only 6 weeks to train, help!! - page 2

hi yall, i just got hired at a dialysis clinic, and only have six weeks to train. there is sooo much to learn, i have to learn everything the techs do, building, tearing down, putting pts on and... Read More

  1. by   jnette
    Quote from imperial
    I agree with industry there is much brooo hahahah.. and it is not a laughing matter. Your unit certainly sounds wonderful. Yes, there are many horror stories out there and there 'are' units which have RNs with no experience, only that which is given by that corporation. Yes, it is like a process line of a manufacturing company, at times.

    In all due respect, I must disagree with you (agree to disagree, my motto) about the regulatory issues. Dialysis is not one of the most regulated. Nursing homes are inspected every year, come h... or highwater.. Dialysis units, 'may' and, I repeat 'may', be inspected once in three years. There is lack of funding, given to States (who enforced the Federal regulations, CFR) in order to conduct routine inspections. Some dialysis units have not had a survey in some 8 years. Several years ago, the OIG had a Congressional Hearing which spoke to these issues and lack of oversight, as well as poor delivery of care.
    It is for the reason of not having enough surveyors (state) as well as funding that the dialysis units have gone without notice.

    If you go to www.dialysisethics.org you will see many posted (actual) survey results and please note that often the plan of correction (given by unit) might be repeated several times. The consequences for non compliance have been nil.

    As one poster stated, the 'new' proposed language for the Federal ESRD regulations can be viewed at the Federal Register site, of which they were published on 2/4/05. As the poster previously stated, they are open for public comment for 90 days from 2/4/05. It would benefit all who work in dialysis, or who have anything to do with dialysis to read and make your comments known.

    Industry (large corporations) are running the show. Cost effective in order to make money. For example, FMC had 1.5 billion net profit, to my recall.
    And, you know that the DOJ is now doing an investigation related to usage of Vit D. They have supoenaed documents from large corporations, as well as several lab companies, to my recall.
    Thanx imperial...
    while I dearly love my unit, my patients, CM and my coworkers.. and feel blessed to work in a truly patient oriented environment (as far as our STAFF goes.. we do truly give our ALL in care, concern, and professionalism) I can certainly agree with you once it goes beyond there.. to the profit hungry "corporation" side of things. I do work for FMC and I cannt begin to tell you how distraught I have been over all shiny whitewash here lately. I see so much that is mere "marketing", and the total disregard for the nursing staff, their needs on the floor which of course directly affects the patient care issues. I could go on and on, but I would have to write volumes.

    I so love what I do, but I must be honest and say that this past year has been quite troubling to me. It is not the nurses/techs, or our NM.. it is the upper administrators who are towing the company line, which of course is all about cost effectiveness, often to the detriment of our patients and the nursing staff. While we are VERY conscientious about the care we provide and following all the latest CDC guidelines, etc., there is but so much a nurse can do in the course of a full day with two full shifts of patients.. given the "staffing module" allowed. It is here where I begin to get highly upset.

    To top it off, we were just informed that our mega company with the 1.5 billion dollar net profit has now reduced our annual raise percentage... but they can spend millions on "marketing" and silly "open house" ceremonies while we are working.... :stone

    I understand your concerns.. and while we might not be surveyed as often as nursing homes... (omg, don't even get me started on THAT one!)... I can say with all honesty that we are READY at all times, for we conduct ourselves and our practices accordingly.

    Thank you for your concerns for our fine patients.
  2. by   jnette
    Quote from imperial
    It is for this reason that I have concern for delivery of care in many units. Of course, there is good and bad with all areas of healthcare. I truly believe that more education is needed for, especially, RNs, beit on the floor or in charge. Remember it is your license when a mistake is made. It is most important to continue to educate yourself as much as possible.

    Recently, I was made aware of a situation whereby a large corporation was not following specifics of federal regulations, i.e. assessing patients before and after each treatment. There is a fine line between, in my judgement, of getting to one's dry weight and dehydrating the patient. Many units believe it is important to 'challenge' the patient to their dry weight with patients experiencing hypotensive episodes, requiring saline infusion and feeling horrible i.e. lightheadedness, etc. This can be avoided by using many new procedures/techniques/devices. However, this cost money. I often wonder about industry and why they have so many 'barbaric' performing of care, i.e. taking ppl to their dry weights knowing there will be above stated symptoms.

