Feeling discouraged, freakish. Am I cut out for EMS?

[Altered Mental Status]

I'm an AEMT in my second semester of Paramedic. I don't have a whole lot of experience but I've had a few incidents on clinical rotations that are making me feel like maybe I wasted all my money and time trying to shoe-horn myself into a world in which I do not belong and am not really welcome.

I'm a mess. Too smart for my own good yet socially clumsy, underconfident and I end up getting under someone's skin everywhere I go. It's been like this since I was a little girl; I've always been the nerdy oddball who comes off as a know-it-all. Even worse, I'm clumsy and inexperienced so I seem like an incompetent know-it-all. I try to mitigate this by being humble and showing gratitude but I always find myself getting rolled-eyes looks from the nurses and and the sneaking suspicion that they're whispering about me at the nurse's station. I end up cleaning a lot of beds and sent to bring things to the lab a lot.

It's snowballed into this giant ball of angst and dread in my chest that seems to just be getting worse and worse. The more nervous and underconfident I am, the more clumsy and prone to make mistakes. The harder I try to power through that, the more likely I am to screw something up and look like an arrogant B--ch who fell on her *** and needs to be run off.

Things I do wrong pretty regularly:
1. I'm too slow about placing 12-leads. I try not to make the patient feel like I'm manhandling (or lady-handling) them and then I struggle with the giant ball of tangled leads like an idiot for a while. I feel like a moron because I keep clipping them on and then the patient moves or they get caught and the ones I just placed come off while I'm placing others. It's freaking slapstick...I know I look like a G.D. clownshow.

2. I've lost all confidence getting IVs and now I take forever and miss about half of them. My heart is in my chest because I always end up getting that patient who says "One chance, that's all you get." Furthermore, I have tiny, tiny hands (I wear a size 4.5 ring, if that tells you anything) and I have trouble knowing what to do with my fingers and never manage to occlude the vein enough so there's always a mess to clean.

3. I open my G.D. mouth too much. I think I'm helping myself by asking for guidance or discussing my interventions but really, I'm making myself look like a naive idiot. No one cares what my thoughts are, no one wants to stop and talk, you either get it or you don't. Lead, follow or GTFO of the way. Even worse; I talk when I'm nervous and end up putting my foot so far in my mouth, I kick my own a$$.

I've made 3 mistakes in my career that were bad enough to be officially reprimanded for. One had to do with saying something stupid in the box that got completely (understandably) misinterpreted. I'm still kicking myself a year later. It was so dumb, it's embarrassing.

The second was that I am prescribed medication that I left in my purse under the desk at the hospital which was subsequently stolen. When I reported it, the charge nurse felt as though I was accusing people and possibly drug-seeking. I had to explain to my director that I was actually OVERDUE to have my script refilled because I'd skipped a few doses (with my doc's approval) to avoid downregulation issues. It doesn't matter. I never should have brought them with me and I NEVER should have reported it without calling my director/instructor FIRST. DERP. It was decided that I not return to that ED ever again.

The last (and most serious) was when I began to raise the stretcher for a patient who had pulmonary problems in Cath Lab recovery. I'm lucky I didn't really hurt that patient and I have spent hours crying and kicking myself over it. Honestly, I had no freaking idea I was doing wrong until after the fact. I thought I was helping the poor man because he said he couldn't breathe supine. I should have asked the nurse first.

My director received a stern letter about my incompetence and a whole bunch of "slightly clumsy" things I'd said or done that day ended up being exaggerated and included in that letter. I am in no position to argue or defend myself, obviously because of my giant F-up that comprises the bigger priority.

I am absolutely PANICKED now about doing another rotation. I have a feeling of dread in my gut and that almost GUARANTEES I'm going to fumble the ball and screw something up now.

I'm passionate about EMS, I love people and my patients usually love me back but I know that ain't enough. Half of this job is how you manage a scene, manage other professionals and how quickly, efficiently and confidently you can get it all done and defend your decisions.

