dialysis nursing...i want to run fast and far away

Aaic · Oct 30, 2014

You're 6 weeks in so are you still going to classes? I'd bring it up with your instructor if that's the case. If not, I'd ask for a different preceptor. Dialysis is hard ( 4 years as a tech, currently a nursing student). It's also not for everyone but rule of thumb is that it takes 6 months to "get it". Also, a hypotensive pt close to their dry would still need dialysis to filter the blood. Where I work the pt would be put to a minimum filtration and Bp monitored q15. Also, make sure to ask the pt if they have taken any Bp meds or opioids pre tx. Hang in there.

FransBevy · Oct 31, 2014

That toxic environment will poison your life and the clinic manager should be on it like white on rice. Talk to her and see what happens.

RN yogi · Oct 31, 2014

i told her straight up that this was the most toxic work environment i've ever been in. her response was "i know." she said she was going to have a staff meeting about it next week. meeting shmeeting. from what i understand this has been the culture there for years. i don't think i'm being pessimistic when i say that a meeting isn't going to change anything, especially when people have been allowed to behave in this manner for such a long time.

Chisca, RN · Oct 31, 2014

You are being oriented by a tech? There's your problem. A tech cannot teach you how to assess a dialysis patient.

Guttercat, ASN, RN · Oct 31, 2014

i told her straight up that this was the most toxic work environment i've ever been in. her response was "i know." she said she was going to have a staff meeting about it next week. meeting shmeeting. from what i understand this has been the culture there for years. i don't think i'm being pessimistic when i say that a meeting isn't going to change anything, especially when people have been allowed to behave in this manner for such a long time.

"Culture" is not something that you will fix as a newbie.

If the situation is that bad, get out now. If you think you can hang in there for a time until you get your bearings, by all means stick with it.

I do agree that you and your preceptor should part ways. Just because someone has been appointed your preceptor does not mean they are the best person for you as an individual. Dialysis is a huge learning curve at first. A newbie generally needs a patient teacher to learn the biz; not Atilla the Hun. It sounds like you might have the latter.

My questions to you would be: a.) Do actually like dialysis and dialysis patients? (taking the coworker/preceptor drama fully out of the equation). And if you do like dialysis, then b.) Are you willing to invest in this particular program over the long haul in order to overcome a bumpy start?

Answer those questions, and then bring those answers to your clinical manager. Be prepared to discuss. Good clinical managers can spot a good newbie, and will overlook professional/personal differences between a preceptor and preceptee as long as they believe you are smart, dependable, and worth investing a little extra time in.

donsterRN, ASN, BSN · Nov 1, 2014

I agree with the poster who said being oriented to your position by a tech is a problem. That person may know some stuff, but s/he can't teach assessment, patient teaching, evaluation, etc. It's been my experience that SOME techs, when given the opportunity, will be downright hateful in their treatment of those people they "train". I think that may be what this is. I don't think it's specific to a dialysis unit.

To the OP: can you stick it out until orientation is over? I'm assuming you chose dialysis nursing as a specialty. Once orientation is over, and you're functioning as an RN on your own, you may find that things are better. I believe those preceptors would be the way they are regardless of where they work and who they're precepting; this behavior is not specific to Dialysis nursing. I'd almost advise you not to take their crap personally, but I know how that feels and how very personal it can be. You are correct in that you have a license to protect; you are expected to know what your state's practice act says, and to behave accordingly. Don't let these jerks compromise that. If you don't think you can stick it out, then run, don't walk, out of that toxic environment.

Lastly, here's a hug. (((you)))

madwife2002, BSN, RN · Nov 2, 2014

A tech can train an RN to do dialysis but they can't train the RN to do the assessments. I am sorry you are having such a bad time in dialysis-prior to employment did you not shadow at the clinic? Normally you can pick up the culture when you spend a day there. In dialysis you either love it or you hate it-there just isn't an in-between.

Cultures in some dialysis clinics can be toxic, the culture depends on the manager

RN yogi · Nov 3, 2014

Guttercat, to answer your questions i'm not even sure i like dialysis. i'm not sure i particularly enjoy the patients. some are fun and nice, others are miserable and not afraid to let you know it. i can't say i really blame the miserable ones. i'd be miserable too if i had to live their lifestyle. i've been thinking over the weekend and i've come to the conclusion that i'm going to try to stick it out at least until the RN training is complete. however, i can tell you that i am not in this specialty for the long haul.

RN yogi · Nov 3, 2014

I agree with the poster who said being oriented to your position by a tech is a problem. That person may know some stuff, but s/he can't teach assessment, patient teaching, evaluation, etc. It's been my experience that SOME techs, when given the opportunity, will be downright hateful in their treatment of those people they "train". I think that may be what this is. I don't think it's specific to a dialysis unit.
To the OP: can you stick it out until orientation is over? I'm assuming you chose dialysis nursing as a specialty. Once orientation is over, and you're functioning as an RN on your own, you may find that things are better. I believe those preceptors would be the way they are regardless of where they work and who they're precepting; this behavior is not specific to Dialysis nursing. I'd almost advise you not to take their crap personally, but I know how that feels and how very personal it can be. You are correct in that you have a license to protect; you are expected to know what your state's practice act says, and to behave accordingly. Don't let these jerks compromise that. If you don't think you can stick it out, then run, don't walk, out of that toxic environment.
Lastly, here's a hug. (((you)))

thanks for the hug! i needed it. it really is hard not to take these things personally. and, it's challenging to be trained by someone who doesn't have anything to lose, like say, an RN license. i will try to stick it out. at least until the RN training is over, but will still be looking for other job opportunities meanwhile. dialysis is not my passion. it's just a job i took to pay the bills.

RN yogi · Nov 3, 2014

A tech can train an RN to do dialysis but they can't train the RN to do the assessments. I am sorry you are having such a bad time in dialysis-prior to employment did you not shadow at the clinic? Normally you can pick up the culture when you spend a day there. In dialysis you either love it or you hate it-there just isn't an in-between.
Cultures in some dialysis clinics can be toxic, the culture depends on the manager

i didn't shadow the clinic before i took the position. i will take this valuable lesson with me into the future.

SmilingBluEyes · Nov 3, 2014

Being oriented by a tech is NOT abnormal nor wrong. It's how it's done where I work. We spend several weeks learning the teching side of things, with a preceptor technician. THEN we go to RN classes and spend the next several weeks/months with a precepting nurse. You can not very well be an effective dialysis nurse if you cannot do or understand what the technicians aligned with you do.

One more point; you won't resolve a toxic work environment or culture yourself. It will be futile. If you cannot work like this, it's probably best you move on. You can definitely do what you have already done by bringing it to the attention of the manager,but I doubt much will change. That would require a change in management, not just staff. I would move on if I were you.