RN- Is This common practice in Dialysis Training? - page 2

I am new to Dialysis and recently started orientation. I am a RN and my preceptor is a PCT with dialysis experience as a PCT but no nursing experience. Is this common practice in Dialysis for PCTs to... Read More

  1. by   DeLana_RN
    Quote from sueinga
    MY question is that after only 6 monthes of training, should I be the only RN on the floor when starting the day? or should the "charge nurse" be there?? I'm being told I've been trained and should handle it- I also feel my license is on the line-
    Are you the only nurse in the early morning, or do you have experienced LPNs with you? If you're the only RN with techs, then I would say the answer is a clear NO. After 6 months - and everyone knows this - you cannot possibly know how to handle everything that can go wrong in a dialysis clinic. Some examples: water problems - do you know when and how to switch to DI if the RO fails? Or when to put the pts in bypass due to less serious water problems? Patient problems - access (clotted); seizures; GI bleed; sepsis; and, of course, the dreaded code. Machine problems - reverse TMP, blood leak. These are just some examples. Of course, as a trained RN (nobody cares how much experience you have if you find yourself before the BON or in court!) you are fully responsible if any of these happen and you don't know how to handle them.

    No they should not leave you alone unless - and until - you feel comfortable to be able to handle ordinary and unusual problems that may occur, or have experienced LPNs with you that do (of course, as you know, the RN is still liable).

    I would talk to the manager. Good luck!

    DeLana
  2. by   DeLana_RN
    Quote from LPN2RNBSN
    Several things come to mind: (1) When mentioned assessments, the techs in our unit ask a question, prior to initiation of treatment, i.e. "Have you had any problems?" ofcourse, new patients do not even know what problems the tech is talking about. The RN is busy with catheters, administrative duties and patients do not even have auscultation performed, at all, unless there is a specific problem or a request is made of the RN. Techs need more education/training considering they are the ones with the patient for their entire treatment.
    I don't understand this. Does your state not require that each and every pt be assessed for heart and lung sounds, edema, neuro status and other problems? Usually, this has to be done by and RN or LPN, although a few states allow PCTs to do assessments; this must be the case here. Still, the nurse is of course liable if anything is missed. Can your techs also push heparin? If not, then do a quick assessment while you are doing this. I suspect, however, you're in a state that allows techs to push heparin and do assessments... scary.

    Good luck! I know how it can be a losing battle to get all your work done in a clinic and go over and above what is required of you.

    DeLana
  3. by   NeosynephRN
    Quote from DeLana_RN
    Are you the only nurse in the early morning, or do you have experienced LPNs with you? If you're the only RN with techs, then I would say the answer is a clear NO. After 6 months - and everyone knows this - you cannot possibly know how to handle everything that can go wrong in a dialysis clinic. Some examples: water problems - do you know when and how to switch to DI if the RO fails? Or when to put the pts in bypass due to less serious water problems? Patient problems - access (clotted); seizures; GI bleed; sepsis; and, of course, the dreaded code. Machine problems - reverse TMP, blood leak. These are just some examples. Of course, as a trained RN (nobody cares how much experience you have if you find yourself before the BON or in court!) you are fully responsible if any of these happen and you don't know how to handle them.

    No they should not leave you alone unless - and until - you feel comfortable to be able to handle ordinary and unusual problems that may occur, or have experienced LPNs with you that do (of course, as you know, the RN is still liable).

    I would talk to the manager. Good luck!

