Brand-new tech

[Febrifuge]

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Hi, I'm Feb. Non-trad, making a shift into medicine. I've had a lot of good advice and encouragement, and already I'm making progress on re-shuffling my whole damn life.

Early this month I got my EMT certification, and the ED where I've been volunteering for about seven months just agreed to hire me as a healthcare assistant. (Basically, this is a combination of nursing assistant and ED Tech. No IV's; no procedures, interventions, or medications.) We're a Level I Trauma Center, so we're butt-deep in residents and students who will do stuff that as an EMT I might like to. However, I get to observe and assist and put my hands on patients, which is what my resume needs at this time. Initial assessment, vitals, transports, misc. duties as assigned. Demi-scut, basically.

They'll teach me 12-lead EKG and phlebotomy, and I'll work about three to five shifts a month without quitting my day job. I start in November. Since I have some lead time, I'm thinking that advice from this crowd could help me avoid stupid mistakes, and perform closer to my generally stellar potential.

DocWagner wasn't talking to me specifically, but in another thread he said this:

Remember, be prepared for ANYTHING happening in the ED...immaculate conceptions included.

When you walk into the ED, the laws of physics reverse and you have entered into the twilight zone...bizarro earth.

...and this seems to me the sort of perspective a well-meaning but inexperienced new tech can use. What else should I know, as I go forth to join the team? My goals include providing good care, not making an ass of myself (or anyone else), and (in a longer-term, hypothetical sense), impressing people who can write LOR's that glow with praise and enthusiasm, and quake with gravity and influence. You know, the usual stuff.

So, please, bring it on: what advice would you have liked to have when you started working in this environment? What makes a person a good ED worker? A good tech? A good doc? What have techs and assistants done in your ED's that have made you think "this kid has the stuff?" What has happened to make you think, "Gomer, please don't go to med school?"

 

[deleted6669]

as a former ER tech I can offer a few suggestions:
never be late for work. always stay late if the dept is busy. your contribution will be remembered when it's LOR time.
try to anticipate clinician's needs: for example if someone has a laceration which obviously will need to be sutured go ahead and set up a lac tray so they don't have to ask for 1 later. learn everyones sterile glove sizes and put them out before procedures. go the extra mile in the dept. this will involve being the go-to guy for everything: take specimens to lab, track down charts, help pts back to their cars after d/c, fix the broken copy machine, etc
try to have an attitude open to learning but if people are busy don't pester them with a billion questions. you will learn quickly enough who wants to teach and who doesn't. you may also want to arrange some ride alongs with the local ems service, both for the experience and to familiarize yourself with their procedures. er tech is great experience for any later career in mediciine. you will see everything and get lots of great material for war stories.
good luck

 

[Febrifuge]

Gracias. Somehow, I figured you might have perspective on the subject. I appreciate the heads-up. And ride-alongs are a brilliant idea. 😉

 

[edinOH]

You will later find that many of the duties of an EM tech and third year MS are very similar. I pretty much agree with the above poster's suggestions. Be proactive and help to make the physician's job of seeing and treating pts easier. If you try to remember the big picture in this regard, you will do well and be seen by all as a team player. Just as an excellent ED nurse is worth his/her weight in gold, so is an excellent ED tech. Getting used to working hard, doing the extra things, and not complaining will help you stand out, build good relationships, and prepare for your third and fourth years of medical school.

 

[Sessamoid]

Try to anticipate what a patient will need done (and get noticed doing so).

Little things can bug as physicians. Triage is an imperfect science, and it's more imperfect with some nurses than others. If you see that a patient with any sort of vaguely cardiopulmonary complaint hasn't had a pulse oximetry done in triage, do it. Make sure that patients are changed into gowns when put in rooms. It bugs me when patients with abdominal complaints still have on jeans that come up to their navel. More unnecessary delay. These are probably things that the medical students won't think of.

 

[Febrifuge]

That's good advice, EdinOH; thanks. Sessamoid, that's the kind of thing I might not have thought of... pretty obvious when you think of it, but nonetheless, just the kind of thing I might not have ever been told about. Thanks. (We do get SpO2 on all pts at triage, per ED policy, I'm happy to say.)

And I hear ya when it comes to triage; my months as a volunteer have been spent sitting next to nurses out at the desk. Some of them seem to despise working triage, and barely bother to talk. Others get into the idea of preliminary diagnosis, and take pride in being complete and concise with their notes. Those are the ones I like; we'll look at a chart on the system two hours later, and if the RN correctly called a dx, s/he gets a high five from me.

 

[lytesnsyrens]

I've been an EMT for 4 years now and an ER tech for almost 2. I agree with the above posters on anticipating what the physician will be doing.
set up the lac trays and ENT carts as soon as you see they will be needed, it saves the doc from having to do it or find you to do it.

Also, be available. Don't hide in the back for half an hour doing nothing cuz believe me you will hear your name being yelled and there's nothing worse than getting the doc and/or nurse on your bad side. Also, if they call you to come in to work at 2 am cuz they are short, be sure to go in at least some of the time. I'm not
saying to give up your private life, but you will gain alot of respect from the nurses and docs if you do. And that will surely help in the long run, for example with LORs.

