How to get most out of clinicals

justin1232

Forum Lieutenant
132
18
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Hey all,

So I started paramedic clinicals and had my first shift the other night. All in all wasn't to bad. Made some mistakes which i expected and was pretty slow which I also expected since it was a graveyard shift. Only thing is none of the staff i feel like to teach. I would ask about there way of going about an IV stick and about certain meds and I'll just get very short responses.

So how can I make the most of clinicals? Instead of giving me a certain RN or
MD to follow/precept me. they just let me walk around ER
 

akflightmedic

Forum Deputy Chief
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Sounds like a crappy program. Every program I have been affiliated with, the SCHOOL has a preceptor who is present. The preceptor facilitates your presence by interacting professionally with the staff, seeking out opportunities for you and then overseeing any procedures or assessments you perform. It is not the staff's job to train you and the facility should have a better agreement with the school. It is an unfair burden because not everyone is or wants to be a teacher, they just want to show up, do their job and go home. I cannot blame them.
 

akflightmedic

Forum Deputy Chief
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As for how to make it better, my advice is for you to approach each person on duty when you show up for your shift and ask if they are willing to take you on for your time there. Then whoever agrees, self-assign yourself to them and help them every way possible with their patient care load to include the menial labor/tasks which may be "beneath" you. Not saying you implied that, just saying get in there and get dirty regardless of the need. Do not only seek out the cool or new stuff. Act like you are an employee and do what needs to be done. The other staff will see your willingness and eagerness and then seek you out when they have needs. They may not train you or teach you, but you may find they involve you.
 

luke_31

Forum Asst. Chief
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As for how to make it better, my advice is for you to approach each person on duty when you show up for your shift and ask if they are willing to take you on for your time there. Then whoever agrees, self-assign yourself to them and help them every way possible with their patient care load to include the menial labor/tasks which may be "beneath" you. Not saying you implied that, just saying get in there and get dirty regardless of the need. Do not only seek out the cool or new stuff. Act like you are an employee and do what needs to be done. The other staff will see your willingness and eagerness and then seek you out when they have needs. They may not train you or teach you, but you may find they involve you.
I’ll echo what akflightmedic said, introduce yourself to the staff on duty and let them know why you’re there and that you’re willing to help with anything. I got a lot of really great experiences because I was willing to help get blankets, change sheets, and assist with the nurses and doctors when they were doing procedures where my only job was to put stuff on the sterile field as they requested it.
 

VFlutter

Flight Nurse
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As mentioned make sure you volunteer to help with the busy work as well and not just the procedures. Try to find someone who seems to enjoy teaching and stick with them. Not everyone is great with students and some of the people you are asking may be new themselves. Obviously you need good clinical experience so do not settle if you are not learning however be understanding and know that i may take a little trial and error at first.

I really enjoy teaching however between Nursing Students, Paramedic Students, New hire RNs, etc that constantly rotated through the ICU it was easy to get burnt out and there were days that I just wanted to get my work done without having to explain everything I was doing.
 

justin1232

Forum Lieutenant
132
18
18
Thanks for the feedback everyone! Was your guys first few clinical shifts really eventful? Or should I expect the next couple to be more of staff getting to know me and doing the "dirty" work
 

Akulahawk

EMT-P/ED RN
Community Leader
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Most of my Paramedic clinical shifts were relatively uneventful, but then again I was focused on learning the various skills. That being said, I also applied myself rather diligently to helping out whenever and wherever I could because once you're known widely as someone willing to help out and learn, you're often going to be specifically sought out for learning opportunities you might not otherwise get.

I have continued this even today, as a staff RN in an ED, where I've been for nearly 2 years. When I'm on shift, if someone has a really tough IV stick, I'm one of the people they seek out before they go to attempting ultrasound guided IV lines or having one of the providers get involved. It's rare that I can't find something... and when I can't, the next step is a big one.

