struggling with learning the dialysis job

Nurseatyourcervix · Aug 7, 2005

From my experience in dialysis I can tell you that it'll take you at least one full year before you're comfortable with the entire process. The first 6 months were the worst for me. I made every mistake possible, from not double clamping, air detector alarms 'cuz air went past the venous chamber, saline bag running out of saline and letting air in the system, blown fistula's, or not even being able to cannulate them, cathetars not working, doctors loosing patients with me, other nurses not helping...more like intimidating, calling my supervisor complaining...being assigned to a patient who didn't have a chance, BP drops to 60 over nothing while on the machine...You name it..and it has happened to me. We all learn from our mistakes. Dialysis gets stressful at times. You just need to know how much stress you can tolerate before you go off the deep end. I've been to the deep end and back due to working in dialysis. I've had the worse case and the best. I've been in acutes for nearly three years and I'm thinking its time for a change. I hope I offered some insightful info for you. Dialysis isn't for everyone; dats for sure.

donroberto · Aug 8, 2005

Your experiences are typical of all persons entering into the area of hemo dialysis. It will take you at least six months of working on the floor as a PCT before you feel comfortable and competent during what I refer to as 'rush hour' (take off and put on). Another six months of PCT work and shift into the nursing role will result in your being very competent at running the unit. While it's true that as a nurse you are not expected to be able to keep up with the PCT's....you will gain a lot more respect from your subordinates if you can....and your unit will run much smoother when you can chip in and help some of your slower PCT's....as the person in charge.....you are expected to touble shoot problems at a different level than your underlings....You need a year 'bustn' your butt' on the floor in order to deal with 95% of the problems that arise....what you don't want is to have the 'deer in the headlight' look when something happens.....time and experience is all it takes.....There will be days when you ask yourself if you made the right decision....tha't normal....hang in there....it does get easier.

Dormkare1 · Aug 8, 2005

I am new to dialysis too. August 30 will be my one year. I felt terrible for a long time and still do at times. My confidence has tumbled since I started this job. I think the training process is wrong. When hired as a RN I don't feel that the orientation is adequate. I agree with PCT training first but I think more emphasis is needed on the RN side of things also. Some PCT's need to realize that we have a job to do too. I am always willing to help on the floor but when there are two PCT to 8pts, they should be able to function on their own so I can oversee the clinic and complete my job duties. I have made mistakes in this learning process, my clinical manager has NOT been supportive! Actually discusses my errors with other staff members! Love the job, do not appreciate the staff at times. No autonomy, no confidence! Thinking about leaving too. I used to pride myself on my nursing abilities, assessment, intervention, careplanning.... now I dont know:uhoh3:

Nurseinthemaking · Aug 12, 2005

Wow, you guys are scaring the crud out of me. I am not only a new GVN, but will be a New Dialysis Nurse in 10 days. I have heard good and bad (mostly about the rush hour thing), but I haven't met anyone who doesn't like it. I guess it is good to see both sides.

Can I ask a question? When you accepted the postion, was it because you wanted to take it or was it because you needed the job? Nephrology for me is something that has been a huge interest of mine, when I applied for this job I wasn't planning on being offered, I was actually there to talk to them about what I needed to be doing now to get myself in the door later. She told me, that she felt that because of my personal interests in it and how much I love the field, she felt like I would be a good candidate to start now.

Is this something you guys have "longed" for or were just trying out? I am hoping that I don't feel the way you do in a year. Hope things work out for he best for ya'll.

donroberto · Aug 12, 2005

My wife does dialysis...I would visit her at work and I became interested...I had a full time job...two small children and went to nursing school specifically for dialysis....I wouldn't do any other kind of nursing. When I interviewed for the job I mentioned the immortal words spoken by 'Curly' from the movie CITY SLICKERS. The secret of life is 'one' (finger extended)...just find one thing you like and do it right. I want to be the person people come to for answers...Dialysis is not for everyone....it can be intense.

missbodine · Aug 17, 2005

Just wanted to respond to you and encourage you to hang in there if you really like dialysis. My first mentor, a pct, was very good but also left me nervous. I learned how to "string" the machine but forgot some things. My next mentor, who was to finish the training, showed me the same thing, step by step with rationale. She made sure I could do everything technical first then the last thing was putting the patient on. Once I learned to stick, everything else felt comfortable, Maybe I'm just slow but that made all the difference! I went from being visibly nervous having my own team of patients. Hopefully you can find someone who will teach you the way you need them to teach you. Best to you...

started training as a dialysis nurse at the end of June. My anxiety level is very high and I keep forgetting little things as far as the set-up of the Phoenix dialysis machine. Things like turning off the KT/V but only on occasion or forgetting to put the prime line into the WHO when it is time to prime the darn thing. My Mentor (who is a PCT) keeps telling me that the she has trained other nurses who were not cut out for dialysis. Worked with another person this week who was more laid back than my present trainer and things went much better. I only forgot to turn of the KT/V once with the setups that I did. I enjoy the patient care and want to learn the nursing part of things. The other nurses tell me that I will never be as fast as a tech and that is not my job anyway but I do need to know how to take someone on and off the machine safely. I totally understand this. However I feel like that unless I am running around from machine to machine at take off and put on with my hair on fire that I am not keeping my mentor happy. I just feel like it is an impossible environment to learn the job in. If I were hiring on as a PCT I suspect I would have been booted out the door already. My manager is willing to work with me and I will be with the laid back trainer for another day then I need to make a decision as whether this type of nursing is for me. Any input from you dialysis types would be greatly appreciated. I don't know if I am just very intimdated by the technical nature of the job or if I am just too dumb to know that I am not cut out for this job.

sherryg0 · Aug 18, 2005

I just have one question? Are you a fairly new nurse? If so, study, study, study. If not, call on your experience. You KNOW you are a good nurse. Your previous patients tell you so.. First you must learn to string the machine and then you learn about the patients. The phoenix is just another machine.

