Help Me get my Partner IV Certified.

[MedicPrincess]

My partner took the classroom portion of the IV class 5 weeks ago. She is only required to get in 10 successful sticks, she has had 3 successful, multiple not. I told her in the beginning I will not let her "practice" on children, Old people where I might only have 1 good shot anyway, or Critical Load-n-Go patients.

On her first attempt, as she went to stick the pt, I attempted to show her that she is going to want to secure the vein. She looked right at me and said, "I took the class. I know how to do this." Ok then...go for it. She tried, she missed, she got up front and drove while I did it enroute.

And this is how it has gone for the last 5 weeks. She got 2 attempts on 7 patients yesterday. Not because the other 5 fell into the above mentioned catagories, but becasue I have reached a point with her that I just don't really care if she gets her 10 sticks in.

If I will point out where a great-easy site to get is, she will intentionally not stick the patient there. And EVERYTIME she has not stuck the patient where I told her to, she has blown it. So I have reached a point where if she wants to figure it out on her own, it WILL NOT be on patients I am siging my name to.

So, any suggestions? She has actually "told on me" for not letting her attempt more sticks. Our supervisor told me I must let her attempt on every patient that is not critical. I respectfully told him I will not allow her to attempt on every single patient, until she decides to take my suggestions shen I tell her where to stick them. He then told me I have to allow her to attempt more than once on the patients I allow her to try on. I pointed out that per protocol we are only allowed 2 attempts, unless absolutely critical and I will not allow her to use the patients in our truck as a pin cushion while she does whatever she wants. I offered to let him come ride on my truck until she gets certified and I will be happy to QRV all day or she can go work on a different truck until she gets her sticks in (or permanently!!!)....and that way she can stick all she wants under his liscense. He declined.

 

[disassociative]

Take her to the training room(if your service has one) and pull out the training arm. Focus your efforts on proper angle and technique as well as FEELING for the veins rather than going by site 100% of the time. It has been my experience; that most students that get on the rigs want to go for the first vein they see rather than taking their time and assessing. Furthermore, try not to open the back doors and throw her out as you are going down the road, everyone had to start somewhere. This one, unfortunately needs humility.
Hang in there princess.

 

[Ridryder911]

Our supervisor told me I must let her attempt on every patient that is not critical. I respectfully told him I will not allow her to attempt on every single patient, until she decides to take my suggestions shen I tell her where to stick them. He then told me I have to allow her to attempt more than once on the patients I allow her to try on. I pointed out that per protocol we are only allowed 2 attempts, unless absolutely critical and I will not allow her to use the patients in our truck as a pin cushion while she does whatever she wants. I offered to let him come ride on my truck until she gets certified and I will be happy to QRV all day or she can go work on a different truck until she gets her sticks in (or permanently!!!)....and that way she can stick all she wants under his liscense. He declined.

I would had told the supervisor if he/she wanted them IV certified so much, then she can start the remainder sticks on them (supv)... or they can respond and let them start on their patients as much as they want... sorry, no empathy if the person will not listen.

R/r 911

 

[bstone]

disassociative and Rid have the same icon. Interesting.

Good luck with the IV sticks.

 

[IrishMedic]

its great to see that patient advocacy is strong out there, i think you're right, when i was a student getting my sticks we had to get 50 plus to be certified and well if missed a stick on a pt, i knew my limit's; your partner needs to be reminded she is doing it for pt care and not for herself....i knew if a pt needed an IV i had one shot....my medic instructors said i could try more, but if a pt needs one they need one...im not gonna mess it up or just try for the hell of it....she'll get it eventually but sounds like she is just gonna have to work out for herself she needs to listen, i use to critique everything i did looking for improvement and asking for as much advise as i could get on the road....i know i found it great when an instructor would say ok you did well on that one thing i wanna show you is........then they'd put on tourniquet and get me to attempt one on them....your doing a great job keep it up and dont lose the head......you can come ride with me anytime...

