ER Clinicals = More Stress than Experience

[Andrea]

Hello All,

I am pretty new here and have only posted an intro and read up on a few threads over the past few weeks. I'm a current Paramedic student (just starting my second semester) with absolutely no previous EMS or hospital type experience. I went straight from EMT-B into the Paramedic program and am not involved with a service outside of school. At present, I'm working clinical hours in the ER about once a week (more during school breaks) and will soon start in on specialty areas and ambulance time coming up toward summer. I will finish the course at year's end and though I had hoped to get a job right out of school, I'm starting to think that volunteering in order to sharpen my skills first and possible getting a tech job in a hospital may be where I'm heading.

So, here's where I could really use some advice, criticism, guidance, lecturing, experience... whatever you have to offer!...

During my clinical shifts I feel like I should be gaining quality hands on experience and learning as I go. Unfortunately, more often than not, I feel like I am in the way and a hassle to the nurses that I am suppose to be gaining knowledge and experience from. They really don't take the time to "teach" or sometimes even explain what's going on with a patient and I don't always know what questions to ask. I am always ready and willing to help out and do everything that is asked of me unless I'm not sure how to, in which case I ask them to show me. I spend my shift following my assigned preceptor and when I find myself standing around, I try to ask other nurses if they need anything. I try to offer help and ask questions but, often times feel like I'm getting the cold shoulder and they simply have me run their errands; fetching pillows, blankets and water. While I'm off fetching, they are starting IV's, pushing meds, hooking patients up to monitors and conducting exams so I miss out on learning about different cases as well as the skills I greatly need. If I do have the opportunity to start an IV and miss it or don't feel a vein I think I can get successfully, the nurse is quick to jump in and take over without showing me what I could have done differently or advising me on difficult sticks.

I've worked with a couple of great nurses that readily offer useful information, make sure I get all the case information I need for my documentation and are great about having me start IV's, push medications and gain the experience I need most. They even let me know if an interesting case is coming in so I can go and observe. If it were possible to work only with those couple of nurses, I would but, my availability is limited and they aren't always scheduled the same days I've picked up.

No matter who I end up with, I'm always thanked for all my help and some go as far as to make comments on my days evaluation like: "a pleasure to work with", "knows her meds", "great patient rapport", "doing well with IV's". If I'm going about something wrong, no one has told me. Perhaps I am expecting too much from my preceptors but, in an 8 hour shift, I feel like I should be doing more than I have... especially when the ER is just about full! It almost makes me want to come out and ask if I've done something wrong or if there is something they expect of me that I'm not doing.

I am not very outspoken and hate feeling like I'm in the way or stepping on toes. If I've pissed someone off, I'm not aware of it. I'm pretty good about staying out of conversations that don't pertain to me or the patient, I don't complain and I help where and when I can. Because of the vibe I've been getting from some preceptors, and sometimes the obvious brush-off, I find my confidence dwindling and I'm not sure how to ask my preceptors for more hands on work and more guidance/feedback. Perhaps I'm being paranoid because this is all new to me and I haven't heard of other students feeling this way. Is this typical and I'm taking it too personally and should I just continue as I have; observing and happily running off for blankets and supplies? I'm really not looking for my preceptors to hold my hand through clinicals, I'd just like to gain the most from my shifts and not feel like I'm a pest.

Thanks for taking the time to read my mini-book and I look forward to any tidbits you have to offer!

[Bieber]

My advice, as a new paramedic who just graduated, is that you need to step up and take charge of your own education. I used to be a fairly quiet guy, and when it comes to social hour I still am fairly quiet, but when it comes to work I get loud--just like you need to be.

I'm going to be brutally honest with you and tell you this: nobody is going to make you a paramedic but yourself. You say they aren't explaining things to you, have you been asking them questions? You made it sound like you didn't know what questions to ask; start with the clinically relevant ones. Is this the normal presentation for this condition? What is the long term treatment? What are the goals of emergency treatment? Don't know anything about a patient's condition? Time to start asking questions, and more questions, and more questions--until they're so sick of hearing your voice they tell you to piss off.

