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How to get most out of clinicals

Discussion in 'ALS Discussion' started by justin1232, Dec 31, 2018.

  1. justin1232

    justin1232 Forum Lieutenant

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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
     
  2. akflightmedic

    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.
     
  3. akflightmedic

    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 and mgr22 like this.
  4. luke_31

    luke_31 Forum Asst. Chief

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    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.
     
  5. VFlutter

    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.
     
  6. justin1232

    justin1232 Forum Lieutenant

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    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
     
  7. Akulahawk

    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!
     
    justin1232 likes this.
  8. akflightmedic

    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...
     
    Capital, justin1232, Hemi and 2 others like this.
  9. Peak

    Peak ED/Prehospital Registered Nurse

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    I could not agree more.
     
  10. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

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    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.
     
    justin1232 likes this.
  11. Joshua Henson

    Joshua Henson Forum Ride Along

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    It’s really hard, but it’s totally worth it.
     
  12. Peak

    Peak ED/Prehospital Registered Nurse

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    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 likes this.
  13. justin1232

    justin1232 Forum Lieutenant

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    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
     
    PotatoMedic and Capital like this.

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