only 6 weeks to train, help!!

stidget99 · Feb 19, 2005

hi yall, i just got hired at a dialysis clinic, and only have six weeks to train. there is sooo much to learn, i have to learn everything the techs do, building, tearing down, putting pts on and taking them off. plus i also have to learn all of the rn stuff. and i also have to train for acutes and on call. seems like 6 weeks is not ecough time to learn everything. does anyone have any advise to make it
less stressful? i need the advise !!!!!

My one piece of advice that I would give........talk to your manager explaining that you are very uncomfortable w/ the limited amount of time allotted for orientation. If they are unwilling to extend that time, I would not take the job. We all have worked hard for our licenses and we don't need them to be jeopardized right out of the starting gate because managers take advantage of the newbies.

jnette, ASN, EMT-I · Feb 19, 2005

Six weeks is the average ACTUAL trng. period.. this does not mean that anyone expects you to be proficient at what you do in a mere six weeks.

The training itself of "all things new" encompasses 6 weeks. But any manager worth her salt (as well as your coworkers) will tell you that it will take you a full year to feel comfortable and confident in your skills and abilities. So relax.

No one is expecting you to run out on the floor and know or do it all in six weeks.

I have been in dialysis for eight years, and we tell all our new staff.. techs and nurses alike, to take all the time they need, and to know that it will be a year before they feel like they are finally getting it.

It WILL come... you'll be fine.

Let me know if there's anything I can help you with as you progress. :)

RM23 · Feb 20, 2005

Six weeks is the average ACTUAL trng. period.. this does not mean that anyone expects you to be proficient at what you do in a mere six weeks.
The training itself of "all things new" encompasses 6 weeks. But any manager worth her salt (as well as your coworkers) will tell you that it will take you a full year to feel comfortable and confident in your skills and abilities. So relax.
No one is expecting you to run out on the floor and know or do it all in six weeks.
I have been in dialysis for eight years, and we tell all our new staff.. techs and nurses alike, to take all the time they need, and to know that it will be a year before they feel like they are finally getting it.
It WILL come... you'll be fine.
Let me know if there's anything I can help you with as you progress. :)

What you are saying is of some concern considering errors can kill on dialysis. In the new regulations, an RN to be a unit manager must have one year clinical and six months of dialysis maintenance. From what I hear you saying, this is pretty scarey that the RN does not have more than six weeks of dialysis considering all the potential problems that arise, as well as being the supervisor of techs. Very scarey.

jnette, ASN, EMT-I · Feb 20, 2005

What you are saying is of some concern considering errors can kill on dialysis. In the new regulations, an RN to be a unit manager must have one year clinical and six months of dialysis maintenance. From what I hear you saying, this is pretty scarey that the RN does not have more than six weeks of dialysis considering all the potential problems that arise, as well as being the supervisor of techs. Very scarey.

I think you are misunderstanding what I am saying.

First, there was no mention of her being unit manager. She said she has 6 weeks to TRAIN. And that is the norm at most, if not all dialysis facilities.. whether tech or RN.

But the training period is just that.. training and learning all about how the machines work, the basics of dialysis and how the body responds, nutritional and fluid restrictions, how to adjust target weights, and why..etc., etc.

Again, that does NOT mean she will be thrown out onto the floor and be expected to know everything or be unsupervised. Yes, mistakes in dialysis can be deadly.. the training points this out, and the training is intense.

Where I work, any new staff is sent off for the six week training period, hten comes to the unit and is put on the floor where the training CONTINUES in the form of orientation/preceptorship.

I think it is more a matter of semantics.. just what the definition of "training" is. There is the initial training, and then there is continued orientation/supervision on the floor. And as always, when in doubt about ANYTHING, ask, ask, ask. :)

She might want to ask her DON/Mgr. to elaborate on this and clarify. Ask about the initial classroom/lab training versus the "on the floor" preceptorship and orientation. Just what can she expect? That should give her a pretty good idea of what lies ahead, and help put her more at ease.

imperial · Feb 20, 2005

I, too, have concerns regarding training of dialysis nurses. Techs, many without medical backgrounds, often rely upon RNs to supervise. Supervising a dialysis unit, in my opinion is a very difficult job. Rising number of geriatric patients, with many comorbid conditions warrant the RN to have more than one year clinical experience and six months training. I reviewed the ESRD proposed language that was suggested by poster and also have some concerns focused on experience needed to be unit manager, as well as charge nurse (RN or LVN/LPN). There are so many concerns that have been voiced about the dialysis units/industry related to delivery of care, training, education and patients being discharged for no apparent reason(s). This is most disturbing. I am interested in obtaining the input of you all related to dialysis environments and would appreciate any education you can provide.