Doing clinicals is a GREAT experience, and something you can get a LOT out of, but YOU have to take charge and take advantage of it. I saw a lot of people in my EMT and paramedic class go in, get their competencies, and go home. And that may have worked for you as an EMT, but it's time to put on your big girl paramedic pants and go above and beyond. If a patient goes to the cath lab, you need to ask if you could come and watch the procedure; or to surgery, or to the CT scanner, or wherever. The worst they can say is no, and throughout all my clinicals I was never turned down; because of that, I got to witness multiple surgeries (outside of our scheduled OR time), a heart cath, and a lot of other very cool, very interesting things.

Pretty soon you're going to be hitting the streets and YOU are going to be the one making the decisions, and if you can't step up and advocate for yourself and your own education how in the world are you going to advocate for your patients? Yes, you should be helpful, but you're not there to learn to play gofer, you're there to learn to be a paramedic. And you don't become a paramedic the day you pass boards, or the day you get your cards; you're becoming a paramedic now, throughout this whole process. And right now you're determining what kind of paramedic you're going to be.

I'm not trying to make you feel bad, but you HAVE to be in charge of your own education. Your paramedic program isn't going to make you a paramedic, only you can do that. And you have to come out of your shell and start chasing down opportunities, because they're not going to come to you in a silver platter. The nurse has no vested interest in making you a paramedic, neither do any of the doctors. And they're NOT going to go out of their way to help you in this journey. It's on your shoulders. So it's time to buck up and start taking control of your own education, instead of waiting for someone else to hand it to you. Quit waiting for them to teach you and start ASKING them to teach you.

Carpe diem, seize your own education.

[DwayneEMTP]

No babe, you're not being paranoid most likely, but you are also likely going to have to make some changes.

First, nurses, in my experience at several hospitals are not big fans of being medic preceptors, particularly if there are also nursing students in the environment. But, it's really not personal, it's just part of the whole medic/nurse bullshit game that's played. Plus it's part of the game. Figure out how to win it.

Second, no one is there with the only purpose of teaching you. Where you see yourself as being polite and unobtrusive, they see a waste of time. EMS is a contact sport. You truly can be polite and aggressive at the same time. If someone tells you to do something that you're not SURE that you know how to do, but you think that you MIGHT know how to do...then start doing it. Unless someone is going to be damaged, the nurse will stop you if you're wrong. I'm guessing nurses, as I have as a medic, get tired of hearing, "Can you just show me a few times and then I'll try." Nah, man, bullshit. If you don't want to learn badly enough to chance making yourself look like a dancing monkey then you don't want to learn badly enough for me to invest my time. See? I can watch you prep an IV while I do something else, catch your mistakes and set you right, but I can't teach your to prep an IV without stopping what I'm doing. If you're willing to try and figure things out to the best of your ability you'll get the nod 10/10 over Mr. Show me a few times.

Also, talk to your preceptor. Stop trying to guess what you are doing wrong, because while you're doing so you're wasting valuable clinical time. Tell him/her "I'm not sure what I'm doing wrong but I just don't feel like I'm getting a lot out of my clinical time. I seem to often be near things that I want to learn, but not IN them. Can you see what I need to do differently?" And most will help.

Also, never be without gloves. The 'real' medics gave me no end to shit when I was doing my clinicals because I was either wearing gloves or holding a pair of gloves. Why? Because on one of the first days on clinicals I saw them bring in a bloody trauma and the doc poked his head out into the hall and yelled, "Who's got gloves?" And a nursing student run in to help do...I don't know what, and I friggin' hated that! From then on anytime something like that happened I was involved, because often in the really cool stuff they just need a pair of hands, but those hands have to have gloves on them...see?

You're going to get no end to shit for being 'zero to hero' but don't take it seriously. Many of us here took the same path and have turned out ok...Focus on your education, work on putting yourself into situations that make you uncomfortable so that you learn how to work in that place..You're going to do awesome! Wait and see...You have one of the smartest 3rd posts that we've seen here in a really, really long time.

Welcome Lady. I look forward to watching you come along...

Dwayne

[Andrea]

My advice, as a new paramedic who just graduated, is that you need to step up and take charge of your own education. I used to be a fairly quiet guy, and when it comes to social hour I still am fairly quiet, but when it comes to work I get loud--just like you need to be.

