Being a Newly Qualified Paramedic (NQP)

#HelloMyNameIsHolly I graduated from Surrey in 2018. I now work as a newly qualified paramedic (NQP), almost 1 year into my paramedic career with South Central Ambulance Service (SCAS). I am keen to help out student paramedics and other NQPs as I have been there and I know how daunting it is.

Being an NQP is scary. I remember being absolutely terrified on my first day out on the road as an NQP. Thankfully I was shadowing a band 6 paramedic for 4 days, as our first patient on day 1 was a AAA (Abdominal Aortic Aneurysm) and the patient was dying in front of our faces. It was at that job I was reminded that as a clinician, if you’re not sure, GO BACK TO BASICS and if in doubt, convey the patient to A&E. We always have that fall back, and no one will criticise you as an NQP for playing it safe.

Being an NQP forces you to start making decisions and to become confident in your decision-making ability. However, if you’re unsure, you do not have to be alone in your decision making. There’s always clinical desk in control, NQP validation line, the patient’s own GP/111, hospice staff, mental health teams etc to talk to- the list is endless. Being an NQP will also make you realise that you know more than you think, especially when you do your first few shifts as the senior clinician with just you and an ECA/ECSW/whatever your local trust calls them! Your confidence in your own ability will grow.

I have found that some ECAs/ECSWs can sometimes be more willing to take chances with their decisions/treatment plans- but they don’t have a registration to think about. I don’t mean this dismissively towards them. They are fantastic, so listen to what they say and include them in the decision making! The chances are they have a lot more experience than you! However, I believe you never truly understand the gravity of clinical decisions until you have a registration and those heavy shoulders with the word ‘Paramedic’ on. Do not be afraid to go against your ECA/ECSW’s decision if you are not happy with it. At the end of the day, you are the senior clinician, and the final decision lies with you. Obviously, be professional about it, and make sure you explain to your ECA/ECSW why you think a different care pathway should be chosen.

As an NQP there are certain milestones that you may or may not hit. Some are moments that you want to avoid, some are moments where you feel like high fiving everyone including the patient. As an NQP 6 months qualified I have already given IV morphine, felt very out of depth at a job, been to a certain type of job for the very first time e.g. actively seizing patient, made a drug error, lead my first resuscitation as senior clinician on scene, joined the ambulance station WhatsApp group, been on an action plan, and pre-alerted a patient with a description of “I don’t know what going on with their ECG, but I don’t like the look of it. There’s lots of very wide complexes!”.

On my 8th shift out on the road as an NQP, I experienced what it is like to feel truly out of your depth at a job. The job came through on the MDT as something fairly common and easy to deal with. When we arrive on scene it very quickly became apparent that this job was not as given. It was a major trauma job where HEMS were involved. I struggled with a systematic assessment of the patient, and I also had a student paramedic to supervise too. The job went so horribly wrong in my eyes that when we returned back to the ambulance station to restock, I immediately went and cried in the toilets. I was convinced that I was going to lose my job and my registration. However, in order to turn a negative in to a positive, I learnt a lot from that job. I wrote a reflection on it, I made sure I revised my systematic trauma assessment, I listened to the job debrief back at station, I made sure I was familiarised with the ambulance and the kit bag layouts. And most importantly, I spoke to my support network.

My support network consists of my family, my friends that were in my cohort at uni, my friends from the blue light driving course (you become surprisingly close over the 4 week course), my new ambulance station friends, and also my other friends outside of the ambulance world. It is so important to step back from the job on your days off otherwise you will burn out, and quickly! The first few months as an NQP are filled with a fairly constant level of stress. It is a high intensity job that we do, we’re playing with people’s lives. You may find in the first couple of months, you struggle to truly relax. That is where self-care comes in. Have distractions from your work life, things such as going to the gym, getting a massage, going for walks, meeting up regularly with your family, and making a special effort to keep up your usual hobbies despite now having to work around your shifts. I would also recommend getting involved in the social side of things at your ambulance station, Christmas parties, pub crawls, days out etc. It’s good to get to know your colleagues in a more relaxed setting.

Being an NQP, you may find that CPD opportunities may be harder to come by. You won’t have the lovely ParaSoc to organise lots of fab events for you. However, my advice is look on the College of Paramedics website- they have details of several CPD events, get on Twitter and follow lots of medical/CPD/ ambulance people, also keep an eye on ParaSoc’s social media, because they do like to include us qualified staff in their some of their events, and they’re often a lot cheaper than other CPD events.

When I became an NQP I took the plunge and went to a new ambulance trust. I was living on my own and working in a completely new area, with differently laid out ambulances and kit bags, with new policies and PGDs and with a new electronic PCR. There is no “student” label to hide behind, the staff at the new trust have never seen you as a student. As far as they’re concerned, you’re a paramedic and you know what you’re doing. It was a challenge, but I’m very glad I did it. If you’re unsure whether to branch out to a new trust or stick with your student trust, feel free to drop me a message, I’m happy to talk in through with you.

 Alongside all of these challenges, sit back and enjoy the ride! This job is amazing. It’s so fulfilling. It’s such a privilege, and that’s how you’ve got to see it. You are privileged to be the person who people call on in their time of need. I still turn up to work most days, sit in the front of the ambulance doing up my shoe laces before my crew mate has arrived and think, “Wow. I did it. I’m a paramedic!”.

If anyone has any questions about anything I’ve written above, or they just want to talk through the NQP process with me, drop me a message. Remember, I was a student paramedic on the verge of qualifying not very long ago! I know what it’s like.

Holly Adcock

holly.adcock@scas.nhs.uk