leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Tue Jul 29, 2003 7:35 am Post subject: new laws?
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The staff at the dialysis center appeared upset yesterday. Apparantly, someone came in an inspected one of the other units they operate in a different town and the unit was written up for a number of things. Sounded like the tech's were doing things not allowed. That the RN's were going to have to start doing the heparin, blood draws from dwells(whatever that is) and some other things. The changes were going to happen right away at the written up unit and over time at this unit(I suspect until they get inspected and written up also).<
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>Any idea what
ought this about?
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Hemo RN
Joined: 24 Feb 2003
Posts: 17
Posted: Wed Jul 30, 2003 2:13 pm Post subject: New laws
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Is your unit in Indiana?
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Thu Jul 31, 2003 12:06 am Post subject: location of unit
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Yes it is. Did Indiana recently pass a new law?
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Hemo RN
Joined: 24 Feb 2003
Posts: 17
Posted: Fri Aug 01, 2003 1:36 pm Post subject: new law
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My unit is in Indiana and we were inspected by the state in June. There were questions from the inspectors regarding the technicians giving heparin. Furthermore, our plan of correction has been rejected (this has never happened to our unit in my 14 years) and this is the area they seem to be focusing on although the state has not came right out and said so. I am sure that you can well imagine the problems that would develop if the PCTs could not give heparin. Most units are already minimally staffed with nurses. This may be by choice or by due to the nursing shortage. Currently I have 2 RN positions open. I ran six ads in local papers and got 2 responses. Of those two that I interviewed, one decided she did not want to work "that hard" and be on her feet "that much" and the other I probably will not hire as she lacked the enthusiasm and professionalism I look for in employees. So, the nurses I have are putting on patients side by side with the PCTs so that the patients all get on at a reasonable time. If it becomes the case that only nurses can give heparin we will have to stop what we are doing to give the heparin on all patients. Yes, heparin is a medication. However, all of our PCTs have been trained and checked off by an RN before they can give heparin. This competency is rechecked at least every year. Frankly, you are in much more danger if a tech does not know how to operate a machine well or is unable to trouble-shoot problems. That is all that I know right now as we are still in the middle of trying to figure out exactly what we are doing wrong in their opinion.
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Working RN
Joined: 01 Aug 2003
Posts: 3
Posted: Fri Aug 01, 2003 2:07 pm Post subject: To Hemo RN
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I work in a unit that does not allow pct's to give the heparin. The RN's must not only draw up the heparin, but before they give it, they must ask the patient if they have any bleeding since their last run. This is a safety check that is done and I think it very prudent to do. A LOT of problems have been avoided because of this practice. RN's have the education to know how to deal with these things, pct's don't and my experience has been that there are many out there who wouldn't even tell an RN if they saw anything out of the ordinary. We have 2 RN's who do this while the pct's put on patients and this is a very large unit!<
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>Maybe you need to look at hiring more pct's to put on patients to free up your RN's to do this. I think you will find that in the coming years, things will become far more restricted in what pct's are allowed to do and the RN's will be doing far more RN type of things and being required to interact more with the patients in that capacity. I see a return to a more hospital type running and care of dialysis patients. No more of this kind of jiffy lube stuff. The word is out!<
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>And why should RN's have to work like the companies make them? With the nursing shortage out there, we have our choice of places to work and as the pay and benefits are rarely comparable to what is required, I don't blame those RN's at all for not wanting to work in dialysis.<
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>The changes are coming and this is one state it is starting in. <
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>
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Fri Aug 01, 2003 5:53 pm Post subject: RN
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yes changes are coming and it is going to be more than giving meds. why don,t the clinics wake up and start self along with adaquate treatment. why are not the patients being more like humans not a profit milk cow who is sent to the trash pile after they are used up.
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Rathernotsay
Joined: 19 Jun 2003
Posts: 2
Posted: Sat Aug 02, 2003 7:27 am Post subject: new tech
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Friday I had one of the PCT that just completed the in house training last week I think it was. Anyway, she started off by putting the blood pressure cuff on my wrist. Of course this did not give an accurate reading. After discussing with her she went and found a larger cuff. Where does she put this? On my forearm!!!<
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>Needless to say, when it came time to put the needles in she was not able to accomplish this either. One of the RN's had to come over and re-stick me.<
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>I am more comfortable wiht many of the experienced PCT's doing things than some of the RN's who do not do it every day. But until the PCT has had enough on the job experience, being on there own, I think the RN's need to monitor them more. Let alone letting the new PCT give meds.
