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RN- Is This common practice in Dialysis Training?

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jen75RN jen75RN (New) New

I am new to Dialysis and recently started orientation. I am a RN and my preceptor is a PCT with dialysis experience as a PCT but no nursing experience. Is this common practice in Dialysis for PCTs to orient RNs. I am afraid I am not going to get adequate training as my preceptor can not answer most of my nursing questions. Any information will be greatly appreciated.

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.

kdhnursern

Specializes in LTC, WCC, MDS Coordinator.

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. :twocents: :Reindeer:

DeLana_RN, BSN, RN

Has 23 years experience.

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.

DeLana_RN, BSN, RN

Has 23 years experience.

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.:o

DeLana_RN, BSN, RN

Has 23 years experience.

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 :madface: ! 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.

DeLana_RN, BSN, RN

Has 23 years experience.

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-

Are you the only nurse in the early morning, or do you have experienced LPNs with you? If you're the only RN with techs, then I would say the answer is a clear NO. After 6 months - and everyone knows this - you cannot possibly know how to handle everything that can go wrong in a dialysis clinic. Some examples: water problems - do you know when and how to switch to DI if the RO fails? Or when to put the pts in bypass due to less serious water problems? Patient problems - access (clotted); seizures; GI bleed; sepsis; and, of course, the dreaded code. Machine problems - reverse TMP, blood leak. These are just some examples. Of course, as a trained RN (nobody cares how much experience you have if you find yourself before the BON or in court!) you are fully responsible if any of these happen and you don't know how to handle them.

No they should not leave you alone unless - and until - you feel comfortable to be able to handle ordinary and unusual problems that may occur, or have experienced LPNs with you that do (of course, as you know, the RN is still liable).

I would talk to the manager. Good luck!

DeLana

DeLana_RN, BSN, RN

Has 23 years experience.

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.

I don't understand this. Does your state not require that each and every pt be assessed for heart and lung sounds, edema, neuro status and other problems? Usually, this has to be done by and RN or LPN, although a few states allow PCTs to do assessments; this must be the case here. Still, the nurse is of course liable if anything is missed. Can your techs also push heparin? If not, then do a quick assessment while you are doing this. I suspect, however, you're in a state that allows techs to push heparin and do assessments... scary.

Good luck! I know how it can be a losing battle to get all your work done in a clinic and go over and above what is required of you.

DeLana

NeosynephRN

Specializes in ICU, PACU, Cath Lab.

Are you the only nurse in the early morning, or do you have experienced LPNs with you? If you're the only RN with techs, then I would say the answer is a clear NO. After 6 months - and everyone knows this - you cannot possibly know how to handle everything that can go wrong in a dialysis clinic. Some examples: water problems - do you know when and how to switch to DI if the RO fails? Or when to put the pts in bypass due to less serious water problems? Patient problems - access (clotted); seizures; GI bleed; sepsis; and, of course, the dreaded code. Machine problems - reverse TMP, blood leak. These are just some examples. Of course, as a trained RN (nobody cares how much experience you have if you find yourself before the BON or in court!) you are fully responsible if any of these happen and you don't know how to handle them.

No they should not leave you alone unless - and until - you feel comfortable to be able to handle ordinary and unusual problems that may occur, or have experienced LPNs with you that do (of course, as you know, the RN is still liable).

I would talk to the manager. Good luck!

DeLana

As a former tech in a Dialysis unit, and almost done with my RN...these problems were all delt with by tech's..the RN's were required to be trainned on the water system, but you could not drag one of them back there if there was a problem...however 1 RN opening a unit does seem like a lack of staffing...I guess how many patients are involved and like you said are there any LPN's with you too??

You all seem very anti-tech in this thread..personally I think it is a great idea to have a tech "train"" you on the way to run, set up and clean machines....I mean what are you going to do if your machine goes down on you and you are the only one there...which I could not see happening very often..but it could!! I am sorry that it seems that you have had bad luck with tech's with bad attitudes, I have also seen my fair share!! I have also been in the position to light a fire under the butt of my nurse...I was a strong tech, not by my own assesment, but coming from my nurse manager. So I would routinly be placed with a "weak" nurse. I would have to keep her moving...It should not take 45 min to get someone with a perm cath running...when you have been there for almost a year. I mean if we are 45 min late then the whole day is messed up soooo bad!! We ran 4 teams of 8 patients three rounds a day...so you can see where time is of the essence with a turnover time of 15 min between pt's...which obviously becomes an issue if you have complications!! When we opened in the morning...every team had a tech and a Nurse and we had a Charge...then at night when we closed the Nurses could leave when the last patient on the team left. While us tech's are left to clean up and do all the dirty work;) which was fine with me cause that is what I signed up for when I took the job!!! I would try to find a way to not work with that tech if possible..or maybe look to another facility...Dialysis is very rewarding and trust me all tech's are not like that!!! GL!!!