Am I wasting my time?

 

[Masenko]

I'm also a paramedic student in my first semester and I've been on a couple clinicals so far. Needless to say, I've made a mistake each time I've been on a clinical. But I try not view those mistakes as negative. Sure I f'd up, but better now than when I'm on my own truck. Mistakes and opportunity for failure are also ways to improve. I know I'm not going to easily repeat the mistakes I've made at clinical, at least not without the neuralyzer from MIB. It looks like you've done a pretty good job at burning your mistakes into your head, and instead of using them as something positive, you've used them as a way to increase your anxiety.

I mean we are just students. :blink:
I'm never going to know how my preceptor's attitude or patience is going to be, so just try to make the most of it. Try and realize that, while yes our future profession is serious, we'll all go insane if we let every little thing get us down. Try to lighten up mehbeh?

 

[sweetpete]

Hey AMS,

Okay....that's alot to go wrong in a short period of time. I'll give you that. However, I'm not going to address any of the 3 issues you pointed out. As far as I'm concerned, that's water over the dam. Nothing you can do but learn from it and go from there.

I will say this though....you sound like you're being very sensible in your rationale. All I can say is hang in there. Yes, perhaps you should wait and give yourself some more time to cut your teeth as an advanced EMT. That's NOTHING to be ashamed of. Perhaps you rushed into medic a little sooner than you should have.

Maybe, if possible, you should consider taking some time off from medic school after this semester. I don't know what's best for you, but I've always been a proponent of the "wait and see" over "hurry and see".

Lastly, let me just add: it sounds like you're a good kid with a big heart. We all make mistakes. You're not the first and GOD know you won't be the last student to screw up. I did, others have, and more will.

This career doesn't make you a good or bad person. You make you a good or bad person. Hang in there and try not to be too hard on yourself. We live in an age of bullies and a**holes. Don't let them get to you.

There are a lot of people (myself included) who would rather see you succeed as a good friend or family member. The world needs more "good people" than "good medics (Which by the way, is a relative term).

So, take some time. Talk to a close friend or family member. Explain how you feel. Maybe talk to an instructor or peer you respect or a fellow class mate. Either way, take some time. It'll figure itself out sooner or later and in 25 years....who'll care anyway?

Take it easy,
Pete

 

[VFlutter]

The last (and most serious) was when I began to raise the stretcher for a patient who had pulmonary problems in Cath Lab recovery. I'm lucky I didn't really hurt that patient and I have spent hours crying and kicking myself over it. Honestly, I had no freaking idea I was doing wrong until after the fact. I thought I was helping the poor man because he said he couldn't breathe supine. I should have asked the nurse first.

Everyone makes mistakes when they are new and many people exaggerate the frequency and extent of their own mistakes. That being said if there are multiple non-biased people telling you there is a problem then you really do need to reevaluate yourself and see what you can do to improve.

As you mentioned the last situation is serious but may not have been entirely your fault. Were you given adequate preparation and orientation before going to the cath lab? Did the CCL Nurse explain post cath care? If not then they are partly to blame. But as you mentioned it is always a good idea to ask the nurse before doing anything in a procedural area.

Do not let yourself get over confident and get into dangerous situations. You should not be in a critical care area unless you are adequately prepared and you certainly should not be in direct patient care without supervision.

It sounds harsh but as I am sure you were made aware that simple act of raising the head of the bed could have killed that patient.

 

[mycrofft]

Get a mentor or a buddy who's been at it longer or something, but you need someone who is there and knows you. We're ok but actually we are all the figments of someone's fevered imagination......

Just kidding about that second part, but the first is true. Not necessarily someone at work.

Having been the newb they ran to the curb a couple times then eventually being the old guy they always turned to for corporate knowledge, I think the trick is to show results, ask intelligent questions, but don't pester people unless you have a real reason for it. Acclaim and credit will come in time. Find out who your trainer is and sit down to talk to them about things.

