It has been a challenge for EMS educators and then their managers to build confidence in new clinicians and to help them balance confidence with arrogance. There is a fine line between humility and superiority.
Within days of getting my National Registry card, then Assistant Chief R. David Hays hired me as a paramedic with Community Rescue Service in Hagerstown, Maryland. At the time, it was by far the biggest life decision I had made. CRS was the busiest EMS agency in Washington County, Maryland.
Nervous was an understatement. I can remember making myself sick driving the hour to work not knowing what the day would bring. I had an excellent paramedic education and mentors. Community Rescue Service had amazing preceptors and duty officers available to support their staff, but as a new clinician, I felt like I had to prove myself and worried endlessly about it.
I tell new hires and students that I mentor today, I don’t know when that feeling of nervousness, worry and sense I had to prove my worth ended. CRS took a young, under-confident, naïve paramedic and – through training, crew resource management, call repetition, quality assurance and reassurance – made a clinician.
Here are 5 ways to inspire confidence in your medics.
1. Training
Teach providers that confidence doesn’t come from having all the answers; knowing where to find them is far more important. That can mean referencing the protocol book, using online medical directions or simply using communicating with the team. I still look protocols up on the way to calls and confer with my partners: that is what a team is for.
2. Crew resource management
Confidence is formed when you have a standardized dispatch and paramedics don’t have to worry about additional resources that are responding.
From day one at CRS, I knew that on the highest priority call, I was getting an engine and a duty officer. Additionally, I could request a duty officer at any point, and if one wasn’t available, a second medic unit would be started, no questions asked.
On the reverse side of that, I have been the second medic to other units’ requests. I know the feeling of showing up when a patient is decompensating and seeing the look of relief on the paramedic’s face, knowing they have another pair of hands to help.
There was no judgement. There was no one to tear you down. Everyone had a job to do.
3. Call repetition
Nearly 15 years ago, when I started at CRS, a full-time paramedic working out of the main station would average nearly 1,000 calls a year. I did, several years in a row.
Call repetition builds confidence. It shows a clinician how a call should run and shouldn’t run. It quickly identifies where you might need more training. It gives the clinician valuable face-to-face time with the patients and plenty of time at the keyboard doing the patient care report to build their skills.
4. Quality assurance programs
A properly run quality assurance program should run in concert with a training program and should build confidence, not fear in a clinician. Clinicians should be comfortable enough with their QA/QI officers to report infractions before they are discovered on daily or monthly reviews.
Quality assurance is a valuable tool that is underutilized because it is usually mismanaged. Clinicians should know in advance how the process will work, how it may affect them and what could potentially happen to their credentials. This should be the same across the board for all clinicians called before a quality review board or panel. Clinicians lose trust when rulings deviate for the same infractions, causing personal confidence to be shaken or lost completely.
A QA/QI manager must be experienced, smart and tactful. They must have the ability to work with the medical director, managers and clinicians alike. Their conclusions must be based off what is best for the patients and not punitive. QA/QI programs should never be used as a branch of human resources.
A properly run QA/QI program that can identify trends, and work with the systems training program and the clinicians to get comfortable and confident would ultimately benefit the agency and the clinicians. This model has become increasing more important recently in times of staffing shortages and crises.
5. Reassurance
Finally, reassurance helps to build confidence. Every clinician we work with is built differently – the way they learn, receive information, interact, etc. Simple reassurance can go a long way in building their confidence. Knowing that they have the support of a peer, a coworker or a friend is beneficial in this fast-paced, high-stress environment.
Encourage medics to reevaluate the situation when their confidence is lacking. Is it something that they can fix on their own? Make sure they know when to ask for help and that it is encouraged. Afterall, we all need a little reassurance from time-to-time.