One areas is patient education and do units sincerely take time to provide detailed education, or, in reality, are staff too busy. Recently, I saw a website, http://www.dialysisethics.org which is a patient advocacy group. Here they posted many survey results from dialysis units throughout the United States. After reading some of the survey results, I am totally taken back to realizing how fearful it must be for patients, especially those who are, in fact, educated. Do your units allow patients to ask questions, and, to question what is being done? Again, thanks. Am trying to completely understand this world of dialysis. Another area of concern is such that there has been little oversight by government agencies.

jnette, ASN, EMT-I · Feb 20, 2005

While your concerns are valid, I believe there are some misconceptions out there as well.

No RN without dailysis experience, knowlege, or background will be walking in and running a unit. Not even after initial training. To run the unit, one must be Clinical Mgr./DON and this requires a BSN/CNN today.

Yes, there are numerous comorbidities with these patients, but we have standing protocols in place. Also, we do strictly dialysis.. should other problems arise, these patients are sent to a local hospital where the other problems can be addressed, and they are dialyzed there. We can refuse tx. if we feel a patient has something going on which needs to be evaluated, and we send them to the ER where they are either stabilized or transfered out to a hospsital for further care.

As for supervision of techs, our techs are well trained (although I have heard some horror stories from some of the really large clinics).. but am pleased to say that in my case this is not so. Out techs are highly qualified, motivated, and responsible. They have limits to their care and interventions and do not exceed those boundaries.

I'm not quite sure I understand what you mean by "patients being discharged with no apparant reason"...?

Our patients are discharged only by our medical director who is the patient's nephrologist.

Yes, a dialysis unit is high maintenance and VERY busy.. but new staff is precepted and oriented just as in any other specialty.. in ADDITION TO an actual 6 week classroom/lab training period BEFORE they are ever put on the floor. There they continue to learn and grow.. and remain supervised whether LPN or RN for the following year.. again, just as any other specialty.

As for our patients.. they absolutely are encouraged to ask questions, to educate themselves and their families. We have an excellent team of dietician, social worker, and PA who visit with them on a weekly basis and go over all their labs, meds, nutrition, and personal matters pertaining to them. The nursing staff provide continuing education in their daily interactions with the patients as well... so much so, that most of our patients just brush us off with a wink and a grin. And there are those who also have no desire to learn or participate in their own care, expecting us to do it all FOR them, regardless of how we stress the importance of doing their part. We can only do so much.. they MUST contribute.

As far as Gov't oversight, I believe dialysis is one of THE most highly regulated industries there is.. I know we must be careful to dot every "I" and cross every "T" to the point of being ridiculous, due to medicare and gov't. oversight, audits, and unannounced "walk through inspections".

Again, I am speaking here for chronic ESRD, freestanding outpatient clinics.. and in my case a "small one".. 12 chairs, 40 patients, we work Monday through Saturday two shifts per day. I know the larger clinics have some issues, and I've heard it is nearly "assembly line" style at many of these anymore. Very scary, impersonal, and demoralizing for patients and nurses alike. Our census has doubled over the past year.. and I can't help but wonder why so MANY suddenly are referred to dialysis.. especially those who with their age and many comorbidities have truly little to gain.