And remember one provider/employer is not the same as another.

 

[Altered Mental Status]

Thank y'all for your responses.

SweetePete and Masenko: Thank you for these kind words. I almost don't even feel like a human being lately and that made me feel human again.

Re: wait and see vs. Hurry and see: I'm unfortunately in the position to have to make up my mind soon; the Paramedic "cycle" starts on the summer semester. If I drop from the program after this semester, I'll have to wait an entire year to take the last semester of Paramedic. There are other factors at play too as to why it has to be "now or never." *Le sigh*

Chase: No, I wasn't given an orientation at all. I there was no post op explained at all. However, I should have known better. If I had an iota of common sense, I would have thought to myself "Gee, I wonder why this patient with a Hx of CHF is supine. It can't possibly be that everyone else is dumb, right? There's probably a REASON, right?" DURR.

And yeah, I know I could have killed the patient NOW. I went into a google g-hole about it as soon as I saw the stern look on my instructor's face and put together how serious he was. I haven't been able to sleep well since. I wake up in sweats about it. I feel so bad, I started writing a paper on it...half as penance and half because I hope maybe I can turn it in and save some other poor schlub the same dumb mistake in the future.

The funny thing is, nurse told me it was "fine" at the time. She put pressure on the femoral until someone came in and gave her a pressure dressing and told me it'd be okay. Later, she must have gone to her director with a laundry list on me because in the letter contained everything from the fact that I (politely) asked if there was a smoking area where I was allowed use my e-cig (deemed completely inappropriate) to the fact that I missed a stick and it appeared that I'd never done one before. (*bangs head*)

mycrofft: I've asked on two occasions at the ED if there was someone I could shadow and was told I need to take the initiative to just "jump in wherever" so I jump in, only to be treated like I'm getting in the way and sent out of the room to clean a bed or something. I might need to just wait for a day when my instructor is available to come precept. I managed to get on the good side of one of the nurses in the ED (Oddly: she's the one who doesn't like most students and isn't part of the nurse-station gossip gathering--just does her job and stays out of the chit-chat) but she's not always there.

The thing is: I work better with constructive criticism. I'm a Navy vet; go ahead and be stern with me, instruct me, correct me. I'll do whatever I'm told. The WORST thing people do is expect me to "figure it out" without any feedback and then roll their eyes at me when I don't get it right. I realize that's a personal blind spot because the other students appear to be holding their own but I never believed until now that that blind spot necessarily excluded me from being competent at this.

So the overwhelming vibe I'm getting from you guys is that I haven't necessarily hit the wall yet, just that I need to maybe circle the flight pattern a bit more and adjust my speed and angle before I try my approach again. I feel like I've gotten very honest feedback from you--that you do comprehend the gravity of my mistakes--yet no one's telling me "yeah, find another job" just yet. That's a good sign to me. Thank you.

I think what I'm going to do is work with my County volunteer truck doing ride-alongs as an AEMT while I finish school. I worked for a short while as a paid employee at County and I have some friends there. Unfortunately, I didn't get to do much more than drive the box. They're a full ALS service. My veteran's school grant requires that I not be making an income to receive it so I've been inactive but I know I'm always welcome to ride the #20 (volunteer) truck. Hopefully, I can build some confidence that way.

My strategy for completing clinicals (and this is per advice from my instructor) includes keeping my mouth shut and asking permission before I do ANYthing. If they want to treat me like a stupid dog, so be it but I'm not going to give them an actual reason to run me off. I'll make it so that the worst thing they can possibly say about me is "doesn't do a single G.D.thing without asking first." They'll probably abuse the hell out of me and I'll change a lot of bed pans but they won't be able to throw me under the bus if something goes wrong because I ASKED FIRST.

It's all I have at this point...

 

[firetender]

You're asking yourself all the right questions. Unfortunately, you're beating yourself over the head (AND heart!) over them.

