encouragement needed

jnette, ASN, EMT-I · Dec 13, 2005

Hello, I am in my second week of my new dialysis job and really enjoy the work but am having a tough time learning the machine. The nurse that I have been paired with to train is not the most patient...she keeps saying how she always has to train the new staff and it slows her down, how she should get paid extra to train but does not. I have gotten no feedback about how I am doing so today I came out and asked her point blank.
Her reply was "well (other nurse in clinic) learned it in 3 weeks". I then asked her was I behind or a slow learner in her eyes and she replied "yes, most people have it figured out by now".
What is the typical learning curve for someone changing to dialysis from another field? I am a BSN with 5 yrs total experience if that matters at all...it does not seem to matter, though, as far as I can tell. My "trainer" is an LPN who has been doing it for about 9 years I think.
i am not going to let her get me down. The ironic thing is that right now I am the only RN in the clinic since the other one resigned right before I came due to a family crisis.
I just need some reassurance that I am not "slow", or maybe someone else to tell me that I am not learning fast enough...then I can take it.

Wow... honestly, it takes a good 6 mos. to begin to feel comfortable with your routine and what you should know in this field. A year to feel "confident".

Your preceptor knows this full well. It is absurd to expect someone to learn the ropes in two weeks. It takes a good three-four weeks to feel like you're really getting the setting up of a machine.

Practice makes perfect. Check, and double check you machine before you step away from it. Make yourself a cheat sheet to keep in your pocket.. write down all the steps to setting up a machine in the order you do it. Keep it with you while you set up, and practice until you know it in your sleep.

Your preceptor is being unprofessional in her comments about not being paid to teach (although I agree with her that she should be) and that she is the one always "stuck" teaching the new person. This certainly does NOT make you feel welcome or confident.. but instills guilt and is intimidating. Shame on her. :nono:

Go at your own pace. Dialysis is NOT something you want to learn in a hurry.. too many mistakes can be made. These mistakes can be fatal.

Please do not allow your preceptor to make you feel rushed or inadequate.

Try to learn one thing at a time. Starting with setting up and tearing down the machines. Go in steps. From there, initiating tx., taking off, etc. Then start looking at labs and meds... all in due time.

As the RN you will be ultimately responsible for all of it there, so please do not allow anyone to rush you.

Dialysis is multifaceted, there is much to be learned. Your BSN really doesn't play into it.. it won't help you learn the ropes any quicker.. practice will.

After you've been there a year or two and feel like you've really got a handle on things, your BSN will be helpful if you are wanting to go into a management position, such as Clinic Mgr./DON, etc. ...which is a HUGE headache at most facilities, and they could not pay me enough to do it ! :eek:

Go easy on yourself, and please don't take her words to heart. Practice, and learn all you can.. make all the cheat sheets you want and refer to them often.

Sounds like this nurse has a chip on her shoulder, but that will have to be HER problem.. she should not be taking it out on you.. or any new person for that matter.

Hang in there. Dialysis is super.. once you get the hang of it... and I know you will ! :)

mtnmom · Dec 13, 2005

thank you Jnette!!! I am really trying to work past her pettiness but most of all am really trying just to learn and to do a good job.

I dont think my style of learning is the same as hers either. I like to use a combination of reading and doing, so a cheat sheet would be great....I was using one and she scolded me for doing so, saying that I was "taking too much time reading" and missing steps ?!?!

I am just praying for strength and that I can master it soon.

jnette, ASN, EMT-I · Dec 13, 2005

thank you Jnette!!! I am really trying to work past her pettiness but most of all am really trying just to learn and to do a good job.
I dont think my style of learning is the same as hers either. I like to use a combination of reading and doing, so a cheat sheet would be great....I was using one and she scolded me for doing so, saying that I was "taking too much time reading" and missing steps ?!?!
I am just praying for strength and that I can master it soon.

Just block her out, and do what works for YOU. I kept my little cheat sheet in my pocket for MONTHS. That way I could always refer to it if I was in doubt about something.

Hang in there.. she might be feeling stressed, too. And somewhat disgruntled. Maybe you can find a way to lighten her mood, and a way the two of you can work better together. Keep a sense of humour ! You'll get there! (((HUGS))) :)

babyboomerRN, RN · Dec 13, 2005

hi! don't let her get to you! it took me about 5 months to stop using my index cards completly! ( i highly recommend you also make index cards w/each step written down for set up,rinseback,etc.) i was not mechanically inclined at all!! it took me about one year to feel confident and capable in my job. i work chronics and acutes, in fact i was recently made lead (charge) nurse of our acute, crrt and pd program! it's a great field to work in so hang in there,it really gets better!!

mtnmom · Dec 15, 2005

thanks to those who replied. today was a better day overall. I am still reminded that I have a lot to learn (duh!) but only had one period when I was close to tears. I am finally getting the hang of machine setup but now have to master troubleshooting. Funny thing is, I was talking to our one tech today and she does everything totally different...she received a VERY thorough training, though, with her prior company and has served as a preceptor herself for techs....as far as I am concerned she is very knowledgeable overall. Everything that she showed me she had a rationale for why she did it that way...I was very impressed.

sassylassy · Dec 25, 2005

thanks to those who replied. today was a better day overall. I am still reminded that I have a lot to learn (duh!) but only had one period when I was close to tears. I am finally getting the hang of machine setup but now have to master troubleshooting. Funny thing is, I was talking to our one tech today and she does everything totally different...she received a VERY thorough training, though, with her prior company and has served as a preceptor herself for techs....as far as I am concerned she is very knowledgeable overall. Everything that she showed me she had a rationale for why she did it that way...I was very impressed.

