Keeping skills up while working per diem?

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Knightinwhitesatin

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I'm new here. I'm a busy mom of two little kids and a medic. I took a few years off with my kids and am now getting back into it again working a 911 system as a per diem medic. Being per diem works great for my family schedule but I feel like my skills were more top notch when I worked full time. Anyone else ever feel like this? I use to rock at IVs and now I feel like I'm just okay cuz I don't do them very much being per diem. Any others just work as a medic per diem and not a full time job too? Being a mom is my full time job!
 
Nature of the beast.

I suppose there are two ways to go with this, you could stick everyone you see for the practice, or use smaller needles on those who truly need an IV. Well I guess there is a 3rd option you could just IO everyone. But I am pretty sure most of our patients can wait until the IV nurse gets to them in the ED.
 
I work per diem, usually a 16 or 24 on the weekends, and we're not super busy. We have a skills day every quarter that I attend. Other than that, I haven't found my skills have degraded that much. I had a decent trauma and an arrest the other day, it's like riding a bike. I find it harder to remember where stuff is on the truck. After 4 years of doing it in the same place, with the same gear, it's a bit of a shock to show up at a new service, with different stuff and only work once a week. We don't have RSI here, which is a bit of blessing. I don't think I'd be comfortable performing that procedure every other year or so. :)
 
Ewok Jerky said:
Nature of the beast.

I suppose there are two ways to go with this, you could stick everyone you see for the practice, or use smaller needles on those who truly need an IV. Well I guess there is a 3rd option you could just IO everyone. But I am pretty sure most of our patients can wait until the IV nurse gets to them in the ED.
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Most veins that can fit a 20 can fit a 14 (grab an ultrasound to prove it). Most IVs are about confidence in your skills. How long have you been per diem? How many calls do you run a week on average?
 
It's rural so it's really hit or miss on calls. Sometimes 0 sometimes 8. I've been per diem a few months now but did take some time prior to starting back again to do some IVs in the ER just to get my practice up and it really helped. But man I haven't intubated in years I have practiced on the dummy. We don't have RSI either. Unfortunately the hospitals won't let medics ett anymore some liability issue. As they use to let us.
 
NYBLS said:
Most veins that can fit a 20 can fit a 14 (grab an ultrasound to prove it). Most IVs are about confidence in your skills. How long have you been per diem? How many calls do you run a week on average?
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BS.
The only reason I'm ever dropping a 20g is if I can't get an 18. If I can't get an 18, I'm surely not going to get a 14...


Have you ever looked at the difference in sizes of an 20 and a 14? It's substantial.
 
What about getting a per diem job at an ER as well? That should certainly help increase IV iterations.
 
NYBLS said:
Most veins that can fit a 20 can fit a 14 (grab an ultrasound to prove it). Most IVs are about confidence in your skills. How long have you been per diem? How many calls do you run a week on average?
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There is a big difference between using US to place a larger line than you would be able to place blindly, and saying "you can fit any size catheter anywhere". That's plain untrue.
 
COmedic17 said:
BS.
The only reason I'm ever dropping a 20g is if I can't get an 18. If I can't get an 18, I'm surely not going to get a 14...


Have you ever looked at the difference in sizes of an 20 and a 14? It's substantial.
Click to expand...

I'm not saying utilize US to guide insertion, I'm saying use it to measure the size of many of the veins sometime.
 
Remi said:
There is a big difference between using US to place a larger line than you would be able to place blindly, and saying "you can fit any size catheter anywhere". That's plain untrue.
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I'm not certain where I said "you can fit any size catheter anywhere.".....
 
Tigger said:
We would still be having a discussion as that is a completely inappropriate intervention.

A 14 is hardly ever necessary, and certainly not in the back of the hand.
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I can think of several.
 
NYBLS said:
I'm not certain where I said "you can fit any size catheter anywhere.".....
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A 14g has roughly twice the outer diameter that a 20g does. Claiming to be able to put a 14g anywhere you can put a 20g is just ridiculous. You may as well have claimed to be able to poop diamonds.
 
When do you need to flow more then 220ml of NS per minute? (That is the published flow rate for a BD 16g iv catch.)
 
NYBLS said:
And if your mom is truly ill?
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I would be pissed that you dropped a 14g when it's unnecessary.

The hospital can even push blood through a 18g or 16g. There's no reason for a 14g.

Get a line because you need it. Not because "it would look cool" if you rolled in with a 14g.
 
NYBLS said:
I can think of several.
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Then post them for all to critique. No need to be coy.

You have made several absurd statement that you have yet to backup. Now would be a good time to do so.
 
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