I'm going to be brutally honest with you and tell you this: nobody is going to make you a paramedic but yourself. You say they aren't explaining things to you, have you been asking them questions? You made it sound like you didn't know what questions to ask; start with the clinically relevant ones. Is this the normal presentation for this condition? What is the long term treatment? What are the goals of emergency treatment? Don't know anything about a patient's condition? Time to start asking questions, and more questions, and more questions--until they're so sick of hearing your voice they tell you to piss off.

Doing clinicals is a GREAT experience, and something you can get a LOT out of, but YOU have to take charge and take advantage of it. I saw a lot of people in my EMT and paramedic class go in, get their competencies, and go home. And that may have worked for you as an EMT, but it's time to put on your big girl paramedic pants and go above and beyond. If a patient goes to the cath lab, you need to ask if you could come and watch the procedure; or to surgery, or to the CT scanner, or wherever. The worst they can say is no, and throughout all my clinicals I was never turned down; because of that, I got to witness multiple surgeries (outside of our scheduled OR time), a heart cath, and a lot of other very cool, very interesting things.

Pretty soon you're going to be hitting the streets and YOU are going to be the one making the decisions, and if you can't step up and advocate for yourself and your own education how in the world are you going to advocate for your patients? Yes, you should be helpful, but you're not there to learn to play gofer, you're there to learn to be a paramedic. And you don't become a paramedic the day you pass boards, or the day you get your cards; you're becoming a paramedic now, throughout this whole process. And right now you're determining what kind of paramedic you're going to be.

I'm not trying to make you feel bad, but you HAVE to be in charge of your own education. Your paramedic program isn't going to make you a paramedic, only you can do that. And you have to come out of your shell and start chasing down opportunities, because they're not going to come to you in a silver platter. The nurse has no vested interest in making you a paramedic, neither do any of the doctors. And they're NOT going to go out of their way to help you in this journey. It's on your shoulders. So it's time to buck up and start taking control of your own education, instead of waiting for someone else to hand it to you. Quit waiting for them to teach you and start ASKING them to teach you.

Carpe diem, seize your own education.

I very much appreciate your "go get it" advice. I do ask questions, lots of them but, I know sometimes I'm just not asking the RIGHT questions because I get very basic answers when I'm looking for some "depth" in what should be a teachable moment. Often times I think they are giving me the quick version because they just want to get on with their charting and orders. I could honestly spend an entire shift asking questions because I have that drive to learn. I've never had a problem advocating for others, especially when it was my job to do so... I think I'm having a problem using my "big-girl voice" and advocating for myself in all of this because I don't want to piss anyone off and have them avoid me and not give me the opportunity to work on skills. What I am "permitted" to do is entirely up to them because they are ultimately responsible. I guess that I was under the assumption that when a hospital allowed students to follow their employees, it's expected that said employee teach/train/advise the student. I will definitely work on asking better questions, and seeking out more opportunity. You've given me some great ideas in how to ask for what I need out of this and perhaps that is the majority of my problem... I'm just not asking the right way.

I've definitely gotta start asking to observe procedures when I hear of them, even if I know they are gonna say no! We don't get OR rotations in my program but, that's something I would LOVE to see! Thanks again for all your input, it really helped me kinda reset my thinking and next Sunday I'm going to be more proactive.

[Andrea]

No babe, you're not being paranoid most likely, but you are also likely going to have to make some changes.

First, nurses, in my experience at several hospitals are not big fans of being medic preceptors, particularly if there are also nursing students in the environment. But, it's really not personal, it's just part of the whole medic/nurse bullshit game that's played. Plus it's part of the game. Figure out how to win it.

Second, no one is there with the only purpose of teaching you. Where you see yourself as being polite and unobtrusive, they see a waste of time. EMS is a contact sport. You truly can be polite and aggressive at the same time. If someone tells you to do something that you're not SURE that you know how to do, but you think that you MIGHT know how to do...then start doing it. Unless someone is going to be damaged, the nurse will stop you if you're wrong. I'm guessing nurses, as I have as a medic, get tired of hearing, "Can you just show me a few times and then I'll try." Nah, man, bullshit. If you don't want to learn badly enough to chance making yourself look like a dancing monkey then you don't want to learn badly enough for me to invest my time. See? I can watch you prep an IV while I do something else, catch your mistakes and set you right, but I can't teach your to prep an IV without stopping what I'm doing. If you're willing to try and figure things out to the best of your ability you'll get the nod 10/10 over Mr. Show me a few times.