Jump in and help out. For instance, if a code comes in dont just stand there with the 😱 face on (unless its your 1st time and you have NO CLUE what to do). Otherwise, jump up there with compressions.

Don't be afraid to ask questions. If you don't know how to do something, don't pretend that you do. If you're not sure how to splint something, ask. I know most of the physicians I work with are more than willing to help me out with something like that.

and last but not least, when they need someone to go pick up dinner, DO IT! Not only will they love ya for it, it'll give you a break from the chaos for awhile.

Well, looks like I babbled on for awhile here. Good luck on your job, I'm sure you'll enjoy it!

 

[spyderdoc]

I was an ED Tech for several years before, and during the summer b/w MS1+MS2 years (dummy me should have gone backpacking in Europe that summer). I learned a ton of stuff as a tech. I got to help in traumas (albeit cutting off clothes and log rolling), watch procedures (central lines, intubations), do CPR, blood draws, etc. Make sure to do as much as possible, see as much as possible, and ask a lot of questions. Look at the ECG's, x-rays. This will help you out so much in your future years as a med student. Even just being in the ED and interacting with patients is so helpful...You will feel so much more comfortable when it comes time for your clinical years, especially early on when you are laughing at all the other MS's who have their stethescopes with the ear pieces facing the wrong way, the chest xray hung backwards, and the ECG upside down!
Good luck, and make sure to keep a great attitude, show interest, and ask lots of questions.
Another great LOR would be from doing research stuff at an academic facility (RA). This will look good on your med school app, and will land you a valuable LOR...
Mark

 

[Mew]

Whats a ER tech and what do you need to be able to be one?

 

[Febrifuge]

Jobs with titles like "ER Technician" or "ED Technician" or "Health Care Assistant" or "Emergency Room Nursing Assistant" or even the good old-fashioned "Orderly" exist in most ED's. They're the people who assist the nurses and docs with anything that needs doing. I'm not housekeeping, but I clean carts and make beds. I'm not a HUC or a clerical person, but I'll run papers and lab specimens to where they need to go.

I'll push wheelchairs and beds, help moms in labor get up to Labor & Delivery, get patients upstairs if they're being admitted, assist nurses with triage and vital signs, hold squirmy kids, set up 12-lead EKG's, do blood draws, dress wounds, teach people to walk with crutches, assist with simple procedures (emphasis on 'simple' and 'assist'), and generally be the scut-monkey. In theory, I imagine I'd have to take instructions from med students, though I don't see that happening anytime soon. 🙂

At the place I work, some of the 'people in burgundy scrubs' have training as Certified Nursing Assistants, and some (like me) are Certified and/or Nationally Registered Emergency Medical Technicians.

If you're interested in working in an ER, you should investigate volunteering, and then EMT. You can earn EMT certification in a couple of months, and for not too much money when it comes to tuition. I got mine as a 6-credit class through a very good local community college program for $700. Others here on SDN paid a LOT less, sometimes for college credit and sometimes not.

If you're interested but not crazy about time, expense, and effort, then check out volunteering in your local ER. You may see nothing but a desk, but you'll get a flavor for the people and the atmosphere - just enough of the emergency dept to know if you're into it. Good luck!

 

[colforbinMD]

I don't mean to say this in a belitteling manner but I was a tech for 3 years and made a few mistakes in this area and saw other techs make even more. When a trauma comes in your either helping or in the way so be proactive but don't be pushy. Since you can't do IVs or Foleys (I think you said that at least) if someone else is allready on CPR stand in the back out of the way and wait. Offer every 5 minutes or so or when he/she is obviously fatigued to take over. Offer to set up a chest tube drainage or thoracotamy tray if needed. Don't be pushy to get in there it's better to do nothing out of the way. Also looking at ECGs and XRAYs is great and you will get to know which doctors don't mind talking with you about them however if a doctor is too busy or just doesn't want to help you respect that and don't be in the way. I learned the best techs are almost invisible because they are never in the way and when a doc wants something done they have allready forseen it and gotten it done. Hope that helps. Good luck and have fun. Oh yeah pick up as many extra shifts as you can because they always remember that.

 

[Febrifuge]

drkp, I hear that. Thank you.

They'll teach me phlebotomy, but not IVs... and I do believe Foleys will be my thing as well. On an overnight shift I'll do more, of course, since EKG techs and everyone else will be in shorter supply.

Sadly, I won't amass hours fast enough to get my trauma room training as soon as I'd like, but I totally agree with being either a) actively helping, as directed -- or b) invisible. Already out at triage, I've become the guy who's already dashing for a wheelchair when a laboring mom waddles in the front door and the nurse says, "could you get a ch--." Hopefully that will progress and continue.

 

[Mew]

Originally posted by Febrifuge
Jobs with titles like "ER Technician" or "ED Technician" or "Health Care Assistant" or "Emergency Room Nursing Assistant" or even the good old-fashioned "Orderly" exist in most ED's. They're the people who assist the nurses and docs with anything that needs doing. I'm not housekeeping, but I clean carts and make beds. I'm not a HUC or a clerical person, but I'll run papers and lab specimens to where they need to go.

