Frustration with Dialysis Technicians

Trauma Columnist · Mar 25, 2009

I think when you give respect, you get it back. Working with techs is an art: when to collaborate, when to guide, when to correct. It just comes with experience. If there are issues and the tech is disrespectful, there are avenues, including disciplinary action that must be followed.

zimm4er · Mar 26, 2009

I agree with the respect. Often it is the old nonlicesed vs licensed butting heads. In nursing often the nonlicensed person has been there so long they really do know a lot, and often tey teach you the ropes. Of course they usually are not able to think holistically regarding the patient. :yawn:

corky1272RN · Mar 26, 2009

I have found that on occasion, a tech will "try you" or test the limits. This has happened to me before. Just stand your ground.

Valerie Salva, BSN, RN · Mar 26, 2009

A lot of techs have that "We have to get to the dry weight" tunnel vision. They do not understand that how a pt feels during and after tx and what their VS are are more important than some arbitrary dry wt number.

I have worked in "upsidedown" clinics where the techs have all the power. They call pts in themselves, change the schedule all round, change goals on their own, add or D/C profiles and Na+ modeling as they see fit- disappear from the floor for long periods of time, and so on. They basically just bat the nurse around as they see fit. These techs often give "medical advice" which is totally false- such as telling a pt "You have Lupus, so you won't live very long anyway. So, it won't really hurt you to miss tx."

I have found techs asleep in conference rooms, and in their cars in the parking lot. One even had a pillow and blanket in the conference room.

When these kinds of antics are ingrained into a unit's culture due ineffective and disfunctional mgmt, there is nothing you can do but get out.

This is one reason why I'm so glad to be a traveler- when I come across this kind of unit at least I know I will be done soon.

Where I am now, I am very fortunate to be working with some of the best techs ever. We have a great time, and give excellent care together. I've made friendships that I hope will last a long time.

I will truly miss these exceptional techs.

RoseBud2009 · Apr 3, 2009

Here is a doozy for y'all. There is a female tech, who writes in red ink, even tho she used to be an AA. "I did not know I was supposed to document in black ink," :banghead: Today more passive-aggressive behavior, she did not label,date and initial 4 dialyzers.plain and simple policy and procedure, not to mention patient safety!! She is mean, grumpy, short tempered and of course everything is wrong with every one else and she is Miss Perfect....I don't want to share my license with her !! My manager knows the lady has "issues" perhaps she is a pet ?? I did 2 incident reports on her, today alone. Any ideas ?

traveler RN · Apr 5, 2009

I agree with Corky, they will try u qd. It is so funny when they think they are the nurse and have to ask what is PTH. I will work with them, but I do stand my ground when my butt is on the line, whether they like it or not. They do not realize they are working under your license. Had a tech one call the police on a pt. without my knowledge or ok. Imagine my surprise when a uniformed officer appeared in the clinic!. The incident had been initiated by the tech who had been out all nite and was particularly "evil" because she hadn't slept. When I called the pt. inside, she questioned him on who had called him back and he informed her "My nurse called me" and then proceeded to argue with him. At 6am this is going on while others are trying to get going.:argue: I stepped between the 2, and told them I did not want to hear another word. To the pt. I stated if he could not contain himself, he would have to leave and to the tech I would deal with her in private. I still had a whole clinic that had to be seated! Off and on the tech created drama with him, I was actually able to calm him because he knew I was a fair person. It could have easily escalated into a more serious matter. Later that day when the policeman arrived, this heifer by then had gotten my last nerve. I really felt liking kicking her behind all over that clinic! :lol_hittiI spoke with the officer to explain that the tech had gone over my head and called and at no time was her life ever in danger. She had told them when she called that he had threatened her. This guy was already a 2 timer so she really meant to get even when she had been the instigator from jumpstreet. I proceeded to chew her out in front of the police and that this matter would be handled by the clinic adm. d/t her part in the whole thing. The police left without any problem. I didn't care how she liked it, the whole day had been screwed because she had partied all nite! By the time my assign. was up, my pt. was eternally grateful and Miss Thing who only had 1 yr as a tech, expressed desire to go school. Well I'll be! I let her know if needed help with nursing she could call me.

DeLana_RN, BSN, RN · Apr 6, 2009

I have worked in "upsidedown" clinics where the techs have all the power. They call pts in themselves, change the schedule all round, change goals on their own, add or D/C profiles and Na+ modeling as they see fit- disappear from the floor for long periods of time, and so on. They basically just bat the nurse around as they see fit. These techs often give "medical advice" which is totally false- such as telling a pt "You have Lupus, so you won't live very long anyway. So, it won't really hurt you to miss tx."
I have found techs asleep in conference rooms, and in their cars in the parking lot. One even had a pillow and blanket in the conference room.
When these kinds of antics are ingrained into a unit's culture due ineffective and disfunctional mgmt, there is nothing you can do but get out.
This is one reason why I'm so glad to be a traveler- when I come across this kind of unit at least I know I will be done soon.

I guess that's why dysfunctional clinics like these hire travelers - they can't get any local RNs to stay. No wonder!

PCTs with bad attitudes and habits is one of the major reasons why I would never work chronic dialysis again (I liked the acute job I had after that, unfortunately lost it due to low pt census. But it would never occur to me to return to chronics, even if they paid me a fortune.)

In my experience, the problem is not with the individual nurse's attitude (I've rarely seen a nurse treat a tech with disrespect; it's typically the other way around). The problem is the chronic dialysis culture, fostered by for-profit companies trying to maximize their profits by hiring as many UAPs (unlicensed personnel) as possible with the minimum number of nurses they can get away with. As a result, the lines between nurses and UAPs are incredibly blurred in this field - more than in any other area of nursing. My company even trained techs and nurses together, which undoubtedly gave the techs the impressions that their job was exactly like that of the nurse; and this is how they behaved on the job. Because nurses in dialysis do much of the same work that techs do (e.g., cleaning machines, putting on pts, carrying acid jugs), and techs usually don't understand what else the nurse is responsible for, it's easy to see why they might get this idea. However, it's notoriously difficult to deal with it.

The key is, of course, good management, something I have not seen in all my years in dialysis. Not only is it difficult to attract nurses in general to dialysis, good managers are rare as gold. Usually, they are nurses who were promoted from the floor and bring they same problems they had with their techs to their managerial job. Of course, they can hire and fire now and techs do understand that. However, while they may now "respect" the manager, they still don't respect the other nurses and typically the manager will not help in this area (e.g., by making sure that techs understand that they are subordinate to the nurse, that they are to help the nurse, etc. The ostrich syndrome is also widespread in management, as is the attitude that problems with the tech have to be the nurse's incompetent leadership). I have never had - or heard of - a manager who dealt with this problem appropriately (e.g., firing the worst offenders).

If you go back on this board, you will find similar threads from years ago. This is not a new, nor rare problem in chronics. This will be your work environment, and although there are a few good clinics that happen to have a good crew of respectful, hard-working techs at the moment, they're few and far between. I personally had a couple of wonderful techs who were a joy to work with; however, the bad apples harrassed them for "kissing up to the nurse", making their worklife difficult.

I can only recommend that you try a much more rewarding area of dialysis: acutes (hospital) dialysis, especially if you can find a unit that is hospital-run. The best part in unit was that they had no techs (and if they did, they would have known their place just like all hospital techs do). Unfortunately, the work dried up in my unit and I didn't get enough hours and finally quit. I miss dialysis, but I would never return to chronics.

Good luck to you,

DeLana