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  • Dec 19 '12

    Originally Posted by Natkat

    Anyway, from what I understand the nurse in the story drew up the bleach into syringes. I've been in dialysis four years and I've never drawn bleach up into a syringe for anything. This had to be deliberate.
    I have seen dialysis nurses and techs draw bleach into syringes, and I have done it myself. Let me explain.

    I worked from 1999-2005 in an outpatient dialysis clinic for a company that was later bought by DaVita. We used COBE dialysis machines, which are cleaned internally with bleach (and once a week or month, respectively, also disinfected with other chemicals) at the end of the day, i.e., after the last patient is off the machine. The daily bleach cycle ended with a rinse cycle, which was to remove the bleach. However, because this rinsing could get interrupted (e.g., power problems), it was imperative that the machines' drain fluid be checked for residuals before they were turned off for the day. In addition, workers had to check the drain fluid again for chemical residuals (bleach or others, depending on which was last used) first thing in the morning. For this, we had special test strips for each chemical. These procedures were spelled out in great detail in the company P&P and drilled into all workers who worked with the machines (RNs, LPNs, PCTs, reuse techs) during their training period.

    The machines also had a special drain, called the "WHO", that was used when a patient's treatment was started (the dialysis lines and dialyzer were primed with saline, which had to be removed at the beginning of dialysis to avoid adding additional fluid to the patient's circulation. The worker had to be vigilant during this procedure ("dumping the prime") to prevent some of the patient's blood entering the WHO. However, occasionally this did happen and even a few blood cells in the WHO (the line was pink) required the that the WHO be disinfected with a syringe of bleach before the next patient was put on this machine. Therefore, you would draw up a syringe, 10cc usually, from a bleach bottle (there are many in a dialysis unit, bleach has many uses) and inject it into the WHO. Done correctely, there was absolutely no danger that any of this bleach could get to a patient (it was possible to do this procedure withthe current patient on the machine, since the WHO was just a drain, but I normally put a note on the WHO reminding me to do so after the pt was off. However, this wasn't mandatory.)

    Eventually, a new procedure was mandated for starting a dialysis treatment (forbidding "dumping the prime"*) which would make it unlikely that the WHO would have to be bleached during the workday.

    That said, there are also some facts about outpatient dialysis clinics that need to be considered.

    In my experience, dialysis does attract some troubled nurses (e.g., hx of substance abuse). In general, it's difficult to attract nurses to outpatient dialysis. The work is hard, exhausting, sometimes demeaning (the lines between nurses and UAPs are very blurred in dialysis; many techs have bad attitudes and are difficult to deal with. Due to staff shortages, this insubordination is usually tolerated by management.) The patient load is heavy (assembly line nursing comes to mind, especially during 'turnover' when one group of pts is taken off while the next group has to be put on the machines) and the hours are bad. If you like to do things right, avoiding "shortcuts" and following the law (e.g., that UAPs cannot give meds), it is very difficult. Plus, RNs have a lot of responsibility as there is rarely a physician on the premises, and often only a single RN.

    So why do I think dialysis is attractive to nurses who have problems? Well, I have seen it in several of my coworkers (one RN was in an intervention program for diverting drugs in her previous job - there are no narcs in a dialysis clinic; another was an alcoholic). Most nurses allowed their assigned UAPs to illegally give heparin boluses and other meds (so they wouldn't have to leave their own assigned pts to do so for the UAP) and many took short-cuts violating P&P and, sadly, patient safety. It is a high-stress, very fast-paced environment. Checks and double-checks are in place, but what good do they do if they're not followed? (e.g., to avoid putting a pt on another pt's dialyzer, two staff members had to verify the pt's name on the dialyzer. I know of several times when a pt was put, or almost put, on the wrong dialyzer (and those are only the ones that were caught). In each case, the LPN in question was "written up". Several times for the same no-no offense (remember, staff shortage). Common short-cuts also included not checking the machines for chemical residuals (essentially trusting that the rinse cycle had worked, or that "someone else probably did it").

    And my point? Well, I find it very hard to believe that a nurse, even a trouble one with a hx of drug divertion, would deliberately inject syringes of bleach into a pt's blood lines. I don't see that such a deed would not be immediately caught (for instance, there has to be an RN on the premises, she could never have been the only nurse there). Injecting even a trace amount of bleach directly into the bloodstream would cause intense burning and pain immediately, not something that would manifest later.