Your lucky the LPN is only rude, I have been in Dialysis for 11 months now and like you I have had my problems learning the machines and such, my whole way of thinking as a nurse had to change. And I work with the nurse from HELL! She is so insecure in herself that she runs all the good ones off, I stayed and fought, now I am paying the piper, I have been taken off as team leader and put on the floor in a tech position. I am a strong person but I have cried many days, and wanted to quit. After being a travel nurse and a CVICU nurse for 12 years I had no idea what I was getting into. I am hanging in there and the nurse from hell is on another shift most of the time thanks tho Corporate HR. But my supervisor was not please that I went ove rher head since she did nothing to stop the harrassment. Nursing in general is tough, and as they say they eat their young, well i am older then all of them and they have broken me down too. Its a shame we all can't work together for the good of the patientds who need us so desparately. I am their for them not my co workers.

RM23 · Dec 26, 2005

Are these units of which you speak one of the larger companies, i.e. Davita, FMC? To my knowledge there is suppose to be an intensive training prior to being put on the floor to go through, yet another training. Dialysis treatment is not something to take lightly and does, in fact, take alot of education about the machines and physiology. Many mistakes happen especially when staff are short, overworked, have one crisis and then are behind schedule, etc. A simple mistake i.e. taking too much fluid off can cause death, not to scare you, but does happen. There are so many aspects to delivering a treatment and the problem is that many companies train as they want to and do not give full information. A perfect example is that most, after t raining, techs and nurses, will say that bleeding is from too much heparin and will lower the dose without checking any other possible cause. Scarey, you betcha. Many staff only know a few reasons for situations occuring. Now with mostly techs doing the treatments, that is even scarier esp the new ones who are put to the wolves and become omnipotent.. lol... think they know it all.. be the best you can be.. educate yourself.. and go to the higher person and tell them u need to be adequately trained in order to be responsible for deliveyr of care in the unit. if you are the only RN you will be the one held accountable and you wll be the one overseeing the unit. What surprises me that if you are the only RN with little training, and, you will be the one who will take the fall if something happens while u are there,,,,this is a big problem... i bet u work for one of the larger companies lol.

sassylassy · Dec 26, 2005

yes i do work for the largest company, FMC. They do give you extensive training, until you hi the floor, then the nursing supervisor is way to busy to train you when you have a problem. their solution is to tell you , write down your questions and they will answer them. Well sometimes you dont have the time to stop and write them down, not when you are expected to have 4 patients at a time and have them on and running at a specified time, not allowing for machine problems, catheter problems and access problems. It is dangerous for the patient to be expected to be on a tight time schedule without considering these factors.

RM23 · Dec 27, 2005

SassyLassy: Your honesty in what is happening is appreciated and well respected. It is obvious that you have a sincere interest in the patient and shame on FMC and any other corporation that does not have the patient as their priority. In a case such as this, I would think the Nurse Educator/Inservice/Training RN would be there for you. I realize that they travel from clinic to clinic however, it is situations such as this that contribute to errors that can be deadly. It is hard place that we nurses are caught in when we want/need our jobs and then are not provided tools (education, training) that we need to deliver care. Dialysis is a speciality in and of itself and nurses need to be trained as it is the RN who is held accountable when errors occur as well as techs, LVN's looking towards the RN for direction. There are so many physiological aspects of dialysis that whoever is adminstering the treatment really needs to be aware of...ofcourse, to have an untrained tech or nurse not understand fully.. i.e. i overheard a tech say to a patient,,, experiencing chest pain.. 'oh steve (tech) told me that when someone has chest pain i can give oxygen;.. ofcourse not knowing why.. etc.. what if the patient had copd and was given too much oxygen??? goodness,,,, deadly. mistakes do happen

mtnmom · Dec 27, 2005

hi, its the OP again. Today the 3 other nurses in the clinic pulled me aside and asked me how it was going...told me that I am learning slow and what can they do to help me. I stated that I needed something written to refer to and that so far I have been discouraged from using anything. They offered to put me with someone else to train, but I dont know.

Here's the catch...They did this with a PATIENT STILL IN THE CLINIC sitting right next to where we were talking...he could hear every word...I was mortified!!!! I wanted to burst into tears.

I am really starting to think I made a bad choice here. Every day I am so stressed and am close to tears at least once a day. I love the patients and the work is interesting but does it have to be like this????

I have never had a problem learning anything before...although admittedly I am a little clumsy, maybe that is a huge handicap.

I just want to scream, go to sleep and never wake up.

nosonew, BSN, RN · Dec 28, 2005

My first 3 months were a nightmare. Large unit, hateful staff, none of whom had ever heard of teamwork.

When I went to a smaller unit, it was soo much better. Honestly, if I had stayed at the larger unit, I would have ended up quitting. I worked in dialysis 7 years and loved it.

It was unprofessional of those nurses to speak to you in front of the patient, AND I know the Althin machines take a long time to learn (which is what I have always used).

Best wishes...