parolang

Wow, I don't blame you. It always seemed to me that they have an SOL approach to FA's, and they will cut you on budget and staff, and then kind of silo with any internal problems you might be having.

Are you responsible for what PCTs do under your charge? Yes, just like any other unlicensed assistive personnel. Can RN's be penalized for PCT negligence? Depends on your FA and the command chain above them. That said, it would be unusual for you to be held directly responsible for what the PCTs do that doesn't directly affect the patients. You are their supervisor, not their manager. Document and report your concerns to the FA. I was a PCT for five years. I was a stickler for the rules, and eventually I just gave up because FA's are way more concerned about budget than doing dialysis correctly. They pick their battles, and if you want to continue in this environment, you have to pick yours. When your PCT says they are always in a rush, believe them. We had five patient pods, and they were always looking for ways to squeeze the patient schedule together as much as possible. When I left, they were getting on our new FA about budget, so I can't really blame her, but she was going around cutting treatment times so that we can leave earlier. When I was having difficulty getting my patients started on treatment in time, and I mean on a consistent basis, it eventually became about some PCTs could get them on treatment on time, and I couldn't. I didn't have time to watch what the other PCTs were doing, or not doing, and it just became a toxic environment for me in general. So I gave them my notice and quit. Honestly, your clinic is sounding kind of toxic. I never had to work short, so I don't know what that was about. IMO, dialysis is not what it should be, and that's why I'm done with healthcare. Just be sure to look at the bigger picture, because it is too easy to blame the front line guy, the nurse or PCT, when it's really a leadership problem, an institutional problem, or a systemic problem. For example, how are you supposed to follow all of your policies and procedures when you are working short on a regular basis? Your PCTs have to take shortcuts, because they know what happens when their patients miss treatment or cut their treatments short, because they aren't able to start their treatments on time. Also, when you are multitasking constantly, especially during turnover, you are relying on habits. When you correct your PCT about hand hygiene, and they return to their bad habits later, you have to have some understanding about this. You are totally correct, but don't misunderstand this as a moral failing or laziness. That said, there needs to be accountability if you want the behavior to change in the long run. That requires that RN's report things to the FA, and the FA to hold them accountable. You also have to hold the FA accountable for following through and not avoiding hard conversations. Good luck.

It sounds like the bigger problem is that you don't like dialysis. Would it really be better if you just worked 36 hours if you hate the job? I'm not trying to minimize your complaint, I think 14 hours is too much for anyone really. But it's not being done to punish you, you know?

FWIW, I left in October. Best thing I ever did. In the end, it doesn't matter what other people say they can do, or what you are being told that other people do, but what you know what you can do, and what your standard is. And it is stupid, it really is. I was going to be a preceptor, I knew the job inside out. I worked with integrity. You have to have your own standard, and hold the company you work for accountable. That's what I left.

It's kind of an interesting question. One thing that is different is the rate of blood volume increase. During treatment, ideally, there is no change in total blood volume. But blood volume increase a small amount during blood return. But that's just me trying to rationalize the policy. More likely it is for reasons of "abundance of caution" and the precautionary principle like most of the other policies. Maybe it is just so that you aren't accidently returning too much saline, a slower return rate makes it easier to judge when to stop returning.

The issue isn't the difficulty of the job. It is whether I can reasonably do the job on a consistent basis while meeting all of the requirements. It's a matter of whether am I doing all that I signed up for. I'm having the same difficulty speaking with them. I tell them all of this, and they reply as if I'm just being hard on myself. Clearly we're not communicating. I will be giving them my notice. I wish them the best of luck. There isn't that vast of difference between PCTs such that one couldn't be reasonably replaced with another.

Fair enough. It was arrogant for me to make assumptions. I apologise.

My guess is that they just don't. They are just really good at letting you think that they do. I follow policy more than anyone at our clinic. But I can't blame them...I run behind a lot. Nonetheless, I could just be too slow for this job. I'm 38. I'm not getting any faster. There are other things I could probably do. Thanks for your insights.

