coworker need to talk, with you as the mentee, and (s)he as the mentor.


----------



## brandnewemt (Jan 19, 2012)

swampwolf said:


> Hi Brandnewemt~ I'm a newbie as well. I have gone on 4 calls so far since finishing my basic class. I'm still pretty nervous but eager to learn. I feel confident about my "textbook" knowledge, but I'm overwhelmed by it at the same time. I feel like I have so much info in my head that when I'm on a call, I try to dial in to what's going on, but I forget the stupidest stuff, stuff that I KNOW is in my brain but somehow I don't recall it in the moment.
> 
> For the rest of the forum, please tell me that, with experience, all this information swirrling around in my head will fall into order...Did or does anyone else feel the same way when starting out?



This is EXACTLY how I feel! It make me feel much better that others feel the same way. it seems like there are so many people who get their EMT card and want/expect to take charge right off the bat. To me, the ability to lead a call should be something that's earned, not expected...


----------



## mycrofft (Jan 19, 2012)

Relax a little. You will learn through experience what horses (versus zebras) to expect and what to do, and especially how to assess a patient. There is NO replacement for real patients with a variety of repeating problems to teach you patient assessment and care, and every day has the chance to toss you a curve.
Once you get by this initial stage, they will trust you more (maybe too much at first) and you will feel the pressure lift if you are not beating yourself up. That will never end if you don't end it.


----------



## Veneficus (Jan 19, 2012)

brandnewemt said:


> it seems like there are so many people who get their EMT card and want/expect to take charge right off the bat.



With the exception of some rather reputable field training programs in a handful of very reputable agencies, you likely will be expected to take charge in short order.

Depending on your area or agency, you might just show up and be the highest trained provider on sceen. (If not in your circumstance, remember that somebody somewhere is facing this with the same training and experience as you.)

There is no classroom exercise that prepares you for the moment everyone looks to you to take direction from. It is scary and seldom goes perfectly.

But you cannot be in charge a second time until you have been in charge the first. Relax. You will make mistakes. (Now you don't have to worry about if you will.)  Nobody is perfect, those claiming such are fools or liars. Learn and move on.  



brandnewemt said:


> To me, the ability to lead a call should be something that's earned, not expected...



:rofl:

Sorry, don't know if you know what you signed up for. Emergency medicine and service is known for giving people enough rope to hang themselves prior to being thrown to the wolves. 

The experienced people are also known to eat their own young.

But we made it and so can you.

Don't worry about what cannot be changed.


----------



## BLS Systems Limited (Jan 19, 2012)

I always recommend to anyone entering into a new field or role to keep a journal for the first year.  After you get the hang of things, what was once really exciting becomes a common occurrence.  Gradually you may even become bored of things that almost gave you a heart attack in the early days.  What's truly humbling is your recorded attitude when your first "regular customer" passes away.   Its a riot when you go back and read about these constantly new occurrences, your fears and attitudes.  I recommend that to all healthcare providers regardless of their role.


----------



## mycrofft (Jan 19, 2012)

Roger that tederator!


----------



## TLettuce (Jan 25, 2012)

Always remember it's their emergency, not yours. 

We're all human, if you intend to stay in this field you will make your fair share of mistakes. We all have our stories.

If you find yourself too anxious on calls to remember your duties just remember your basics. Don't get tunnel visioned... Distended abdomen, flail chest, cardiac or stroke like symptoms, it doesn't matter. Keep your ABC's in mind, trend your vitals, treat what you can but most importantly never lose site of what is REALLY important.

Keep this in mind and you will go far. For now relax, take in what you can.


----------



## Hellsbells (Feb 7, 2012)

I can't speak to your partner(s), but personally I'd rather a rookie step on my toes, so to speak, than be a wallflower on calls. You should work out beforehand who will take the lead on a particular call. Once you have done your primary survey and vitals, if your are not 100% sure how to carry on communicate with your partner, recap briefy your findings, then suggest what you think the next course of action should be, even if youre not totally sure. 