    DeLana
    As a former tech in a Dialysis unit, and almost done with my RN...these problems were all delt with by tech's..the RN's were required to be trainned on the water system, but you could not drag one of them back there if there was a problem...however 1 RN opening a unit does seem like a lack of staffing...I guess how many patients are involved and like you said are there any LPN's with you too??
    You all seem very anti-tech in this thread..personally I think it is a great idea to have a tech "train"" you on the way to run, set up and clean machines....I mean what are you going to do if your machine goes down on you and you are the only one there...which I could not see happening very often..but it could!! I am sorry that it seems that you have had bad luck with tech's with bad attitudes, I have also seen my fair share!! I have also been in the position to light a fire under the butt of my nurse...I was a strong tech, not by my own assesment, but coming from my nurse manager. So I would routinly be placed with a "weak" nurse. I would have to keep her moving...It should not take 45 min to get someone with a perm cath running...when you have been there for almost a year. I mean if we are 45 min late then the whole day is messed up soooo bad!! We ran 4 teams of 8 patients three rounds a day...so you can see where time is of the essence with a turnover time of 15 min between pt's...which obviously becomes an issue if you have complications!! When we opened in the morning...every team had a tech and a Nurse and we had a Charge...then at night when we closed the Nurses could leave when the last patient on the team left. While us tech's are left to clean up and do all the dirty work which was fine with me cause that is what I signed up for when I took the job!!! I would try to find a way to not work with that tech if possible..or maybe look to another facility...Dialysis is very rewarding and trust me all tech's are not like that!!! GL!!!
  4. by   DeLana_RN
    Quote from calla2114
    I have also been in the position to light a fire under the butt of my nurse...I was a strong tech, not by my own assesment, but coming from my nurse manager. So I would routinly be placed with a "weak" nurse. I would have to keep her moving...It should not take 45 min to get someone with a perm cath running...when you have been there for almost a year.
    Do you know why it took so long? Perhaps the permcath was clotted, and the nurse had to instill TPA; this can take a long time.

    This is a typical example of techs not really understanding a nurse's job. Nurses have all the responsibilities of techs (setting up, putting on/taking off pts, clean-up, water testing, etc.), in addition to many, more responsibilities that most techs don't appreciate.

    In my clinic, we did not have tech's do the clean-up, except for their own assigned machines (pods). Nurses also had to stock their own pods (consisting of two machines), test the water, assess all patients - their own, those of the techs - and give all meds including heparin. So, yes, it would take a nurse much longer to put on a pt if they were constantly called away from that pt to do an assessment or push a heparin (including handwashing before and after); that is, if they took their jobs seriously and actually did those tasks. Plus, the nurses would also have to deal with any problems that occurred with any pts on the team (e.g., clotted access).

    Naturally, conscientious nurses would appear to be "slow" in the eyes of the techs who have to only "put them on/get them off", especially if relatively inexperienced. This does, however, not make them "weak". If your manager described such as nurse as weak, s/he was just wrong (and perhaps trying to flatter you. Believe me, I have seen it all.)

    How can some nurses be "as fast as techs"? Years of experience, short-cuts, not doing their duties (not assessing the pts, letting the techs push the heparin even if illegal in that state). Some are naturally a bit faster - also among techs - but there is usually a whole lot going on that you may not be aware of if there seem to be large discrepancies.

    Don't get me wrong, I'm not anti-tech. I have had some wonderful ones with great attitudes. Techs are an essential part of outpatient dialysis (the companies would do away with nurses if they could), and a good tech is worth a lot. Unfortunately, there are also lots of bad apples who have bad attitudes, are lazy, and badmouth nurses about things they know nothing about.

    Good luck to you! Some of the best nurses I have known were former techs.

    DeLana
  5. by   NeosynephRN
    Quote from DeLana_RN
    Do you know why it took so long? Perhaps the permcath was clotted, and the nurse had to instill TPA; this can take a long time.

    This is a typical example of techs not really understanding a nurse's job. Nurses have all the responsibilities of techs (setting up, putting on/taking off pts, clean-up, water testing, etc.), in addition to many, more responsibilities that most techs don't appreciate.