    More likely, P&P was not being followed here. This relatively new nurse may have felt the pressure of having to keep up with the frantic pace ("team mates" are very unforgiving when you're "slow") and took irresponsible short-cuts, including not checking bleach residuals (bleach in the machine would affect the pt's blood indirectly, via the dialysate, and cause hemolysis. The bloodline could show traces of bleach). She may have dumped the prime, contaminated the WHO, and drawn up bleach to inject into the drain (dumping the prime is no longer allowed, but I know this doesn't always mean much in a clinic; I had nurses try to encourage me to use forbidden procedures - e.g., squeezing the bag; dialysis nurses know what I mean).

    * * *

    I guess I find it hard to believe someone with no previous hx of pt harm (I assume) would use bleach to try to kill pts... why not simply use air? This could easily happen and be more easily covered up. My guess would be extreme negligence and carelessness - and who's to say that this one nurse wasn't made the scapegoat for others who were equally careless (e.g., not checking residuals). The very limited facts given in the media make it difficult to say (I assume the nurse did not confess).

    Just my .


    *Rumor had it that this was because a careless worker had walked away from a patient while dumping the prime and much of the patient's blood drained out of his body, leading to his death. This was never officially confirmed, however.

    Please note that I have focused on the "bad" in dialysis here. I have to add that there are also some excellent nurses and techs who work in this field and would never take short-cuts or do other unethical things that could put pts at risk.

  • Dec 14 '12

    Actually sailornurse, you are incorrect. I am working towards the nurse clinician educator and I had to take the same three core courses you listed right along with the NP students. I can still be an NP in the future with these courses, I would just have to do a post-masters certificate with a couple of more courses plus clinical hours.

  • Jul 17 '12

    The only good thing is that you actually get adequate staffing during their visits... hmmm...
    JCAHO knows every place they go is putting up a good front, so what the point?

  • May 29 '12

    Sometimes, I think that some techs just make stuff up, then they start believing what they are saying.

  • May 29 '12

    I am cuurently working with FMC, sub-acute (nursing home program). I recently completed my dialysis training. I was precepted by a Tech who has 15 yrs of dialysis experience. She is just great. She knows her job very well. Now I am the charge nurse (we have a one nurse, and one or two tech team with the nurse being the charge), and my preceptor is my Tech. My preceptor was upset that I got less training than I was supposed to, and believes that I will not be able to handle the situations. I am new to dialysis and I know there is a lot to learn. But I just feel that unless I am given the opportunity to handle the situation, I will never learn. If I show confidence in preceptor/tech would say,,,, "I would not dare being that confident with just few months of training". I must admire that she knows a lot, but she has very much hard time accepting that other people also know as much. When a patient admired me for doing a good job, she told the patient to "give her some time because she is very new in dialysis". A patient was very comfortable with me, letting me do everything until she told the patient that I had no dialysis experience and I had just been trained by her. Next day the patient asked me if I knew what I was doing.
    I am 30 years younger than her, and new to dialysis. It seems like she is just not comfortable with the way I deal with things. I am clam most of the time, dealing with difficult patient or trouble shooting. I don't panic..thats just me. If I say I will take care of something...she tries to scare me. She has been repeatedly telling that when she goes on vacation, I may not have as strong tech. as her..and I might be in trouble. I said "well, we will learn together". She was so disappointed that I was not even afraid. She doesn't directly say that she wants to see me anxious, confused, lost, but the way she puts on looks like she just wants to instill fear about the dialysis. I think it is mostly because she always wants to have certain control over it.
    I think after they train the nurses, techs have very hard time accepting the nurse as their charge. They probably want the nurse to depend on them.

  • May 29 '12

    No code meds can be given unless the MD is in the building and he is there maybe once a month for only a few hours. So for a code you can do compressions and AED if necessary etc, but really you are just trying to keep them alive until the EMS arrives. And my clinic on 3rd shift has just me and one tech, so that means she calls 911 while I rinse back and try to code. Heaven forbid she is in the restroom or something. We do not have enough staff to properly code someone. Also the code cart cord is too short to reach a plug behind the machines, and even though this has been reported numerous times in writing, nothing has been done about it. We are not permitted to use extension cords. So really the AED is a decoration.

    Assessments are pre and post treatment. Vitals, lung sounds, edema, etc.

    I really enjoy dialysis much more than I did Med Surg, because dialysis although crazy busy does have some routine and regular schedules. It is predictable and you get to know the patients so you know their normals and when somthing is wrong. It is the same comorbidities ou deal with day after day unlike med surg where you are expected to remember something you have not seen for 8 months.

