Nurses eat their young.

[Maya]

I'm in my second semester of medic school, just started clinicals. I just got off my second shift in the ER. Are all nurses really just total and absolute b*****s? They're barely giving me any chance at all to get patient contact. I'm a nice person, easy to get along with, although maybe a little shy because I feel like I'm getting in the way.

Five hours into my eight-hour shift--with not even one patient contact--and I was ready to go home and email the clinical coordinator to have my clinicals set up at another hospital. One of the nurses asked me if I wanted to start a line on this patient and one of the other nurses said "no, he's not a good start. He has really bad veins." I asked the first nurse if I could just watch her start the line. I walk into the room... the guy's 27 years old, healthy, with ropes for veins. He says he's never had a problem getting a line started before. Obviously, there was some reason the nurse was lying about him being a bad start. I would have thought that I had given her the impression somehow that I was incompetent, except for the fact that I haven't even gotten the chance to do that--seriously, NO patient contact.

I have no idea what I've done to make the nurses have this attitude towards me and I have no idea how to change it! If it keeps up this rate, I won't be able to get all of my patient contacts. What can I do to change this?! Any advice would be appreciated!

 

[boingo]

Tough situation. For some reason, perhaps someone will elaborate, or maybe its just my personal observation, female medic students get treated terrible in the ED by female nurses. The opposite is the case in OB. Your best bet is to shadow a doctor, resident or med student even, or make friends with the nursing staff. Maybe I'm way out of line, but I see it all the time around here. I'm sure one of the ladies here will set me straight, in the interim, good luck!

 

[Maya]

Yeah, that was kind of my impression. It was a really weird vibe that I was getting from the nurses. I'm a nice person, I usually don't have any problems getting along with people. I think, like you said, I'm going to have to find the one person who's a little more friendly and shadow them. Otherwise, I'll have to schedule my clinicals at the local community hospital.

Thanks for the advice!

 

[VentMedic]

Unfortunately some of these nurses also see the slackers that come through as both Paramedic and nursing students. They'll test you for awhile to see if you are a serious student or just in it for the patch as a Paramedic or for the money as a nurse. Nurses also are nurturing and protective of their patients, even the ones that some in EMS would throw out of their trucks as "BS" or find some reason to abuse them (see Appalled thread). Hang in there and show an interest in patient care. Eventually they'll let you participate if they see you are serious about providing patient care rather than occupying space just to get the hours in.

 

[Dominion]

Mirror to what vent said and to add that I have had experiences with nurses in the past who were....less than friendly....around me. Ones who despite me sticking hundreds of patients in my clinicals still are VERY reluctant to give me the supplies to do it myself. I am fortunate to have had in my opinion one of the best clinical experiences I have heard of yet so I am a little biased in my ideals.

With that said here is what I did when I first started. First day I was VERY nervous. I didn't do much. My first stick my hands were shaking. Second day I kinda had a feel for what to expect and I had a better day. By my third day I felt confident enough, I already had access to the supply pixis so I told myself the only way I was going to get contacts was to jump in. So everytime I saw a patient being brought in from triage, I walked with the triage nurse and asked what was going on and if they would need an IV/Blood draw. I DID cross some people but for the most part the nurse would come in "Oh, you already got the line and bloods? Awesome" It took time but I worked with the same shift everytime and eventually it got to the point where I would be sought out to start lines, give meds, and perform other procedures. In all of my clinicals I followed that attitude and jumped in head first on everything. Got a cool sounding prodcedure? Ask the doc if you can watch. At the OR and there is a cool surgery happening? Ask to go watch. You'd be suprised at how much you will start to see and experience. I never though I would get the chance to place a chest tube with the direction of a doc, but I did because I asked. He kinda guided my hands but he took the time to show me how it was done.

You need to be confident, it's ok to be nervous your first couple days, that's natural. Be confident in your skills, even if you suck at IV's go stick the hardest patients. Limit yourself to two sticks and go find someone else, eventually you'll get a HARD stick and you'll get it and you'll feel 100 ft tall. The more you psych yourself out about it the more likely you will be to fail and get discouraged. I approach every patient I am about to perform a procedure on as if I WILL get that procedure done.

With all that said, it still doesn't make up for snotty nurses. Some just don't want you to be there, plain and simple. If you continue to have issues I recommend you speak with your program director or clinical coordinator to have those issues resolved.

 

[46Young]

Speaking of eating their young, most local (RN) assoc. programs are exceedingly difficult to handle while working FT. It still puzzles me why nursing programs have to be FT only. In speaking with local nurses, with both the NVCC program and the Germanna CC program (two local colleges), they basically tell you to quit your FT job, and that they "own you" for the next two years.

