new to dialysis, please help!

  1. Hi. I am an RN with 1 yr experience in a busy medsurg floor. I recently left that floor for a dialysis clinic. I really think I like it at this clinic. I am still in training with a tech (learning machines, sticking pts, troubleshooting, etc...). I am in my 5th and final wk of tech training and at the end of this wk I am expected to beable to handle a pod of 4 pts all by myself with eveything the tech does (put on, take off, break down and set up machines and stick the pt.) There is 15 minutes allowed with each pt before the next one comes in. The problem is I am not able to handle this load of 4 pts in a timely manner. I feel confident in performing all the skills, I am just not fast enough. I am getting very frustrated because I have high expectations for myself and I feel I am failing. I was able to handle 7 pts on medsurg why cant I do this? I am wondering if this is the job for me, maybe I just am not cut out for it. I really do find it interesting and enjoy the pts and roles the nurses have. What has everyones experiences been when they first started there new dialysis job for the first time? Another question is my manager told me that my nursing training is going to be two wks. Is this average for a nurse who has no dialysis experience? It will be a total of 7 wks with tech and nurse training put together. Thanks for reading this! I look forward to everyone s answers.
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  2. 12 Comments

  3. by   s9283
    someone...anyone?
  4. by   Dialyser
    I cant comment on what is normal in the States but i run a haemodialysis unit in the UK and our training programme takes 3-6 months to complete. I also tell my new staff that it takes 12 months to really develop your skills.

    From what you said it sounds to me as though you have done really well for length of time you have been in post. when you are still learning its not an area to rush things i think it is more important to take your time and get things right! The speed will follow as you become more experienced.
  5. by   km5v6r
    I am still in training with a tech (learning machines, sticking pts, troubleshooting, etc...). I am in my 5th and final wk of tech training and at the end of this wk I am expected to beable to handle a pod of 4 pts all by myself with eveything the tech does (put on, take off, break down and set up machines and stick the pt.)

    Who the heck set up that expectation???? Of course your slow at the beginning. After 5 weeks I thought I was doing well to set up 1 machine in 15 minutes and not tie the tubing in knots. If these are the companies expectations get out now. They are totally unresonable. 2 weeks to learn all a chronic dialysis nurse needs to know? Good Grief. Try at least a year. My old company had new staff with a preceptor for at least 3 months. I'm sorry but you keep up at this pace and you will burn out quickly. Dialysis is like nothing else. You either love it or hate. Nothing in school or hospital work prepares you for this. Learning dialysis after 15 yrs of ICU was one of the most ego busting moves of my career. I love it but it was very hard to go from being the expert on the unit in ICU to knowing nothing and making simple mistakes. Give your self time. You are learning a whole new set of skills and way of thinking. Do not compare your self to the other techs. In all probability they have beening doing the same thing (stringing, stripping, sticking) 8-12 times a day, 3-4 days a week for years. These are skills you are not going to learn in a matter of weeks. Remember learning to drive? You weren't a master of all road conditions, in all weather conditions in a few weeks.

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  6. by   trvlnRN
    After five weeks you are expected to handle a four patient pod yourself! That is ridiculous!!! Either you are being "set up" by the company or by the tech! Where are you working?! What does the manager say about this! It is conditions like these that cause errors to occur! It takes a good 5-6 months before you get comfortable working in dialysis and a good year before you are really comfortable. That's ridiculous! Don't let them push you around and burn you out....if they are...you might consider going elsewhere. Dialysis is a good profession...but I get tired of hearing these stories from techs and other nurses. That's why we end up with what I refer to as "sloppy" techs...meaning that they just work fast and don't pay attention to detail....thus you have patients running on the wrong bath (a big NO NO that I see way too often) and you end up with patients with infilrated accesses, wrong goals set, etc. I have a new tech who will be completing her training soon....and when she asked me if she would have to take a four patient pod after training...I said "no way" "I'd rather have a training tech go slow and do things right first....speed will come later". I'd much rather fill in the gaps by putting on some patients myself. In my experience the techs that are slower and pay attention to detail turn out to be the better techs later down the road. And it's a much less stressful learning environment. I hear the same horror stories from nurses too. I'm glad I got my first dialysis experience in acutes for that reason. Nurses will always be slower than the techs. We have a lot more things to consider than just the mechanics of the process....and we don't work a pod day in and day out. We should really support those that are starting out in the field rather than stressing them out! Don't you just get tired of hearing these stories over and over again?! Hang in there 9283....and don't let the tech push you around! Talk to your manager...see if the company supports you or not! I can tell you....the current expectations are absolutely ridiculous! So what's really going on here? What's the history at that clinic?
  7. by   s9283
    It is the Nurse manager of the clinic that has the expectations for me to beable to handle a pod of four pts by myself. I have told her that I am worried that I will fall behind , but she told me that I need to bable to handle a pod of four pts without working with my preceptor, and really didn't give me any other options. I am NOT looking forward to next week at all. I am going to have to rely on other techs to help me with shift change, and they already have enough to do. The clinic I am working at is a clinic owned by a group of doctors. Everyone tells me that speed will come later and not to worry, but then why am I being put in this situation? I do like the pts at this clinic and the techs and nurses are great (very friendly and helpful) but they just have GREAT expectations for me. I am just freaking out about next wk being all by myself, I am actullay loosing sleep over it. I cant just leave because I dont know where else to work. The only other dialysis place in my area in Davita, and I dont think they are hiring. I guess I am gong to have to tough out next wk. Should I talk to my nurse manager again? Thanks for everyones post.
  8. by   sueinga
    Hello,
    I'm an new RN to dilaysis and just started about 7 weeks ago. My clinic manager said I would be a trainee for 6 months and would not be thrown to the wolves, so to speak. Without this support I do not think I would have stayed. I am just now to the point I can set up a machine, cannulate and run a treatment on my own ( my pct is not far away for support) but I am only doing one pt per shift right now- probably could do 2 but they are not pushing me- wanting me to be comfortable. I am very slow but as everyone here has said speed comes with time- alot of it. Dialysis nurses are in great need. I took my initial training at a Fresenius facility for 4 weeks- to my clinic now for 5 weeks and then back to training facility for one more week- a total of 10 weeks and yet my own facility(not a fresenius facility) as I say will consider me a trainee for much longer.

