# ER Nurses make horrible Paramedic precepters



## hogwiley (Oct 1, 2014)

Sorry, but its true. Finishing up my program I have done several hundred hours in the ER, and although there have been exceptions, by and large I found the ER Nurses useless in anything other than signing paperwork. No teaching, no precepting, frequent rude snotty attitudes, things like asking a student to leave the room before they do something(imagine a Paramedic preceptor asking a student to leave the patients room or house, or stepping outside of the ambulance so they can do an assessment).

Its not just me either, this was the same experience for literally EVERY other student in my class and the classes before and after ours, even students that were RNs commented on how much harder Paramedic clinicals were compared to Nursing clinicals and how much better they were treated as a Nursing student. One student who was an RN said he felt pampered as a Nursing student compared to how he was treated as a Medic student.

I guess its because they have no real incentive to teach, and don't even know what's important for a Paramedic to know. Its basically a situation where they are precepters by default because there is no one else to do it in a hospital setting. Its not practical to have ER docs do it and most ER techs aren't Paramedics, so that kind of leaves RNs stuck with a job they don't want and aren't very good at, and don't really have the time for.

I understand some of the hostility. You have a lot of really cocky Paramedic students, particularly some of the firefighters, so some RNs will intentionally try to make life difficult for EMS students out of resentment, but it really makes it hard to get much out of clinicals in that environment.


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## DesertMedic66 (Oct 1, 2014)

It is completely hospital and area dependent. The majority of the nurses that I had were amazing. Letting me do my own assessments on the patients, doing every skill in my scope, admin every med possible, loved to teach, and overall really well.


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## hogwiley (Oct 1, 2014)

What I don't understand is that if it is a regional or hospital thing, why were the RTs, techs, CRNAs, docs PAs and other staff in the same hospital usually great at teaching Paramedic students and volunteering information? I learned more from the ER docs than I ever learned from any of the Nurses, despite having a fraction of the interaction with them I had with the Nurses. I don't think I ever ran into a snotty RT with an attitude, but that was pretty much the default mentality with the RNs. It was usually the older really senior RNs that were the best, maybe because they had the most respect for the Paramedics, or something to do with the the education they had verus more recent nurses, but many of the younger ones were horrible.


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## gotbeerz001 (Oct 1, 2014)

I have found the best RN preceptors were previously field medics that bridged over to nursing. Find them and make friends.


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## sjukrabilalfur (Oct 1, 2014)

It sounds like your program rolled the dice and got affiliated with a crummy hospital. The E.D. where I did my time was excellent. They even had me gown up and practically shoved me in to do CPR on a cardiac code on my first day, an ER doc gave me a play by play of intubation while he was doing it, and had me follow a stroke alert call from the door through CT to admission to understand the process. 

Our program made it clear that we had a specific number of required patient contacts, and our nurse preceptors had to sign off on each of our contacts. That might have been the difference. I assumed that's the norm but maybe not.


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## VFlutter (Oct 1, 2014)

Sorry to hear that you had a bad experience. ER RNs are a weird bunch, I can't seem to figure them out, some are awesome and others leave much to be desired. But I guess that is every area not just ER.


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## Christopher (Oct 1, 2014)

I loved my RN preceptors and enjoyed just about all of my clinical time in the hospital...


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## sjukrabilalfur (Oct 1, 2014)

One question I have is, did you or your classmates take your concern about it to your program coordinator/chairperson? I'm sure your class's experience is the sort of thing a program head and hospital EMS director would want to know about, even if it's the only hospital in your area.


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## Medic Tim (Oct 1, 2014)

I spent most of my ER time with PAs or Docs. Very little time was spent with the RNs.


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## hogwiley (Oct 1, 2014)

hogwiley said:


> Our program made it clear that we had a specific number of required patient contacts, and our nurse preceptors had to sign off on each of our contacts. That might have been the difference. I assumed that's the norm but maybe not.



