clinical experience for nurses and new ESRD regulations

RRN · Apr 3, 2005

I would like your feedback and opinions regarding the following. I can see that you all have a wealth of knowledge and I have learned much from you all.
In reading through the new ESRD proposed regulations, I note that there is only 12 months of clinical experience and either 3 or 6 months of dialysis experience needed to work in a dialysis unit. I have some concerns regarding the 12 months of clinical experience due to rising age of population, comorbid conditions, multiple medications, etc. What are your thoughts. The regulations state the supervising nurse and charge nurse need these above qualifications. thanks.

How many months do you suppose a nurse has to have to work in an ICU?

ageless · Apr 3, 2005

This is a typical standard throughout the medical profession for specialty and non speciality areas in acute and chronic care. This includes dialysis, ICU, OR, recovery room, chemotherapy, the list can go on forever. It also includes respiratory therapy, social work, physical therapy, etc. :uhoh3:

How much clinical experience do want your physician to have before he/she manages your rising age of population, comorbid conditions, multiple medications, etc. :stone

jnette, ASN, EMT-I · Apr 3, 2005

I would like your feedback and opinions regarding the following. I can see that you all have a wealth of knowledge and I have learned much from you all.
In reading through the new ESRD proposed regulations, I note that there is only 12 months of clinical experience and either 3 or 6 months of dialysis experience needed to work in a dialysis unit. I have some concerns regarding the 12 months of clinical experience due to rising age of population, comorbid conditions, multiple medications, etc. What are your thoughts. The regulations state the supervising nurse and charge nurse need these above qualifications. thanks.

Really, imperial...

You say you are (were) a nurse.. surely you see this question is just a bit overboard ?

How many months of clincal experience did you have before you were allowed to practice in YOUR chosen field ?

"rising age of population, comorbid conditions, multiple medications, etc."... are these not found in ALL areas of nursing, not just dialysis? :confused:

RRN · Apr 3, 2005

This is a typical standard throughout the medical profession for specialty and non speciality areas in acute and chronic care. This includes dialysis, ICU, OR, recovery room, chemotherapy, the list can go on forever. It also includes respiratory therapy, social work, physical therapy, etc.
How much clinical experience do want your physician to have before he/she manages your rising age of population, comorbid conditions, multiple medications, etc. :stone

Isn't this just a bit of a harsh answer.. After all the woman is trying to learn...

ageless · Apr 3, 2005

Isn't this just a bit of a harsh answer.. After all the woman is trying to learn...

It is obvious that we disagree on Imperial and his motives. I choose to believe that he/she is trying to improve dialysis outcomes just as we all are. That is a honorable goal for all of us. Open and honest communication about what is right and wrong with the nursing profession is where change can occur.

My answer is not harsh, but rather thought provoking.

Snide comments directed to individuals in a conversation never bring us in the right direction.

rnnow1 · Apr 3, 2005

I'm not surprised by this. After all dialysis providers have replaced nurses with techs as much as possible. From what my employer tells me, techs are often used in the critical care areas of the hospitals in metropolitan areas, administering the dialysis treatment. There the primary RN is responsible for EVERYTHING with regard to the patient's care and safety. The tech has limited knowledge regarding the pt's overall condition and what hemodynamic changes mean. This is very disconcerting to thoses of us who have worked as acute dialysis nurses. Let's face it...some the docs, as well as the people we work for would have a bunch of chimps doing the treatment if they thought they could get away with it because they do not spend the time at the bedside and they have forgotten and no longer CARE that an experienced, RN with good clinical skills is BETTER equiped to give a SAFE treatment and the patients will be dialyzed with better accuracy. The truth is: The dialysis nurse in an acute setting needs to have a good understanding of the drugs being administered, and what the hemodynamic readings mean. If you have the knowledge and demonstrate these skills when dialyzing pts in ICU, you will gain the other nurses trust, cooperation and comraderie, not to mention the respect of the nephrologists.

What say you?

RRN · Apr 3, 2005

I'm not surprised by this. After all dialysis providers have replaced nurses with techs as much as possible. From what my employer tells me, techs are often used in the critical care areas of the hospitals in metropolitan areas, administering the dialysis treatment. There the primary RN is responsible for EVERYTHING with regard to the patient's care and safety. The tech has limited knowledge regarding the pt's overall condition and what hemodynamic changes mean. This is very disconcerting to thoses of us who have worked as acute dialysis nurses. Let's face it...some the docs, as well as the people we work for would have a bunch of chimps doing the treatment if they thought they could get away with it because they do not spend the time at the bedside and they have forgotten and no longer CARE that an experienced, RN with good clinical skills is BETTER equiped to give a SAFE treatment and the patients will be dialyzed with better accuracy. The truth is: The dialysis nurse in an acute setting needs to have a good understanding of the drugs being administered, and what the hemodynamic readings mean. If you have the knowledge and demonstrate these skills when dialyzing pts in ICU, you will gain the other nurses trust, cooperation and comraderie, not to mention the respect of the nephrologists.
What say you?

Dialysis has been "dumbing down" for years. In it's infancy dialysis was only done by Physicians then only RN's and now techs.. Some of the technical aspects are acceptable to be performed by techs. i.e. sticks. After all teenagers are inserting IV's all the time in our big cities and small towns. IV drug use......