The most important thing is to try and base the decision on the information you have. My biggest peeve with EMT partners is when they look to me to make decisions for them. That said, I step in if he is doing something out of line, or if interventions are out of his scope. Otherwise, I want my partner to be able to make independent decisions as for his scope will allow.


----------



## xrsm002 (Oct 26, 2012)

I'm a student still and have trouble being assertive no one in my family is assertive. I've also had calls where im leading and I walk I forget everything I learned. Anyone ever have that issue?


----------



## Brandon O (Oct 26, 2012)

xrsm002 said:


> I'm a student still and have trouble being assertive no one in my family is assertive. I've also had calls where im leading and I walk I forget everything I learned. Anyone ever have that issue?



You'll learn to develop a "work face." Plenty of mousy people in this job who know how to turn it on when they make patient contact.

As far as assertiveness, just remember that your degree of confidence reflects your level of actual competence. You don't want to learn to waltz around acting confident before you actually know what you're doing, because you're sending out a message that you don't need any help and you've "got this"; if you actually don't, then you're going to hurt somebody. If you've got a pretty good handle on the work and you're still timid, that's one thing, but if you're still figuring things out and you look that way, there is absolutely nothing wrong with that. Like a "Student Driver" sign on your roof, it's a useful and important signal to those around you.


----------



## Refino827 (Oct 26, 2012)

brandnewemt said:


> Hi all,
> 
> I just finished my EMT-B course a month ago. When going on calls, my biggest issue seems to be that I'm not being assertive enough. The problem is, I'm worried about overstepping and pissing off those who have been doing this much longer than I have. I'm confident in what I've learned, yet I find myself fumbling around at the simplest things. Does anyone have any advice on how to overcome this? I'm only 3 calls in, but I'd like to resolve this issue ASAP.
> 
> Thanks!



Here at the station I usually have a set group of people that I work with. We all have a rule that we will take turns scribing/taking lead/doing vitals. That way no one over steps the boundary of another person. You aren't going to get anywhere if you don't ask if you can take lead, they're just going to assume you aren't confident or comfortable and keep taking lead. Either that or they're just going to throw you in one day and tell you to do it. Don't be afraid, the only way you get any attention to the problem is if you speak up about it. And definitely don't go hijacking the other person's scene.


----------



## Shishkabob (Oct 26, 2012)

Be assertive.  Who cares if you piss someone off?  It's your patient, your responsibility.

I am shy as hell outside of work, however once the uniform comes on, I have a job to do and I do it, and anyone who gets in my way preventing me from doing the job I'm paid and educated to do will get theirs.  




Be respectful, but don't be afraid to hurt feelings if it's called for.


----------



## mycrofft (Oct 27, 2012)

OP how'd it go?:mellow:


----------



## hogwiley (Oct 29, 2012)

Are you basing this conclusion that your not assertive enough on EMT school clinicals, or are you currently working as an EMT?

EMT school is to learn. I was horrible early on in clinicals simply because I had no clue what was going on. Because I had no clue I wisely attempted to stay back and observe. Towards the very end of class I was more assertive because I actually kind of had a clue what I was doing. 

I would worry more about the people who are assertive and overconfident but DONT know what theyre doing, and there are a lot of them in EMS. 

We had one guy in my EMT class who would jump right in on calls during ride alongs, and acted like he had been doing this all his life. Problem was whenever we did scenarios and practical stations or were just asked questions, this guy never had any clue what he was doing and always got the minimum passing score on tests, just enough to not fail, before finally failing the final exam. This despite the fact he was supposedly this star student on clinicals.

I also see a first responder on many calls who because hes been a first responder for many years, thinks he knows everything. In fact he has no medical training or education beyond first responder, and consistently will say things that are flat out wrong, and does these haphhazard patient assessments that focus in on some hunch he has to the neglect of everything else. 

Ill welcome someone who is self conscious and questions themselves over an overconfident knowitall idiot any day.