Oh we had more than just patient contacts, we had plenty of objectives that had to be done and evaluated, in fact I believe its a requirement for all Paramedic programs. its not like EMT Basic where you just do x amount of hours. You need so many IVs, meds, advanced airways, assessments etc, with plenty of documentation to go with it, and its set up so you HAVE to do the bulk of them in a hospital setting, so the uncooperative Nurses were more than just a nuisance. They made life extremely difficult for us.


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## MrJones (Oct 1, 2014)

I agree that one's experience will be largely location dependent (I had some very good Nurse preceptors). With that said, I don't agree with Nurses being our preceptors. I know the odds of it happening are slim to none (and slim just took the last train to Clarksville), but our preceptors should be the ED Doctors.

Discuss.


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## sjukrabilalfur (Oct 1, 2014)

hogwiley said:


> Oh we had more than just patient contacts, we had plenty of objectives that had to be done and evaluated, in fact I believe its a requirement for all Paramedic programs. its not like EMT Basic where you just do x amount of hours. You need so many IVs, meds, advanced airways, assessments etc, with plenty of documentation to go with it, and its set up so you HAVE to do the bulk of them in a hospital setting, so the uncooperative Nurses were more than just a nuisance. They made life extremely difficult for us.


Yeah that's a huge problem.


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## Medic Tim (Oct 1, 2014)

MrJones said:


> I agree that one's experience will be largely location dependent (I had some very good Nurse preceptors). With that said, I don't agree with Nurses being our preceptors. I know the odds of it happening are slim to none (and slim just took the last train to Clarksville), but our preceptors should be the ED Doctors.
> 
> Discuss.


Agreed. 
We were told the ER was not a place to get skills checked off (IVs, meds, pumps, etc) as we did rotations in other departments where they were the focus. We were to focus on our and the doctors assessments. The skills we got there were just a bonus.

Earning the trust of the docs exposed me to a much better experience. It also made interaction with the nurses a bit better. In my down time I would help out the nurses with pts, clean ups and lab runs.


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## Carlos Danger (Oct 1, 2014)

hogwiley said:


> What I don't understand is that if it is a regional or hospital thing, why were the RTs, techs, CRNAs, docs PAs and other staff in the same hospital usually great at teaching Paramedic students and volunteering information?



Because generally speaking, life doesn't suck nearly as bad for any of them as it does for the nursing staff. No one puts up with more BS and a heavier workload than the ED nursing staff, though depending on physician staffing and what is going on with the patients, the docs can be right there, too. Add to that the possibility that there could be things behind the scenes making the nursing staff even more miserable that usual (contract negotiations, new rules being implemented, etc.), and you have a recipe for crappiness. And remember that probably not one of them ever asked to precept a paramedic student, and they probably don't get any kind of differential for it - precepting just adds to an already stressful job and there is nothing in it for them.

None of that justifies them treating a paramedic student like crap, of course. It is what it is, though. Some people are just jerks.




MrJones said:


> I agree that one's experience will be largely location dependent (I had some very good Nurse preceptors). With that said, I don't agree with Nurses being our preceptors. I know the odds of it happening are slim to none (and slim just took the last train to Clarksville), but our preceptors should be the ED Doctors.
> 
> Discuss.



If the docs have time to teach, sure. But often the docs are very busy doing mundane things that have little relevance to the things a paramedic student needs to learn. The ED I used to work in was crazy busy and except for maybe having a couple minutes to pull a medic student to the side to show them an interesting EKG, there's no way they had time to let someone shadow them and explain and discuss everything along the way. We (the nurses) didn't have time either, but we could at least show the medic students where the IV stuff was and let them do IV starts, EKG's, patient assessments, and let them draw up and push a med here and there.


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## blachatch (Oct 1, 2014)

I learned more from the respiratory therapists in 6 shifts then I did from any ER nurse . I had the same experience as you they were rude and wouldn't give us the time of day.


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## DrParasite (Oct 2, 2014)

MrJones said:


> With that said, I don't agree with Nurses being our preceptors. I know the odds of it happening are slim to none (and slim just took the last train to Clarksville), but our preceptors should be the ED Doctors.
> 
> Discuss.


