HD orientation?

[kdunurse]

I just finished my first week of orientation on a 19 chair hospital HD unit - most of the patients are outpatient, but some inpatient (I will be learning acute dialysis, but for now just the chronic). We have 10 RNs, 6 LPNs and 2 PCTs, so the nurses do most of the work, including starting/ending runs, assessments, dressing changes and meds. We do have a team leader to handle most of the orders and phone calls, scheduling, etc. My question is this: is 5 weeks enough orientation to be able to function independently? I'm an experienced surgical RN, but I'm overwhelmed at how much there is to learn, both theory and practice - after 1 week, I still don't feel like I have the hang of the machine, let alone the rest of it. How long is a reasonable orientation?

[traumaRUs, MSN, APRN]

I don't think 5 weeks is adequate. I'm an APN, I've never done HD nursing. However, I go to multiple HD clinics that are Fresenius. FMC gives RNs 12 weeks of orientation - combo of classroom and on the floor. 5 weeks isn't enough.

[anurseadvocate]

I agree that five weeks is not enough. Experienced HD nurses will tell you that sometimes it takes years to become seasoned e.g. being able to trouble shoot when machine problems happen --identify potential problems that patients are having because of individual medical needs, being able to direct a technician when he/she comes to you for direction... RNs need to make judgement calls -- I have been told, by several RNs in outpatient units, that they rely on technicians to make their own judgement calls.. I have been informed also by FMC RNs that often they allow technicians to make judgement calls.. for me, this is not ok in many situations due to the complexity of the treatment process. Although FMC and maybe Davita, as well, do 12 weeks training, often RNs are not given the training related to ALL the faciity policies and procedures and often this is identified in the facility survey. Having recently sat on a major task force for an insurance company - related to dialysis, as well as consulting with an insurance company -- I did find that, as mentioned, RNs are often put on the floor and given responsibilities that they are not prepared for... I always advise RNs to make sure they are comfortable prior to being put in any position of responsibility. just my opinion ---

[550Qb]

5 weeks is nowhere near enough. If I were you I would request several weeks to work with a PCT prior to learning the nursing role. Once you are comfortable with the PCT role and you can set up, put on, take off, tear down, and trouble shoot machine problems.... then you can start worrying about training for your nursing tasks. You're already a nurse- it's all about learning to prioritize and manage your time in terms of nursing tasks. Your job as a nurse will be a lot more manageable once you're capable of helping the techs out and you're not intimidated by the tasks you aren't familiar with (the "tech work").

[kdunurse]

I may not have been clear enough - in our unit, there are only 2 PCTs so the nurses string and tear down the machines, program them and start and end treatments. In other words, we do the work of the PCT as well as the nurse. I have a fantastic preceptor, but I can't imagine being able to do all the work of the PCT plus assessments, meds and troubleshooting by the end of 5 weeks. How long did everyone else get for orientation?

[anurseadvocate]

In my experience hospital=based units are much different than free standing dialysis outpatient clinics.. ---> as far as staffing goes. In outpatient settings, the technicians cannulate but don't do catheters, in most states, as I understand.. Hospital units have more RNs

[Erikadawn RN]

I work at a vey small and independently owned unit, and I had 12 weeks. Still something different every day.

[anurseadvocate]

Experienced dialysis nurses will tell you it takes years, sometimes, to be really proficient and able to trouble shoot with patient-problems, machine-problems and potential problems.. Dialysis is a life-sustaining treatment that we all know can become life-threatening at any time. Unfortunately, many providers do a cookie cutter training and set machines at the same parameters -- e.g. one patient might be ok with a systolic of 110 while another might be hypotensive, for him/her.. each pt is individual

[rnmariz]

I work as a Clinical Educator in one of the largest dialysis center & training centre here in saudi arabia and we have a lot of nurses from other hospitals come in for training. And i say 5 weeks is definitely not enough. Our orientation and training program lasts for 3 months (practical) & 1 month lectures (theory). Its not just enough to learn how to operate & troubleshoot your dialysis machines, but understanding the theories e.g. basics & principles of dialysis, H.D apparatus, care and use of vascular access, anti coagulation, common complications in H.D, infection control, and a lot more...would make you a better-educated and more effecient dialysis nurse.

[anurseadvocate]

RN MARIZ -- you are ABSOLUTELY CORRECT -- however, here in the US, the LDOs do not provide as much training as you are stating, from my experience and what I am continually being told by RNs, that they don't get enough training and are thrown out on the floor --- Again, I agree completely and you are correct, so hopefully those entering into dialysis field will take heed to what you have stated

[zorabanks]

5 weeks is not enough time for someone new to HD! I had 3 months and that was not enough! It took me about 5 weeks just to learn the machine and I am a fast learner. Try to hang in there if you can. So, far I really enjoy the work, regardless of the overwhelming amount of information to learn. I work with a great team which is a blessing. Everyone has told me it takes at least a year to "really get" it. Good luck to you! :-)