ER Nurses make horrible Paramedic precepters

hogwiley

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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.
 

DesertMedic66

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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

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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.
 

gotbeerz001

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

sjukrabilalfur

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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.
 

VFlutter

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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.
 

Christopher

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

sjukrabilalfur

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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.
 

Medic Tim

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

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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

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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.
 

sjukrabilalfur

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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.
 

Medic Tim

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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.
 

Carlos Danger

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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.


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.
 

blachatch

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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.
 

DrParasite

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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?
 

wanderingmedic

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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.
 

Ewok Jerky

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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.
 

Medic Tim

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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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