Try to memorize the steps and then complete them in order checking as you go. I think your PCT is trying to hurry you.. DONT let her. Take your time and do it right, The speed will come with time.

I am a DON in a dialysis unit and have been in dialysis two years. I did acutes for 1 year before coming here. I've seen nurses that made it and some that didn't. The ones that did used the above to help them. YOu are in training. Take your time. It should take at least two weeks to get the stringing down.

Do you mind me asking what state you are in?

Sherryg

started training as a dialysis nurse at the end of June. My anxiety level is very high and I keep forgetting little things as far as the set-up of the Phoenix dialysis machine. Things like turning off the KT/V but only on occasion or forgetting to put the prime line into the WHO when it is time to prime the darn thing. My Mentor (who is a PCT) keeps telling me that the she has trained other nurses who were not cut out for dialysis. Worked with another person this week who was more laid back than my present trainer and things went much better. I only forgot to turn of the KT/V once with the setups that I did. I enjoy the patient care and want to learn the nursing part of things. The other nurses tell me that I will never be as fast as a tech and that is not my job anyway but I do need to know how to take someone on and off the machine safely. I totally understand this. However I feel like that unless I am running around from machine to machine at take off and put on with my hair on fire that I am not keeping my mentor happy. I just feel like it is an impossible environment to learn the job in. If I were hiring on as a PCT I suspect I would have been booted out the door already. My manager is willing to work with me and I will be with the laid back trainer for another day then I need to make a decision as whether this type of nursing is for me. Any input from you dialysis types would be greatly appreciated. I don't know if I am just very intimdated by the technical nature of the job or if I am just too dumb to know that I am not cut out for this job.

jnette, ASN, EMT-I · Aug 21, 2005

While it's true that as a nurse you are not expected to be able to keep up with the PCT's....you will gain a lot more respect from your subordinates if you can....and your unit will run much smoother when you can chip in and help some of your slower PCT's....as the person in charge.....you are expected to touble shoot problems at a different level than your underlings....You need a year 'bustn' your butt' on the floor in order to deal with 95% of the problems that arise....what you don't want is to have the 'deer in the headlight' look when something happens.....time and experience is all it takes.....There will be days when you ask yourself if you made the right decision....tha't normal....hang in there....it does get easier.

hmmmmmmmm.... aways interesting to see how other facilities operate.

Where I work, nurses take the same load of patients as the techs.. even if you're the charge nurse. There is no such thing as "separate" nursing duties..we do it ALL. We have four patients apiece...whether you are nurse or tech. All depends on who's working .. if there are two techs and two nurses, or three nurses and one tech. We usually have at least two licensed staff on the floor and one tech.. then another tech OR nurse to do the water chores, jugs, etc., plus help out with machines during "rush hour".

The nurses have the ADDED responsibility of assessments, drawing up meds and administering them, doing labs and the occasional bloodcultures, antibiotics, and handling any emergencies or variances that come up plus the end of the day paperwork.

We string our own machines , tear them down and clean them, just as our PCTs do. In essence, we do everything the PCTs do PLUS our nursing responsibilities.

The way some of you describe your operations sounds wonderful.. unfortunately, we don't operate that way.

Maybe someday, eh?

munki32 · Oct 28, 2008

I have only been in haemodialysis for 7 weeks, and only worked part time for all of that. I dont feel at all confident and find that before I am able to fully master one aspect of the job, ie priming the machine or taking patients off, I am being rushed onto the next thing. Consequently I am dreading going into work and actually feel nervous before and during the shift.They already have me needling when I am struggling to remember the basics. I often forget to do little things, am told, "dont worry it comes with time", then instead of working on that one thing, I am shown how to do the next thing:bugeyes:.

I have been told that I will be ready to go off on my own in 5 weeks and this has filled me with absolute dread.I have worked for 8 years as a nurse on a variety of wards and never felt like this!! I am wondering if I should leave,as if I feel like this now,I will feel alot worse when I am flying solo! :confused:

sissib · Oct 29, 2008

You are normal, don't give up yet, ask your manager if you can switch mentors before you decide you can't do this. I have a great trainer and have had a couple others fill in on her days off. There is a difference. Get your quality in threading and priming your machines first before you let anyone rush you, your speed will come naturally as time goes on. Don't worry too much about the nursing part now, nursing is nursing. Our trainer gave us a refresher course of 2 classes in (2 days) of the process the kidneys and that kind of brought it to light. I hated osmosis and filtration in nursing school but it really hits home when you are actually using it daily.

This is my second week on the floor, my trainer usually gives me 2 machines to prime during change over, and today I actually set one up without asking questions, then I also finished one she had started too. I have not stuck anyone yet, just put on and take off ones with catheters. Changing catheter dressings, etc.

Where I work, nurses and techs all do everything, they work as a team always, change over is very hectic but if the staff can't work as team it is even harder.

Hope you don't give up on this sounds like you really want this to work. Good luck!

maddiedog · Nov 1, 2008

Can anyone give me the steps to learn to memorize,(threading)Priming I am going into the residency program and I would like to come up with an acronym for it and any othe suggestions to keep stress down, while learning. I know any new job brings stress, I try to think of the good I can bring with the hands that the good Lord gave me, that is what keeps me going. Are there sites to go to study until I get into a program? I can't get in until Jan, so thought I could learn on line or pick up some of the language, as it is different too. Thanks