Also, talk to your preceptor. Stop trying to guess what you are doing wrong, because while you're doing so you're wasting valuable clinical time. Tell him/her "I'm not sure what I'm doing wrong but I just don't feel like I'm getting a lot out of my clinical time. I seem to often be near things that I want to learn, but not IN them. Can you see what I need to do differently?" And most will help.

Also, never be without gloves. The 'real' medics gave me no end to shit when I was doing my clinicals because I was either wearing gloves or holding a pair of gloves. Why? Because on one of the first days on clinicals I saw them bring in a bloody trauma and the doc poked his head out into the hall and yelled, "Who's got gloves?" And a nursing student run in to help do...I don't know what, and I friggin' hated that! From then on anytime something like that happened I was involved, because often in the really cool stuff they just need a pair of hands, but those hands have to have gloves on them...see?

You're going to get no end to shit for being 'zero to hero' but don't take it seriously. Many of us here took the same path and have turned out ok...Focus on your education, work on putting yourself into situations that make you uncomfortable so that you learn how to work in that place..You're going to do awesome! Wait and see...You have one of the smartest 3rd posts that we've seen here in a really, really long time.

Welcome Lady. I look forward to watching you come along...

Dwayne

Thanks for taking the time to reply! I've heard about the whole Nurse/Medic conflict from both sides and I think it's just stupid... I've wondered if part of the reason I see them really taking their time in explaining things to nursing students verses me had anything to do with that. But, on the same token, I've followed nurses that are also medics and still had issues.

I completely get that they aren't there for the purpose of teaching me, I guess I had just hoped that since I was there to learn that some teaching would be involved in my observing and skill experiences. Going into this, I thought things would be a little different because they were all students once too. I guess my compassion for such things is just different. Like I was saying in my above reply, I need to work on being more proactive about what it is I need/want to know and do and asking the right way.

I'm not the type to ask preceptors to show me how to do something a few times before I will try it out... I was asked to do an NG tube and let the nurse know I'd never done it before but, needed to learn how and was it something easy enough for her to walk me through? She preferred I watch since I'd never seen it done, so I paid close attention and will jump on the next opportunity. On the other hand, I had another nurse ask me to hook a patient up to a monitor... the patient was already on the monitor so I asked what kind of monitor the patient needed... She said a transport monitor and before I could even ask where to find one, she was asking the tech to do it instead.

I get that when a patient comes in, everyone has their job and they just jump in and start doing it... I'm gonna try to get in the room just ahead of the patient and jump into action - hooking up the monitor, getting out the IV supplies and what-not. It's not always worked for me in the past though, I will start working on something and be sent off to do something else or I will ask if I can do something and I'm told, "no, it's ok, I've got it". I guess I just gotta keep asking and trying to get it done first!

I love this... "I'm not sure what I'm doing wrong but I just don't feel like I'm getting a lot out of my clinical time. I seem to often be near things that I want to learn, but not IN them. Can you see what I need to do differently?" I never asked for help this way and I think it will play in my favor. I appreciate that. Even with simple things like a tough stick, I simply let the nurse know I'm not sure I can get it started and ask them to help... but, instead of helping, they take over. It seems that if I attempt an IV and don't get it, they are reluctant to ask me to start another one. I almost always make the attempt anyway. I've also wondered if they don't help me through it and just do it themselves because they don't want the patient to feel like a test subject.

When I first started clinicals a few months back, my pockets were always loaded... gloves, tape, sheers, stethoscope, alcohol swabs, flushes... I've kinda slacked off on that a bit and your glove story has interesting timing... I was asked for a stethoscope today and didn't have mine because I've used it once - about two months ago so I just stopped carrying it in order to free up some pocket space! Won't be doing that again!

I'm feeling tons better after your advice, and Biebers... can't thank you enough. I look forward to taking a new approach next Sunday and being more proactive about care and the right kinds of questions.

