Spunky Tech

Hello everyone I have been having problems with one of my charge nurses for quite sometime now. She is a charge nurse from hell, and I am so sick and tired of her alpha male flat out rude atitude. She is so bossy, when the pts. family come in to visit with pts after they have been hooked up, she puts them to work. Yes, I swear she puts them to work. She told the pts. husband to sit down and fold plastic bags that we use to cover our dialyzers to prevent blood splatter. He laughed it off, she said no, I'm serious and pulled him up a chair. he got a odd look on his face, sat down, and began folding. I felt bad for the guy, I told him he could quit if he wanted. He just grunted and said I'm ok. Well, he's visits to his wife are now cut short, and I feel it is bc he is afraid she will put him to work. She works the hell out of her staff, and there is no need for that bc we are all self-starting people who are not afraid of hard work. The enviroment is always tense when she's there. she argues with pts, and talks badly about our director but yet smiles in her face and acts like their the best of friends when the director is around. she is a very good nurse, she's detail oriented, but she is so MENTAL. I am one of the techs there. I always work along side the RN's, I am respectful to the RN's and I do my job. She runs over me like a door mat. I tried to talk to the director about the RN but I believe that this charge nurse may be even too much for her to handle. Last month, I found out I had gallbladder disease when I was awakened at 3am sharp massive pains in my right side. I went to the ER, but I was supposed to report to work at 6am. I had the ER nurse call over to my clinic and tell the charge nurse what was going on. The ER nurse came back in the room, there I am balled up bc the pain was so intense, I had been puking, and she told me my charge nurse said that I need to call my director to get permission to miss work that day to be at the ER? She's nuts. Come to find out I had a massive stone stuck in there, and the valve was constricting on the stone causing the pain. worse than labor pains for me. i dont know what to do. i like my job, I get along great with the pts, and I am taking prereq's in the SP for nursing program? I need the money, but she wears me down. Even the other charge nurse had thought about quitting bc of her and that charge nurse has been there 5yrs. The crazy nurse has been there a year. One day, she coped an atitude with me over a machine, and I told her I was not telling her what she was saying was wrong, but I didn't appreciate the atitude she was giving me. Later on she asked my if I was on my meds? Talk about a low blow. Awhile back I told her that I took med once a day for anxiety. She's the one off her meds. I dont know what to do?

Okay, i was a bit confused when you mentioned the button hole technique, but yet he does NOT have an access set up for buttonhole? In that case, do not stick the same spot over and over again. It will make it harder for him to clot at the end of tx, and I do not feel he would be getting the quality dialysis that he deserves. As for his prior clinic, they claim they stick the same site even though he is not buttonhole? That to me makes absolutely no sense. If it were me if would suggest the ladder rope technique to your pt. stating that he will have a better tx and that it is not good for his access to be stuck in the same place over and over again. But you also need to keep in mind that the pt. primarily has the last say in this. Perhaps he has had alot of bad experiences with cannulations and he feels comfortable with the same site cannulation. It is our position to provide the pts with the best tx possible and keep our pts informed. There is no sense in getting into a tiffy with a pt over where to stick him if that is where is insist on being stuck. Just inform him of the consequences and if you are able to, it wouldn't hurt to contact his neph. and let him know what is going on. Good Luck to You.

Since the button hole sites are so big, i'd advise the director of the clinic. Yes, I know that the site is button hole and the site should always be stuck in the same place bc there is a tunnel that has been developed for that pt, by sticking elsewhere I would be hesistant as well. i'd just cover my own butt and advise a superior b4 I did anything or since you stated the pts are seasonal hence they are transient pts, call their regular clinic and tell them the problem. With such large sites, it could open the door for problems. When in doubt, ask.

Lunden, i'm so sorry. since I am not in the nursing program yet can u tell me what the A&P course is bc I do not know. So did that hold u back bc you got a B in A&P bc I think a B is a good grade. As for your soc. class u received a C right? I know its frustrating and I would be mad too. Youve got what it takes, it just hard when you have kids and a full-time job and the whole nine yards believe I know, and I really feel for you. So are u gonna take these two courses over again for Spring Semester? And look at it this way, u can learn from ur mistakes so whatever parts of the courses u found difficult, u can know that for next time so u can work on those parts a little harder. And if u feel comfortable enough maybe u talk to ur old professors and discuss which parts of the class u had difficulty with and how to go about working on it. Since u still have ur text books for those classes, u can go over the parts u didn't understand and be one step ahead for next semester. Hopefully the textbooks won't change by that time bc they change so often. Thats what I would do If I were u. Id read the books and get a step ahead. You have till Jan b4 the SP semester starts so pace yourself. It's hard when u have kids too. So maybe when the kids go to bed for the night crack open the book and read for 30 min or so. I wouldnt try to read the whole thing in a week bc youll burn yourself out. If you need any more advice, I'm here. I check this blog several times per day especially if I think u may have left a message. Also heres my email address [email protected]. I'll talk to u later

Thanks everyone for the advice. I will do my very best to use it. It makes it hard bc the other charge nurse who works at the facility backs her up. She wasnt even there to see how the other nurse treated me so who does she think she is to give her two cents? Guess what she told me today, I'm too much of a softy. What a crock?

