New to HD & equipment--learning curve??

**nurse** · Aug 12, 2006

Ewwww, I remember that time. I got it better after the RN instructor took us in and had us one after another run saline through an unused set over and over. It ISN'T easy to trust that damn machine to do what it does so quickly. And then it beeps and gets air and you picture a patient sitting there looking at you like you have two heads, but eventually you will get it. Give yourself time, every new nursing job I've had has made me feel stupid all over, but the day arrives when you have a right answer or know you are proficient.

Hang in there!

wordsmith · Aug 12, 2006

Hey, thanks for the good words. Just gotta remember not to get too wired up about it. My husband (the problem solver) is wondering if he should create a mock-up of the fronts of the machines so I can practice with the tubing :) Next he'll want me to bring home one of the Cobes and one of the Phoenixes, too. I think part of the problem is trying to learn both of them at the same time. Hopefully they won't give up on me! It's huge, making this kind of career change at this time in my life, and I so want it to work.

Have a good one!

km5v6r, EdD, RN · Aug 13, 2006

I became a dialysis nurse after 15 yrs in ICU as a preceptor/instructor. It was one of the biggest ego busting moves of my career. I went from being the expert to knowing nothing. I would practice all shift on stringing a machine have it down pat by the end of the day and come in the next morning and literally tie the tubing in knots. What finally worked for me was writing out the whole procedure on 3 x 5 cards and keeping them in my pocket. Personally, studing the manuel did nothing as I couldn't necessarily remember the names they gave the different parts. I developed my own names that made sense to me for the various pieces. Any experienced person probably would have laughed at my notes but it helped me. I can't imagine trying to learn 2 different set ups at the same time. Concentrate on 1, learn it then work on the other. It truely does take about a year to become comfortable in dialysis.

wordsmith · Aug 14, 2006

Thanks for the post. I know what you mean about feeling like you know nothing. I was doing oncology in my last job and I think that's one reason I was hired--they figured I was used to taking care of "frequent flyers" and would also know how to react if one of the chairs didn't have a regular occupant one morning...

The index cards are a great idea. I scribbled sort of incomprehensible notes the other day when one of the PCTs was giving me a tutorial (over and over again, running saline through a machine, poor guy), but I can sure turn those into pocket-sized references. I asked him if this stuff was written down somewhere and he said he didn't think so, we just sort of learned it. I did eventually find it in a policy manual but it was buried deep and dark.

I've had the weekend off and have tried really hard not to think too much about work, put my feet up, got some stuff ready for a yard sale next weekend, things like that, so my head should be refreshed and ready at 0600 Monday morning. Definitely feeling better about it than I was Friday evening, and you have really helped with your post and suggestions.

Thanks, and have a good one!

Farkinott, RN · Sep 9, 2006

It sounds to me like you guys were either putting yourselves under too much pressure or "the system" is not supportive in allowing you to learn. My unit uses preceptors with each new staff member for at least 6 or 7 weeks (i.e. working every shift with them after one or two weeks of being supernumary).

I know many nurses with many years of experience in high tech places like ICU and they go to water when faced with working in the renal unit.

It is so hard when going from a place where you are skilled and capable to somewhere where you have to learn a completely differnt set of skills.

I love my job and love teaching and helping new staff members to get up to speed. The nursing woorld would be a much nicer place if we we all just a little bit nicer to each other and stood up for ourselves and our colleagues.

rizenfly · Oct 4, 2006

I am a new grad of 6 months and went directly into dialysis nursing. It took 3 months to learn the basics of the michines (yes, we also have 2 types). I also fluctuate between 2 units, two different hospitals, and two different sets of dynamics. I wonder every day when I will get the hang of it. What gets me through is evaluating what my weaknesses are and asking people whom I trust and who respect me to help my iron out my problems. (For example: once I started nursing, I forgot how to put the pts. on. In one unit, I don't have to worry. But when I go to the other unit, it is required.) So now I practice that. My colleques tease me about me notebook because I'm always running over to write more notes in, but they also ask to see my notes on occasion! Hang in ther! Let's keep in touch...

kdhnursern · Oct 5, 2006

When I started 3 1/2 years ago, the company was Renal Care Group but now it's Fresenius Medical Care. In training, we were given 3 x 5 note cards with the machine stringing sequence typed on them. They were my bible! I now have a unique situation. My mentor back then quit and went to work for Home Health. Two years later, I talked her into coming back to dialysis:biggringi During that time, we went from Cobes to Brauns and was she lost!!! So, sometimes when things go totally wrong, I tell them she taught me everything I know. And then she'll use the same line when it happens to her.

I don't remember just when it finally hit me, that I finally had this handled. I've been told that things don't become habit until after 3000 repetitions. When I was here a year, I had surgery and was gone for 6 weeks. It took a bit to get back into the swing of things. When I took 2 wks vacation was when we switched from Cobes to Brauns. That was fun! :uhoh3: My facility manager doesn't work the floor often but has been here for 9 years. She makes what we call "ticks" (blood up in the saline bag), forgets how to string machines, forgets some settings on the machine, .... you get the idea. But she is VERY experienced in dialysis. Repetition, repetition, repetition!:yeahthat:

DeLana_RN, BSN, RN · Oct 10, 2006

My training in 1999 was so horrible that it can only serve as a bad example - and maybe give someone else hope :rolleyes: (because I learned HD despite my "training"!)

First, I knew that machines and I don't get along - I had the hardest time figuring out the IV pumps at the hospital :uhoh21: (so why did I go into dialysis? Must have been temporary insanity, LOL). But I thought I had a nice preceptor who was going to be patient with me - wrong! :madface:

First, "SB" didn't want to precept anyone; held a grudge against the manager (who made her do it) for another reason; and guess who she let her frustrations out on? :rolleyes: I was belittled ("Are you ever going to figure this out?"), humiliated (in front of the whole staff, in a loud voice: "Will you ever get recirculation?"), and given useless "advice" ("Just connect A to B to C to D; that's how I learned it!" Well, the A-B-C-D method has never worked for me, because I need to know why I'm doing what I'm doing. You can teach a monkey do connect A to B to C to D, and this doesn't mean he knows why. Neither would I... but "SB" never got that.

She even threatened me with an egg timer: "You have 15 minutes to get a patient on. If you can't get that done, I'll have to get an egg timer. That's what my preceptor did." A-ha.

Did I quit? Did I run? Oh, I wanted to. But it wasn't an option at the time for various reasons. So I had to figure out a way to deal with it. And this is what worked for me, the-most-hopeless-ever-dialysis (RN) trainee:

Index cards. Yes, I looked up my company's P&P (which was great, it spelled everything out in great detail and gave the reason for each step - just what I needed!) and copied the steps onto 3X5 cards (machine set-up, priming, recirculation, and later patient care); I kept them in my pockets, and referred to them often. And guess what, despite (not because of) my "preceptor", I figured out those Cobe machines and came to really like them (later, I asked our machine tech lots of questions and became a machine expert)

I just gave you the worst possible scenario. I had it, and I survived (barely). And despite of the obstacles I came to love dialysis. And so will you, if you give it a chance. No matter what, you will figure out these machines and other procedures. One very strong positive in your favor: you're apparently in a very supportive environment (unlike mine was ), and this means a lot!

Good luck to you and all newbies.

DeLana :)

P.S. If they'd had two different machines at the time, I doubt I would have made it...