Oh, and........ I feel like a dancing monkey more often than I'd like so, I must be doing at least one thing right! : )

[HERBIE1]

Andrea- Listen to Dwayne. He's a very perceptive guy and his advice is sound. What I will say won't help you per se, but it may put things in perspective as to why you feel as you do. You noted that you went directly from EMTB to paramedic school. I have to say that's probably at the root of your lack of assertiveness. Generally if someone is shy, working as an EMT forces them to come out of their shell. Not possible for you now, so you'll have double duty- learn how to be an EMT, and a paramedic at the same time. Step up, be proactive in your education and training. It's YOUR training- fight for it.

I've worked in ER's for years in a busy teaching hospital which was also a Level 1 trauma center. I would see nursing students, residents, medical students, paramedic and EMT students. Often times these folks were competing for the attention of SOMEONE to help them out. The ones who got the most out of their clinical experiences were the ones who stepped up and "fought" for the right to help on some procedure, get in the middle of an interesting case, or be able to perform a skill you need to master. Volunteer for the unpleasant tasks like cleaning up an incontinent patient. You will endear yourself to the staff and your preceptor. Everyone wants the "fun" stuff, but if you ingratiate yourself to the staff by stepping up, they WILL remember.that.

[Andrea]

Andrea- Listen to Dwayne. He's a very perceptive guy and his advice is sound. What I will say won't help you per se, but it may put things in perspective as to why you feel as you do. You noted that you went directly from EMTB to paramedic school. I have to say that's probably at the root of your lack of assertiveness. Generally if someone is shy, working as an EMT forces them to come out of their shell. Not possible for you now, so you'll have double duty- learn how to be an EMT, and a paramedic at the same time. Step up, be proactive in your education and training. It's YOUR training- fight for it.

I've worked in ER's for years in a busy teaching hospital which was also a Level 1 trauma center. I would see nursing students, residents, medical students, paramedic and EMT students. Often times these folks were competing for the attention of SOMEONE to help them out. The ones who got the most out of their clinical experiences were the ones who stepped up and "fought" for the right to help on some procedure, get in the middle of an interesting case, or be able to perform a skill you need to master. Volunteer for the unpleasant tasks like cleaning up an incontinent patient. You will endear yourself to the staff and your preceptor. Everyone wants the "fun" stuff, but if you ingratiate yourself to the staff by stepping up, they WILL remember.that.

I can definitely, without a doubt, agree with your statement about jumping from basic to paramedic... I've told a couple of people now, if I had it to do all over again, I would have gotten my EMT- Advanced/Intermediate first, gotten some experience with a service and then gone on. I am however, on a bit of a time constraint... I'm in the Midwest at present, a resident where tuition is cheap and trying to get my degree and get to Virginia as quick as I can.

I am not a shy person, I have no problem interacting with patients and their families or my instructors in class... It's the preceptors I'm having trouble with, mostly because I don't want to jeopardize my standing with them and lose their faith in letting me work on my skills. I'm definitely starting my next shift with a whole lot more of the proactive bit! As I had mentioned somewhere in one of my way too long posts above, I thought that doing the "dirty work" would help build some rapport with the nurses so they would feel better about asking me to do the "fun" stuff. I'm not with the same person every time so, that's not worked out as well as I'd hoped. I know I can get where I need to be, I definitely want it bad enough... It's just a matter of figuring out how to make the most of it. I've gotten some great advice that I will certainly be using, not just letting it flow in one ear and out the other so-to-speak. Thanks so much for your input.

[zippyRN]

Dwayne and Bieber have posted a lot of relevant and spot on stuff here

there are a number of things you need to address

1. what is the purpose of your placement, are there specific competencies to be signed off ?

2. do you have a named mentor / preceptor for the placement ? is this a requirement for the programme ? are you routinely working with your named mentor?

3. what 'extra' do you want to learn from your placement

Don't over think the medic- nurse issue in the 'getting in the way' issue, having a student of any profession can be a real pain in the behind for the mentor ... especially if you are relatively limited in what you can be set off to do with reduced supervision - when you've got 'senior' students or supernumerary preceptees the student can be an effective 'force multiplier' but if you aren't in a position to do that you can 'slow things down' and if the pressure is on workload wise it;s unsuprising you feel 'in the way'

another thought with respect to the OPs personal situation - is it common for people where you are to go straight from EMT class to paramedic class without Any ride time ?

if this is rare then you might find that it's harder work for your mentors as they aren't used to this ... All my new crewmates in my EMS role are all experienced Events first aiders and/or community first responders so have got a certain level of skills in various areas of practice and it's more about shifting up a gear thinking like crew and adding in the extra decision making and psychomotor skills rather than looking at the whole package from rookie status ...