 

[firetender]

Is there anything that prevents you from putting a statement in writing that you feel strongly that this particular student needs to go back to get more clinical exposure before you'll work with her?

Given what you said, I don't think that's unreasonable. You are NOT doing your partner a disservice by submitting this to her instructor and then, if unheard, working up the food chain until someone listens to you.

It is critical that when she's in the field with you she does what she's told. If she can't do that, then that is a clinical problem that should be handled by the instructors in a clinical setting. You are there (presumably) to ASSESS her skills, not teach her them. Your assessment is she needs more clinical. Period. (That's what I heard, anyway.)

If you're doing this as an official Training Officer, then boot her back to clinicals. If not, then refuse to work with her in that capacity. You have the right and the responsibility to protect the integrity of the care you render to your patients.

That's one Grand dilemma, AND you'll get through it!

 

[VentMedic]

Who does the initial classroom EMT-B IV training in your area? Are they adequately prepared? What is the total hours of training involved? Does a clinical instructor monitor their ability/technique in a controlled setting such as an ED for the first couple of sticks before they are allowed to do the rest on an ambulance?

 

[mdtaylor]

So, any suggestions?

Either your skills as a precept are lacking or the student does not have enough confidence in you as a clinician to accept your instruction.

Perhaps you could sit down with your sup and approach it as "I want to be a better clinical precept but I am having trouble communicating with this particular student."

 

[MedicPrincess]

VentMedicWho does the initial classroom EMT-B IV training in your area? Are they adequately prepared? What is the total hours of training involved? Does a clinical instructor monitor their ability/technique in a controlled setting such as an ED for the first couple of sticks before they are allowed to do the rest on an ambulance?

This isn't a "student" still in school. This is my regular, every shift partner.

The classroom training is done by the person in charge of training for our service. It was an 8 hour class. As for monitor in a controlled setting, no. They get the class, and then are sent to their trucks to practice.

I make a "practice arm" out of an arm board and IV tubing. Same thing I was given when I was first learning. Gave it to her to practice technique and angle on.....found it in the trash.

I am not a preceptor. I have not been a Medic long enough to be a preceptor. And as for not being a good one, I know I am not a great teacher. I learn best by watching/then doing. I do best with students who learn best the same way. Now that being said, my EMT partner I had when I was with the county always disagreed, saying she had learned tons from me, it was just a matter of listening to what I was saying. I don't know.

The problems with the partner and I are so much deeper than just the IV issue. I could have an entire forum just on the issues between us. I have requested a new partner. Got shot down. I will ask again....and again. In the mean time I keep a journal, make sure I check and double check anything she does, do my job and part of hers, have really great FF we work with daily and use them to the fullest of their abilities, and stay out of it when someone calls her a "driver" and then procedes to tell her why they call her "driver" and not EMT.

 

[VentMedic]

Unfortunately the Florida Statutes are very weak when it comes to EMT-B IV certifications. Actually, that is one of many weak areas when it comes to clarifying training and education within the statutes. If EMTs were to attend an IV class sponsored by a state vocational school or hospital that also trains LVNs, MAs and phlebotomists they would have monitored clincal rotations by the school's instructors or appointed preceptors. In EMS, it is more often than not a random luck of the draw for the quality of clinical experience.

This isn't a "student" still in school. This is my regular, every shift partner.

Your partner is an EMT-B, correct?

Intresting you all feel the A&P classes and advanced airway classes should be taken prior to ACLS. I have encouraged my EMT partner to attend an ACLS class, as well as the others that are offered to us (ITLS, PALS, Advanced Airway/RSI, ect), for the simple knowledge of whats to come when we are in that situation.

I don't expect for her to be able to interpret any rhythms for me, or perform the skills, but it is a comfort that she has a general knowledge base to be prepared for what I may be asking for next when we do finally have a code that isn't in Asystole/DOA/Signal 7.

http://www.emtlife.com/newreply.php?do=newreply&p=65512

You may be pushing her to be a "paramedic" while still an EMT-B. She may know her education/training level limitations and comfort zone for her training. 140 hours of EMT-B and attending "cert" classes do not develop a secure foundation for working in the field.