Thanks so much for the advice Lunden. I will do my best but it still hurts. In the back of my head i always wonder is it my performance or is it bc i dont suck up? I love my job and I treat my boss with respect, I try to approach her as I would a friend, I try not to be intimidated by her bc of her status and I treat her as kind as I would anyone else. Do u think it would be inappropriate if i asked her? Or maybe it would be putting coal in the fire? Who knows. All I know is that I'm begining to feel a unappreciated and looking forward to nursing school so that maybe one day I can possibly find a job that is not so much full of politics. I know that no job is perfect, but perhaps I would feel better in an environment that was more appreciative. OBTW, the arrogant nurse has her lips glued to the bosses but all the time. Offering to do this and that and run errands etc. Not that I mind doing things like that myself but my main focus is my pts, their well being and my own personal duties such as water room etc. I dont know why she is the favorite bc she'd rather run errands than do her pct duties which she waits till the last minute to do. maybe she should be hired as a secretary. She hardly talks to the pts. she's rude and says mean things in front of them. Beats me?

Hey Lunden, How are u? Thanks for the advice on the graft I will try it. I didn't have a very good day today. Remember when u told me that u felt that ur facility had favorites when it came to techs. I really don't know how to take this but we had a new girl come in today that is going to start next week. Well, the senior tech, who is great by the way, told the director that she is tired of training everyone in the facility and that the techs that work there all do a good job and that she thought that is was time that someone else do their share. Lunden, I know that i do a good job and I was excited and anticipating that she would ask me, well she did not. The girl that she elected to do so, who wasn't even working today may I add. She totally bypassed me and filled in the training log for the one who is arrogant and thinks she knows everything to train this girl. My feelings are hurt and I don't understand why the director does the things she does. The arrogant tech has only been there a month longer than me so she cant use expereince as an excuse. I tell ya, i just feel like a shadow in that place, I feel so unappreciated. Last time, we had a new girl to train and I wasnt able to train, I asked the director why and that I would be happy to, and I asked if there were any problems that I was unaware of. she said no, everything was fine. I do feel like a shadow. The pts care about me and I care for them as well. But I have a hard time knowing that my services are appreciated. Sometimes, I wonder why I even bother?

Lunden, I'm on my lunch break at home, so I thought I'd drop u a line. I am SO sure you'll get in with no problems. Look at what u have to offer you have worked as a dialysis tech for 8 yrs, and you really know your stuff. I know people who had been accepted to nursing school right out of high school with no nursing experience at all. You'll get in and they won't even doubt your application when they see all the credentials and experience you have to offer. I'd just try to focus on other things until ur acceptance letter comes in. Yeah, I know easier said than done. Before I sign off, I got another question about cannulation for you since ur so smart. Since I had good luck with that other pt. on Sat. I thought I'd try to work on one of the others who is hard for me, but I scared. His is hard to figure out. He has a graft in his thigh, I hate that. Well, the inside site is a piece of cake, the outside is vicious. Since his is a horse shoe shape around his thigh, his skin is real tough like chicken skin, and the graft dosent pertrude out any so there is nothing to grip on to and its hard to see. I always feel, but he claims the direction is toward the belly button. So naturally I listen to him, thats where I start. I never feel a pop even when I do get in everyonce in a great while, and when I don't get in I get a small flashback, but when I try to pull back on the syringe I cannot there is lots of resistence. Am I even near it when this happens. His outside site is so curvy. Do u have any advice? Oh and by the way, I betcha we do work the same weekends, cool.

Hey Lunden, I thought I'd drop you a line and see how you are doing today. You know things seem to be going a little better at work lately, knock on wood. I thought of u yesterday when I decided to stick one of those pts. that I usually never get. I made myself remain calm and I remained totally focused on every aspect of the process, the bottom needle always goes in with no problem at all, its that top one that is the tough one. When I went in for the top site, I started out real slow. At first, I felt as if I was not in the fistula, so I backed up and changed directions just a hair, no flashback. I then REALLY concentrated and I felt of the access several times I gripped the fistula with my thumb and index finger firm, lined the needle up between the two fingers, and BINGO I got him! I then had a after thought after it was all said and done. Since the top site is so small and narrowed, I can always stick the bottom site with the needle facing down bc the bottom site is much wider and bigger, and then It would allow me to stick the top needle not so high up where the narrowed vein is. I am sure the needles would be far enough apart that it wouldn't affect his adequacy or recirculate. Thanks so Much. Lacey

Thanks for the info Nurse advocate, we do use tourniquets for those hard to stickers, but what about the ones who have them in their inner thigh?