[mobey]

So, here's where I could really use some advice, criticism, guidance, lecturing, experience... whatever you have to offer!...

During my clinical shifts I feel like I should be gaining quality hands on experience and learning as I go. Unfortunately, more often than not, I feel like I am in the way and a hassle to the nurses that I am suppose to be gaining knowledge and experience from. They really don't take the time to "teach" or sometimes even explain what's going on with a patient and I don't always know what questions to ask. I am always ready and willing to help out and do everything that is asked of me unless I'm not sure how to, in which case I ask them to show me. I spend my shift following my assigned preceptor and when I find myself standing around, I try to ask other nurses if they need anything. I try to offer help and ask questions but, often times feel like I'm getting the cold shoulder and they simply have me run their errands; fetching pillows, blankets and water. While I'm off fetching, they are starting IV's, pushing meds, hooking patients up to monitors and conducting exams so I miss out on learning about different cases as well as the skills I greatly need. If I do have the opportunity to start an IV and miss it or don't feel a vein I think I can get successfully, the nurse is quick to jump in and take over without showing me what I could have done differently or advising me on difficult sticks.

I've worked with a couple of great nurses that readily offer useful information, make sure I get all the case information I need for my documentation and are great about having me start IV's, push medications and gain the experience I need most. They even let me know if an interesting case is coming in so I can go and observe. If it were possible to work only with those couple of nurses, I would but, my availability is limited and they aren't always scheduled the same days I've picked up.

No matter who I end up with, I'm always thanked for all my help and some go as far as to make comments on my days evaluation like: "a pleasure to work with", "knows her meds", "great patient rapport", "doing well with IV's". If I'm going about something wrong, no one has told me. Perhaps I am expecting too much from my preceptors but, in an 8 hour shift, I feel like I should be doing more than I have... especially when the ER is just about full! It almost makes me want to come out and ask if I've done something wrong or if there is something they expect of me that I'm not doing.

I am not very outspoken and hate feeling like I'm in the way or stepping on toes. If I've pissed someone off, I'm not aware of it. I'm pretty good about staying out of conversations that don't pertain to me or the patient, I don't complain and I help where and when I can. Because of the vibe I've been getting from some preceptors, and sometimes the obvious brush-off, I find my confidence dwindling and I'm not sure how to ask my preceptors for more hands on work and more guidance/feedback. Perhaps I'm being paranoid because this is all new to me and I haven't heard of other students feeling this way. Is this typical and I'm taking it too personally and should I just continue as I have; observing and happily running off for blankets and supplies? I'm really not looking for my preceptors to hold my hand through clinicals, I'd just like to gain the most from my shifts and not feel like I'm a pest.

Thanks for taking the time to read my mini-book and I look forward to any tidbits you have to offer!

The others have said all that needed to be said.

When I was on ER practicum, I took control of the ER beds my preceptor was assigned too, and he sat on Facebook! Just the kind of student he likes. Nurses are classicaly not teachers, and they may not want to be.

Just wanted to highlight a few things in your original post for you to reflect on now that you have had feedback from the others.

This is not a jab: but you kinda remind me of a friend of mine who was so hung up on trying to gain the approval of her preceptor, and not "step on toes" by waiting to be asked to do things, it nearly cost her her career.

BTW: If you want to see something (NG tube) before doing it, go to youtube

As long as there is someone watching you perform the procedure, there is not much we do as medics that can really cause damage if done wrong. Well.... except that airway stuff....

[Andrea]

Ok, so I don't know how to use that seemingly awesome multi-quote button but, I can copy, paste, edit and color coordinate! : )

1. what is the purpose of your placement, are there specific competencies to be signed off ?

