• So you have a Paramedic student…..What now?

    by Jess Morton. Last modified: 18/05/14

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    **********     It’s a long one……. Brace yourself…..*********

    Clinical placement is an event that is filled with both fear & excitement. The journey to setting foot for the first time in the ambulance station is a long and often an expensive one. In Australia, many students are required to self-fund an extensive occupational health & fitness assessment which may reach into the hundreds of dollars as well update any vaccinations required at our own expense.

    We are required to fill out a multitude of forms and attach JP signed documents. We then buy our uniform and kit. Mine cost around $450. We often must travel away from home and rent accommodation & transport etc. Many students also have no income during this time as well as they cannot work.

    It is of no surprise that by the time we turn up at your station, looking very shiny in our un-tarnished reflectors and far too excited to be there at 7am, we are keen & ready to get into it & make the most of every moment.

    So what is it about our on-road preceptors that can help all of that process become worth every minute by moulding us into competent, skilled & mindful paramedics?

    Burn out

    I admit, my original post was a generic letter to the ‘burnt out preceptor’. It was based on my experiences & stories from others. I decided to opt against that. Instead I have flipped it and written about what makes a great on-road mentor. Sadly, we know that burn out is common. It isn’t just in paramedicine. However…if you scroll back to the very start of this article and remember all of those hurdles we jump over to step foot in your ambulance, you will know that we really DO want to be there. We want to make the most of that time and soak up every piece of information & experience that we can.

    The paramedic who is burnt out, cynical & who no longer enjoys their job may inevitably transfer that to us. We do not expect rainbows & unicorns, we don’t want high fives and ‘Yippees’ about attending those jobs that many love to hate. We expect and hope for reality.

    We need demonstrated to us what professionalism & patient-centred care is. We need to learn how to effectively manage the jobs that you personally don’t like, but are still a daily part of being paramedic.

    Inclusion

    My first week I was paired with two paramedics who were laid-back, easy to get along with and like myself, enjoyed a laugh. On station and out for the obligatory “first-chance” morning coffee, they would include me in conversation & chat to me as though I was just another member of the team. Because I was included in the typical station banter and made to feel right at home, my confidence going into jobs was far greater. I was able to relax & let my own personality come out in my care.

    If we were to leave a patient at home, not only would they consult with each other to make sure that each were happy with the decision, many would also turn to me and ask how I felt about it. Whilst, I am not naïve enough to think my thoughts would have any real impact, they still asked. An inclusive preceptorship also testified to the teamwork model of care. No decisions about high-risk manuevers , entries in potentially dangerous conditions were made without also discussing with me. It has given me a strong sense of the model of care and operating standard that I wish to aim for.

    Understanding

    Just because I packed my bags, left the state and went on five weeks of placement does not mean that my life stopped. I was also going through a chaotic marriage separation, I missed my kids and I had assignments due for other subjects. Every now and then when something else in life was causing issues, my motivation would drop, my self-confidence would plummet and I just wanted to go home. The vast majority of the crews I worked with understood this & were encouraging & supportive. The paramedic who could see things through my eyes, could also help me see the end goal.

    A preceptor who understands the journey that students take to get out on placement and the stress of the intense university degree is one who will be better equipped to keep their student focused on the right path. We as students will feel more trusting of the preceptor to let our guard down, jump in, make a few mistakes & be ok with it.

    Commitment

    When I have asked many student and qualified paramedics what they most value in a preceptor, many have commented about how hard it can be chasing up their mentor for their appraisal paperwork. Every uni and college is different. Some students may only need a quick tick & flick and a lovely one-line comment. Others may require much more of you. This paperwork is not optional for us. It is not to use as a CV reference for later on. It is compulsory and failure to hand in by the designated date may and can result in a fail for the course.

    Please, please, be committed to helping us complete what we have to. Many students have  told stories of paramedics going on leave, changing stations or just not responding to requests to return their paperwork to them. We appreciate beyond words the time you have spent teaching us, demonstrating skills and the fun along the way. We gain so much from our time with you, but if we do not get those forms back, it all means nothing to our uni.