  • May 29 '12

    I'm not disagreeing with this per post say but it does sound a little holier than thou almost like your trying to bolster your self esteem by point out in detail the flaws of someone you don't really know. I'm an agency nurse. I love being an agency nurse but I do have situations where a staff nurse will assume I am incompetent simply because they don't understand that I'm talking about something on a slightly more complex level.

    Good on you for going to extra mile. But don't make one person a scapegoat for your own ego.

  • May 24 '12

    I started dialysis in TX, and imo, the bad attitude of dialysis techs re: nurses is very common in TX, especially in FMC units. I became a traveler and found it is not that way in a lot of other states.

    You earned the title nurse, and please refer to yourself proudly as a nurse. Techs are techs. They earned that title and should use it proudly. Poorly defined and poorly delineated role of nurses and techs is a big problem in TX.

  • May 3 '12

    Your article is true.I've worked there for four years as hemodialysis nurse without experienced from the Phils.but I had my training before I handled patient.I just want to share my experience is that most saudi nurse are lazy.They will come to the unit to continue their sleep from their house,often seating and eating without any motivation to learn that's why they are obviously fat.Knowing they have high salaries!That for us is nothing to do because were just foreigner.Salary deduction or bad mouthing from the wacher or director if something happen to the patient.But if the the native who had fault 'malise'for arabic sorry!

  • Mar 6 '12

    "d" is a fine company to work for but working the floor as a new grad is no joke. Some clinics are terrible places to work, just like some hospitals and nursing homes. I started as a new grad at a "D"clinic, it was not my first choice, but it has worked out for me wonderfuly. Do not expect to take a vacation for the first year in any nursing job. If you have a job that you would rather take take it. If not be happy "D" want to spend the money training you. The thother big company "F" is a fine place to work as well.

  • Feb 25 '12

    Quote from laborer
    ........... National Nurse United is the union you want to talk to.......
    True - you can find them online. They (we - I'm a member in another state) currently represent about 6 or 7 hospitals in Texas - I can't remember where all of them are, but I know they include Corpus Christi, Brownsville and McAllen. And in areas where things are not yet ready to organize workplaces, there are metro committees working to support better legislation for nursing.

  • Feb 14 '12

    I spent many, many years living and working in the US before returning to Canada last year. I was overworked, underpaid, and had no health insurance while working in an LTC in Florida.

    I'm back in Alberta. I love my union and am grateful for every negotiation and ratification that has gone on. I'm not sure who my union rep is, but it would be easy to find out. I'm grateful that my rep would be standing beside me if I had an issue with my employer.

    So, OP, was your union rep talking about your job or another company? Unions will often band together to protest against another company that is mistreating its workers.

  • Feb 14 '12

    Aylix while you are so comfortable in your position it is due to the work of previous employees and union reps , gaining the pay and conditions you are presently working under .
    I wonder how quickly you would be on a thread if you were employed by a facility that did have bad working conditions and poor pay , complaining about your lot there .
    seems you are as my mother would put it " happy in your misery "

  • Feb 14 '12

    I see you are in Canada. I am glad things are fine for you and generally in your line of sight.

    However, things may be very different in other countries, facilities and units.

    I live in the US, and generally working conditions in non-union facilities, like nursing homes, are orders of magnitude worse than union facilities like hospitals.

    I would love to get you a job in one of those non union facilities and count the minutes until you run screaming.

    But I cannot. So you may continue to enjoy the working conditions that were in part fought for and won by your past and current union representatives while you pee all over them for their effort. Classy.

  • Feb 14 '12

    Wow! Right to work, Right to be fired without any reason. So can you be fired for Union activity. The fact is they can't say you are being fired for the union activity. But yes you can be fired, and most likely you will be. Another question to add is who looks out for the safety of the nurse in NC? The board will be the first to tell you, they are there to protect the public from poor nursing. But make no stand of nurse/pt ratios. Where as a Union would be an advocate for both the nurse safety, and would be a soapbox for nurse situations that the management, or higher ups turn a deaf ear to. Any nurse who really thinks that their employer is covering their liability is a fool. ALWAYS cover yourself with your own mal-practice insurance. When it comes to your job/career and the companie's PR. YOU LOSE! Why no unions in NC?. Right to work state is all for the employer's benefit...I know of contrated healthcare provider corps that will only work in the Right to work states. Not all but many nurse have been drinking the cool-aid, of "You don't need an outsider to do you speaking"(Unions). True you can talk, present and complain and they will listen to you. Then do nothing!!!!! Good luck........