DIALYSIS! I am new in the field and feeling very discouraged


I am loving dialysis but I am so scared that I will never get up to the speed expected of me. I have made the mistake of leaving the saline lines unclampedd 4 times now in just a month of being out of training. The lines were saved once but the others were wasted blood and all. My patient left with more weight than shecame in with. I would like to say that I will NEVER do that again but that's what I thought the first time. I know i need to slow down but I don't have my system or organization established yet.Therefore time management is at its worst for me. I feel so rushed. Does anyone have an organizational system that they would like to share? I hope that will help me slow down and save time? In training we didn't really get a chance to watch others from start to finish it was pretty chopped up. during trainingwi only treated two patients at a time and day one out of training i had four at a time. I have three shifts Monday, Wednesday, and Friday and two shifts on Tuesday, Thursday, and Saturday. Other tech's and nurses help me here and there but it almost feels like that throws me off more. I'm love staying busy but not being rushed! Any advice is greatly appreciated. I just hope they don't let me go before I can prove myself.


55 Posts

Sounds like you are a tech working a 4 patient pod? I am an RN but worked as a tech first. You need a system. Here is mine.

1) Check your 4 patient's orders. If you need a special bath or dialyzer place it at that machine now.

2) Get the needed supplies and string all 4 machines and get them started priming, starting with your earliest patient and moving to your latest.

3) get your heparin, put on supplies ready at each chair, again going from earliest to latest.

4) get your pre- documentation i.e., machine checks, chlorine/chloramine in the EMR.

5) check with your team leader for any special instructions re labs, special meds like antibiotics being given or schedule changes.


7 Posts

Yes idodialysis . They are waiting for me to get this part down and then train on meds. I am also doing the focused assessment and catheters. What you have mentioned above I have down pretty well unless I run into some trouble while the machine test which may slow me down a bit. The trouble I'm having is change over when I have them coming off and others coming on while documenting and accessing and restringing new lines. Change over is very difficult for me. My CN tells me to write everything down and input in the computer later but that just seems to disorganize and slow me down more. :dead:

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.

Thread has been moved to our Dialysis forum for more feedback.

Chisca, RN

745 Posts

Specializes in Dialysis. Has 39 years experience.

Don't start a new treatment until you have finished charting on the previous patient. This will upset a your charge nurse and maybe the next patient but you are a nurse not an assembly line robot. Nursing requires assessment and judgement. The mistakes you are making with saline are a result of not finishing before you start on the next treatment. This is very hard and why there is so much turnover of staff in the dialysis world. Kent Thiry, CEO of Davita, can't make 26 million a year if you don't hurry up. Persist and you will eventually find your rhythm.


7 Posts

Thank you Chista! You are so right. Im loving my job but not putting the patients in jeopardy. I'm going to take your advice and if they get upset oh well.Atleast I know I'm doing what is in the best interest of the patient. Can't wait to find my rhythm and speed.


10 Posts

I've been in dialysis for 11 years. It took me almost 2 years to say, "I might like this." So, definitely give it some time. You will find your way of doing things. But, if I had any advice to give, what works for me is to prepare as early as possible. Sometimes, starting my day 15mins early helps me stay ahead of the game. Ask your FA if it's okay to clock in a little earlier until you get the swing of things..


7 Posts

adsmithrn you are so right. I do come in a little early but I don't get paid for it which is fine with me being its only between 15to 30 min. That does help my first shift go much smoother. The changeover is what is so challenging. By the time I get everyone on and charting up to time I have very little time to prepare for their coming off and the next coming in. That's where the chaos begins.Patients complaining they need to come off early/now to catch their ride ( usually at least 3 of the 4) and the ones coming in for 2nd shift complaining they need to come on now ( unfortunately i usually get them on late). Then we do it all again for third shift. Those change overs are hectic! I am slowly getting to where I have their supplies ready ahead of time. For each shift. Wowzers my head spins just thinking about it. My manager actually told me some people just learn slower than others! :( The guy that was in training with me is doing pretty well but he is a tech only. Therefore he doesn't do assessments or put on catheters. I wasn't even trained on catheters until I was " on my own" and they expected me to already have it down. They told me catheters are easy. I do agree now that they are but I still needed to be trained on them to feel comfortable! Thank you all so much for your support. No one outside of work understands what I'm going through so this really helps. You all are very encouraging❤


10 Posts

I definitely know how you feel. It will get easier/better. I always encourage new nurses/ techs to give it at least one year before quitting. Dialysis is, in my opinion, challenging and rewarding at the same time. I couldn't see myself in any other field [emoji57]


7 Posts

Yes adsmithrn, I'm not going anywhere I just hope they don't get impatient and fire me!í ½í¸ž


155 Posts

It does take a couple of years to finally get out of the task mode. My rule of thumb when I'm talking to new nurses and PCTs is that when in doubt, clamp it. If it's clamped in error, the machine stops and you have time to think it over. If it's opened in error, you have a mess and hopefully the machine stops before it becomes a crime scene.

How long was your training? Most training periods are 3 months. Your catheter training should have been completed before you were put on the dialysis floor by yourself. You should have been completely trained and checked off. Therefore you should talk to your manager Charge nurse is giving you instruction for best out comes. How are other technicians charting? It is very difficult to e chart during a change over. So write down the information and put it down at non change over time.Final assessments are done by the charge nurse. Are you an LVN or RN? LVNS in the dialysis units are considered technicians. It is most important to get the patient on in a timely manner. That means 15 minutes within their schedule time. Most patients have prearranged transportation and shortening the treatment time is not following the prescribed treatment time ordered by the physician. Working off the clock is not recommended due to insurance issues. It sounds like your whole predicament starts with improper training. Once you are on the floor, every one in else is their own assigned role.