I get the feeling you set a very high standard for yourself and use the opportunity of not quite meeting it by doubting your fitness to...do anything.

Each of the things you mentioned was pretty much run-of-the-mill errors for a Newbie. And, yes, we deal with life and death stakes here and sometimes the simplest mistake can reap devastating consequences.

The name of the game is to minimize the mistakes you make more than once and any mistake you make, learn from.

You have no reason that I can see to prolong the agony of your learning curve. It's gonna suck for a while but you don't really need your own inner-voice trash-mouthing you.

You can tell whom amongst your teachers and peers has patience for normal learning-curve anxieties. Those are the people you seek.

Thanks for bringing your experience here. As you can see, you've earned some friends.

 

[sweetpete]

I couldn't agree more with what Firetender just said!! Spot on and probably post of the day, in my opinion!!

Well said Firetender!!!

Take care,
Pete

 

[TechYourself]

Any ER that just says "jump in whenever" instead of pairing you with a preceptor sounds like a wasted clinical. I know you feel like you should be doing your best to stay under the radar, but you're not doing yourself any favors by doing clinicals in a place that refuses to cultivate your learning. I don't know if that ER is the only one in the area, but if there's other options it might be a good time for a change of scenery.

Just a thought.



Keep staying the course. We all mess up, but the beauty of having a partner or working in a department is that we don't have to do it alone. Help is there when you need it.

 

[Christopher]

The last (and most serious) was when I began to raise the stretcher for a patient who had pulmonary problems in Cath Lab recovery. I'm lucky I didn't really hurt that patient and I have spent hours crying and kicking myself over it. Honestly, I had no freaking idea I was doing wrong until after the fact. I thought I was helping the poor man because he said he couldn't breathe supine. I should have asked the nurse first.

I'd have raised him up without realizing too, and I'm not a medic student.

Honest mistake on your part.

 

[sweetpete]

Any ER that just says "jump in whenever" instead of pairing you with a preceptor sounds like a wasted clinical. I know you feel like you should be doing your best to stay under the radar, but you're not doing yourself any favors by doing clinicals in a place that refuses to cultivate your learning. I don't know if that ER is the only one in the area, but if there's other options it might be a good time for a change of scenery.

Just a thought.



Keep staying the course. We all mess up, but the beauty of having a partner or working in a department is that we don't have to do it alone. Help is there when you need it.

IMHO....this is MORE great advice. True beyond words. I learned (hence enjoyed) more in the ER and ambulance rotations when I went full throttle and begged/offered to help in any way possible without trying to be a burden.

I think you'll find the balance sooner or later. Don't give up!!

What a great thread!!

Pete

 

[Blue Medic]

Well, I guess I'm going to be the voice from the other side...
EVERYBODY is NOT cut our for this line of work, and it sounds like you are not. It's not a game, and it's not a hobby. If you make a mistake and are that nervous where you get a lump in your throat because you're starting an IV, someone holding your hand and saying "it'll be ok. You'll get it next time!" will not keep your patient alive.

There is no shame in trying and figuring out it's not for you. In fact, there is valor in acknowledging your weaknesses and stepping aside. I'm certain you have a million other talents. But for the sake of your sanity, and the safety of those who trust you for care, don't keep at it "just because".

 

[9D4]

Well, I guess I'm going to be the voice from the other side...
EVERYBODY is NOT cut our for this line of work, and it sounds like you are not. It's not a game, and it's not a hobby. If you make a mistake and are that nervous where you get a lump in your throat because you're starting an IV, someone holding your hand and saying "it'll be ok. You'll get it next time!" will not keep your patient alive.

There is no shame in trying and figuring out it's not for you. In fact, there is valor in acknowledging your weaknesses and stepping aside. I'm certain you have a million other talents. But for the sake of your sanity, and the safety of those who trust you for care, don't keep at it "just because".

