Clinical Rotation Question

[Guest guest]

Being in paramedic classes has given me another opportunity to ponder how we do

EMS education.? I think we all have horror stories of our hospital rotations

where the quality of preception varied from nurse to nurse, many of whom did not

know (or care to know) what a paramedic student knows - or is allowed to do.

Considering this issue, has anyone considered working out clinical agreements

with physician groups instead?? For example, instead of a hospital ICU rotation

where the paramedic student is precepted by the nursing staff, has anyone

contemplated a rotation (or shadowing assignment) with an internal medicine

physician?? Likewise for anesthesiologists, emergency medicine physicians, etc.

It would seem that this might be a way around the " tyranny " of some hospitals'

nurse managers whose first instinct may be to deny or severely curtail EMS

clinical site agreements.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

________________________________________________________________________

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[Guest guest]

I know that Paramedic students that do their rotations at & White ER

shadow ER Residents and not the nurses. It seems to be working out well. Years

ago, we had Paramedic or RN preceptors paid by the college to ensure the

quality of ER rotations. That model worked well too, but became cost

prohibitive.

" Scooter " Green FP-C

PHI / STAT Air 2

town, TX

************************************** Get a sneak peak of the all-new AOL at

http://discover.aol.com/memed/aolcom30tour

[Guest guest]

Wes, that sounds like a good idea. The roadblock would be that the hospital

administrators (who hire the nurses) own the hospital, not the doctor. Even if

you are shadowing the doc, you are still in the administrator's building. It

would seem for this to work, the physician group would have to have an agreement

with the hospital in order to protect the hospital from any potential liability

caused by the doctor's " guest " . Otherwise, you might be stuck doing a rotation

where the doc control's the environment...his or her office (if they have an

office practice).

A second option would be to work the rotations out with the both the hospital

adminsitration and the hospital's medical board in order to have the student's

assigned to physicians rather than nurses. This might be more complicated to

accomplish, but would both protect the hospital while enhancing the learning

experience of the student. (Provided they don't run into docs with the same bad

attitudes they find with some nurses.)

Barry

________________________________

From: texasems-l on behalf of ExLngHrn@...

Sent: Fri 7/13/2007 12:18 PM

To: texasems-l ; ems-l@...; Paramedicine

Subject: Clinical Rotation Question

Being in paramedic classes has given me another opportunity to ponder how we do

EMS education.? I think we all have horror stories of our hospital rotations

where the quality of preception varied from nurse to nurse, many of whom did not

know (or care to know) what a paramedic student knows - or is allowed to do.

Considering this issue, has anyone considered working out clinical agreements

with physician groups instead?? For example, instead of a hospital ICU rotation

where the paramedic student is precepted by the nursing staff, has anyone

contemplated a rotation (or shadowing assignment) with an internal medicine

physician?? Likewise for anesthesiologists, emergency medicine physicians, etc.

It would seem that this might be a way around the " tyranny " of some hospitals'

nurse managers whose first instinct may be to deny or severely curtail EMS

clinical site agreements.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free from AOL

at AOL.com.

[Guest guest]

I agree with doing the so called " shadowing. " I am a fairly new parmedic out of

school and the nursing staff wernt at all helpful and at times done right rude

and i was made to empty bed pans and change the beds instead of doing skills or

learning about something that just came in the trauma or cardiac rooms. There

was one doctor that I always tried to get one his shift and I more or less

" shadowed " him and I learned a great deal. The doctors know what we can do for

the most part as they are our medical directors.

ExLngHrn@... wrote:

Being in paramedic classes has given me another opportunity to ponder

how we do EMS education.? I think we all have horror stories of our hospital

rotations where the quality of preception varied from nurse to nurse, many of

whom did not know (or care to know) what a paramedic student knows - or is

allowed to do.

Considering this issue, has anyone considered working out clinical agreements

with physician groups instead?? For example, instead of a hospital ICU rotation

where the paramedic student is precepted by the nursing staff, has anyone

contemplated a rotation (or shadowing assignment) with an internal medicine

physician?? Likewise for anesthesiologists, emergency medicine physicians, etc.

It would seem that this might be a way around the " tyranny " of some hospitals'

nurse managers whose first instinct may be to deny or severely curtail EMS

clinical site agreements.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free from AOL

at AOL.com.

[Guest guest]

-- personally speaking, I've had a variety of experiences with nurses.?

I've had some who say, " Oh, you're an EMS student.? Go to triage and get vital

signs. " ? Others have come to me and asked if I wanted to observe a procedure or

administer a medication.? I think a positive attitude helps with some, although

not all, nurses.

But the reality is, EMS is not nursing.? Nor is nursing EMS.? We need to be

learning as much as we can from physicians, as we are an extension of our

medical director's practice of medicine.

I believe that we need rotations in the ER, ICU, PICU, Labor & Delivery, etc.? I

just question if being assigned to a random nurse as our preceptor really

prepares us to make the independent decisions and clinical judgment expected of

us in the field.