Yes, dialysis, just like so many other health care industries is just that.. another industry... complete with marketing tools and all the broohaha that goes with it. And it is this which concerns me more than anything else discussed here so far.

steelcityrn, RN · Feb 20, 2005

Vidrine....Just take it day by day. Alot will depend on who is showing you the ropes. Gravitate towards the best. Pick up all the good tips, ans chit can the stuff you see that does not seem correct. You will do well....relax...I have never found one r.n. that didn't find a new job overwelming at times.

hi yall, i just got hired at a dialysis clinic, and only have six weeks to train. there is sooo much to learn, i have to learn everything the techs do, building, tearing down, putting pts on and taking them off. plus i also have to learn all of the rn stuff. and i also have to train for acutes and on call. seems like 6 weeks is not ecough time to learn everything. does anyone have any advise to make it
less stressful? i need the advise !!!!!

gfrn02 · Feb 20, 2005

hi yall, i just got hired at a dialysis clinic, and only have six weeks to train. there is sooo much to learn, i have to learn everything the techs do, building, tearing down, putting pts on and taking them off. plus i also have to learn all of the rn stuff. and i also have to train for acutes and on call. seems like 6 weeks is not ecough time to learn everything. does anyone have any advise to make it
less stressful? i need the advise !!!!!

Don't stress. I only had two weeks of training and then only two weeks on the floor before I was alone with 8 patients in my pod alone. You just need to get the basic knowledge of why you are doing what you are doing and the rest will fall in place with a little time.

vidrine rn · Feb 20, 2005

the training is on the floor. basically I just run around and have to ask how to do things. the rn has yet to take me with her when she goes into the computor

to chart or when she does orders. i havent been shown their daily routine.

its very frustrating. i told my husband today im thinking about going back to work at the hospital. :uhoh3:

imperial · Feb 20, 2005

I agree with industry there is much brooo hahahah.. and it is not a laughing matter. Your unit certainly sounds wonderful. Yes, there are many horror stories out there and there 'are' units which have RNs with no experience, only that which is given by that corporation. Yes, it is like a process line of a manufacturing company, at times.

In all due respect, I must disagree with you (agree to disagree, my motto) about the regulatory issues. Dialysis is not one of the most regulated. Nursing homes are inspected every year, come h... or highwater.. Dialysis units, 'may' and, I repeat 'may', be inspected once in three years. There is lack of funding, given to States (who enforced the Federal regulations, CFR) in order to conduct routine inspections. Some dialysis units have not had a survey in some 8 years. Several years ago, the OIG had a Congressional Hearing which spoke to these issues and lack of oversight, as well as poor delivery of care.

It is for the reason of not having enough surveyors (state) as well as funding that the dialysis units have gone without notice.

If you go to http://www.dialysisethics.org you will see many posted (actual) survey results and please note that often the plan of correction (given by unit) might be repeated several times. The consequences for non compliance have been nil.

As one poster stated, the 'new' proposed language for the Federal ESRD regulations can be viewed at the Federal Register site, of which they were published on 2/4/05. As the poster previously stated, they are open for public comment for 90 days from 2/4/05. It would benefit all who work in dialysis, or who have anything to do with dialysis to read and make your comments known.

Industry (large corporations) are running the show. Cost effective in order to make money. For example, FMC had 1.5 billion net profit, to my recall.

And, you know that the DOJ is now doing an investigation related to usage of Vit D. They have supoenaed documents from large corporations, as well as several lab companies, to my recall.

imperial · Feb 20, 2005

It is for this reason that I have concern for delivery of care in many units. Of course, there is good and bad with all areas of healthcare. I truly believe that more education is needed for, especially, RNs, beit on the floor or in charge. Remember it is your license when a mistake is made. It is most important to continue to educate yourself as much as possible.

Recently, I was made aware of a situation whereby a large corporation was not following specifics of federal regulations, i.e. assessing patients before and after each treatment. There is a fine line between, in my judgement, of getting to one's dry weight and dehydrating the patient. Many units believe it is important to 'challenge' the patient to their dry weight with patients experiencing hypotensive episodes, requiring saline infusion and feeling horrible i.e. lightheadedness, etc. This can be avoided by using many new procedures/techniques/devices. However, this cost money. I often wonder about industry and why they have so many 'barbaric' performing of care, i.e. taking ppl to their dry weights knowing there will be above stated symptoms.

At one time I observed, over and over, staff doing this, then giving saline, while never readjusting the dry weight, nor taking into account, what the patient is wearing when weighing in. But again, not everything is perfect and we certainly do not live in a perfect world. BUT, we can try our best to provide a safe environment for the patient with the least amount of complications/symptoms.