I find this strange, since there is still a high demand for nurses. I've also heard that the reason for the lack of availability in nursing programs is due to a lack of faculty, not so much as an overabundance of nursing hopefulls. I've been shopping around for the most job friendly program in my area, and came across this site:

http://www.virginia-nursing-schools.com/RN.htm

At the top of the page, it discusses the excellent job availability and industry growth for the field, and it also says the same thing about the lack of faculty for nursing programs near the bottom under the Virginia RN job outlook section. Perhaps this is a major factor in the unavailability of Pt participation, such as less than a full class load, or taking a semester off if needed, like degree programs in other non healthcare fields. I'm also at a loss as to why degree medic programs don't allow PT enrollment, either. When you're told that you need to give up your life for two years, and not work FT either, some will look for shortcuts (or not do it at all). Shortcuts such as five month medic mills and the Excelsior Medic-RN bridge.

At least NVCC's medic program holds the same class on two consecutive days, to accomidate personnel with rotating shifts. That's what I'm talking about, little things like that to help the working person.

 

[46Young]

During my ER clinicals, the RN's were more then happy to let me do their sticks and blood draws. Less work for them. I think that the key was that I was always asking "How can I help you", and "Is there anything else I can do to help right now". I would always step up to help pts to the restroom, always asking them how I can make them more comfortable, empty foleys, clean the cots for the next pt, do triage vitals, etc. I would usually initiate conversations with the pts as well, to help put them at ease, maybe pass a joke in good taste and such.

 

[mycrofft]

Ah here we go again. Yes, we eat our young.

Remember that those folks who are not inhibiting you are invisible, the ones who stand out are the ones you are having trouble with.

As with tiger and shark attacks, you may be doing something that sets them off, but historically many nurses in my opinion and experience, and through anecdotes of many friends and classmates from nursing college, tend to make a decision about you, or the class they perceive you to belong to, and tend to want to drop the boom on "upstarts". If they don't, then they are "knowledgable but unassistive bystanders".

Nurses tend to be busy, and they are not being paid extra or even trained to be de facto instructors. Many (again, not a majority) also have a disdainful attitude towards EMT's and paramedics.

Suggestions as a former EMT, turned RN:
1. Go to your educational suprvisor/instructor/whoever put you there and complain. Keep a diary of who what and when, and don't start throwing that info until you are forced to. That includes the contacts with your school on the matter. Once you start naming names you are only trying to protect your scholastic reputation, maybe trying to get your tuition back, because you may be through at that training location.
2. Carry a flip pad in your pocket. Whenever you are called into a situation you anticipate to result insome sort of BS, go in with it already out, pen ready, and as you sit down write the date at the top of the page. Amazing how businesslike it gets, but it must be on your side of the table as wll as theirs.
3. Before all of that, come early one shift, seek out a sympathetic nurse or at least an honest one and ask to speak to them aside and privately. State that you feel you are not getting the chances you need, and ask if there is something you need to do or a way to act differently that will enlist these folks. Chances are this will get out in various versions to every gossip in the ED in a couple days, and things get better, or at least you may get some feedback.

I was screwed a couple times like that before I got the picture when a nurse took me aside, after I'd been fired, and apologized about the politics. I took the abuse I was getting to be like that we used to hassle each other with goodnaturedly at the firehouse, but it was serious and wound up with me getting insufficient mentorship and being judged too slow to get with it.

Be sharp, be confident without bragging or trying to get buddy buddy, know your stuff, bring food if it is customary, and just get it over with. You might even make some friends.

 

[VentMedic]

Speaking of eating their young, most local (RN) assoc. programs are exceedingly difficult to handle while working FT. It still puzzles me why nursing programs have to be FT only. In speaking with local nurses, with both the NVCC program and the Germanna CC program (two local colleges), they basically tell you to quit your FT job, and that they "own you" for the next two years.

Are you on that soapbox again?

Be glad it is only a 2 year program and it really should be a Bachelors. Thank goodness you don't want to do another health care program that does require a Bachelors or a Masters.

Also, as I have stated before, many of us who worked in the FDs and other full time jobs with families did advance our education because we knew of the rewards it would bring for a career. If you don't have the ambition, don't go into nursing.

Now at least Maya may have some idea of what the nurses who precept medic and nursing students go through with some entering these programs and those who do nothing but complain their entire time during clinicals. There are those that will spend 7.5 hours complaining about how they shouldn't have to do this or they are too good for that and they have every excuse to accompany their shoulds and should nots. These are the ones who are also always looking for a shortcuts when they don't feel like they are the "same as everyone else" and should be treated differently.