Really? That's your first post? You wanna tell me how your first few times with sticks were? You were just automatically comfortable with it, because sticking a needle in the immediate area of the lateral antebrachial cutaneous nerve and the brachial artery (if drawing from antecubital fossa) is a thing to take lightly when you're inexperienced... You made absolutely no mistakes in clinicals? Paragod, much?


OP, sticks do get easier. My first few draws in phlebotomy school were nervous wrecks. The last day of class, however, I had a patient come in for practice sticks for me and I successfully drew 13/14 times (the miss was still a hit, I just accidently pulled the needle out).
You weren't briefed on the cath lab thing, that wasn't your fault. Only thing you could've changed was asking before hand, but I think most people wouldn't think to ask if they can help someone sit up.
The 3rd thing is the clinical sites fault. You shouldn't be discounted for trying to understand something.

 

[VFlutter]

I'd have raised him up without realizing too, and I'm not a medic student.

Honest mistake on your part.

Exactly. Like I said, the majority of the blame is on her instructor and preceptor for not adeqtuely preparing her.

No student is coming anywhere near my post cath patient, or any patient, unless I am absolutely sure that they understand the basic care and precautions.

 

[Carlos Danger]

EVERYBODY is NOT cut our for this line of work, and it sounds like you are not. It's not a game, and it's not a hobby. If you make a mistake and are that nervous where you get a lump in your throat because you're starting an IV, someone holding your hand and saying "it'll be ok. You'll get it next time!" will not keep your patient alive.

This is bull:censored::censored::censored::censored:.

It's true that not everyone is cut out for EMS, but there is nothing in the OP's post that indicates she is not. Lots of people are anxious and clumsy in new, unfamiliar, and stressful situations.

Blue Medic, I'm sure you were just the picture of competence and confidence during your first clinical experience. Only the truly clueless are never nervous or afraid.

 

[mycrofft]

Remember Ruth Gordon's quote:
If you don't blow your own horn, someone else will use it for a spittoon".

Quit borrowing trouble too. Accentuate your positives and your triumphs, even it is finding your way to and from clinical and remembering where your car is parked.

 

[Altered Mental Status]

You guys are awesome. AWEsome. And yes, I do feel like I've made some friends here. I feel much better, actually.

Like I said; I'm gonna hop on the County volunteer truck a bit more and try to get over my choking stage fright by riding in the back instead of just driving for a Medic. I've decided that there's good advice on both sides of the equation but I'm not ready to give up on myself yet. I think I can be great at this but I have a challenge in front of me that requires me to be creative about finding solutions. I need to figure out my learning-style for competence-related skills and I need to work harder at it to build my own confidence.

I received some encouragement from someone here in town actually, for whom I have a lot of respect. She told me that two of the medics working for the County right now who were abysmally nervous and awkward have both blossomed in the last year. That making mistakes and feeling like a clown is still not the end of the line...it's not the end unless I've failed to learn or improve after several months of doing it.

If it does appear that I'm more of a danger than a help, I guess I'll sort that out too. It'll break my heart but I agree, walking away would be the right thing to do in that case.

Thank you, guys. <3

 

[UKMEDICARABIA]

This is the Kind of job you will always be learning from as you practice. If I could show you the mistakes medics (junior doctors) Make then you'd be feeling much more comfortable about everything.

My advice, carry on get finished and when you start working, learn from the mistakes of others and you will lean twice as fast.

 

[teedubbyaw]

Sounds like you need experience and confidence. It seems like nerves are getting the best of you and may be the root of your problems.

Volunteer like you plan, take a deep breath in those situations you find your nerves kicking in, and most of all, shut up and listen. That may be the take home point for you.

We all make mistakes, and as a 3rd semester medic student myself, I've made plenty. I've learned from them and have built confidence from them. As one instructor once told me, you're going to kill a patient or two in your career. It's inevitable.

Good luck.

 

[Altered Mental Status]

I love you guys. Seriously. I have a volunteer shift tomorrow at 0800 with good people like yourselves. If it weren't for good folks, I think we'd all be toast.