The fact that you are requesting a new partner and keeping a journal on her every move makes for a less than ideal learning environment for her.

 

[MedicPrincess]

The fact that you are requesting a new partner and keeping a journal on her every move makes for a less than ideal learning environment for her.

Not a journal of "her every move." However, when we are preparing to make a decision of intubation vs. CPAP and she cannot figure out what the CPAP looks like...I do note it. (And before you ask...Yes....I have gone over every single piece of equipment on our truck with her, at some point she needs to have her own initiative to take another look at the stuff we don't use to often.) Or when I have to tell her to stop hitting on the patient long enough to help get him on the backboard...or when I have to ask her to stop showing a FF how the electrodes will make great pasties and help with the pt that is working hard at coding......or when I have tell her for the unknown number of times to STOP TEXTING while responding to the hospital and she would have seen that car that is pulling out in front of her.....


And I could have been more specific about the ACLS class....I have worked 2 jobs for the last 2 months....I wouldn't encourage this partner to attend anything except maybe an EMT refresher....I was referring to my partner at the other job I had.

 

[triemal04]

she cannot figure out what the CPAP looks like

First offense=remedial training (assuming a new employee). Second offense=termination.

I have to tell her to stop hitting on the patient long enough to help get him on the backboard

Suspension, termination for a second offense.

I have to ask her to stop showing a FF how the electrodes will make great pasties and help with the pt that is working hard at coding

Suspension followed by termination the next occurence.

I have tell her for the unknown number of times to STOP TEXTING while responding to the hospital

Immediate termination. As in the moment you arrived at the hospital. Hopefully followed by a loss of her EMT cert and revocation of her driver's licence. Though that's just a dream I suppose...

If any of these things are remotely true, especially the last, then it is beyond time for you to take this to your supervisor. At this point your partner has gone beyond being a danger to herself and is now putting the public (not to mention the profession) at risk. Stop worrying about "helping" her with her IV skills and instead begin to worry about her basic EMT skills, not to mention her common sense skills which also seem to be lacking.

This is not an issue to let slide anymore, and the longer you go without taking any sort of action the worse things will become, and you will being exposing yourself to further problems and liabilities. It's never fun to be the one to tell someone that they are not cut out for this and that it's time to seek a different line of work, but there is no alternative in this job. Step up and do what's right.

 

[oldschoolmedic]

Hmmm

Maybe, just maybe, a brand-new paramedic shouldn't be in a precepting position at all.

Take your little notebook, and your partner, and go see your supervisor. This way he gets both sides of your "differences" at the same time, not just you coming in and venting about her.

The training officer should be in there as well, since you are casting aspersions about the quality of his trainng standard.

Hopefully, the four of you can work this out before someone gets hurt. Until then, "Life's rough. Just put on your big girl (or boy) panties and deal with it!"

 

[MedicPrincess]

This is not an issue to let slide anymore, and the longer you go without taking any sort of action the worse things will become, and you will being exposing yourself to further problems and liabilities. It's never fun to be the one to tell someone that they are not cut out for this and that it's time to seek a different line of work, but there is no alternative in this job. Step up and do what's right.

Done that already. Was in a nutshell told to make sure I have on my big girl panties when I come to work. Took it to our Ops Mgr....he gave it back to our supervisor.

Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.

 

[mdtaylor]

Done that already. Was in a nutshell told to make sure I have on my big girl panties when I come to work. Took it to our Ops Mgr....he gave it back to our supervisor.

Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.

Maybe it's time you took your 'big girl panties' to an employer worthy of them? Is that an option?

 

[MedicPrincess]

You know that saying "There is no job Utopia...." Well everything else about this employer is great....it is my unfortunant circumstance that I happen to have possilby the most apathetic supervisor ever created. He ran the previous service for 10 years prior to them - for whatever reasons - not getting the contract to provide EMS service for the county. He then was hired as a supervisor with the new service. With his salary and bonuses he would get for keeping the previous company under budget, this new service is paying him about 1/3 of what he was bringing in before.

