Pushing to leave early

[Hazmat35]

So i am sitting in my chair doing my four hours,  I just finished working 8 hours.  Now the Tech at my center has been on me since Monday, to leave early today,  He said he's been here since 3:30 AM and has to close so tonight he has to work until 9:00.  Now i know they work long hours but he had off yesterday and tomorrow,,,,,i do not.

He said he will fill out the AMA and all I have to do is sign. 

I dont know about you but that is bordering on harassment.  Why should i cut my time because he is tired?   I thought he was joking but he isn't. 

This center is going down hill fast. 

[Simon Dog]

You do not was "leaving early AMA" on your record if you ever expect to be evaluated for transplant or home treatment.

Tell the tech you will sign is he signs "Tech is requesting patient sign off AMA so he can leave early today" on the form.

[kickingandscreaming]

Assuming you are in the U.S., we Americans already are being shortchanged in in-center Hemo (according to Dr. Agar and the Australians who seem to know more about D than we do--we should do more days or more hours/day).  I know that 4 hours can seem like an eternity (I did it long enough to figure that out) and it is sorely tempting to want to cut it short, but your tech has no right to cut it short for you.

[cattlekid]

That would be enough to warrant a report up the chain from me.  While I can understand that a 18 hour shift is not optimal, it should have no bearing on your treatment.

I had one of my worst treatment experiences EVER from a tech at the end of an 18 hour shift.  She was cutting corners right and left and I just wanted out, but there was no way that I was going to sign out and have that possibly held against me for a transplant eval.  I did tell my trusted nurse the next treatment that I didn't want that tech near me again and why.  It seemed to work for the short time I was still on dialysis, or at least our schedules just never crossed again.

[Michael Murphy]

A quick word to the manager is appropriate.  They would rather you tell your story to them instead of CMS.  The nurses at the center I go have a fit when they are told to cut time for patients.  It's happened a couple of times. Blizzards and  Hurricanes tend to delay arrivals of patients causing a backup.  Meeting your clearance numbers each and every time is important. 

[hatedialysis2]

There is no nurse on the shift? Is that legal?   Are you the only patient that this tech has under his care?

[iolaire]

Talk to the nurse or center manager about this.  It sounds like a scheduling or understaffing issue.  In my center someone comes in at 5 am or so, an hour before the others, to setup, that person leaves the earliest because they get in earliest.  I don't see how they expect to keep these techs as employees if they are forcing them to work 18 hours days.  Also I second @hatedialysis2's question about the nurse, is the nurse complicit in this or not managing the techs?

The hours the management forces our techs and nurses to work is the problem.  Even hospital's 12 hour shifts bug me.  How can we receive quality care from someone who is at the end of a very long shift. 

Some days I work 12 or so hours, and I'm only more productive near the end because I'm by myself and not bothered by emails and other people.  For a caregiver that's not the case, they need to be on their game at hour 12 or 18 just as they were at hour 1.  Our healthcare/dialysis costs are VERY high yet our level of people service seems to be one of the lowest in the developed world as compared to what I see in other dialysis centers around the globe.

[Simon Dog]

Even hospital's 12 hour shifts bug me.

That't nothing compared to the shifts of residents.

Some days I work 12 or so hours, and I'm only more productive near the end because I'm by myself and not bothered by emails and other people.

Back when I was working, I found 6 to 8 PM the most productive hours for exactly that reason.

[Michael Murphy]

Personally I found 6:00 AM till about 8:30 the most productive time with the added benefit is a system crashed during the night it was up and running before the masses arrived.

[kitkatz]

    For the tech!  No way do you sign an AMA because he is tired!

[Michael Murphy]

Hatedialysis2 makes a great point CMS and state laws require minimum staffing and it must include a nurse on duty if a patient is being treated.  My understanding is that the facility must have a charge nurse to oversee all patient care. I can't see how a patient can be left alone with a tech and meet the staffing requirements. 

[Charlie B53]

I can easily picture that happening.   A long day plus a double, or added late shift, the tech gets the draw to be responsible for making sure all doors are closed and locked.  The Nurse claims to have an urgent errand that just 'has to be now' and takes off a bit earlier than normal.   Leaving the Tech to handle everything on his own.   Tech just wants to close and go home.

It wouldn't surprise me to find out this happens far more than this one time.  They just haven't been reported and made public, yet.

[iolaire]

Hatedialysis2 makes a great point CMS and state laws require minimum staffing and it must include a nurse on duty if a patient is being treated.  My understanding is that the facility must have a charge nurse to oversee all patient care. I can't see how a patient can be left alone with a tech and meet the staffing requirements.

I come off at about 6:40 to 7:20, the only nurse takes a break at around 6:30 so its fairly common that I'm coming off about then without a nurse.

[hatedialysis2]

I come off at about 6:40 to 7:20, the only nurse takes a break at around 6:30 so its fairly common that I'm coming off about then without a nurse.

Still there is at least a nurse on duty, just maybe in the break room in case there is a medical emergency.   When I was in center there were at least 2 RNs on each shift so if one goes to for a break there is coverage. 

[Simon Dog]

There are also things that only an RN can do, with the limitations varying by state.  In MA, a tech can give heparin and hook up catheters, but cannot inject other drugs into the system (venofer, zemplar, etc.) into the system.  In NY a tech can't even give heparin or hook up a catheter patient.  So, do "get those things done", you need an RN on duty.

[Hazmat35]

There is no nurse on the shift? Is that legal?   Are you the only patient that this tech has under his care?

No; I'm not always the last or only patient.  There is always at least ONE nurse on Duty; but sometimes she isn't even on the floor; she's in the office doing paperwork.  You would have to SCREAM for her; because she's behind a closed door...and she's hard of hearing anyway.

[Michael Murphy]

The center I usually go to was closed for major renovations, we were shifted to a new center that does not have any patients on the Tuesday, Thursday, Saturday schedule.  Because the closed center has 4 shifts 6 days a week patients were sent all over the state so every one had a place to go.  My shift was 6:30 PM T,T,S.  So I show up a little early but don't get on the machine till 7:15. Since I am a 4:30 patient that means I should be getting off at 11:45.  Well at 10:45 they announce that the water system needs to be shut down by 11 PM so it will be ready of the morning.  I am coming off a hour early one of my fellow patients began yelling at the tech and nurse.  To no avail we both got short treatments.  Next day I went and saw my center manager and complained,also called the nurse practitioner at my doctors office.  Was called that night with a apology and a new time to start 3:00 PM.  They also started telling patients who were late that if they were late they could be sent to another center for treatment.

[supertramp1228]

I thought that's only gona happen in china.the tech in china are very rude.they always shouting to a patient who is late for the treatment, and cut your 30 mins or disconnect u from the machine 30 mins earlier as long as u r late anyway.





sp mod Cas

[Michael Murphy]

Most people are late occasionally but in the clinic I go to unless you are on the last shift there is some one scheduled to be in the seat you are using when you are done come in 30 minutes late and the next person isstarting 30 minutes later. If that happens on the first three shifts the last person is impacted by 90 minutes.  Come in regularly late in the center I use you get no help in rescheduling, no one wants to trade with you when you need a different time and you are always the last to be put on.  Why you are always late and it effects everyone else.