Why do you have nurses precepting paramedic students?  aren't nurses and paramedics supposed to be equals?  I mean, could you imagine the outcry from the nursing community when they were told that student nurses would be precepted by (gasp!!!) paramedics?


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## wanderingmedic (Oct 2, 2014)

I was precepted by RNs and ED docs; it was a phenomenal experience. I found that everyone was very willing to teach and go out of their way to help me. However, I think that my preceptors liked paramedics to begin with. Many of the RNs I worked with were at one point paramedics or EMTs, and the ones that weren't directly involved in EMS had family that was (e.g. my ICU preceptor's son was a medic). Needless to say, I think I lucked out with my nursing preceptors. But, I do think that if the RN has ample motivation - likes to teach, was a paramedic, worked flight, etc - they can make great preceptors for Medic students. 

I do think that ED docs make good preceptors, but I do not think that they should be the *only* ones to precept students. The nursing approach is extremely helpful in teaching medics to think further than the 15 mins to 1 hour medics have the patient. Infection control, understanding the helpfulness of a social history, bed sores, are all helpful things medics can and should learn from nurses. If you want to be a medic that provides great care - not just a medic that provides the bare minimum standard of care - then understanding a basic nursing approach is extremely helpful. The majority of EMS patients won't benefit from ALS interventions, but they will benefit from an understanding medic who can direct them to good social services, or communicate pertinent social concerns to a social worker. Having a basic grasp of nursing care is also helpful for medics who do inter-facility transfers, especially with patients that have infectious diseases, are being fed through a PEG tube, etc.


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## Ewok Jerky (Oct 2, 2014)

the thread title is pretty blanket statement to make based N=1.

I wouldn't want to learn how to stick an IV from a doc who probly hasn't done it since before residency.


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## Medic Tim (Oct 2, 2014)

Double post


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## Medic Tim (Oct 2, 2014)

Medic Tim said:


> If you are being sent to the ER to learn how to do IVs your program is failing its students.





It appears a lot of school just send student to the ER to do basic skills. I see this as a huge waste. If that is what the program is doing an rn is more than enough as a preceptor. Maybe I am off here but could the reason the nurses don't like medics student be that they are there for the skills and not the education? I know that was a very general and large brush stroke and I know not all programs and student act that way, but I have had alot and seen a lot of students that only cared about the skills and couldn't be bothered to lift a finger for anything else.

To me this is a huge waste and does a disservice to the student.


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## Carlos Danger (Oct 2, 2014)

DrParasite said:


> Why do you have nurses precepting paramedic students?



Because there are a lot of basic skills that paramedic students need to learn that nurses do a lot of.



DrParasite said:


> aren't nurses and paramedics supposed to be equals?



What does 'equality' have to do with it? Aren't paramedic students also precepted by paramedics?


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## Tigger (Oct 2, 2014)

beano said:


> the thread title is pretty blanket statement to make based N=1.
> 
> I wouldn't want to learn how to stick an IV from a doc who probly hasn't done it since before residency.


Pretty much this. "Me have bad time, nurses are bad."

If your program does not communicate with the people precepting you what the goals of your experience should be it's kind of hard to blame the people.


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## Ewok Jerky (Oct 2, 2014)

Medic Tim said:


> Maybe I am off here but could the reason the nurses don't like medics student be that they are there for the skills and not the education? I know that was a very general and large brush stroke and I know not all programs and student act that way, but I have had alot and seen a lot of students that only cared about the skills and couldn't be bothered to lift a finger for anything else.



Maybe part of the problem is a culture of bashing nurses and their "nursing model" of education. By that I mean I think a lot of medics don't think nurses have anything to teach them besides skills.


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## Akulahawk (Oct 2, 2014)

beano said:


> Maybe part of the problem is a culture of bashing nurses and their "nursing model" of education. By that I mean *I think a lot of medics don't think nurses have anything to teach them *besides skills.


