Clinical preceptors

[reaper]

Yes, the good old days when ACLS was a pass or fail course. Now everyone passes, no matter what. That is why none of the AHA courses hold any credit with anyone any more. They are all a big joke now.

 

[Veneficus]

Yes, the good old days when ACLS was a pass or fail course. Now everyone passes, no matter what. That is why none of the AHA courses hold any credit with anyone any more. They are all a big joke now.

I would just like to point out that while I don't agree with everything the AHA says or does, the purpose of ACLS has undergone some revision.

It takes considerably more knowledge and ability to bring people back from the dead than a supposedly 16 hour course.

While the title of "advanced cardiac life support" was maintained, there is absolutely nothing advanced about it. It is CPR with a couple of toys.

It is an algorythm that is recommended in order to help the most people most of the time. The purpose of the class is not to teach people how to be experts in resuscitation.

The purpose is to teach people the algorythms and practice the flow of them in order for longer retention. The more user friendly format is designed to build confidence so that people will step up in an emergency rather than shrink into the shadows.

Most people who are now required by their respective authorities to take ACLS may never see an arrest or peri arrest in their careers. We cannot hope to turn these providers into resuscitation experts. All that we can do is give them some skills and confidence to attempt to do something to help. The more simple the format, the more likely it will be remembered by these occasional rescuers.

 

[thegreypilgrim]

Wouldn't it be more helpful if we went back to having doctors be the primary preceptors for paramedics?

+1 x Infinity...plus one.

I would have given anything for more time with physicians during my training. The only situation where I was directly supervised by an MD was in the OR with the anesthesiologists. And it was great. Truly beneficial experience.

In all other aspects of my clinicals I was supervised by RNs, some of whom were quite good, others not so much. I agree that the psychomotor elements of our skillset should probably be taught by RNs since that's what they do day in and day out, but for assessments, invasive interventions, and DDx that should be done by physicians.

A nursing assessment is just fundamentally different from a primary medical one, the latter of which is more in line with what we do in EMS. I've always thought the paramedic's mode of thinking is far more in congruence with physicians than nurses, and have always been entirely baffled by this nauseating empowerment issue nurses have with us. There's this unyielding need on their part to make sure everyone knows that nurses are a "higher medical authority" than paramedics which I don't know the source/history of but it's quite tiresome. To me it's like saying a physical therapist is a higher authority than a paramedic...it's just apples and oranges.

 

[18G]

We had many different clinicals areas to complete... so many hours in the ED, ED w/ a physician, resp dept, ICU, PCU, OR, Cadaver Lab w/ physician, and field time...

so we had equal amt of time with RN's and other Paramedics.

 

[Phlipper]

Wouldn't it be more helpful if we went back to having doctors be the primary preceptors for paramedics?

I am not nor ever will be a nurse, but it seems to me from my observations, the thought process of a paramedic is more like a doctor than a nurse. (especially when it comes to charting)

I left out other paramedics intentionally because there is a great discrepancy in paramedic providers. In the same agency you could get the finest prehospital provider ever one shift and a skills monkey the next. US paramedics are not at the level they need to be to exclusively train their own.

What do you think?

In the small town hospitals where I work and do medic clinicals I have been very, very impressed with almost all the nurses I have come in contact with. They are impressive, really. Doctors just don't have time to give where I work/intern. So the Nurses do it and they do it very, very well.

I have seen them queried for advice by EDMDs during a code or other adverse event and then quickly nail the diagnoses and tx over and over. This may reflect on the MDs they work with (also stellar) but they have certainly done their part. They are very, very impressive and will also bend over backwards for a motivated medic intern, as well. I'd say at least 90% of them have been truly excellent. Unfortunately, I cannot say the same thing about the medics I have worked with or precepted under. I'd say only 50% of them are clearly squared away. I see this changing as medic school becomes tougher and education requirements are raised. But for now, I'm glad I have access to the EDRNs in my little community hospitals. They totally rock in my neck o' the woods.

 

[Akulahawk]

Looking back at my Paramedic clinical time, I was precepted primarily by RNs. My primary clinical preceptor was a very experienced RN who had been a Paramedic prior to becoming a Nurse. Prior to entering EMS, much of my precepting was done by an exceptionally good Ortho Doc. I learned more about the feel of injuries and diagnostic processes from him than under previous clinical preceptors.

I would have to say that Nurses and Paramedics have different modes of thinking, and that's a direct result of their usage in patient care. Many of the psychomotor skills are very similar, if not identical. It's highly beneficial to learn those things from the people that do them all the time. Once you have those skills down, then the real learning can begin... when and when not to use them. For that, a Paramedic will need to be precepted by a PA or MD because we will be out in the field, on our own, and have to come up with a working diagnosis so that we can then come up with an appropriate treatment plan. Even looking at the language we use, it's more in-line with medicine than nursing. Our patients who lack fluid volume are described as being hypovolemic, not in a fluid deficit.

In my "ideal world," a Paramedic would be more akin to a PA-Light than a very advanced Nursing-technician. That Paramedic would be able to function outside the supervision of Nurses as they're not Nursing personnel and would retain their full scope of practice from bedside to bedside (in the IFT environment) and would not "lose" any scope once in a hospital environment. Yes, this will require a LOT more education for most Paramedics. The Paramedic would then be able to "upgrade" to a PA by completing a Bridge course and an additional year of didactic and clinical time. In time, the Paramedic would evolve into what's essentially a Pre-Hospital/IFT PA.

I can already hear the howling beginning... It will take time, be expensive, and result in very competent prehospital providers as the general rule, not the exception. In the clinical setting, I see such a provider not replacing PAs or RNs... but rather complimenting both.

Big goal... but I doubt it'll happen any time soon, especially in times of more limited funding.

 

[8jimi8]

I like it.

Looking back at my Paramedic clinical time, I was precepted primarily by RNs. My primary clinical preceptor was a very experienced RN who had been a Paramedic prior to becoming a Nurse. Prior to entering EMS, much of my precepting was done by an exceptionally good Ortho Doc. I learned more about the feel of injuries and diagnostic processes from him than under previous clinical preceptors.

I would have to say that Nurses and Paramedics have different modes of thinking, and that's a direct result of their usage in patient care. Many of the psychomotor skills are very similar, if not identical. It's highly beneficial to learn those things from the people that do them all the time. Once you have those skills down, then the real learning can begin... when and when not to use them. For that, a Paramedic will need to be precepted by a PA or MD because we will be out in the field, on our own, and have to come up with a working diagnosis so that we can then come up with an appropriate treatment plan. Even looking at the language we use, it's more in-line with medicine than nursing. Our patients who lack fluid volume are described as being hypovolemic, not in a fluid deficit.

In my "ideal world," a Paramedic would be more akin to a PA-Light than a very advanced Nursing-technician. That Paramedic would be able to function outside the supervision of Nurses as they're not Nursing personnel and would retain their full scope of practice from bedside to bedside (in the IFT environment) and would not "lose" any scope once in a hospital environment. Yes, this will require a LOT more education for most Paramedics. The Paramedic would then be able to "upgrade" to a PA by completing a Bridge course and an additional year of didactic and clinical time. In time, the Paramedic would evolve into what's essentially a Pre-Hospital/IFT PA.

I can already hear the howling beginning... It will take time, be expensive, and result in very competent prehospital providers as the general rule, not the exception. In the clinical setting, I see such a provider not replacing PAs or RNs... but rather complimenting both.

Big goal... but I doubt it'll happen any time soon, especially in times of more limited funding.