 

[VentMedic]

Nurses tend to be busy, and they are not being paid extra or even trained to be de facto instructors. Many (again, not a majority) also have a disdainful attitude towards EMT's and paramedics.

Have you noticed the nurse bashing threads on the EMS forums?

The student, especially for Paramedic, must remember that the hospital is extending a learning privilege to the school which can be taken back. It is becoming harder to find hospitals that even allow clinicals for Paramedic students due to attitudes and screwups from improper training/education and screening in the Paramedic programs.

Many of our hospitals no longer allow ETI in the ED by Paramedic students and IV starts were almost lost also due to the ignorance of a few students. They were racing each other starting IVs the "EMS way" with very little care for the site or for the patient. The L&D and Neonatal unit are also off limits and there is a very limited access to the Pedi ICU.

 

[ExpatMedic0]

I don't want to sound sexist but maybe try a male nurse to shadow if ones available, Its worth a shot? I was lucky most of my nurses where a blast to work with during my clinicals.

On another note the younger doctors just out of school where always cooler to me

 

[Ocean711]

I think it might help to be proactive in your approach. I used to volunteer in a local ED and I had a hard time at first with the nurses and staff until I started asking if they needed any help. By the time I stopped volunteering, I knew the majority of the ED staff very well and was constantly busy because they knew I knew what I was doing. I noticed that they would give me more to do than some of the other volunteers who sat around and waited for the nurses to come over.

 

[mycrofft]

Vent I hear you about students coming in and acting badly.

Fastest way out is to start complaining about your situation and trying to get an easy ride.

Institutions teaching paramedic need better incentives, then some sort of standards. I think it is something of an organizational CT scan when, due to BS like racing IV's, a training section is denied. They couldn't be bothered to find and eliminate or correct the problem cases so they deleted valuable experience for everyone...and probably meeting an organzational prejudice, revealing that their prioritization and value for training is not that high.

"Due to bad behavior, US History 101 is no longer being offered". What cr&p.

(We had a similar case where a surgeon acted badly with nursing students so we had our OR rotations cut to 1/2 length to avoid him. The other unit cut in half to take up the slack...ER).

I found most males in the teaching situation to be more collaborative, but not always.

These are my observations. I'm sincerely sorry if they are too narrow, but "subjective is what I got".

 

[Shishkabob]

I only ever had 1 problem with a nurse in all my clinical time, and she was promptly put in her place by the doctor I was with.


If you aren't getting enough stuff to do, befriend the Charge nurse. Ask if anything needs to be done, even if it's just changing the sheets or taking granny to the bathroom. Always restock / fix the rooms as soon as it's clear so that it can be used for the next pt asap.



On the same token, some nurses don't know that you're a medic student as opposed to a Basic student. I had several nurses say they forgot I could give meds / start IV/ do NG/OG tubes/ other invasive things because they thought I was in EMT school. Once they realized I was in medic school they let me do A LOT more.

They all know you'll suck at IVs. All of us did when starting. I still suck at babies and grannies with no veins. But once you start getting comfortable with your skills, they'll notice and be more lenient with you. My 2nd day of clinicals, one of the nurses didn't believe I've only done IVs for one day as I was getting pretty good at them. That boosted her confidence in me and let me do more.



Might be better if you befriend the techs, as most are either EMTs or medics themselves. Once you get in good with them, they will get you on the nice side of the nurses.

 

[kittaypie]

i agree with you about some nurses being like that. i've come across a few in my clinicals that haven't been the nicest. i've been very fortunate though to have mostly friendly and helpful staff at my clinical sites. try and find nurses and doctors that are genuinely interested in helping you learn, and stick with them!

 

[46Young]

Are you on that soapbox again?

Be glad it is only a 2 year program and it really should be a Bachelors. Thank goodness you don't want to do another health care program that does require a Bachelors or a Masters.

Also, as I have stated before, many of us who worked in the FDs and other full time jobs with families did advance our education because we knew of the rewards it would bring for a career. If you don't have the ambition, don't go into nursing.

Now at least Maya may have some idea of what the nurses who precept medic and nursing students go through with some entering these programs and those who do nothing but complain their entire time during clinicals. There are those that will spend 7.5 hours complaining about how they shouldn't have to do this or they are too good for that and they have every excuse to accompany their shoulds and should nots. These are the ones who are also always looking for a shortcuts when they don't feel like they are the "same as everyone else" and should be treated differently.

Funny how after you get your Assosciates you can do the next two years at your own pace. Why not the first two? I don't see anything wrong with that.