So essentially, he just doesn't care...and says so just about every shift. And dealing with a problem, and making people upset, is not anywhere on his agenda at all...thats to much conflict. Its time for him to go....but thats MUCH BIGGER than me...I really do love just coming in to work, getting into my truck, running my calls, and moving where ever dispatch feels as though they need us today.

We are only 4 months into a 5 year contract with the county. Bugs, complications, and a weeding out process is expected. I just wonder how long it will take.

This service has a ground and an air division. I am extremely intrested in the Air Transport side, once I get enough expierience....a long time away....and the correct alphabet after my name.

 

[EMT19053]

Done that already. Was in a nutshell told to make sure I have on my big girl panties when I come to work. Took it to our Ops Mgr....he gave it back to our supervisor.

Now I am wearing the big girl panties every shift....and waiting for the moment when she sinks herself.

When she does sink herself, hopefully, you and/or the patient are not on the same boat.:sad:

 

[firetender]

There are few things more frustrating than having an almost-dangerous partner and an unresponsive, next-highest authority to help you deal with it.

Documenting what you are experiencing is important in case YOU catch some hell on a call for her behavior. Don't neglect it.

And if the Owner of your company will not respond to a personal request for a private, confidential meeting because you feel un-responded to by your Supervisor and feel it is a disservice to the system and perhaps danger to patients to MANDATE you as a trainer, then it's REALLY time to find a new company. Problems like these will not get better.

If you get the chance to sit with the Head-Honchos, present them with your documentation and ask them to place it in your file. Record that you gave it to them and keep a copy. This is now "on the record". The next step is to gently ask how the company will handle this information if your partner causes harm and the company goes to court.

It's really NOT about getting her bounced. Bottom line is the partnership is not serving anyone and if you feel it hinders your ability to render the care you're contracted to. You have the right and responsibility to ask her to be moved to another partner.

All this is based on -- and I'm asking you to really look at this -- if you really beleive she could be or is a danger. If not, and you can weasel your way around minimizing her patient contact, tough it out, it's just one ca-ca head partner in a career that I'm sure, will have many.

Experiences like this are not unusual and this really is your learning time to figure out what works best. Sorry you have to go through it in extremis so early, but it WILL give you good a good foundation to work from when things like this come up again.

 

[Jon]

From my read, I don't think the issue is training-based... this seems to be an attitude issue with the subject who doesn't want to listen or improve themselves. The subject seems to repeatedly demonstrate that they don't want to let Princess assist them. As for new providers teaching - isn't the saying in Medical School "See one, Do one, Teach one". By teaching, we complete the cycle and solidify our understanding of the topic. I see no problem with a "newer" medic (who was a student for a year or two and doing IV's for that whole time) teaching someone else how to do IV's... IV is a "monkey" skill... you can train anyone how to do it (the military trains EVERYONE)... no different than boarding/collaring. (Generalization).

I think that Princess needs to do something about this person... if they are acting in a way that could be offensive to other EMS/Fire service members and/or the general public, than they don't belong on the ambulance. We all drive a rolling billboard and represent every EMT and FF everywhere.

If the person is exhibiting behavor that puts YOU and YOUR PATIENT at risk (Texting while driving class I/II/III) they need to be unemployed, and you need to NEVER work with them again. Your life is more important than your job. Communicate that to your boss and ask him HOW he will keep her out of your ambulance so she doesn't impact your safety

 

[VentMedic]

I think there is more than one side to every story. The partner is not on the forum to defend herself. Or, maybe she is and doesn't want to slander anyone or the company's training since we do now know where this is taking place from previous posts by MedicPrincess. It would be too easy for the people being discussed here to find out that they are the topic of the day. EMS is a rather small community especially in Florida. Things posted on the internet have a way of biting one in the butt if restraint is not exercised on some issues.

Since this is a public forum there are some issues here that would be better benefited if they were hashed out in the company's office with all persons present to represent their own point of view.