In some ways, I think the reverse is also true as well. 

I should certainly say that I had some very good RN preceptors in the ED when I was doing my hospital internship while in Paramedic school. My primary RN preceptor had been a Paramedic for about 7 years before becoming an RN and while she had been an ED RN (at that point) for nearly 10 years, she still kept her Paramedic license active. She certainly understood what was needed in the field and could show how the things I did in the field could affect patient outcomes in the hospital. I would have been nice to get in-patient experience during that time, but not for "skills" practice, but more for seeing patient flow through the hospital.


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## hogwiley (Oct 8, 2014)

I'm not really complaining about RNs being mean. The meanest precepters I've had by far were Paramedics or RNs that were/are Paramedics. But while they may not have minced words or shyed away from letting a student know it if they screw up or aren't doing things good enough, most of them also at least taught.

The problem with a lot of the non Paramedic RNs though is that they pretty much ignored Paramedic students, or didn't really seem to know or care what would be beneficial for them. Airway skills in particular were something the RNs didn't really seem particularly knowledgeable in, and in some cases I saw experienced ER Nurses doing things wrong. I understand its not something that's really taught in RN school, so the ER Nurses basically just learned by watching the docs and RTs. Some of them apparently picked up these things well and some didn't. ICU Nurses were usually a little better sources of info for airway, RSI and ventilator related stuff, but we didn't do a lot of time in the ICU.

I'm not trashing ER Nurses. They have a very tough job, im just not sure they make the greatest Paramedic precepters. That doesn't mean I look down on them. An experienced Paramedic would probably make an even more horrible Nursing school preceptor, but nursing students don't spend any time on an ambulance. They are just very different jobs.


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## Angel (Oct 9, 2014)

eh, i also had a good clinical experience. you get from it what you put in which is #1, and your attitude goes a long way as well. seems this post was created out of a broad generalization, but its obviously not been the case for most of us. 
at the end of the day, you need them more than they need you.


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## hogwiley (Oct 9, 2014)

Angel said:


> eh, i also had a good clinical experience. you get from it what you put in which is #1, and your attitude goes a long way as well. seems this post was created out of a broad generalization, but its obviously not been the case for most of us.
> at the end of the day, you need them more than they need you.



Well its not a question of whether they need me. An RN needs a Nursing student like they need a hangnail, but they still are used as precepters and generally do at least a decent job of teaching them during clinicals.


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## Angel (Oct 9, 2014)

*i think* because theres more they (nursing students can do) you/we cant place foleys, ng tubes, ortho reductions ect. about all we can do is ivs, meds and blood, (splinting ect if the ER tech lets you, where I was that was about all they did) some places will let you intubate but our skill set is fairly limited in the ER. this of course isnt an excuse, but maybe an explaination...


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## Akulahawk (Oct 9, 2014)

Angel said:


> *i think* because theres more they (nursing students can do) you/we cant place foleys, ng tubes, ortho reductions ect. about all we can do is ivs, meds and blood, (splinting ect if the ER tech lets you, where I was that was about all they did) some places will let you intubate but our skill set is fairly limited in the ER. this of course isnt an excuse, but maybe an explaination...


When I was doing my ED rotation, there really wasn't a whole lot that I couldn't do, but the point was more skill development and practice rather than work on nursing care because I wasn't a nursing student. So, I got to place foleys, drop NG and OG tubes, start IVs, draw labs, do vitals, interpret EKG's, and so on. As a Nursing student, I did much of the same but thrown in doing med passes, doing assessments & charting them, and the like. I just couldn't do any Code stuff beyond doing compressions.

ER Nurses that haven't been Paramedics or worked in the field in some capacity don't really know a whole lot about field work, so they're not going to really know what the Paramedic Student is going to need. This isn't anywhere near as true for the Nursing Student or New Grad RN as the nurses know what the newbie nurses need to know. It's just that Nurses don't get a whole lot of exposure to field personnel nor do they get much first aid training while in school nor do they have much of an introduction to what the field personnel can do or what they actually know.


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