I'm also happy to step in and help with pretty much anything that I can and that includes helping other services get their jobs done. As a result, EVS often cleans my rooms sooner, lab techs wait for me to get a line, and so on. Treat everyone with respect and you'd be amazed what get in return!
 

akflightmedic

Forum Deputy Chief
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You may also learn/discover as you advance your education that the "uneventful" stuff is where the most serious things occur. It is also where the majority of our knowledge gaps within EMS exist among our providers.

Look at it this way...you have hours of patients at your disposal. Histories to gather, different interview techniques to try out, charts and reports to comb through and then relate or correlate to the underlying comorbidities and think about what you would expect to see and do prehospitally. None of it is "high speed or glamorous", yet it is critically important if you expect to be a knowledgeable and competent clinician.

Anyone can teach a monkey to do an IV, intubate, sew a laceration...these are all skills and easily teachable.

The critical thinking part, the knowledge acquisition part...these are the hidden gems where if you apply yourself and take advantage of what is being offered, you may find your Daniel-son moment out in the field one day and you will be happy you were "Miyagied" way back when...
 

Peak

ED/Prehospital Registered Nurse
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You may also learn/discover as you advance your education that the "uneventful" stuff is where the most serious things occur. It is also where the majority of our knowledge gaps within EMS exist among our providers.
I could not agree more.
 

Akulahawk

EMT-P/ED RN
Community Leader
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780
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You may also learn/discover as you advance your education that the "uneventful" stuff is where the most serious things occur. It is also where the majority of our knowledge gaps within EMS exist among our providers.
I'm with Peak on this! It's also during those relatively "uneventful" shifts that you can get a chance to start putting things together. You can sometimes start seeing the early indicators of "badness" brewing and how various problems can mix together to enhance a problem. If you also have a chance, start taking a look at medications that patients are taking at home. Meds can be clues to underlying problems and sometimes meds can cause problems when they interact badly.

I like "uneventful" shifts in the ED because it means two things: One is that I don't have to run around at 300 mph. Two is that we're keeping small problems from blowing up into big ones where we have to work. It means we're managing things reasonably well. Trust me, if I'm working hard, it means something is wrong.
 

Peak

ED/Prehospital Registered Nurse
264
133
43
To build upon @Akulahawk . Slow is a good thing. Panic, adrenaline, and running lead to poor situational awareness and poor decision making.

The best codes and trauma cases that I've even been a part of were ran by very calm (and very clinically excellent) teams who had great communication and understanding of the situation.

If you get rushed take a few seconds to collect yourself. Nobody dies from 10 seconds of BLS care, plenty have from clinicians missing important things right in front of them because they were to rushed to fully understand the clinical situatuon.

The fact that you are concerned about your learning situation is good, it means that you are invested in being a good medic.

If you really feel like you want to be paired up or something like that I would talk to the charge nurse. I've had plenty of medic students who towards the end of their shifts tell me that they really feel like they need more experience in OB or Peds, and I'm more that happy to facilitate that learning experience but I only wish that they had talked to me about it sooner.
 

justin1232

Forum Lieutenant
132
18
18
Thank everyone for the responses. Update. I moved to morning 7am-7pm shifts. Do small things like make beds and help patients to bathroom like you've all suggested and it's def paying off. Other than getting to do more skills, the doctors and one RN in particular have made me part of every critical PT that has came in
 

johnrsemt

Forum Deputy Chief
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When I did ED clinicals (and ICU, L & D, and floor) I did something that no one had ever heard about; but worked great for me and some people that have I told.
I go in and introduce myself to the charge nurses, helped with room checks; then go and find the supply carts and went and restock EVERY room with medical supplies. Then go and find the linen cart and restock every room with linens. I did this at the beginning of every shift; and halfway through the shift, and usually towards then end if I had time.