The purpose is essentially to gain hands on experience in the field. We are given a set number of various skills and types of assessments that must be fulfilled during hospital and ambulance clinicals by the end of the program. Though some of those requirements aren't high enough in my opinion. Example: 25 IV's needed before the end of the program. Really? Only 25? I've done 50 successful out of 64 attempted so far and it's not second nature to me yet so I think that requirement needs a significant boost! There are a few things we learn strictly during clinicals and get signed off by the preceptor like NG tube and foley cath. Other sign offs happen in the classroom (like intubation on a dummy) and we are then allowed to practice live in the field but, I've heard it's rare that students actually get to intubate during clinicals.

2. do you have a named mentor / preceptor for the placement ? is this a requirement for the programme ? are you routinely working with your named mentor?

When I report for a hospital clinical, I check in with the charge nurse and am then assigned to follow someone. I cannot schedule to be with a specific person on a specific shift because schedules are constantly changing but, when someone I work well with is on shift, I seek them out. During ambulance time, I will know who I am riding with when I sign up, so that's a bonus. I got a lot out of my ride time during basic and will be able to ride with that medic again when the time comes.

3. what 'extra' do you want to learn from your placement

Extra? I will take all that I can get! I soak up everything that I possibly can... I want to be good at what I do and I'm willing to work hard at it, practice, practice, practice! Getting the opportunity to do the work has been difficult at times and I'm hoping to begin correcting that during my next shift, thanks to all the great advice I've gotten here.

Don't over think the medic- nurse issue in the 'getting in the way' issue, having a student of any profession can be a real pain in the behind for the mentor ... especially if you are relatively limited in what you can be set off to do with reduced supervision - when you've got 'senior' students or supernumerary preceptees the student can be an effective 'force multiplier' but if you aren't in a position to do that you can 'slow things down' and if the pressure is on workload wise it;s unsuprising you feel 'in the way'

another thought with respect to the OPs personal situation - is it common for people where you are to go straight from EMT class to paramedic class without Any ride time ?

It's not common, at least in my class of 16 students (started with 20), there are only a couple other EMT-B's with no experience. Our only experience was the 12 hours hospital and 12 hours ambulance from the basic program. Getting into the paramedic program is based on completion of prerequisites, grades and experience. I had no experience but all other courses completed with good grades, so I got in.

if this is rare then you might find that it's harder work for your mentors as they aren't used to this ... All my new crewmates in my EMS role are all experienced Events first aiders and/or community first responders so have got a certain level of skills in various areas of practice and it's more about shifting up a gear thinking like crew and adding in the extra decision making and psychomotor skills rather than looking at the whole package from rookie status ...

The only benefit I have going into this is about 13 years of direct care experience - CNA work and the like. I have experience with taking vitals, caring for the sick and dying, advocating for patients, administering oral medications and the sort. It's not much to start with but, I think this would have been harder if I didn't already have that. Thanks so much for taking the time to reply, I really do appreciate all the input I can get. I want to get the most out of my educational experience and found myself a bit stressed and lost in trying to achieve that.

The others have said all that needed to be said.

When I was on ER practicum, I took control of the ER beds my preceptor was assigned too, and he sat on Facebook! Just the kind of student he likes. Nurses are classicaly not teachers, and they may not want to be.

Just wanted to highlight a few things in your original post for you to reflect on now that you have had feedback from the others.

This is not a jab: but you kinda remind me of a friend of mine who was so hung up on trying to gain the approval of her preceptor, and not "step on toes" by waiting to be asked to do things, it nearly cost her her career.

BTW: If you want to see something (NG tube) before doing it, go to youtube

As long as there is someone watching you perform the procedure, there is not much we do as medics that can really cause damage if done wrong. Well.... except that airway stuff....

I don't typically wait around to be asked, I'm often asking if there is something I can do. That's not been enough so, I'm just gonna jump in on things a bit stronger. I'm really not looking for acceptance or friendships or hand-holding... I just hate the feeling of "being in the way" and I don't want to do something that will lead to my preceptors not allowing me to do various things. I admit, I've been a bit timid during some (not all) of my shift. If I get a bad vibe from a preceptor it doesn't help the confidence! Gonna keep working on that for sure.

I definitely need to utilize more visual resources on the web, that I'm sure will help me too. The whole thing with the NG tube was the particular nurse wanted me to watch before I was given the opportunity to do it. Which, I can understand... they want me to see how they do it first. I've seen it, so I'm ready for the next chance!!

Thanks for pointers...... I didn't expect so much input and I'm grateful!