Techs vs. RNs in Outpatient Dialysis

bri2012 · Dec 12, 2017

We have a "day shift" vs "night shift". Day shift is 4-1 shift and night shift is the staff that comes in at 10 and after. Stock doesn't get filled at night so day shift sometimes doesn't do it because night shift didn't. It's just a bunch of childish things.

Kay714 · Dec 23, 2017

I have the same issues in my clinic. When I first started, I had the Techs telling me not to be like the "lazy" nurses, and the Nurses telling me not to listen to the Techs and assert my "nursing authority." I value my techs because they know SO much, but I also have to remember at times that they are working under MY license. Nurses have assignments at my clinic so we don't help much during turnover unless we are unassigned that day. But I do understand sometimes about the techs not doing what they are supposed to. They put their patients on and go to break for an hour, while the nurses are still doing assessments and passing meds. It can be frustrating. I also have so many techs that refuse to stock, or close or even update vitals.

parolang · Jan 2, 2018

I'm just a PCT, but our facility has been going through this for quite some time, and the FA might be starting to fix it.

But the FA needs to figure out who the low performers are. Our FA basically started by monitoring the floor and started counting how many patients did each team mate put on and take off, especially during turnover. Then she would look at how many vitals each team mate was signing off on the computer.

We have an LPN who would slow down to a crawl during turnover, and would put on no more than two patients during turn over, and take off maybe three. Most of us really didn't notice it, because we were all busy with our patients, and all I saw was the patients who were ready to get on.

When you have someone like that, it doesn't take much for everyone to be pointing fingers at each other: Without attentive leadership, the best defense against an allegation is a counter-allegation, and it's hard to complain because you are going to rely on these people for possibly years on end.

Kay714: Sounds to me that your techs are being insubordinate. They shouldn't be refusing to do anything within their scope of practice. Also...no one should be getting an hour-long break. I keep hearing about people taking extended breaks at my clinic but I don't time anyone's breaks. But if you're taking an extra 30 minutes for break, well you might run out of time to stock and do other chores.

I don't know what assignments that nurses have at your clinic, but the only time I ask for help from RN's is during turnover. Turnover can either flow smoothly, or turn into madness. I'm generally busy non-stop during turnover, and what I need is someone to help with alarms, vitals, and patients who are cramping. We are a 12 chair clinic, and there have been plenty of days where I easily put on five or six patients, and that's not counting the patients who I just took off, cleaned the machines, and set up for the next shift. I don't take short-cuts either, so I wait for the three minute Heparin dwell time, etc.

But I always saw it as a jump in, assist the patient, and jump out of the pod kind of thing. I don't expect the charge nurse to take my patients and put them on for me or anything like that. But no body should be spending a lot of time at the desk during turnover. This is like the most vulnerable part of the day, for us and the patients. Patients are most likely to crash at the end of their treatments, and that is typically while I'm busy taking off or putting other patients on. This is when patients are most likley to cramp. Also, RN's are supposed to be doing assessments in the first half hour of treatment, right?

perksrn · Mar 4, 2018

I'm a new RN to dialysis. This is an issue at our clinic as well. I see the nurses sitting idly by while they could be helping at changeover. I have vowed not to be that nurse. The techs are so incredible and work very hard. I have learned a lot from them. Our nurses often take "a pod". Generally it is 3 to 4 of their own patients plus charge responsibilities. That can be tricky. What I do have concerns about is that the techs have such an enormous amount of responsibility that they often don't realize the importance of reporting patient issues to the RN and some have little respect for the nursing knowledge we utilize to care for our patients. It's really the environment of dialysis that breeds this particular issue. I am constantly on the floor in my free time helping stock, change over, clean, etc but was recently accused of thinking I was better than the techs and not their equal as my boss expects.

I don't really know what I've done or could do to change this perception. I think our techs are fantastic but can't change my opinion that we have different areas of expertise that should be recognized to best care for our patients as a team.

perksrn · Mar 4, 2018

Error. Posted on wrong comment

perksrn · Mar 4, 2018

Any advice on improving the tech/RN relationship?

parolang · Mar 5, 2018

If you are at least trying to help and treating everyone professionally and with dignity, then there is not much more you can do. Probably the worst part about being a PCT is being in this subordinate role where much of your job are all the jobs that other people don't want to do. That part of the job doesn't change, no matter how nice or helpful your nurses are. Just keep in mind that even the laziest PCT works hard, even if they need to perform better (but that's a manager issue).

Don't bend over backwards for anyone, especially PCT's. It is easy for us to become complacent and forget that regulations give us a more narrow role in the care of our patients. In some cases, if the attitudes get out of line, what might be needed is a one-on-one meeting with the manager where expectations are clarified.

I don't think I have an attitude problem, but I've worked with other PCTs, and I can see how things can get bad. Human nature, no matter who you are, has a way of drifting towards expecting more from others, and expecting less from ourselves. We spend more time thinking about what other people should be doing than what we ourselves should be doing.

Naturally Brilliant, BSN, RN · Apr 26, 2018

Sorry if I'm resurrecting this thread, but I have a question for you all. I'm an RN who left their ICU job to give dialysis a try. I'm going to end up working in the acute (hospital) setting. Right now, though, the training program involves me going to a clinic for six weeks (which feels like an eternity, but that's another story) to train as a hemodialysis tech. Granted, I don't mind being paid for training for a lengthy period of time, but I have to be up front and say it's pretty difficult to try to keep up being precepted by a tech, really understand how to troubleshoot the HD machine, figure out the day-to-day ops of the clinic, and deal with the seeming chaos of the turnover. A small part of me wonders how differently the acute setting is going to be compared to the clinic (people told me that it'll be less fast-paced in the hospital and I'd end up liking it). I also tell myself that since I'm new to dialysis this is just a "hump" that I have to cross before things start to come into place in the future. So my question for you fellow RNs is this: Was the training period supposed to be difficult? And does it get better?

AlabamaBelle · Apr 27, 2018

parolang, if I were in a clinic, I would love to work with you!

I work in acutes. Our program doesn't routinely have a PCT, just occasionally. We feel pampered when she is there. We have a four bed space in our unit, with 2 patients per RN, Hepatitis status permitting. We do a lot of mobiles and are adding CRRT to our program.

I have a different schedule. I do 4p-12a, no weekend, no call. I do treatments that are left from the day, trying to get the on call person out and resting, just in case. I set up paperwork, machines for the next day. The portable ROs are stocked with extra equipment. I initiate all PD treatments. We just all pitch in and do our jobs to best benefit the patients.

Acutes is definitely a different animal from chronics (did that, too). Some days are beastly, some days are little or nothing.

Chisca, RN · Apr 29, 2018

The training period is difficult because you aren't doing any nursing, Dialysis clinics are assembly line factories designed to profit two large companies. Patient care be damned. Learn as much as you can in that environment and then flee. Acutes will at least allow you to use your nursing skills and hopefully the call schedule doesn't grind you down. Good luck.

Naturally Brilliant, BSN, RN · Apr 30, 2018

I don't know why people keep saying that acutes has really long hours, though. When I worked in a medical ICU, I'd come in an hour early to look up my patients, so report would be a breeze, and if the you-know-what hit the fan with the patient during shift change (SUCKS when it happened!), I'd end up staying until 9 AM once in a while. So I'm used to being at work for 13.5+ hours per shift anyway.