RN- Is This common practice in Dialysis Training?

When I started out my orientation in dialysis I oriented with a PCT for the setting up the machine and sticking pts part of the orientation. My orientation with the PCT last 4 wks. After that I oriented with a nurse and learned the nursing part, for 2 wks.

My preceptor for stringing machines, learning to stick, and all other technical aspects was a PCT who had 7 yrs of experience and was great. That lasted the first couple of weeks and then the RN started teaching me the nursing part. The learning, though, is still going on 4 yrs later. There is always something that happens that has not come up yet and you have to learn as you go. :Reindeer:

Yes, PCTs can be preceptors for part of the training; however, these should be very good, mature, experienced PCTs who know their limitations and don't have an "attitude".

When I worked in a clinic, our preceptor was an LPN (who obviously could teach most of the nursing tasks as well). Previously, it had been a PCT, but her attitude was so bad that she ran off two RNs during their orientation... and I'm not surprised. After that, she lost the preceptor position - but the clinic had lost two potential dialysis RNs.

While training with the PCT, just concentrate on the technical aspects (machines, cannulation, putting on and taking off) and save your nursing questions for later; some PCTs do think they're nurses (and some even tell the patients that!) but they obviously should not give you any info regarding assessments, meds, and other nursing responsibilities.

You will find that in outpatient (clinic) dialysis the jobs of the nurse and techs tend to overlap a lot - at least on the surface. Some nurses find this difficult to deal with, especially if some PCTs have a bad attitude. I hope this is not the case in your clinic, but if you have any questions about their role v. yours, don't hesitate to ask your manager.

Good luck!

DeLana :)

This is typical in dialysis training for RNs. I have 5 yrs exp as a tech and 3 yrs as RN in HD. Most of your techs are far superior at machine trouble shooting and difficult cannulations (sticks) as RNs are geared more towards assessments, medications, and orders.

Learn as many tips as you can from your tech trainer, soon you'll be with your RN trainer. I worked for the 2 largerst companies (Davita & Fresenuis), and staff shortages are ongoing due to low pay, poor wage increases, and bad ratios. So plan on working as a tech when tech numbers are low, and learn their duties: machine start up, clean cycles, reuse, patient packs, machine set packs.

I have recently escape HD for a hospital urgent care setting. Outpatient nursing with hospital pay; the best of both worlds.

Good Luck in HD.

I agree it is good to orient with the tech to learn the machines and what their job is. But you need to orient with a RN (preferrablY) or and LPN if a RN is not available. Especially if you do not have any experience in Dailysis. I remember back years ago when I started new to Dialysis and the first time I had to deal with a patient that went unconscious, SCARED to DEATH! You have to learn how to deal with these patients and even the most experience tech cannot do that for you.

I would go to your nurse manager and talk to her about your concerns and if she does not go along, move to another facility if that is possible. Your license is on the line. The responsibility falls with you.

Does your unit have competency sign offs? In our facility the RN and nurse manager has to sign off on a new RN's competency.

Good luck.

Robin A. Clark ,RN, CDN

join dialysis nurses nephrology group at yahoo. com

Thank you all for the information. I just found out today that I will have orietation with a RN the last two weeks of training. As for competency sign offs they are being done by the PCT.

I'm sure the final sign-offs will be with an RN (often the nurse manager). However, if this is not the case, run!!! (I doubt it though.)

Good luck, let us know how it is going.

DeLana :)

In some states it is mandated that any dialysisn training must be with the oversight/direction of a RN. This means that a RN must train both PCT's and RN's to dialysis. I would check your state regulations for Dialysis Facilities.

I think I am going to quit.The disrespect is just too much. I have been having a had time with the preceptor. For example techs tell me "you go strip the machine you go clean the machine I feel they are disrespecting me because I am being trained by one of their peers. When I enounter problems with the machine I ask for help when my preceptor comes all she does is press the machine quickly and I have no idea what she just did or why she did what she did. When I ask she gets an attitude. I have spoken to the manager she said she was aware of the attitude problem and this tech will not precept nomore. What scares me is that I have had this tech say several times that she knows how to get nurses fired she can easily set them up. I am just so afraid to risk my license I feel like I am dragging myself into fire slowly. I did tell the manager about these remarks and she said she would take care of it but I'm sure nothing will happen because this tech has been with the company for more than ten years and she feels like she is running things. I just don't know what to do right now.

jen,

I'm sorry to hear this. I'm not surprised, though; like I said before, the only time a PCT with a major attitude (unfortunately, not unusual in this setting) acted as preceptor in the clinic where I used to work, she ran off two RNs during their orientation; both quit without notice, they were that disgusted. And I can't blame them one bit! (But no, she did not set them up to get fired, and PCTs do not have that kind of power although some like to think they do ! However, they can certainly make a nurse's work life miserable, no doubt about that.)

It did not take me long to see one of the major problems in outpatient (chronic) dialysis: the lines between UAPs and licensed staff are just too blurred. Some PCTs lack the insight to realize that their job is not identical to that of the nurse; giving them positions of (perceived) power over nurses, such as unit preceptor, only makes this worse and is therefore not a good idea IMHO. My NM was desperate at the time, but after her RD jumped on her for losing two RNs, she quickly reinstated an LPN as preceptor (not a great choice, either - long story - I'm sure she had to make concessions regarding his poor overall performance, but he was better that the PCT...) Such is reality in outpt HD, sadly. For every good PCT I know (good performance, attititude, respect for nurses and patients, hard working, good attendance, etc.) I know at least two who are bad to horrible. And no, I'm not on a vendetta against PCTs, the system is the problem (for instance, my company had classroom instruction for PCTs and nurses together; not a good idea, this sent the wrong message from the start.)

In your position (and with the hindsight of 5+ years in outpt HD) I would probably approach your NM one more time and insist that the PCT be relieved of her precepting duties at once; if the NM has to train you herself, so be it (that would send a good message anyway!)

I would hate to lose a nurse as dedicated as you seem to be, but I fully understand that you deserve to be respected in your work environment. If this is simply not the case, and nobody is willing to do something about it, I fully understand your decision.

Good luck to you! Let us know what you decide to do.

DeLana :icon_hug:

P.S. I recently took a position in inpatient/acute dialysis and there is a world of difference - maybe because we have no PCTs at all? Just nurses, the professional atmosphere is refreshing. Do you have a hospital in your area that has a dialysis unit? You may look into it, if they're willing to train (many do) it could be a good alternative for you.

I too have felt and experienced the disrespect of PCTs being an RN new to dialysis. I've been so busy putting on catheter pts that I have not had time to practise sticking pts...and the PCTs know this and their attitude is one of looking down on me. MY question is that after only 6 monthes of training, should I be the only RN on the floor when starting the day? or should the "charge nurse" be there?? I'm being told I've been trained and should handle it- I also feel my license is on the line-

Several things come to mind: (1) When mentioned assessments, the techs in our unit ask a question, prior to initiation of treatment, i.e. "Have you had any problems?" ofcourse, new patients do not even know what problems the tech is talking about. The RN is busy with catheters, administrative duties and patients do not even have auscultation performed, at all, unless there is a specific problem or a request is made of the RN. Techs need more education/training considering they are the ones with the patient for their entire treatment.