celticcare

Hi all, I am currently practicing as an RN in a metropolitin ER in New Zealand. We have student nurses coming in and doing their rotations and have a preceptored and set program for their period of time here. We also have paramedic students come in and have a set requirement to do IV's and 12 Lead ECG's for their clinical rotations and if the ability arises assist in nursing assessment and patient care. What I want to know, is do any of you have a proper mentored program for paramedic students, what sort of things do they do? What sort of assessments do they sit with you? I was a paramedic before I was a nurse and found hospital rotations to be that there was a real Us vs. Them attitude from the nurses to medics. Yes I know the worlds are two very different places, but I want to create a proper placement program for these students and let them do more than just the IV's and ECG's etc. I have approval from the University for these students to become part of a proper student placement program as well as the ER heads and heads of nursing here, I also have approval from the EMS agencies to do so. What I am looking for is guidence, suggestions and anything that you can share with teaching paramedic students and what would be a good set of skills for them to learn and be assessed on by RN's? Like handovers, concepts of Hospital based triage, the flow of patients through the ER, lab values etc. Anything would be appreciated and no EMS vs. RN slagging or vice versa or I will remove the comments. Scotty

I used to get an amazing rush every shift when I put on my uniform, pinned on my medal and smiled in the mirror prior to going to work. I used to get the warm fuzzies when I was asked what did I do for a job or whats it like to be a nurse. Then the reality of working for places that push only for profits or impose unrealistic ideals (well ok, they can be realistic, but when you are six nurses down in an ER at the start of a 12 and no replacement, cover or anything like that, how can you meet the corporate ideals whilst not compromising patient care?) sets in and your body gets worn out. I get told off for being to happy and smiley, and so when you try to tone it to suit their standards you then get told off for being grey and dismal. There is no winning in this world, as well as the extra copious amounts of paperwork to cope with the extra ownus on your own practice. There is a lack of senior staff out there to help guide anyone through and some of the seniors left are close to burning out or retiring that they don't want to teach or teach the short cuts. I love that moment that you get when you know you made a difference in someones life, but it doesn't overshadow the other political crap associated with the career. I love being a nurse, but is my world view of the industry changed, most definately. I had a true thought and guide inside towards nursing as a student, then became an RN, got my BN and look out at the world now and think, ***** But I keep one little hope inside... that it will change, maybe enough of us will make it so. But to be one little voice in a world of thousands, its not easy.

I found I was good at them at first, then took an 8 month break from nursing for a while *needed to find if it was the career for me, thankfully it is :) * and then hard a real hard time cannulating. I have good days and bad days, I felt proud of getting an 18g in a trashing obese IVDU who was also drunk and yet missed another 18 in a perfectly veined youth. Its just practice and practice, I got a beautiful 20g in a bicep of a gentleman who needed bloods and meds and had no troubles compared to two sticks in his lower arms. Just keep focused, cuss in the staff area not at the bedside *easy to do I am guilty of it*. keep the faith and the practice, and take any chance you can :) Scotty

I am lucky, my hospital custom made scrubs for me as I am tall and skinny as well. Most of my female counterparts are of the opposite direction and so they have more scrubs for their sizes rather than ours. good luck mate, I hear you on the hunting.

I am getting married October this year and intend to wear my wedding band on my hand. Compared to some of the rings my female colleagues wear which have diamonds sticking out etc *against dress code but its not often enforced* I think a simple wedding band is something I can wear and hopefully may deter some of the comments or slander put around about guys.

Agree with the other posters, just curious if the BP had been consistently above the 100 mark or teetering? I would have had the IV ready and given 1 to 2 squirts. Then reassessed BP and monitor Chest pain scores. It's tough with any new med in the first instance, but just monitor and observe. Good assessment and remember you made the decision and it was right at the time therefore no one else has the right or ability to poke and say you didn't do the "right thing". Scotty

My understanding of it, is if the person is professing to be an RN, then he is under the accusation of impersinating a registered health proffesional and is accountable under the HPCA act 2003. Anyone, in the general dictionary sense, can be a "nurse" its down to what they are doing and what the risk is to family and friends and other patients. I would probably contact the nursing council for advice mainly to just ascertain what is the right path of action. He may have been an ex nurse struck off the registry for all we know.