Hello everyone, I will be taking preriques in Jan for the nursing program. I have a question, I love patient care, I am all about pt care, I am thorough, good at paper work, and observant, i currently work as a dialysis tech. Heres the thing, I am a team oriented person. i don't like to be in charge. I work very well as a team, and I work well by myself. What kind of nursing positions are there out there that do not require being a charge nurse. I think I might like being a post op nurse bc u focus on the pts, take care of them through anesthesia, get vitals, and give dc instructions. i can handle that. any other ideas or is being an RN all about being in charge of all staff.

Hey, i'm a pre nursing student. I've had it for over 13 yrs. I'm 24. As far as meds go, there isn't much out there that has been proven effective for this condition. The best thing so far is behavior cognitive therapy which is provided by a therapist. I am currently working with a therapist myself for this. A lot of therapists recommend a combo of anafril and cognitive therapy. this is a very serious condition, and some people have it worse than others. I for instance have absolutely no hair at the crown of my scalp its not our fault, its beyond our control, and so far there is no cure. Its very sad. Check out youtube and type in the word trichotillomania under videos. You'll be surprised of all the videos out there where people talk about their experiences and battles with trich. one day, i pray that I can overcome. Just be understanding and nonjudgemental, that's the best you can do hun. Thanks

Hey everyone. Thanks anurseadvocate for the input. the jiff is almost everyone at the facility is quite new to dialysis. There are only 2 individuals who have been there over 2 yrs. One is a charge nurse, the other a tech, which the tech is great at answering ?s. The charge nurse gets irritated when u bother her with probs. Technically we do not even have a inservice educator, there is 1 tech who trains everyone and shes gets tired of doing it, can't say that I blame her. I ask the pts for whom I have trouble cannulating about their accesses before we start, and most of them don't even have a clue which site were pulling and which site were pushing from, those people are the older pts so its understandable, but it makes it hard on me when the pt has no clue about their access. Lunden, do u think it would be embarassing if I ask the senior tech if I can sit in with her on some of the hard pts for me? Most of the time, when i ask for help with a cannulation and the nurse is able to access it for me they can never explain to me how on earth the technique or position depth angle that they used to access. So I never know what it is im doing wrong bc they cant tell me what it is they are doing right? Lunden, how long did it take you to get good at cannulating. I was super excited when I seen that u had wrote a post to me. I so hope ur day goes better wed. Did u have a good halloween with ur kids? I did, my little girl was a unicorn, shes so cute. I tell u lunden there are a many days when i hate even going to work bc I fear that i am going to be stuck with one of those pts i cant cannulate. We have no pts assignments, its free for all. So if everyone grabs all the pts i can do, im stuck with the hard ones. will it ever get better. I talk to u later Lunden take care and I love to chat with ya.

Lunden, you are such an awesome person. thanks so much for giving me advice, i work for a hospital my clinic is privately owned. i do plan on taking preriquesites in Jan. so that I can apply for the RN program at a later time. It's cool to have someone like you who has been doing it for such a long time to talk to about this. I am not usually negative person, and I do love my job I get along great with the pts. Sometimes, I feel like everyone at this site probably thinks I'm a nut bc of the ranting posts I made about the cannulation problems. i just know that if I could get better at my sticks than those arrogant know it alls would have nothing to use to make me feel bad, because I would then feel confident that I do do a good job. Im not out to make others feel like they are inferior I just want some confidence to claim as my own. the thing is I picked up on the other aspects of dialysis with no prob, cant figure out the prob with the cannulations though? Thanks so much Lunden, and please feel free to write me any time bc I enjoy talkin to u!

Hi everyone, and thank you for the good advice you are so right on. I should definetly observe what it is that I am doing differently during these cannulations and I should also watch the ones who I feel are really good at it. The thing about it is, i get nervous during cannulations and although I plan it all through before I cannulate, once I punch through the skin, its like a fog comes over my mind and I have a hard time remembring every detail of how I positioned the needle or depth or angle. i find that particular difficult when I stick pts. who I havent cannulated in a long time. I am also embarassed to ask to stand in with a tech or nurse bc i have been there a year and I feel like i am in orientation all over again. We have a nurse and 1 tech there who I absolutely hate to ask for help bc they are so arrogant. When others ask them for help they sense that as power and they will immediately take over every aspect of the duties, and I'm not the only one there who feels that way. When I ask them for help, i am only feeding into their arrogancy. And the tech who is so arrogant has only been there a year, miss know it all, she runs around trying to tell people about certain aspect of dialysis when i know her information is wrong bc I either look it up or check with the director, but she'll fight you to death that shes always right. She evens bucks our senior tech who has been there for such a long time she is so knowlegeable. If the senior tech is working I have no problem asking her for help bc shes sweet and dosent make you feel stupid. Thanks for letting me vent bc I've had that on my mind for a long time.