    DeLana
    Thanks but I really do and did understand the Nurses job....and no there were no complications with the cath...maybe I should have clarified that in my post...she was just slow...with each and every patient...My nurse manager told me I was a strong tech...never told me that, this particular nurse was weak...but that was the general thought on the unit...she was just not very good...nothing against her, but I am not sure dialysis was a fit...example We had a meeting and this nurse was on my team alone..she is an RN has been on the unit for about a year...one of the machines kept alarming that the Arterial and Venous pressures were off and shutting down...you know...she kept hitting mute, reset...and it happened over and over for about 35 minutes! She never asked for help, from another team or the charge nurse...and you know in the busy units machines can be alarming all the time for various reasons...well I get back and the machine alarms...I go up to it and look it over..nothing...uncover the patient...which is against our policy to have their access covered anyways...and her needle had fallen out and she was bleeding out...and had been for a while!!
    We had so many great nurses...I mean like these guys rocked!! Many with 20-30 years dialysis exp. so maybe that is why they viewed her as weak..and it was not just cause she was new...like I said maybe not the right fit for her!!
    We obviously work for very different types of unit as the RN does not have all the same responsibilites as a tech at ours...they are trainned...but do not set up, tear down, clean or do water tests..as that is all below them...which like I said before I was fine with...I am not a nurse yet...was not then, so I did not expect to do the same job, or have the same responsibilites...I am not your typical tech...but there is no way you could know that...since you do not know me!!! I am an EMT and I feel that I did my part to make sure that treatments were done right and the patient was well taken care of...so I was not just an unlisenced dummy with a bad attitude off the street!! Though we would get them once in a while!!
    I did my job so that the nurses could do theirs which was obviously more consuming than mine...with care confrences, meds, complications, and all that fun stuff!!! I agree with you I think my time as a tech will definately help me be a better Nurse!!! I may go back to dialysis PRN...they keep asking me to come back and I would be good in Acute...since I am VERY famiallar with the machines...LOL!!! This is a great forum, but it is just interesting to be able to see the situations from both sides!!!
  6. by   DeLana_RN
    Quote from calla2114
    Thanks but I really do and did understand the Nurses job....and no there were no complications with the cath...maybe I should have clarified that in my post...she was just slow...with each and every patient...My nurse manager told me I was a strong tech...never told me that, this particular nurse was weak...but that was the general thought on the unit...she was just not very good...nothing against her, but I am not sure dialysis was a fit...example We had a meeting and this nurse was on my team alone..she is an RN has been on the unit for about a year...one of the machines kept alarming that the Arterial and Venous pressures were off and shutting down...you know...she kept hitting mute, reset...and it happened over and over for about 35 minutes! She never asked for help, from another team or the charge nurse...and you know in the busy units machines can be alarming all the time for various reasons...well I get back and the machine alarms...I go up to it and look it over..nothing...uncover the patient...which is against our policy to have their access covered anyways...and her needle had fallen out and she was bleeding out...and had been for a while!!!
    calla,

    sorry if I implied anything, I knew my post could be misunderstood. But you are right, it sounds like this nurse had some serious problems if she failed to find out why the machine kept alarming and never asked anyone for help - my goodness, the pt could have exsanguinated! This nurse was not weak, she was dangerous! Is she still working there? I wonder what she didn't understand about dialysis, or has it improved?

    Anyway, thanks for the clarification. Since you're an EMT as well, you will make an awesome RN - knowing the technical aspects, emergency management (IMO, a major weakness of outpatient clinics), and nursing as well. You should definitely look into acutes, I just started there 6 weeks ago and like it a lot.

    Best wishes,

    DeLana
  7. by   NeosynephRN
    Quote from DeLana_RN
    calla,

    sorry if I implied anything, I knew my post could be misunderstood. But you are right, it sounds like this nurse had some serious problems if she failed to find out why the machine kept alarming and never asked anyone for help - my goodness, the pt could have exsanguinated! This nurse was not weak, she was dangerous! Is she still working there? I wonder what she didn't understand about dialysis, or has it improved?

    Anyway, thanks for the clarification. Since you're an EMT as well, you will make an awesome RN - knowing the technical aspects, emergency management (IMO, a major weakness of outpatient clinics), and nursing as well. You should definitely look into acutes, I just started there 6 weeks ago and like it a lot.