Okay... I'm running into the same problems. So I broke it down on a spreadsheet even. If I give myself a minimum amount of time of 5min to take a patient off, 5min to wipe down a station, and 5min to setup a station, I'm getting that it takes 75min between the take-off of your first first-shift patient and being ready for your first second-shift patient for a five patient pods. How the heck does your region do this in under an hour? And I'm pretty much assuming ideal circumstances: not responding to alarms, charting patients during turnover, bleeders, helping patient transfer, post-tx blood pressure measurements taking forever, etc. Basically, I'm trying to figure out if it is that my performance doesn't meet expectations, or if the expectations aren't meeting reality. It could be me then at least I know what I need to work on. But if it isn't me, then I'm in a bad situation.

I'm actually going to write that down and maybe share it with others. The whole idea of air drying makes sense, and is generally recommended for infection control, yet it isn't in our P&P to my knowledge. But it makes sense to break that time up. Also a lot of patients make it hard to multitask. Either they can't hold on their own, the clamp slips off the site, etc etc, or I'm getting called back because they want taped up after two minutes...but this can be worked out. I'm going to try it. Thank you for spelling it out.

I'm not a nurse, but I think the ethical question is more about whether you guys consider nursing a profession, and kind of profession you believe it to be. Generally, for non-professionals and paraprofessionals, or basically anyone who has "just a job", I believe that it shouldn't matter what that person does on their time off work. But when you hire a "professional", you are hiring more than someone who performs work for pay. There are supposed to ethical guidelines that that person has to follow, and there is a commitment to "the profession" over and above whatever rules or dictates of the organization that he it she works for. In return, you have better job security, higher pay, and in many cases some kind of appeal to the profession with regards to expectations, etc. My opinion, I think nursing should be a profession, but are more often treated as semi-professionals. But even as a profession, I don't think it is that kind of profession where moonlighting as whatever-you-want-to-call-it betrays the standards of the profession. Contrast nursing with teachers, for example. Teachers educate children, and so there is a professional obligation to at least not contradict the even conservative norms and mores of society, whether you agree with them or not. But what is the public role of the nurse? Frankly, I would be more concerned about a nurse blatantly violating mask-wearing recommendations in public, than making money on the side in legal ways that violate conservative norms. IMHO

Sounds like untreated or poorly treated ADHD. Doesn't matter, I wouldn't say anything about it.

I'm actually going to write that down and maybe share it with others. The whole idea of air drying makes sense, and is generally recommended for infection control, yet it isn't in our P&P to my knowledge. But it makes sense to break that time up. Also a lot of patients make it hard to multitask. Either they can't hold on their own, the clamp slips off the site, etc etc, or I'm getting called back because they want taped up after two minutes...but this can be worked out. I'm going to try it. Thank you for spelling it out.

DaVita. I have heard from people in management something like an hour between patients at each station, but I never really understood what exactly they are talking about. It seems they mean I can take a patient off, run around and take the other patients off, then be able to have the next patient on in an hour? What if you are running five patient pods? Thanks for your insights.

I'm a PCT at a dialysis clinic, and there had been a policy for a couple of years now that the patient has to completely vacate the station before disinfecting and setting up for the next patient. Basically, I always do it, and everything else that we have to do between patients: Cleaning the lines and chase box behind the dialysis machine, wiping down the back wall, counter, and television, etc. It's a lot. Basically, you get the idea from the policies that disinfection is supposed to be a thorough, meticulous process. I know not everyone does all of this, but that isn't something that should concern me. My problem is that I'm again not able to put patients on on-time and I get a reputation from the patients for being slow. All of this, I guess, is old news. I've been doing this for going on five years now. The old manager adjusted the schedule so that I can get patients on on-time, but the new one tells me there isn't a budget for that. I've had to reduce my hours due to the pandemic, so it doesn't affect me as much. But they praise me saying that I do everything right and even wanted me to be preceptor. My only question is... Are all the clinics like this? I'm not talking about that some pcts and nurses don't do what they are supposed to, but that this even becomes institutionalized by management because it helps them make budget. It seems that whenever we get techs or nurses from the float pool or other clinics, they immediately start doing things the old way before the policies were updated. So my sense has never been that I am doing things the normal way, but that I stick out conspicuously, not just in my clinic, but in the majority of clinics. I have gotten my share of passive aggression from techs and nurses for doing that I'm clearly supposed to do, and am not even allowed not to do. It just shouldn't be like this.