Kbaxley

Fresenius will at least follow a progressive counseling process. You may try reaching out to the next supervisor in line. If no success there, reach out to HR. Is your state a "right to work" state? If so, you don't have much recourse after that. File for unemployment either way.

I have found that catheter function is all about who places them. Is it an interventional radiologist, surgeon, etc who does them all the time or is it someone training? They may work at more than 1 hospital. Start tracking names & locations where the catheters are placed. Ifyou find a good one, try to stick to them. Your nephrologist may have to get involved to determine if there are any internal issues with the hospital(s). Are they flushing them after placement to verify function? It sounds like if the function is gradually worsening, they are developing fibrin sheaths. What about options for permanent access placement?

Doing acutes when new in HD is tough. Acute HD nurses can be tougher! Have you thought about working in a chronic outpatient unit where you can solidify your skills with more support with other staff. Sounds like your preceptor may be a big part of the staffing issue, especially with his behavior. Not to impressed that he didn't do his documentation for your training either. The fastest trainee, is not always the best. One of the best techs in our area was pushed out of his 1st facility because he was so slow. I took him because we were so short & somebody was better than nobody. We gave him extra time, mentored him & he blossomed. That being said, generally I look for an employee to gradually improve, & make few mistakes, & have a positive attitude.

In general, DCI has a very good reputation as a company. As with anywhere, the local management & your fit with them is the biggest part. In addition, you will be in an outpatient environment, working with technicians who will have a large scope of practice, depending on the state's laws.

Which company depends on the area you are in. In our area Fresenius has the better reputation. Also for us, orientation is regulated by the state. I now work for American Renal, best move ever!

The turnover & missing manager tells the story. I have been in dialysis over 20 years & got into it because of the schedule. If it is a facility that has 2 patient shifts, then you will usually be at work 11 hours total. 3 patient shifts will depend on how they staff the unit. Some turnover for newbies is common, as dialysis isn't for everyone. It will take you at least 2 years before you will have enough experience to feel like you've "got it". The best part is knowing your patients & working with a good multidisciplinary team. The worst part is problem patients, ifyou have a dysfunctional team, the factory like work, & the financial constraints from CMS on dialysis. Dialysis is a small community, ask around about the best facilities to work for, the company with the best training in your area. To get started, you may have to take the lesser facility, then transfer. Inner city units are usually the toughest. Go on the CMS website &look up the grades of your facility. They only report on Medicare pts, so it's not a complete story, but will help educate you on some of the quality standards. Good Luck to you!