-Wes Ogilvie, MPA, JD, EMT

Attorney at Law/Paramedic Student

Austin, Texas

Re: Clinical Rotation Question

I agree with doing the so called " shadowing. " I am a fairly new parmedic out of

school and the nursing staff wernt at all helpful and at times done right rude

and i was made to empty bed pans and change the beds instead of doing skills or

learning about something that just came in the trauma or cardiac rooms. There

was one doctor that I always tried to get one his shift and I more or less

" shadowed " him and I learned a great deal. The doctors know what we can do for

the most part as they are our medical directors.

ExLngHrn@... wrote:

Being in paramedic classes has given me another opportunity to ponder how we do

EMS education.? I think we all have horror stories of our hospital rotations

where the quality of preception varied from nurse to nurse, many of whom did not

know (or care to know) what a paramedic student knows - or is allowed to do.

Considering this issue, has anyone considered working out clinical agreements

with physician groups instead?? For example, instead of a hospital ICU rotation

where the paramedic student is precepted by the nursing staff, has anyone

contemplated a rotation (or shadowing assignment) with an internal medicine

physician?? Likewise for anesthesiologists, emergency medicine physicians, etc.

It would seem that this might be a way around the " tyranny " of some hospitals'

nurse managers whose first instinct may be to deny or severely curtail EMS

clinical site agreements.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free from AOL

at AOL.com.

[Guest guest]

I can say that I was fortunate to not have to empty bedpans, or any such

activity when I was doing clinicals. But I definitely had rotations where

when I'd ask a nurse if I could do an IV stick, they'd look at me like I was

absurd " Can you do that? Do you know how? " Our clinicals were always

precepted by a Paramedic, though we were usually assigned to a nurse.

Typically the nurse would skirt out of assisting us with any skill, " Go find

your preceptor " . While I think in some ways having the paramedic preceptor

around helped us get out of the menial tasks, there was only one preceptor

for 5 students or so, and not everybody can have them at once. I think it's

important for us to get as much experience in the hospital as possible.

Perhaps pairing students up with physicians is indeed the way to go,

however, student/nurse interaction is still going to be necesarry as the

doctor isn't the one doing IV sticks and Drug pushes.

Joe Percer, LP

>

>

> -- personally speaking, I've had a variety of experiences with

> nurses.? I've had some who say, " Oh, you're an EMS student.? Go to triage

> and get vital signs. " ? Others have come to me and asked if I wanted to

> observe a procedure or administer a medication.? I think a positive attitude

> helps with some, although not all, nurses.

>

> But the reality is, EMS is not nursing.? Nor is nursing EMS.? We need to

> be learning as much as we can from physicians, as we are an extension of our

> medical director's practice of medicine.

>

> I believe that we need rotations in the ER, ICU, PICU, Labor & Delivery,

> etc.? I just question if being assigned to a random nurse as our preceptor

> really prepares us to make the independent decisions and clinical judgment

> expected of us in the field.

>

> -Wes Ogilvie, MPA, JD, EMT

>

> Attorney at Law/Paramedic Student

>

> Austin, Texas

>

> Re: Clinical Rotation Question

>

> I agree with doing the so called " shadowing. " I am a fairly new parmedic

> out of school and the nursing staff wernt at all helpful and at times done

> right rude and i was made to empty bed pans and change the beds instead of

> doing skills or learning about something that just came in the trauma or

> cardiac rooms. There was one doctor that I always tried to get one his shift

> and I more or less " shadowed " him and I learned a great deal. The doctors

> know what we can do for the most part as they are our medical directors.

>

> ExLngHrn@... <ExLngHrn%40aol.com> wrote:

> Being in paramedic classes has given me another opportunity to ponder how

> we do EMS education.? I think we all have horror stories of our hospital

> rotations where the quality of preception varied from nurse to nurse, many

> of whom did not know (or care to know) what a paramedic student knows - or

> is allowed to do.

>

> Considering this issue, has anyone considered working out clinical

> agreements with physician groups instead?? For example, instead of a

> hospital ICU rotation where the paramedic student is precepted by the

> nursing staff, has anyone contemplated a rotation (or shadowing assignment)

> with an internal medicine physician?? Likewise for anesthesiologists,

> emergency medicine physicians, etc.

>

> It would seem that this might be a way around the " tyranny " of some

> hospitals' nurse managers whose first instinct may be to deny or severely

> curtail EMS clinical site agreements.

>

> -Wes Ogilvie, MPA, JD, EMT

> Austin, Texas

> __________________________________________________________

> AOL now offers free email to everyone. Find out more about what's free

> from AOL at AOL.com.

>

>

[Guest guest]

I'll admit that I had rather beneficial hospital rotations when I did my

Basic. My hospital rotations were done in a " teaching hospital " , and our

official preceptor in the hospital was one of our EMS Instructors (so an

EMT or Paramedic). We were required to go in and do so many write-ups in

a rotation. We were supposed to write up a report like it was a PCR. We

would also have to write what we would do if this was our patient in the

field. Then our preceptor would sit down with us in the hospital, and

review it, and make sure we covered everything, providing constructive

criticism. This preceptor system was a great way to do things. Also, the

fact that the hospital was a " teaching hospital " meant they were used to

having students from the school, from a wide variety of fields (MD, RN,

LVN, EMS, Psychiatry, etc.) So, I felt like that was a great setup. I've

heard lots of horror stories about hospital rotations though!