The charge nurses saw what I did and took me to the Residents in charge of the shock/trauma rooms and told them that whenever they had good things I was to be involved in it.
The Charge nurses would overhead page me when good things were coming in; a few of the residents would have me shadow them and I would be with them when they answered the radios and phones when trauma and medical alerts were called in (only things we had to call in there).
As I was cleared for different things in class I got to do intubations in the ED, I needle decompressed 2 chests (in 1 shift). I helped to do 2 chest tubes; and a couple shifts later when it really got busy I did a chest tube on one side while the resident did one on the other side.
I got to do a needle stick (can't remember the proper name for it) for a pericardial tamponade; the Resident that was guiding me told me it was only his 2nd one; and the only reason he let me do it was the charge nurse threatened him if he wasn't nice to me LOL. Which I later had to do in the street so it was really helpful to do in the ED before hand.

I was in the room when resident cut open a chest and I got to do open chest heart massage.

I had a few residents and staff doc's ask how much I bribed the Charge nurses, and I responded I was just nice to them. A couple of new residents watched me when they saw me on the schedules and started doing the same things. Nurses treated them nicer after that.

Even other medic students in my class told me it was a waste of time and I was crazy to do it; but out of 18 students in my class I was the only one to Needle decompress a chest in the ED or stick a pericardial tamponade or do a chest tube. Only 3 of us got tubes in the ED.
 

akflightmedic

Forum Deputy Chief
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How very fortunate for you....that must be one very serious high volume Level I facility!! Excellent timing on your rotations as well...
 

justin1232

Forum Lieutenant
132
18
18
When I did ED clinicals (and ICU, L & D, and floor) I did something that no one had ever heard about; but worked great for me and some people that have I told.
I go in and introduce myself to the charge nurses, helped with room checks; then go and find the supply carts and went and restock EVERY room with medical supplies. Then go and find the linen cart and restock every room with linens. I did this at the beginning of every shift; and halfway through the shift, and usually towards then end if I had time.

The charge nurses saw what I did and took me to the Residents in charge of the shock/trauma rooms and told them that whenever they had good things I was to be involved in it.
The Charge nurses would overhead page me when good things were coming in; a few of the residents would have me shadow them and I would be with them when they answered the radios and phones when trauma and medical alerts were called in (only things we had to call in there).
As I was cleared for different things in class I got to do intubations in the ED, I needle decompressed 2 chests (in 1 shift). I helped to do 2 chest tubes; and a couple shifts later when it really got busy I did a chest tube on one side while the resident did one on the other side.
I got to do a needle stick (can't remember the proper name for it) for a pericardial tamponade; the Resident that was guiding me told me it was only his 2nd one; and the only reason he let me do it was the charge nurse threatened him if he wasn't nice to me LOL. Which I later had to do in the street so it was really helpful to do in the ED before hand.

I was in the room when resident cut open a chest and I got to do open chest heart massage.

I had a few residents and staff doc's ask how much I bribed the Charge nurses, and I responded I was just nice to them. A couple of new residents watched me when they saw me on the schedules and started doing the same things. Nurses treated them nicer after that.

Even other medic students in my class told me it was a waste of time and I was crazy to do it; but out of 18 students in my class I was the only one to Needle decompress a chest in the ED or stick a pericardial tamponade or do a chest tube. Only 3 of us got tubes in the ED.


I actually have been doing this and it works great! Haha so far I'm only in ED but got two tubes and they've been giving me a pager for critical patients or traumas
 

johnrsemt

Forum Deputy Chief
1,242
133
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It was a high volume ED with about 80 beds (if they didn't do hall beds if they did they could do about 110 beds). Like I said I have suggested that to a lot of students but most of them tell me I am crazy and it is not worth the work. Of course these are students that don't get to do much or see much in their clinicals.
I went in on a Saturday daytime that was slow in the critical rooms, but high flu season, I went through rooms, and did blood draws and IV starts and ended up with almost 250 in an 24 hour shift (the nurses begged me to stay and help, and I told them I was tired, so they let me sleep in a trauma room, with an out of order sign on the door) and bought me dinner. So I did 16 hours, slept 6 and did 8 more hours.
 
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