    Best wishes,

    DeLana
    Hey No problem...I should have been more clear on her "weakness" on my earlier post...yeah that patient had quite the loss...trust me I had to clean it all up...LOL!!! We even had to trash the chair she was in..cause I did not feel I could get it cleaned adequately!! I saw that patient a couple weeks ago and she is still kickin!!! The Nurse did not get fired...I believe she had some "retraining" and they have put her on slower teams with less patients and fewer problem people...but as we all know...even a usual non problem person can all of a sudden turn on you!! I just may look into an acute setting and thanks for the encouragement!!:icon_hug:
  8. by   LPN2RNBSN
    What you are expressing is really scarey. A tech who has that type of attitude working with patients - no good! Also, I have a problem with the techs that I see who silence an alarm without further checking to see if the patient is ok - with elevated AP/VP and blood pressures out of range. I do not believe the training/education for technicians meets their role of expectations - meaning they are the ones who are wiht the patient most of the time,therefore, one would think they would have been training. It is unrealistic for anyone to think that the RN for 16 patients can assess every patient and do other duties as well.
  9. by   DeLana_RN
    Quote from LPN2RNBSN
    What you are expressing is really scarey. A tech who has that type of attitude working with patients - no good! Also, I have a problem with the techs that I see who silence an alarm without further checking to see if the patient is ok - with elevated AP/VP and blood pressures out of range. I do not believe the training/education for technicians meets their role of expectations - meaning they are the ones who are wiht the patient most of the time,therefore, one would think they would have been training. It is unrealistic for anyone to think that the RN for 16 patients can assess every patient and do other duties as well.
    Well said.

    One RN for 16 pts is a bit much (assuming that there are no LPNs present) ... what are these companies thinking?!

    DeLana

    P.S. Some states do require that techs pass rigid certification tests - but far too few do. Sometimes, a tech may have no medical background at all And no, they should never be allowed to give meds (heparin) or do assessments, but in too many states they are
  10. by   sandytambo
    I am on my 8th "training" day at Da Vita.I am a new LPN and the LPN I was replacing just up and quit. The preceptor tech sat me in an office for 2 days with manuals and then "trained " me on the machine. I was then informed that I have to give all patient meds and all assessments before patients get on.I am pulled in a million directions all the while the Techs are snickering and acting like I should know what I am doing because I am a "nurse".This friday I was told that come Monday I will be on my own.So I am now freaking out because #1I don't know what I am doing, and #2 I do not want to jeapordize my license and # I don't know what I am doing!!! I tried to explain it to the RN charge nurse but all I keep getting is attitude.The administrator nurse is never in the building.I was told when I was hired that I would be properly trained for this job! Ha! And the "employer of choice" motto is a joke to me now.I really wanted to work for them but if this is the way the clinics are run,I worry about the patients.And don't get me started on the whole Epogen topic!!! Thanks for having a place for me to get info, visit friends and occasionally RANT!!!
  11. by   LPN2RNBSN
    We all know that the administration of Epo is in the media's attention now. Much has been written, including Medicare revising what they are doing with Epo.. Also, several months ago the House Ways and Means Committee convened and questioned many about the usage of Epogen. I would encourage you all to read the information. Also, there is a great website that has it all. www.assndialysisadvocates.org This is a patient advocacy organization and they have facility surveys on their site - not all - but many.
  12. by   LPN2RNBSN
    This is scarey reading all about training RNs. Do these companies not care about patients. If someone (RN) is interested enough to work in this area then the companies should provide adequate training. I wonder how many patients die due to those who are providing care and do not have enough training? This is scarey. FMC has a 12 training for RNs but still new RNs need to understand in order to problem solve esp . Goodness. Isn't the RN also suppose to supervise technicians? who is aware of medical comorbid problems/conditions and how to intervene? I always thought the RN. Wouldlike input from others on units in S.Diego. Am thinking of moving there again. Although the one unit I am at the northern LA area is not bad.
  13. by   DeLana_RN
    Santam,

    my first reaction to your post was "Run, don't walk out of there" (no need to list them on your resume), but I'm sure that's not what you want to hear.

    I worked for Gambro until the merger (now in a hospital acute unit) and therefore don't know how things have changed under DaVita. However, back in '99 I received 8 weeks of training (including 2 weeks out of town classroom instruction), and the preceptors were only nurses, usually LPNs.

    But you're only getting 2 weeks training by a tech? Unless you have previous dialysis experience (which you don't mention), this doesn't sound right. It is definitely very inadequate considering all the responsibilities you will have as a dialysis nurse (you need to know everything the techs know, plus a whole lot more).

    You need to talk to your hiring manager a.s.a.p. I wish you the best of luck, dialysis nurses are in such demand... it's a shame if the clinics run them off due to poor training. I hope this doesn't happen to you.

    Keep us posted, and come back for answers and support (and venting!)

    DeLana

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