----------



## xrsm002 (Oct 29, 2012)

swampwolf said:


> Hi Brandnewemt~ I'm a newbie as well. I have gone on 4 calls so far since finishing my basic class. I'm still pretty nervous but eager to learn. I feel confident about my "textbook" knowledge, but I'm overwhelmed by it at the same time. I feel like I have so much info in my head that when I'm on a call, I try to dial in to what's going on, but I forget the stupidest stuff, stuff that I KNOW is in my brain but somehow I don't recall it in the moment.
> 
> For the rest of the forum, please tell me that, with experience, all this information swirrling around in my head will fall into order...Did or does anyone else feel the same way when starting out?



@ Swamp wolf I am in the sane boat as you I am able to recall it out in the lab verbally but I get on the truck on a call and all the stuff I learned in class leaves my head, then I forget to do the simplest things.


----------



## Brandon O (Oct 30, 2012)

xrsm002 said:


> @ Swamp wolf I am in the sane boat as you I am able to recall it out in the lab verbally but I get on the truck on a call and all the stuff I learned in class leaves my head, then I forget to do the simplest things.



This is awfully common for new folks. The sheer volume of stuff you have to remember becomes overwhelming, then in the fuss you forget stuff that you actually do know. The trouble is that often the folks with experience forget how much there is to remember, because it's all second nature to them now, so they go around slapping their head: "How could numbnuts forget to tie his shoes?"

Eventually everyone seems to hit a tipping point where you know most of the basic steps, suddenly you realize that you know it, and you start to relax. Some scenario-type work and other drills can help you hammer in some of it so there's less active thinking and more automatic execution.

For now, just start each scene with a deep breath.


----------



## xrsm002 (Oct 30, 2012)

@Brandon OtoWhat about folks who just graduated the class portion of medic school and have been on the truck for over 200 hrs!!


----------



## Brandon O (Oct 30, 2012)

xrsm002 said:


> @Brandon OtoWhat about folks who just graduated the class portion of medic school and have been on the truck for over 200 hrs!!



Eh... that's not so long. Particularly for a new medic, because you've got so much more to think about. Did you have BLS experience prior?

I usually find it takes at least six months (full-time) before people start to get into a real groove, know how to handle most situations, and feel comfortable thinking on the fly. Maybe a little less in very busy systems, but again, that's for BLS.


----------



## Veneficus (Oct 30, 2012)

xrsm002 said:


> @Brandon OtoWhat about folks who just graduated the class portion of medic school and have been on the truck for over 200 hrs!!



Total hours is a poor measurement and indicator.

Number of patient contacts along with severity is a much better indicator.


----------



## xrsm002 (Oct 30, 2012)

My preceptors don't think I'm assertive enough but I move slow due to the fact I have some PTSD according to my therapist. I am debating if I should tell my preceptors or clinical coordinator this, therapist says no, but I know this is what's causing me to freeze up.


----------



## Veneficus (Oct 30, 2012)

xrsm002 said:


> My preceptors don't think I'm assertive enough but I move slow due to the fact I have some PTSD according to my therapist. I am debating if I should tell my preceptors or clinical coordinator this, therapist says no, but I know this is what's causing me to freeze up.



The plot thickens...

One day people will understand it is better to move slow and be right than to move quickly and be wrong.


----------



## Brandon O (Oct 30, 2012)

xrsm002 said:


> My preceptors don't think I'm assertive enough but I move slow due to the fact I have some PTSD according to my therapist. I am debating if I should tell my preceptors or clinical coordinator this, therapist says no, but I know this is what's causing me to freeze up.



I would say no unless it gets to the point where you may end up terminated as a result. Just keep grinding along. Everyone goes through this same process to a greater or lesser extent, and frankly I think some of the slower learners end up being the best providers in the end.


----------



## jonathanrs89 (Oct 30, 2012)

These are my 2 cents. 


Me during the first few weeks of emt course. I was clueless, felt stupid, whenever I would get questioned by the teacher, my head would go blank, and I was nervous all the time thinking my teacher would ask me. I realized I needed to study hard, In case I would get asked by the teacher. In the weeks to follow, I was on top of the game, I was not the smartest in the book, but I was EMT smart. I was participating in the hands on skills, in the scenarios I was first to volunteer, and I was helping my other two friends in their skills. I would come up with scenarios and helped me and them finally get it. We all three did really good in the last tests, in the final, and passed the skills test like a breeze. I gained the confidence to not be nervous when my teacher asked me things. He worked at the hospital we did our clinicals, so he was constantly checking on us. 