-Ben

ExLngHrn@... wrote:

>

> Being in paramedic classes has given me another opportunity to ponder

> how we do EMS education.? I think we all have horror stories of our

> hospital rotations where the quality of preception varied from nurse

> to nurse, many of whom did not know (or care to know) what a paramedic

> student knows - or is allowed to do.

>

> Considering this issue, has anyone considered working out clinical

> agreements with physician groups instead?? For example, instead of a

> hospital ICU rotation where the paramedic student is precepted by the

> nursing staff, has anyone contemplated a rotation (or shadowing

> assignment) with an internal medicine physician?? Likewise for

> anesthesiologists, emergency medicine physicians, etc.

>

> It would seem that this might be a way around the " tyranny " of some

> hospitals' nurse managers whose first instinct may be to deny or

> severely curtail EMS clinical site agreements.

>

> -Wes Ogilvie, MPA, JD, EMT

> Austin, Texas

> __________________________________________________________

> AOL now offers free email to everyone. Find out more about what's free

> from AOL at AOL.com.

>

>

[Guest guest]

I can speak from a couple of different perspectives here. First as a

studnt who completed hospital based clinical rotations and also as

the spouse of a doctor. My wife is a D.O. completing her residency in

Internal Medicine. Here is my take on your idea:

I like it but think most facilities and, unfortunately, many docs too

would poo poo the prospect. Docs already have 3rd and 4th year

medical students, interns, and residents in year 1, 2 or 3 to look

after. Just as some nurses see EMS students as a hassle to deal with

I imagine some docs would as well. In an ideal world all the docs

would have the opinion of EMTs and Medics as held by Dr. Bledsoe or

Dr. Fowler and others like them. Maybe the answer would be to require

all doctors to first be EMTs and then medics?

Working with docs across the spectrum would certainly add some

respectability to EMS especially if doing so was formally instituted

into our educational standards. I think a more practical solution

would be to ask a particular doc if you could work with him or her

informally. I know of a couple that have made that offer. It is a

great way to learn and show folks that you are serious about what you

do for your patients.

Just my two cents.

J. Reeves

Freeman Occumed

Joplin, MO.

Formerly w/ CareFlite

>

> Being in paramedic classes has given me another opportunity to

ponder how we do EMS education.? I think we all have horror stories

of our hospital rotations where the quality of preception varied from

nurse to nurse, many of whom did not know (or care to know) what a

paramedic student knows - or is allowed to do.

>

> Considering this issue, has anyone considered working out clinical

agreements with physician groups instead?? For example, instead of a

hospital ICU rotation where the paramedic student is precepted by the

nursing staff, has anyone contemplated a rotation (or shadowing

assignment) with an internal medicine physician?? Likewise for

anesthesiologists, emergency medicine physicians, etc.

>

> It would seem that this might be a way around the " tyranny " of some

hospitals' nurse managers whose first instinct may be to deny or

severely curtail EMS clinical site agreements.

>

> -Wes Ogilvie, MPA, JD, EMT

> Austin, Texas

>

______________________________________________________________________

__

> AOL now offers free email to everyone. Find out more about what's

free from AOL at AOL.com.

>

>

>

[Guest guest]

Wes,

Way back in the day...the program I attended did rotations in the ER, OR, ICU,

L & D (3 babies first 8 hour shift), and one of my least favorite...but looking

back best ideas....psych ward.?

I know of a number of programs that still do this today....and some have

included other options including the public health clinic and nursing/rehab

facilities.? I think the broader the scope the better the experience.

Dudley

Re: Clinical Rotation Question

I agree with doing the so called " shadowing. " I am a fairly new parmedic out of

school and the nursing staff wernt at all helpful and at times done right rude

and i was made to empty bed pans and change the beds instead of doing skills or

learning about something that just came in the trauma or cardiac rooms. There

was one doctor that I always tried to get one his shift and I more or less

" shadowed " him and I learned a great deal. The doctors know what we can do for

the most part as they are our medical directors.

ExLngHrn@... wrote:

Being in paramedic classes has given me another opportunity to ponder how we do

EMS education.? I think we all have horror stories of our hospital rotations

where the quality of preception varied from nurse to nurse, many of whom did not

know (or care to know) what a paramedic student knows - or is allowed to do.

Considering this issue, has anyone considered working out clinical agreements

with physician groups instead?? For example, instead of a hospital ICU rotation

where the paramedic student is precepted by the nursing staff, has anyone

contemplated a rotation (or shadowing assignment) with an internal medicine

physician?? Likewise for anesthesiologists, emergency medicine physicians, etc.

It would seem that this might be a way around the " tyranny " of some hospitals'

nurse managers whose first instinct may be to deny or severely curtail EMS

clinical site agreements.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free from AOL

at AOL.com.