craigd30

Looks like you've gotten a lot of good advice for where you are at based on your experience - ask or look it up, but your question as to how to develop your knowledge and skill has only been touched on by a few, although I think most would agree - it's going to take time. It sucks right now - probably feels really awkward and sluggish to be looking up every damn drug, but that will help you to develop your practice. It's disheartening to hear but it's going to take at least a year (I know many nurses that will say that - and it's true, but a WHOLE YEAR? Too long! Feels like forever) until you feel like you "get it" and at least 2-3 years till you feel like you can rock it. As far as developing your med skills - everyone will tell you different, but some things you will be thinking about and looking at (probably without even realizing it) once you are comfortable and experienced with the meds are: -what is the point of giving this patient this med and what is it going to do to them (taking into account what they look like at the time) -how do most peoples bodies respond to it/what response am I shooting for -what is a poor response going to look like -how do I deal with a poor response -if this is an atypical med or one I just haven't worked with before - can I find a moment to talk with the doc and ask them "what's up?" with you choosing this drug for this patient? (see what I did there - I managed to fit in a very subtle Bugs Bunny reference. Ohh behold the wit.....) As a side note, my practice is - first dose of ABX is one at a time in case of a reaction. We use Alaris pumps with a drug admin library and I will always use one. As another side note - our in patient units have started giving Zosyn over 4 hours instead of 30min. I guess a study has shown that over a 24hr period 3 doses of Zosyn(each over 4hr/each dose 8hrs apart) is as effective as 4 doses of 30min/each 6hrs apart. This saves 1dose each day, but when I worked there it was a real pain if you ran late or had incompatible drips to run. Hang in there. The only cure for what you are going through is experience.

I saw two things when I read your post. 1) your mom is proud of you. I'm the POA for my gramps and he never fails to mention that "my grandson is a nurse and a paramedic!". I, like you, wish he wouldn't mention anything - but that's a battle I'm not going to win (the battle I choose is him wearing his lifeline. That old turd used to only put it on when he knew I was coming over. Until he fell in the yard. Then it hit home. Why wont't they listen?) Some Geri patients (my gramps included) will say "I hate to be a bother". That's really cool your mom rocks your accomplishments. 2) that nurse (unless they were joking around?) was an a$$. "I hope this is OK by ICU standards"? What? I still get a bit nervous practicing on/in front of medical staff (I actually had an out of town ER doc as a patient today. Husband was a GI doc. Sitting there. Watching me. Judging. It's a good ego check.). Takes me back to the days (not that long ago) that I was a damn student. Nervous about everything I was doing - but part of me still welcomes the "opportunity for improvement" (note the awesome corporate speak). I am far from perfect in my practice. I would welcome the opportunity to get feedback about my care from someone who can help me improve my patient care. Now that I'm typing I note a third point. 3) You are also pretty cool. I would welcome (nervously) the opportunity to take care of someone you know/love. Please give me feedback. And bring granola and yogurt. I am trying to stay healthy. It's easy for me to say - don't be embarrassed. Your mom was probably so happy and reassured that you were there and that you turned out to be the person you are. Kudos. Wow. Now that I look this over I realize I have typed so much I don't even remember what the OG post really read. I sure hope this is relevant :).

Really all you'll be able to add to your job is a better assessment. You will be limited in what you can "do" for interventions. In WI I think EMT-B's can only give 9 meds, and do a few extra interventions. Any extra knowledge you have is great, but any extra skills or interventions you have are going to be limited by what your license says you can do. Your medical director is the one who says what EMT-B's can do, and it's general categories of who can do what, not specified for specific people in the system. I'm currently a paramedic going through an ADN program, and I've found that nursing is vastly different than EMS, but I (and I'm really biased on this) think that being a paramedic (or even an EMT-I) first gives you a great background, great knowledge base, and great experience when going through a nursing program. Having extra skills, teaching, experience, or whatever, won't help you in the field/ED as an EMT-B though. You will still be limited to practicing within your scope of practice and using what you know. As an example: I'm currently a first sem. nursing student. We haven't covered IV's yet in class, yet In my job in the ED as an EMT-P, I learned from my ED director (who is big - and I am talking BIG - into portable diagnostic ultrasound) how to start ultrasound guided IV's in those patients who are really, really, hard starts. I don't want to brag, but I'm going to (brace yourselves). I have gotten really good at them. I get called to the ICU and Med/Surg floors every now and then to start them, and I'm usually pretty lucky identifying the vessels and watching my cath go in. When I'm doing my nursing clinicals (at the same facility where I work in the ED, and get called to do these advanced IV starts) I am not allowed to touch an IV, because it's a skill we haven't covered yet, and as such isn't in my scope of practice when I'm there as a nursing student. I can still try to help by talking one of the nurses through it, but can't physically have anything to do with it. This is a hard thing to justify, but is needed in our field. We can only do what we are legaly there to do. If you are there and punched in as an MA, you can only do MA stuff. If you are there and punched in as an EMT-B, you can only do EMT-B stuff. No matter what your training. Despite that, you can always use your knowledge, just not your physical skills. I hope that makes sense. Also, in WI I think they are phasing out the EMT-I's and just going with paramedics, although when I took the paramedic program they still offered the EMT-I option. You only had to show up at certain classes and test out on certain skills, although I would just recommend going through with the whole EMT-P program. If you want to work in your local ED stop in and talk to them. They will be able to give you better advice than anyone else. If you can, meet their director and see what they think. They should be all about public relations enough for you to get 10 min of their time. Good luck, and don't be afraid to stop in and ask. It may provide you with a future job lead.