DeLana_RN, BSN, RN

Has 23 years experience.

I have also been in the position to light a fire under the butt of my nurse...I was a strong tech, not by my own assesment, but coming from my nurse manager. So I would routinly be placed with a "weak" nurse. I would have to keep her moving...It should not take 45 min to get someone with a perm cath running...when you have been there for almost a year.

Do you know why it took so long? Perhaps the permcath was clotted, and the nurse had to instill TPA; this can take a long time.

This is a typical example of techs not really understanding a nurse's job. Nurses have all the responsibilities of techs (setting up, putting on/taking off pts, clean-up, water testing, etc.), in addition to many, more responsibilities that most techs don't appreciate.

In my clinic, we did not have tech's do the clean-up, except for their own assigned machines (pods). Nurses also had to stock their own pods (consisting of two machines), test the water, assess all patients - their own, those of the techs - and give all meds including heparin. So, yes, it would take a nurse much longer to put on a pt if they were constantly called away from that pt to do an assessment or push a heparin (including handwashing before and after); that is, if they took their jobs seriously and actually did those tasks. Plus, the nurses would also have to deal with any problems that occurred with any pts on the team (e.g., clotted access).

Naturally, conscientious nurses would appear to be "slow" in the eyes of the techs who have to only "put them on/get them off", especially if relatively inexperienced. This does, however, not make them "weak". If your manager described such as nurse as weak, s/he was just wrong (and perhaps trying to flatter you. Believe me, I have seen it all.)

How can some nurses be "as fast as techs"? Years of experience, short-cuts, not doing their duties (not assessing the pts, letting the techs push the heparin even if illegal in that state). Some are naturally a bit faster - also among techs - but there is usually a whole lot going on that you may not be aware of if there seem to be large discrepancies.

Don't get me wrong, I'm not anti-tech. I have had some wonderful ones with great attitudes. Techs are an essential part of outpatient dialysis (the companies would do away with nurses if they could), and a good tech is worth a lot. Unfortunately, there are also lots of bad apples who have bad attitudes, are lazy, and badmouth nurses about things they know nothing about.

Good luck to you! Some of the best nurses I have known were former techs.

DeLana :)

NeosynephRN

Specializes in ICU, PACU, Cath Lab.

Do you know why it took so long? Perhaps the permcath was clotted, and the nurse had to instill TPA; this can take a long time.

This is a typical example of techs not really understanding a nurse's job. Nurses have all the responsibilities of techs (setting up, putting on/taking off pts, clean-up, water testing, etc.), in addition to many, more responsibilities that most techs don't appreciate.

DeLana :)

Thanks but I really do and did understand the Nurses job....and no there were no complications with the cath...maybe I should have clarified that in my post...she was just slow...with each and every patient...My nurse manager told me I was a strong tech...never told me that, this particular nurse was weak...but that was the general thought on the unit...she was just not very good...nothing against her, but I am not sure dialysis was a fit...example We had a meeting and this nurse was on my team alone..she is an RN has been on the unit for about a year...one of the machines kept alarming that the Arterial and Venous pressures were off and shutting down...you know...she kept hitting mute, reset...and it happened over and over for about 35 minutes! She never asked for help, from another team or the charge nurse...and you know in the busy units machines can be alarming all the time for various reasons...well I get back and the machine alarms...I go up to it and look it over..nothing...uncover the patient...which is against our policy to have their access covered anyways...and her needle had fallen out and she was bleeding out...and had been for a while!!

We had so many great nurses...I mean like these guys rocked!! Many with 20-30 years dialysis exp. so maybe that is why they viewed her as weak..and it was not just cause she was new...like I said maybe not the right fit for her!!

We obviously work for very different types of unit as the RN does not have all the same responsibilites as a tech at ours...they are trainned...but do not set up, tear down, clean or do water tests..as that is all below them...which like I said before I was fine with...I am not a nurse yet...was not then, so I did not expect to do the same job, or have the same responsibilites...I am not your typical tech...but there is no way you could know that...since you do not know me!!! I am an EMT and I feel that I did my part to make sure that treatments were done right and the patient was well taken care of...so I was not just an unlisenced dummy with a bad attitude off the street!! Though we would get them once in a while!!

I did my job so that the nurses could do theirs which was obviously more consuming than mine...with care confrences, meds, complications, and all that fun stuff!!! I agree with you I think my time as a tech will definately help me be a better Nurse!!! I may go back to dialysis PRN...they keep asking me to come back and I would be good in Acute...since I am VERY famiallar with the machines...LOL!!! This is a great forum, but it is just interesting to be able to see the situations from both sides!!!

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