I got a job as an emt a month after getting the ambulance license, nremt, county card, etc. And my FTO treated us like scum, questioned every little thing we did wrong. Our orientation consisted of an 8 hr shift, with FTO and EMT. That was it. My first few shifts were with newbies. Our FTO's advice, do not kill anyone. 

Imagine how a new EMT can feel in that situation, now add or I must say subtract, having at least an experienced EMT with you. Well it was rough, but after a month or so. I do not know how many calls exactly I finally got it. I am quiet person, not shy, just serious. My partner was a girl who thought she knew it all. Until my last shift there I saved her from running over a pedestrian because she was texting while driving. For a second I thought, maybe I should have let her run him over, it would have been on her, as it was my last day working there. However I felt bad for the pedestrian. Ms. Know it all said thanks. She probably learned her lesson, she was rude to us new EMTs. 

So just remember you need a huge thick coat of skin for this job, or it wont work. You will get nice people, burn outs, know it alls, d bags.


----------



## bigbaldguy (Oct 31, 2012)

I'm a pretty solid Beta who tends to defer to whoever is present and more qualified than I am. When I was new at EMS this meant pretty much everyone. As I became more confident in what I knew I also became more confident taking charge and suddenly people were looking to me for leadership. I now find there are fewer and fewer situations where there's anyone for me to defer to. Now I've started medic school and once again I've tumbled right back down to the bottom of the hill where I find myself once again looking to others for my cues. 

Once you feel more confident in your skills and knowledge base you'll be fine. In the mean time as someone suggested just try and fake it.

One note though. Being assertive doesn't mean being an :censored:. often people who are trying to act tough take their examples from characters like House.

Be confident but be kind, both to your patient and to your co workers. Pulling the whole sarcastic :censored: routine only works on shows like House where you have time to get to know the warm fuzzy side of the character over the course of a few seasons. We only have a few minutes to an hour with our patients. If you act like a jerk that's all they will remember you for. 

Also one more thing I want to point out. If you're a female it's even harder to manage the assertive but not a jerk thing. This has to do with the fact that society views assertive men as "strong" and assertive women as either insecure or outright :censored:s. This is a double standard that I don't agree with but it is a double standard that isn't going to change anytime soon. Women that manage to walk this line have my utmost admiration.


----------



## xrsm002 (Oct 31, 2012)

Well that's one thing I do have I show compassion for the ones I treat whether it be a frequent flyer or a rich person I try to treat them all like I'd want my family to be treated, kinda angers me when I see experienced providers yelling at the patients, or just talking down to them.


----------



## xrsm002 (Oct 31, 2012)

I have also been told by other people preceptors I am very easy to get along with.


----------



## onabemr (Oct 31, 2012)

I think assertiveness, or at least healthy assertiveness, is a fine balance between natural confidence, experience and the understanding of need.  You turn it on and off.

If I think you really need to listen to me, and your health is in peril, then I'll assert.  If you're getting too far off-topic and I need more specific info, then I'll assert. 

But a lot of the time, assertion is unnecessary or even counterproductive. We need to be active listeners more than anything else.  Don't be shy is saying hello or asking questions, and if you're unsure, double-check stuff.  It's silly, but if I'm floundering, I'll reauscultate, or take a BP again or something. Get more information, build pt confidence, buy time to think.  

We don't always make snap decisions, because deciding too quickly/early isn't always a good idea.

So don't stress.  You'll get better over time as you've seen and done more.


----------



## ah2388 (Nov 5, 2012)

Vene wins thread

gg


----------



## VFlutter (Nov 5, 2012)

I have the opposite problem... I had someone call me "arrogant and cocky" at work the other day. Me? never


----------



## Summit (Nov 8, 2012)

This thread is serious stuff... and it needs a little South Park. 

Cartman knows how to assert his AUTHORITAH!
http://www.youtube.com/watch?v=gx4jn77VKlQ
http://www.youtube.com/watch?v=Cd30JESdb9o


----------