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Hemo RN
Joined: 24 Feb 2003
Posts: 17
Posted: Sat Aug 02, 2003 9:05 am Post subject: working RN
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Do you work for a non profit company? Can your PCTs put cath patients on? Do you work in a state that has already restricted what the PCTs can do? I work for a for profit company. I do believe that the care given at the clinic is safe or I would not be a part of it. However, I also think there is room for improvement. I would love to have more staff. However, we staff at a 4:1 ratio. Until the governing bodies mandate more this will not change. In our state there is no ratio or RN to patient. We can run with 20 patients and 1 nurse should we decide to. (We don't.) I feel like it is the staff and the patients that are stuck in middle of goverment vs. big companies. We do more with less in order to answer to the share holders. However, most patients and family members do not understand this. All they want is to get hooked up on time and out on time. The patients here are the exception not the rule. I am comfortable with my PCTs giving heparin. Most are 5+ year employees, many with 10+ years. Yes, they ask the patients if there have been any problems, including bleeding, since their last treatment. If a patient voices a problem the PCT stops until a nurse can assess and make a judgement. Also, I have interviewed for 7 years now. Just because someone is an RN doesn't always mean they know what they are doing. Also, I think that the nursing shortage has created an atmosphere of arrogance and job hopping for many nurses. It is very frustrating.
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Working RN
Joined: 01 Aug 2003
Posts: 3
Posted: Sat Aug 02, 2003 11:58 am Post subject: Hemo RN
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I have worked for both for-profit and non-profit. My experience has been that the non-profits staff better and appear to give their techs better training than the for-profits. In fact, the reason I left the last for-profit that I worked at was because of the RN to patient ratio. I felt that my license as an RN was in jeopardy when I was the lone RN with 16-22 patients. The techs worked at a 4:1 ratio and took turns dong the reuse on top of their patient load. Add in all the paperwork, care plans, meds, emergencies, anemia management, etc., all for 1 lone RN to do and it is no wonder that no one wants to work like a horse for next to nothing. <
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>The PCT's do put on cath patients, but RN's must do dressing changes, the cath off packs and check all machine settings, baths, etc against the treatment RX. <
>The state I work in also requires that the pct's be state certified.<
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>In my area, the for profit companies are having a very difficult time attracting and retaining adequate staff ( as in actual bodies) as word has gotten around about the working conditions. Those who do stay in dialysis usually go to a staffing agency and work through them for much higher wages and can pick and choose their own work schedule.<
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>Dialysis is such a specialty that I doubt that any RN just off the street would even know much about it, what they learn all depends on the education they are given by the for-profit companies and from what I have seen, it is poor at best. As for the patients and their families, this is where education comes in, something the for-profits don't seem to want to pay for. Much easier to label someone as non-compliant than to educate them about their disease and treatment options. <
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>I don't see the nursing shortage as creating an atmosphere of arrogance for RN's. Instead I see the<
> nursing shortage as finally giving RN's the ability to pick and choose where they want to work. They are no longer so desperate for jobs that they have to take what they can get. Some Administrations are treating RN's with more respect and thinking very hard as to what they can do to retain the RN's they have. Something the dialysis companies are not willing to do because they have such a big obligation to their stockholders. That obligation outweighs their obligation to the very patients who are the ones generating all the $$$$$ for the stockholders. <
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>Yes it is frustrating. But until you and the staff make a stand, it will continue to be that way. These companies only understand when it hits them in the pocket book. And as long as you and the others are willing to put up with the current conditions, then as far as the administration is concerned and the money keeps rolling in, everything is just fine. It is after all your license.
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patientwife
Joined: 18 Jul 2003
Posts: 47
Posted: Sat Aug 02, 2003 1:35 pm Post subject: Hemo RN
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Some of us do understand!<
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>Govt, by lack of adequate oversight, and corps/stockholders, by prioritizing profit before quality healthcare, are perpetuating a disservice upon staff and pts alike. We pts and families know that units need competent staff, at all levels, to achieve that desired and that pts warrant. We know that units are operating with questionable staff/pt ratios.<
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>Unit handbks, as well as other docs given pts, are a farce! Units cannot deliver that written on paper because there is not adequate staff to do so. A nutritionist told me once, upon request for service stated in the pt's handbk, "I don't have time to do that. I have 200 pts." Hmmmm - an average of 10 pts/day, plus all of the paperwk, mtgs, travel time, etc. It is no wonder that nutritional assessmts and care are so bleak. We understand -- BUT<
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>Pts lives are at stake -- not ours, family members, nor staff. We rally on behalf of pts, their survival. It will be helpful if you staff rally, to mangemt, for the staff ratio which will allow safe execution of your duties.<
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>We are all frustrated! We need each other!<
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>Ideal is that we unite in effort to promote quality and safe care at dialysis units.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Aug 04, 2003 1:29 am Post subject: New Jersey
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In New Jersey only RNS can draw and administer drugs. I'm told the dialysis unit is under those same rules and yet the pct's draw up the Heparin all the time. Heparin is a drug and so to my way of thinking if they (pcts) aren't allowed to give epo and Zemplar, they shouldn't be drawing up and giving Heparin either! Most of the time no one asks if there was a problem; I have to make sure to tell them. I fear for the pts. who can't speak up! Lin.