Actually, I've found a way to make it work. I'll finish the EMS AAS, which will give me all the RN pre reqs save NAS 161/162. Everything except for the core classes will be taken care of, so I'll only be doing 9 credits or so per semester, except for the final one, which is unavoidably FT. After we buy a house, I'll bank some of my OT hours as comp time, to use for class time. I'll promote to EMS Tech next year, which is easy to do. I'll defer the LT promotion until I'm done with nursing, since I'll enjoy more seniority and copious OT than at the LT level. Speaking of which, the RN money will be a nice replacement for the lost OT opportunity. I'd like the job, and it's always good to have another income stream if I suffer permanent injury on the job. It would also be a nice part time job to have post retirement.

I still don't understand what purpose it serves to only have FT medic and RN schools, with no consideration for FT workers. Just because others have done it doesn't mean that the rules can't change.

 

[VentMedic]

I still don't understand what purpose it serves to only have FT medic and RN schools, with no consideration for FT workers. Just because others have done it doesn't mean that the rules can't change.

And why should everybody else be slowed down or inconvenienced because of a few "firemedics" that make excuses? With the budget cuts now that don't allow for a variety of programs with an unlimited number of educators, why force all the other nursing students who want to finish in two years to follow your slow pace? Others have actual goals and want to move on with their lives and make adjustments in their busy schedules for school.

 

[46Young]

And why should everybody else be slowed down or inconvenienced because of a few "firemedics" that make excuses? With the budget cuts now that don't allow for a variety of programs with an unlimited number of educators, why force all the other nursing students who want to finish in two years to follow your slow pace? Others have actual goals and want to move on with their lives and make adjustments in their busy schedules for school.

Not a slow pace, but rather at your own pace. If you can finish at your own speed, that wouldn't be holding anyone else back. And how are you trying to make this a firemedic thing? The situation would apply to anyone with a FT job. In fact, what if someone needs their 9-5 job (office job or whatever) to support their family? How is that person supposed to free themselves up for three days/week or more for two years? Those in the fire service at least have a fighting chance with a rotating schedule for ten days a month, and shift swaps available. There do exist some night programs, but not in my area. If there was, I would just switch to day work and be fine.

My example of NVCC holding extra classes for medic students on rotating shifts was just an example of accomidating working professionals. For nursing, allowing flexible clinical days would help. For example, instead of reporting to the hospital on M/W/F, maybe the student could go on M/T/TH that particular week. NVCC's program allows for online didactic, but some of that is synchronous. That takes the benefit of distance learning away, as you still need to be available during the time the synchronous lecture is being held. Realize that when you do shift swaps, those trades need to be repaid. If you don't return the favors, then you'll be stuck in your final semesters with no way to attend class, thereby wasting your time invested, as you can't complete the program.

I don't find flexible classes (or at the very least off site clinicals) or synchronous online classes to be unreasonable. Especially with the demand for nurses still significant. Besides, how many of these older nurses got their start with a simple diploma? Sure, they went back and earned their two and four year degrees (and more), but it was at their own pace, part time if they wanted. Newcomers need to have degrees. The job demands it. The older nurses earned their degrees with a part time option, why not the current students? That's why I see no fault in getting my medic card through a tech school and getting the degree afterward. Just because some have done it FT while working FT doesn't mean that everyone else should be made to do the same, at least not without some accomidations to help with time management. The work in completing the degree gets done regardless, but while allowing other obligations such as providing for a family, and being there physically for them as well, among other things.

How many people wish they could go back to school but can't since they need their FT job to survive, and can't make both schedules jive for whatever legitimate reason?

Synchronous online didactic, flexible clinicals, and/or allowed part time enrollment would make school much more manageable for FT workers. The work still gets done. Family and financial obligations are still satisfied.

When you went to school FT as a FF/medic, did how much irreplaceable time did you lose with your children? They only grow up once. Or was this before children?

 

[JPINFV]

Want to attend: Part time medical school.

 

[firetender]

Something to Consider

You're new. People smell it. They can pick up your insecurities as well as a dog knows when you're afraid. It's part of the territory when you're new. The way it usually lessens its grip on you is when you take your focus off of what everybody else MIGHT be thinking -- about your knowledge and experience or lack thereof -- and just keep focused on the task at hand.

There are aspects of your newness that you don't have control over: like how insecure practitioners will take advantage of caca flowing downhill; and there are things about your newness that you DO have control over: like how much energy you give THE a-holes who like to torture the Newbies!

Though I do see the technical value in Mycrofft's defensive posture, I call in to question the amount of your personal energy that it would take to maintain that kind of vigilance. I'd rather see you keep your eye on the ball, getting to be the best you can and moving around the roadblocks rather than resisting or being stopped by them. Use the others' suggestions about seeking mentors that give you what you need. They are out there.