    At one time I observed, over and over, staff doing this, then giving saline, while never readjusting the dry weight, nor taking into account, what the patient is wearing when weighing in. But again, not everything is perfect and we certainly do not live in a perfect world. BUT, we can try our best to provide a safe environment for the patient with the least amount of complications/symptoms.
    I understand about the adjusting dry wt. issues. This is one area where I attempt to be really consciencious.
    While we do utilize sodium varience modeling and UF profiling.. as well as the use of mannitol for those who "bottom out " regularly regardless, I do look at each patient individulally and get to "know" them and their habits regarding their weight. The more you know your patient, the better you can understand just how much to pull them for.
    We try to be attentive to our patients.. I can tell when one has reached dry weight just by the sound of their voice, hoarseness or a dry cough. It is this fine tuning that comes with experience and a darned good Nurse Mgr. who points these things out while you are learning the ropes.


    I do know nurses who will pull and challenge with no regard for the patient, and excuse it with "well, better sick and puny for awhile on the machine than go out heavy and in fliud overload, or CHF." It's not all that black and white, to me.

    As far as pre and post assessments.. our facility now does only the pre assessments.. we used to do both pre and post, but it has been changed to pre only. Of course we do the weights post tx., etc., but no longer listen to lung sounds post tx.
    I believe each company sets many of its own policies, and they change constantly.

    I CAN tell you that it is of utmost importance to waste good nursing time by having us spend excessive amounts of time in the med room attempting to draw out every last miniscule fraction of a droplet of epo out of the overfill in the vial to be "cost effective" than to spend that time being available to our patients and their needs...
  3. by   vidrine rn
    well i decided to quit the job. im going back to medsurge at the hospital.
    the work at the dialysis center is ok, its the management that is not right.
    i decided that i dont want to travel 200 miles in 1 day, and when i interviewed
    for the job i was told i would get 40 hours. well that did not happened. so im going back to the hospital. thanks for all the advise from every one.
  4. by   missmacrn
    I suggest to you vidrine rn that you speak with your case manager if you are uncomfortable once your 6 week training is through. I was naive and made a big mistake when I first started into dialysis by not voicing my concerns...remember...it is your license on the line. When I first went into dialysis 6 years ago I was with a unit that had I think 12 stations. I was trained by an RN with only 6 months experience in dialysis, a very good RN but still with limited dialysis experience. Once I had 6 weeks training I was ALONE in an out pt clinic on the TTS shift with 2 techs and I think 6 pts. The techs were very knowledgable with years of experience but of course if something happend it is ultimately the RN's responsibility. I have learned my lesson. Thank god nothing happened but I would never put myself or my patients safety on the line again. I have since moved to another facility where I rec'd 6 months training and had to have a year experience before taking on call or doing acutes unsupervised. I learned throughout this training why I was doing certain procedures not just how to do them. ASK lots of questions and be sure you are comfortable before you go on your own!!
  5. by   RRN
    Quote from gfrn02
    Don't stress. I only had two weeks of training and then only two weeks on the floor before I was alone with 8 patients in my pod alone. You just need to get the basic knowledge of why you are doing what you are doing and the rest will fall in place with a little time.


    May I ask what company gave you that inadequate training?
  6. by   MKE247
    Dear vidrine rn
    Please do not take this the wrong way, but have you considered working in another area? The dialysis unit is not a convenient way for RNs to avoid weekends and 3rd shifts.

    I am wait listed for the RN program and doing a 1 year diploma in renal dialysis, as a tech. We are in our first 8 weeks of clinical and while we still have a lot to learn, things are going well. Dialysis training, whether done in 2 semester or 6 weeks on the job can seem overwhelming. However it can be accomplished. The expectation of my instructor as well as your unit manager will not be that you will walk out of the training knowing everything right way. You probably experienced the same a a graduate nurse, knowing that you brought with you certain skills from school, with the expectation that you would still learn a lot in your unit or department on the floor.

    You seem to keep focusing on your own fears or inabilities, and that worries me. Personally I don't like being under the care of nervous health care professionals. ( the nurse in my MD's office usually take about 5 tries before getting my bp reading, which is normal and strong)


    If you keep focusing on what you don't know and if you go into training as nervous as it seem you are online, you will not do well in dialysis. As a tech or RN/LPN, you will spend a lot of time with you patients. ( 3-4 hours, 3 times a week.) Most patients are familiar with their own treatments and they know right away if the tech or RN running the treatment is properly trained and CONFIDENT. They will call you out on your mistakes : ), well some will.

    You have to be confident for the Techs that work under your supervision. You will need to learn a lot from them, as they know the machines and treatments well. What they need from you is your strong ability to lead and supervise.

    Again, the dialysis unit is not a convenient way for RNs to avoid weekends and 3rd shifts. Perhaps you might like working in a MD's office or walk-in clinic. Its really something to think about.


    MKE247,
    Milwaukee, WI

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