Most of the lowering of standards are money driven ..Sorry to say. I for one won't work for less. I am highly skilled and studies have shown in every aspect of nursing that an RN makes a difference. When the powers that be realize that RN's make a difference in their bottom line long term it will be a great day in nursing. Do I think it will happen in my life time.. Probably not..

As an aside I see the ESRD regs require that the SW have a Master's HMMMMM..

Do I want to see dialysis go back to physicians. Certainly not. For one thing dialysis is a nursing function. Nursing is an art as much as a science.

Case in point.. We have a patient who has severe anxiety attacks on dialysis. The physician and CM (BTW) wanted medication. She got a scprit for Xanex but didn't take it until just before treatment and of course it hadn't kicked in. So when she went into her anxiety mode I used my nursing skills to reassure her that she was fine.. Telling her that she was anxious and that we were right here helping her... Worked as well as the medication. I bet she could get through the anxiety attack if we had time to "talk" her through it.

Tech have their place in dialysis but not as a sole caregiver certainly.

imperial · Apr 4, 2005

Dialysis has been "dumbing down" for years. In it's infancy dialysis was only done by Physicians then only RN's and now techs.. Some of the technical aspects are acceptable to be performed by techs. i.e. sticks. After all teenagers are inserting IV's all the time in our big cities and small towns. IV drug use......
Most of the lowering of standards are money driven ..Sorry to say. I for one won't work for less. I am highly skilled and studies have shown in every aspect of nursing that an RN makes a difference. When the powers that be realize that RN's make a difference in their bottom line long term it will be a great day in nursing. Do I think it will happen in my life time.. Probably not..
As an aside I see the ESRD regs require that the SW have a Master's HMMMMM..
Do I want to see dialysis go back to physicians. Certainly not. For one thing dialysis is a nursing function. Nursing is an art as much as a science.
Case in point.. We have a patient who has severe anxiety attacks on dialysis. The physician and CM (BTW) wanted medication. She got a scprit for Xanex but didn't take it until just before treatment and of course it hadn't kicked in. So when she went into her anxiety mode I used my nursing skills to reassure her that she was fine.. Telling her that she was anxious and that we were right here helping her... Worked as well as the medication. I bet she could get through the anxiety attack if we had time to "talk" her through it.
Tech have their place in dialysis but not as a sole caregiver certainly.

Yes, you do understand the mechanics as well as others on this board. The RNs need to be skilled.. I appreciate bringing to my attention that one years experience is pretty standard... however, just seems there are so many things that can go wrong and that more experience would be needed. thx.

rnnow1 · Apr 4, 2005

Agreed. And off I go this AM @ this our to provide 3 acute bedside treatments in an ICU and CCU. Our docs order mainly 4 hr. txs. It'll be a long day...see you later.

Dialysis has been "dumbing down" for years. In it's infancy dialysis was only done by Physicians then only RN's and now techs.. Some of the technical aspects are acceptable to be performed by techs. i.e. sticks. After all teenagers are inserting IV's all the time in our big cities and small towns. IV drug use......
Most of the lowering of standards are money driven ..Sorry to say. I for one won't work for less. I am highly skilled and studies have shown in every aspect of nursing that an RN makes a difference. When the powers that be realize that RN's make a difference in their bottom line long term it will be a great day in nursing. Do I think it will happen in my life time.. Probably not..
As an aside I see the ESRD regs require that the SW have a Master's
HMMMMM..
Do I want to see dialysis go back to physicians. Certainly not. For one thing dialysis is a nursing function. Nursing is an art as much as a science.
Case in point.. We have a patient who has severe anxiety attacks on dialysis. The physician and CM (BTW) wanted medication. She got a scprit for Xanex but didn't take it until just before treatment and of course it hadn't kicked in. So when she went into her anxiety mode I used my nursing skills to reassure her that she was fine.. Telling her that she was anxious and that we were right here helping her... Worked as well as the medication. I bet she could get through the anxiety attack if we had time to "talk" her through it.
Tech have their place in dialysis but not as a sole caregiver certainly.

dikay · Feb 7, 2007

In an attempt to learn more about dialysis, I chose to read this discussion. This has all been very entertaining, reading your comments back and forth to each other.

I just have a couple of things to add. Imperial: I would suggest that if you have questions regarding the care that was given to a family member that you ask that nurse or physician that was caring for the patient. I am a firm believer of being a patient advocate, but I also believe in giving nurses the respect we deserve. And RRN, your comments were a little harsh, even though you were aware of why the questions were being asked. Maybe you have been working in the medical field too long. lol.

:nurse: Take Care.

Di

Chipola · Feb 12, 2007

I take some offense to the comments about techs. A tech is only as good as the nurse above them allows. If the nurse provides education (about hemodynamics, drugs, labs, ex.) to the tech then the tech can be a much better provider. I have been in dialysis for eight years. Six years as a tech, two as a LPN, and I graduate from RN school this May (YEAH). I gained the majority of my dialysis education through my tech years and if I may say so I was a pretty good tech. I'm not saying that there are not bad providers out there , but don't lump everyone into one catergory.