I give my patients the option when I meet them, I let them have the power in their court and reaffirm that I will not be offended if they request a female nurse. I work currently in CCU and of course, 12 leads involve going under/around breast tissue and working around some pendulous women makes the job a little difficult. I realise it is just a breast, but I will make sure I don't do my ecgs without at least someone being close. Most of my patients are in an acute state and often state they "don't care just fix me" but all it takes is just one person to make an accusation or a comment to a family member and BOOM my a** is grass. I get tired of the attitudes not from patients but from fellow staff alot of the time, either saying I need a chaperaune or moan when I ask for one to support. Just the joys of the job I guess. I hate it, we have given equality out for so long and yet it can't be given back. We aren't those oppresors that were around in Edwardian times, some women go on about men out there being abusers, trust me hunny, they would probably abuse us just as much, if not more because they don't want no "queer" touching him or no man helping him. So the excuse that only women get abused by men, is just null and void I am afraid.

CCU is where I came into as a New Grad. To me, cardiology is a new world, Ecg is a new language and without the heart, there is no circulating blood to the body to keep everything awake. I like the patient/RN ratio where you can know your patients, the essentials that make them tick, know their history, their vitals and everything to make their transition to getting home safe and comfortable. I like the intensivity of some days, the mellowness of others, the feeling of being able to look at a bunch of squiggles on a screen and say what that is, like reading egyptian hyroglyphics. I want to progress on eventually, but I know Cardiac care is where I will be for some time yet :) Scotty

We have had a run of them here lately, come in with typical MI symptoms, trop rise, ecg changes, go to the cath lab and boom, clean normal arteries. Each patient that I have had personally, seems to do well out in the community on the medications and relieving of provoking factors such as stressors or issues that brought on the MI. Being scared is natural as we known, but being too scared to maintain a normal life, will cause more harm than good, as it will inhibit his healing and reduce the work the BB and ACEI can do. Support is great and what he needs, but encourage to return to activity under the levels suggested by the cardiologist and have a repeat echo later. EF's can come up and akinetic portions of the ventricle can be temporary.

Hi all, I've come into the current CCU that I am in now, after completing my New Grad year in another. And I'm adjusting to a few different things. One being the accronyms used here. Every class I've taken and book I have used, calls PVC's that, PVC's. Here they are VPBs. That one I have no issue with, but then the staff use the term SVPB for supra ventricular Premature beats, which is one I get a bit irked with. If someone is having a premature beat above the pacemakers within the ventricles, then surely that must make it either a junctional or an atrial ectopic? The term SVPB just doesn't seem to be as precise for me, especially if I have a patient with nodal blocks or post Thrombolysis where AIVR beats take place. Perhaps its being pedantic, I am the only one in the unit that uses the other terms, I guess I am of the mindset that when the Docs read the reports from telemetry, they would rather see an actual description rather than a broad term that has two sub paths it can go down. A couple of docs agree with me on it but I know I would be changing a whole culture in here and I haven't bothered to bring it up. Is it worth it? Scotty

My daughter gets funny looks from the kids at school when she says her daddy is a nurse "only girls are nurses" is the common reply, but then they see her mother and I together *we are engaged to be married* and she is a nurse also.... I guess our little one is lucky both parents are nurses, my friends have been supportive of me being an RN, I actually cop more crap for being a male nurse from female nurses than I do from patients, family or my childs peers. Scotty

Part of me has a yang inside to be a doctor I wont lie there, but then I relate to the reality that I would have no life and I actually really enjoy the work with people, the sitting down with my patients and being the listening ear, the support worker, the all rounder with them. A doctor unfortunatly doesn't get the chance to have those moments like a nurse does and yes they do become limited in their specialty area. I get mistaken for a doctor often as I am the only male in my unit and I carry a stethascope, so naturally patients are making an assumption I am the new intern or the resident, even though I wear blue scrubs that say the word nurse on them and wear a nursing medal on my uniform. Oh maybe the eyesight needs refreshing on my dear patients eyes. Scotty

Hey I hope the right answer has made itself known to you after reading these responses. I ran Pre hospital and did my BHSc (Nursing) as well. I love pre hospital and would love to have a role as a pre hospital RN, but that role doesn't exist in New Zealand, and Nursing is a more secure field to work in, in regards to that you have a variety of fields you can go into and the money is alot more in nursing than in EMS. Definatly follow your heart *I did and no puns intended, am working as Cardiac Care nurse*. Be prepared for struggles as a guy in this field, but you can make the choices and practice more interviewing skills as an EMT than you will in a nursing class room. Utilise everything taught to you in EMS :) Scotty

Thanks also from me for this thread, its great to get some ideas as CCU is where I want to start working when I graduate. Great to know what to get and sort of things to have to get used to carrying them or using them on my final clinical rotations. Keep safe out there Scotty :monkeydance: