I am a new BSN,RN, and I have decided to start a career in dialysis by signing on with a school that trains Techs and RNs. I was just told that I would have a preceptor that is an LVN who is basically a Tech. I understand that she has many years in the field and has great technical skills. Nevertheless, I did sign on to become a dialysis RN and wonder for how long should I stick with the Tech? And when to demand an RN?

What are your thoughts regarding this situation?

Thanks,


RNinLA

Thanks for the post. My thoughts on this are several fold. First and foremost, the preceptor that you have been assigned to has numerous skills and abilities that you can learn from. Her technical skills (to include cannulation, machine preparation, and specimen handling) are probably superb. It has been my experience that you should be able to understand the basics of all of this, and be comfortable working with one or two patients between 4 and 6 weeks. You need to have this basic, fundamental knowledge to move forward.

After you become proficient with the technical aspects of dialysis, I would recommend asking for an RN preceptor. This individual could orient you to care planning, catheter care, RN specific procedures, charge duties or other items that are specifically within the RNs scope of practice.

Either way, don't worry if you don't seem to 'know everything' the first two months. You will wake up one day and all of the knowledge will have 'melded' in your brain, and you will be surprised at how much you know.

Best of wishes to you as you begin this career. We are glad to have you in our ranks. If I can ever be of assistance, please let me know.

Please let us know how things turn out for you.

Carol

I have been in dialysis for a long long time and nothing makes me more upset then to see a question posted like this one...Lady RN, please don't go into this field where RN and Tech must work so closely, with mutual respect and trust for each other. A RN that goes into dialysis with that type of attitude will cause more harm then good in a dialysis setting. Pick ICU or some doctors office for a vocation, it surely sounds more like you. Sorry but true, Pete

RNinLA:

It has been 4 weeks... how is it going?

Pete:

Before we throw the baby out with the bathwater, I think it is important to remember that many colleges of nursing don't teach the fundamental relationships between licensed and unlicensed assistive personnel. This was an incredibly difficult task for me to understand and appreciate when I began my career.

I think you are absolutely on target and I agree fully that you must have trust and respect for one another. However, I also remember being a brand new nurse in a hospital with nursing assistants and LPN's who worked with me. As the RN, I was 'assigned' to oversite of these individuals. Nothing could have been more intimidating or distressing than trying to determine the appropriate 'boundaries'. I think that had less to do with respect, than it did with learning what it was really like being a nurse, and how that applied to the functioning of the unit, and the overall care of the patient.

What are the thoughts of others? I didn't take RNinLA's comments in a condescending, disrespectful manner. Perhaps others have....

Either way, is one of the intrinsic problems in the dialysis unit that there is a lack of understanding or respect between 'levels' of staff? What can be done to improve this? How should it be handled?

This shouldn't be an attack on others, per se, but ideas and suggestions to make things better. I would love to hear from you!

Carol

My company is a not-for-profit chain affiliated with the University of Maryland. Up until about 7-8 years ago the first thing that new fellows did was to go through our tech/nurse training program and actually work in the unit as a tech for a month. The thinking behind this was that they needed to fully understand the technical aspects of dialysis before they can oversee and direct it.

In many facilities, the nurses do little more than paperwork and give meds. This is partly economics since you can have 2 techs for the price of 1 RN but it is also because it is what the nurses want. Even in med/surg units a large portion of the direct patient care is delegated to aides and assistants. How often does a floor nurse give bathe a patient or take routine vitals....not very but...they still need to know how to do them in order to oversee and supervise those that are doing it.

Dialysis is not taught in nursing school so, you should have to train as a tech and work as a tech before you can supervise a tech.

Would a Doctor tell a mechanic how to fix a car?

Sorry,But her remarks were condescending and I agree with Chuck, Give Meds,Do the paperwork and then when the team concept sinks in,perhaps you will be trainable.In the interim I hope you have carefully thought about working in The chronic Dialysis field.

Well, I guess that post was a little bit insensitive to certain people (Phew!). The question was valid since I am new to dialysis which means that I didn't know what to expect.

I have read the responses which ranged from encouragement to discouragement to informative. Thanks for your responses and I enjoyed reading all of them.

So what has transpired since that awful post? I've learned that the LVN can do almost everything that the RN can do if he/she has certain qualifications. As a matter of fact, the LVN that's training me is excellent and I have learned a lot from her. So, I am very pleased with the situation overall.

Additionally, my training excelled since joining up with the LVN. She's a great preceptor and I have developed a great deal of respect for her as well.

Interestingly, I did train with an actual Tech and she is very good with the tasks. For example, she can prime the machine at lightening speed and she puts the patients on in a heartbeat. Also, the patients love her and she has built a great rapport with all of them.

I've enjoyed my training thus far and now I have a better understanding of who's what and who's who in the field of dialysis. Also, I am very glad that I've entered this career, and in two weeks I will ask for my evaluation and start working in a dialysis clinic.

Merry Christmas and Happy Holidays,


RNinLA.............

I am glad that things are going well for you.

Please keep in touch!

Carol