    Patience

    Whilst some may disagree, I still believe we all learn in different ways. I am someone who likes to watch first, then attempt myself. I received 100% in my practical patient history taking and clinical handover  assignment at uni. I have also been doing this in a nursing environment for almost nine years now. However, being supervised & I daresay scrutinised by paramedics was utterly nerve-wrecking. The paramedics who I had built up the most rapport with, were indeed the ones who tended to be the most patient with me, let me go on that rope a bit, but just not far enough to let myself (or the patient) drown. I recall a minor MVA I attended with two ICP’s who I really respect, it was my last week. They obviously did their scan of things and stayed within earshot, but let me take over the patient. I wasn’t hovered over or interrupted. However, I knew they were right there and would not let me do harm. Had I been with a crew who were impatient and just wanted to just pick up the patient and get going, I would not have gained the invaluable experience that I did, nor the things I learnt from that very case.

    Patience is important as we are taught one thing by our university & then something different by each different paramedic. One para would like to cannulate on scene, another in the ambulance.  One may want the dots put back on the ECG wires at the end of the job, another would hate that. We do understand though, that we need to adapt and learn different ways of doing things. We may be slow, we may ask questions that may not be pertinent, we may perhaps be pedantic about palpating that pulse for a whole 1 minute if we think something is wrong, or do a BSL when you don’t think its needed.

    But, as one fantastic Intensive Care paramedic said to me, “As long as you ARE doing what MUST be done and NOT doing what SHOULDN’T be done, the patient is safe”.

    Honesty

    We need to know what we don’t do well. The little things may not matter so much right now, but if we are missing the point on something, or our technique in a skill is poor. We need to be told. There is no point dancing around it trying to tell us something but without actually saying it. Doing it away from the patient or bystanders (if practical), being kind but blunt can be effective. But if you are to tell us where we are wrong, please also tell us how to do it better.

    Just as we need to be told where we stuff up, we also need to be told what we did well. I would always ask after every job, what I did well and what I didn’t do so well. If I don’t know that I’m doing something well, I won’t know to continue it. It is also nice to have a confidence booster every now & then. Be honest with us from the start about your expectations of us as well. Two-way honesty is important

    Educator

    Most paramedics would tell you they learnt more in their first six months on the job than they did in their three year degree. We know and understand that on-road paramedics are not qualified teachers. That’s why we look forward to working with you.

    We are taught to recognise a STEMI from a digitally designed, perfectly legible ECG in a cardiology textbook. But YOU can teach us to recognise it from a 12-lead taken on a bumpy ride to hospital at 100km/hr. Our lecturers have painted a picture of what a ‘pre-arrest’ patient looks like, but only you can walk into a job with us and point it out. We have been told we will just ‘know’ the smell of melena or the breath of a patient in DKA, but it is you who will help us recognise that in reality.

    It is the paramedic who cares enough to go over concepts that are complex, or to sit down and draw a diagram you find helpful for understanding perfusion mismatch that will have the most impact. For me, it has been the paramedics who would open up the discussion and ask if I had questions and would sit there and explain certain concepts until I fully understood that have been my greatest educators.

    Defining roles

    The first time our MDT said Cardiac Arrest, my heart jumped. I was that little bit excited to get the opportunity to witness an OOHCA and how to run it, but suddenly nerves hit in. I knew attending an arrest on a baseball field was extremely different to in a hospital room with an abundance of help & resources only seconds away. The best thing that my crew did on the way to that job was to outline three different scenarios of what may  be occurring  when get there. My role was clearly defined to me for each of those scenarios and what I was required to do before we even pulled up. I was also made aware of the role of each of my two crew members. This is not only essential for educational reasons but can also be used to your advantage as it may not be every day you have a 3rd set of hands first up. It was only my 2nd shift ever on road, however I felt more prepared & confident going into that job than I did for any other job in that five weeks.

    We don’t always know where we stand and what it is you want from us. We don’t want to be in your way, or ever put the patient at risk. Defining roles before attending the scene can be really beneficial.

    Now, my little tribute to the amazing paramedics who I had the absolute privilege of working with in Canberra, Australia. You are a very small service, but you have a very high standard of care and acceptance of students. I have been so fortunate to learn from you.

    Sorry for the length!

    Jess

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    Jess Morton

    Jess Morton

    Student Paramedic.
    I am an Australian undergraduate Student Paramedic. I study part-time as I am also Mum to 2 beautiful boys. I am passionate about Friendship, Family & #FOAMed. I am keen to get more experienced as well as student Paramedics into the FOAM world to enable better access to education to result in better patient care. My interests include photography, thick shakes and sleeping in past 6am.

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