I'll push wheelchairs and beds, help moms in labor get up to Labor & Delivery, get patients upstairs if they're being admitted, assist nurses with triage and vital signs, hold squirmy kids, set up 12-lead EKG's, do blood draws, dress wounds, teach people to walk with crutches, assist with simple procedures (emphasis on 'simple' and 'assist'), and generally be the scut-monkey. In theory, I imagine I'd have to take instructions from med students, though I don't see that happening anytime soon. 🙂

At the place I work, some of the 'people in burgundy scrubs' have training as Certified Nursing Assistants, and some (like me) are Certified and/or Nationally Registered Emergency Medical Technicians.

If you're interested in working in an ER, you should investigate volunteering, and then EMT. You can earn EMT certification in a couple of months, and for not too much money when it comes to tuition. I got mine as a 6-credit class through a very good local community college program for $700. Others here on SDN paid a LOT less, sometimes for college credit and sometimes not.

If you're interested but not crazy about time, expense, and effort, then check out volunteering in your local ER. You may see nothing but a desk, but you'll get a flavor for the people and the atmosphere - just enough of the emergency dept to know if you're into it. Good luck!

Thaks for the words of wisdom. Here in Nevada i do believe to be an emt you much get the AS degree in order to do so. The easyer one to get is basic emt, and im trying for that one.

 

[Febrifuge]

Just checking in with this fine old thread. I finished my orientation, and I'm into the precepted shifts now. A little time under the wing of my own personal Obi-Wan, and I'll be set free to pick up shifts.

I love this job. Right now, I also feel like I know nothing. But I also know that feeling will pass.

 

[DrQuinn]

Originally posted by Febrifuge
I love this job. Right now, I also feel like I know nothing. But I also know that feeling will pass.

Hey, atleast I ain't the only one around here that feels that way.

Medicine is a humbling field.

Q, DO

 

[Febrifuge]

Hi. Long time, no visit this thread. I can't believe it's a year later. But the story continues...

Today I'm trolling for some additional frank discussion and good advice. This crowd, much like the crowd at work, is smart as well as smart-assed. Since that's my own mode so often, I'd be remiss not to use this resource. Sorry for the long post, but I've been mulling for a while... the new development is, I have limited time now before school.

I want to make the most of the time left; I leave next spring for Post-Bacc. So, in addition to all the above, I want to know whether, and to what degree, I can pump it up without becoming obnoxious. I'm following the excellent advice laid out a year ago, but when it's time for med school interviews (then clinical rotations, and eventually, residency interviews), I want to be sure I'm able to paint the picture of a guy who made the most of a good thing while he had it.

So far it's been going fairly well. In a typical floor shift, I'll do some bedpan duty, draw some blood, clean a few dozen rooms... and if I'm lucky there will be something interesting and educational, like a FAST or a conscious sedation, in a setting where my presence is not totally gratuitous.

(In the trauma room, my role is logistical; I activate pagers, call for xrays, labs, EKGs, etc. I manage the flow of people and info into the room. No heroic chest compressions for me.)

I don't ever look down on the scut; I'm grateful just to be there, truly. But it's not all puppies and sunshine, because often, it feels like that's the limit of my contribution: being there. We have a LOT of students around. Honestly, I'm not all that necessary for true medical stuff. (Nor should I be, really, in the scheme of things. I realize that.) My primary duties are those that an NA would do as well, if not better; we never went over the personal-care stuff in EMT training. So I'm talking about those cases where it's nice for the staff to have another pair of hands, and finding ways to encourage the use of my hands.

My strategy so far has been to look people in the eye, introduce myself to those I don't know, say hi to those I do, and try to be on hand for the cool stuff. Last night the FP resident rotating through was glad to have me along to assist with flex-ex C-spine xrays; he moved the pt's neck gently and I kept the pt's shoulders out of the picture.

But does a loose string of such stuff represent a good capitalization of my opportunities, or should I "out" myself a little more as an enthusiastic pre-med? My impulse is toward prudence and working smoothly within the team. Sometimes, when I'm on with a resident I've worked with a couple times, I mention at the beginning of a shift that I'm happy to help out, if appropriate, on anything... should I be more assertive, and risk that dreaded appearance of over-reaching my role?

Assuming I continue to do well at my regular job duties, is more involvement seen as favorable among docs who could write letters... even if it's at the expense of maybe beeing seen as too aggressive by nurses or other techs? I care about being well-liked, and being seen as competent. Perhaps I care too much.

Anyway. Thanks for following along with all that. Personal perspectives and observations welcomed, and oddball stories encouraged, as always.

-F

 

[Apollyon]

Last night the FP resident rotating through was glad to have me along to assist with flex-ex C-spine xrays; he moved the pt's neck gently and I kept the pt's shoulders out of the picture.

Dude, flex-ex's are supposed to be passive, patient movement only. If the res is moving the head, that's wrong!