What I learned about Hospital Clinicals (Part I...A)

I totally forgot about the main thing I really wanted to touch on...

Schedule all of your clinical time early

My program doesn't allow students to begin ride time before hospital clinicals are completely finished. I am way behind where I wanted to be, mostly because it took more time than I was expecting to talk to the people I needed to and schedule time in the departments that I needed too as well.

I just assumed it was going to be as smooth for me to schedule time in the Cath Lab, L and D, ICU, and Pysch as it was for me to schedule time in the ED.

I was very wrong. It sometimes took me weeks to get in touch with those I needed to speak with, so ultimately I had weeks that were lost. Had I begun to schedule my time back in July, then I'm sure things would've been sorted out early. But it took me a 6 weeks to finally get into the ICU, and I ended up having to schedule my L and D time at another hospital.

Plan ahead....like...way ahead.

What I learned about Hospital Clinicals (Part I)

Next week I have my 8 hour Psych clinical shift, then I will have completely my hospital clinical time.

Throughout my journey there are a few things that I learned that I would love to pass along. I figure that these learnings are worth at least a few blog entries, so for this first one I will start with overall things that will help future paramedic students along no matter what department they are in.

Seize every opportunity to learn...even if it has nothing to do with your program.

I watched a plastic surgeon stitch up the face of a guy who got kicked (in the face) by a horse, I watched epidurals get administered, I assisted nurses with placing catheters, I helped clean and dress pressure ulcers, I watched ED docs drain infected cysts, I watched cardiologists start cardiac caths in the femoral and radial arteries, I assisted in reducing dislocated shoulders and ankles.

My clinical time in the hospital was a unique opportunity to see some really awesome medicine that I was paying for in dollars and time. I didn't want to miss any of it.

Smile, be courteous, helpful, thankful, and pay attention to staying out of the way.

I tried to make sure everyone I worked with knew that I was happy that they had given me the opportunity to be there. A lot of the time, having a Paramedic student following you around ends up being more work than not. It is important to realize those moments you can make the Nurses and Doctors life easier and jump on those opportunities.

Don't be afraid to ask about getting it done.

I missed opportunities for skills because I didn't want to bother people. Depending on your disposition and the people that you are working with, this might be more of a problem or less. There are specific things that you need to get done while you are there, and no one will fault you for attempting to get done what you need. There is definitely a balancing act though, and a student might be perceived as pushy, or apathetic.

Don't expect to get any skills or assessments in during your non-ED rotations.

This obviously doesn't include OB/GYN births and OR tubes. But the time I spent in Pediatrics, NICU, ICU, and the Cardiac Cath Lab, I don't think I was able to get much done (in terms of skills). I expected to get 20 pediatric assessments in the 32 hours I spent in Peds and the NICU, and I ended up with 6. There were nurses that didn't want anything to do with me in both departments, and I stacked my hours between a Saturday and a Sunday, so I ended up seeing all the same patients, which I could've probably "re-assessed" but I decided against it. A students best opportunity to "get-er-done" is definitely in the ED, and the ED expects that.

Be extra helpful and courteous to the nurses that don't want anything to do with you.

A paramedic student is definitely going to come up against some adversity. Negativity never helped anyone. The "if you give me crap, I will give it right back" attitude isn't going to help you, or the paramedic students who come along after you are gone. Early in my time at the ED, one nurse flat out ignored me and never asked if I wanted to assist them in any way. I just decided to start helping them any way I could, I would assist them with moving patients, taking vitals, and checking call lights. It only took a few instances of me just going out of my way to help them, and from that point on, this nurse asked me every time if I wanted to start their IVs. There also was a CRNA that didn't seem to keen on me. I was never asked to start any other their tubes, and everyone else in the anaesthesia department seemed to steer me clear of them,  but I had few good conversations regarding patient care and the stock market with them, so I hope that helped whoever came along after me.


I reckon thats enough for now.
 

A Clinical Episode...

So yesterday I was at the ED for clinical time...I am getting ready to start an IV on a patient. She was a woman in her 40s and her father was there. I introduced myself and set about finding a vein that was suitable. The patient father asks

"Are you ready for the hurricane?"

"Well, I bake my own bread and I don't drink milk, so I have no reason to rush out to the store..."

That was kind of a joke....I do bake bread and I don't drink milk, but it was suppose to be an observation of the absurdity of peoples actions when they hear of incoming natural disturbances...They all run out and buy milk and bread. But their response was somewhat suprising....

"You don't drink milk?" the patient said..

There was a harshness in her words that was unexpected for the mildly mannered folks they seemed to be. I told them that I do eat yogurt though. And they were immediately more at ease.

"Do you make your own yogurt?"

I told them I did, then the conversation moved on to using pasteurized milk vs. raw milk for yogurt. If I had ever tried Kefir and why do so many new aged crunchies have to buy cultures and starters through the mail and at Whole Foods that aren't really necessary. We also talked about how greek yogurt has gotten so popular and how it uses more milk.

I looked at them again. They were definitely rural folks, and realizing how dairy-centric the conversation had been, I went for a shot in the dark....

"Are you folks in the dairy business?"

Thank god I'm not lactose intolerant...Security may have to of been called.

Success in Clinicals

People will have different attitudes regarding Paramedics wherever you go. The response I have gotten from the ED has been overwhelmingly positive. Or at least....beige.

So far,  my time in clinicals, I have met people who have been very glad to teach and give me opportunities. I have tried my hardest not to waste their time. I have met people that don't want anything to do with me...And I try my hardest to help them where I can, and show them that I am not there just to waste their time. I could be a snot or ignore those people, and re-enforce the attitudes that already exist. But I feel like I have found a really great site for clinicals, and I want to try my damnest that the paramedic students that come after me have at least as good an experience as I am, hopefully better. My educational experience doesn't exist in a vacuum, and my experience is colored by those that come before me, and my words and actions will affect those that come after me.

Don't touch anything Blue!!!

My instructor stated that the most stressful moment in your Paramedic Education is when you are called into to do your first tube in the Operating Room.


He was definitely right....


The RN firmly told me "Dont touch anything blue!" as I walked in.

The floor was blue, the patient was covered in blue sheets, everyone's scrubs were blue.

I quickly realized that she meant the person with the safety glasses and apron and sterile gloves, and the table covered in surgical instruments.

I didn't touch any of that stuff.
There was a MD anesthesiologist watching, but a CRNA was in charge of this patient. She asked if I had ever intubated anyone....I shook my head.

I wasn't sure if the patient was still awake...in retrospect, I am certain he was not.

She asked if I have intubated the mannikin. I nodded.

I opened the patient's mouth and was amazed at how little it looked at all like those plastic mannikins.

Eventually I found my bearings, and found my patient's larynx. I glanced up,  and saw his oxygen stat was still at 100%.

The seal was cracked. One down....

Uncovering Paramedic Clinicals

It is getting to be the countdown to the start of this show, and I was just looking around for some information about clinicals, and I came across this article:

Uncovering Paramedic Clinicals

It seems like it has some pretty good information.