    Sounds like you are doing great at this point! But being expected to do 4 pts a shift on your own is too much to expect at this early stage, in my opinion. Some managers will push a nurse as far as they can just to see how far they really can go- you may need to respectfully speak up for yourself and request additional time in training. I think this would be a reasonable request-
  9. by   Natkat
    My manager said it takes 6 months to a year before you are comfortable handling 4 patients by yourself. I would hope that your co-workers understand what you are going through and are willing to help you out while you work on your speed. At my clinic, we are not expected to be able to handle things alone that soon.

    It took me every bit of 6 months before I could handle 4 patients alone. Now that I just passed being there one year, I feel fairly comfortable with just about anything that comes up.

    Best of luck to you. I think those expectations are unrealistic and unfair. Is she going to fire you over this?
  10. by   traumaRUs
    I am an advanced practice nurse in a dialysis unit and the expectation is multiple months of orientation for both techs and nurses. In fact, the nurses have to learn more because they draw up all the meds and do the orders.
  11. by   s9283
    So far this week is going ok. I am able to handle about 2-3 pts in a timely manner. The other techs help me out a lot. I feel confident with everything I am doing, I just am as not fast, and I guess that will come with time. I am just doing the best I can do! My nurse manager said that I am going to start my nurse training next week.
  12. by   Migrant_Renal_RN
    I must agree with the majority. I have been in dialysis for over 15 years, it is hard to believe that so much time has passed! I was in one clinic for over 10 years, hospital based. I traveled for just under 5 years, and have been employeed as a Clinical Nurse Manager for just over a year. I am in my 3rd clinic in the area, for multiple reasons. You aren't in the Daytona Beach Area by any chance??? We are in dire need of help. Speed does come later, ACCURACY is much more important. Eventually you will feel like you could do it in your sleep. I have had some wonderful mentors, all of whom have helped to make me who I am today. Be frank with your manager, and if that does not get the job done, go up the line....we all report to someone. Dialysis is a very special field, and you are either a dialysis person or you are not. It sounds as though you are, so hand in there. Don't get frustrated, don't let them push you. If you are moving too slowly the patients will grumble, but they will respect the fact that you are new and only wish to provide the best possible patient care, for their sakes. So, take your time, do the right thing the right way, ask for help, and if it isn't coming...still take enought time to get the job done right, and you will stay in the trenches with us into your old age...Take care, I'll be happy to help you in any way that I can. Buy a Dialysis Handbook by Daugeris, it will be your bible. PP
  13. by   s9283
    Thanks for the great reply. Everyone has made me feel better. I think my week all by myself as a tech has made me feel better. It went pretty well. I think I just need to have more confidence in myself. I always seem to be hard on myself. I am starting my nurse training in the morning, and I am very excited. I really like dialysis and I want to stay in it for long term, thats why I want to make sure I am getting good training at the start. How long was everyones nursing training when they first started? My nurse manager says it will be 2 wks. Is that average? Thanks so much.
  14. by   Migrant_Renal_RN
    How long have you been a nurse? I always base training time on individual needs and strengths. The most important thing to remember is that you know what you know and if you aren't comfortable say so. If you don't know, ask. And there is no such thing as a stupid question. Take your time, do the right thing at the right time, always speak up for your self. Good Luck!!!!

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