Why Can't I have the same Tech?

[Rerun]

Question to you dialysis employees:

Why don't I get the same Tech everytime.  They are there; just in a different pod/section.?

In my opinion it would be better for the patient to have consistency.  They would get to know the patient and if the patient had a complaint about a headache or irregular heartbeat the Tech would know the patient well enough to know if he was just blowing smoke or really sick.  If the Tech notices a new lump on your fistula, then doesn't see you for two weeks, then it gets missed.

Employees.....what is your take on this.

[livecam]

I had people I liked and expressed a preference for them.  On the other hand there were a couple I didn't care for and they knew it.  Some people have the magic touch when it comes to needle placement and some are horrible.  It only makes sense to pick the person who is going to place those needles quickly and not blow your fistula.  It also makes sense to let new unexperienced techs get their on the job training with someone else. Some of techs obviously didn't like me much but who cares? I'm still here to talk about it almost 8 years later.

[Epoman]

I know I am not an employee, however I know the answer in a word: CROSS-TRAINING

The techs get rotated so they can learn to stick everyone in the center and get training in learning to stick different levels of fistula development, and if a tech calls in sick someone can cover they section smoothly. It is you right however to request a certain person. Ask nicely first and if they so no way, then demand it. Or do what I have been telling you all along, learn to stick yourself, once you do it yourself you will never go back. I promise it isn't that hard.

[bioya]

Things you have to watch out for in a dialysis unit is special treatment and inappropriate relationships forming.  In dialysis, unlike other nursing, you have the same patients (for hopefully) years and years, not just in a day or two in the hospital then gone. 
Speaking from a managers point of view, you have to be careful to not let people become too close. I know that sounds horrible, but you have to watch it. If tech 'A' sticks Patient 'B' all of the time, they develop a friendship that becomes more than a tech/patient relationship should become. I can quote two cases...

1.  PCT developed very tight relationship with patient. Patient had a lot of different pain meds. The PCT asked patient for pain meds. Pateint brought in pain meds several times. Other staff found out, Manager found out... PCT fired and was banned from any other Gambro/DaVita employment.

2.  PCT (female) became very close with male patient who she had in her section every treatment. Friendship developed into dating. Dating became serious. Patient had to transfer from a FMC unit to a DaVita unit because staff are not permitted to date patients. Now in this case, they did do the right thing and patient moved.

Its a shame that you can't allow friendships to develop and mature, but there are just too many things that can and do go wrong. 

[Rerun]

I know friendships develop.  As a patient that is what I want.  I want to be with someone who cares.  I feel like I'm trying to "hook" someone so I can develop some sort of relationship so I have someone who "really" cares.  That may be manipulation on my part, but I'm desperate.  Desparate people do desperate things. 

Epoman, it is not just sticking the fistula.  It is general care when I go there.  When I go back to the fistula, I will demand only certain people stick it.  I just cannot imagine sticking myself.  Ewuuu!!   

[angieskidney]

I am scared to stick myself too .. I mean .. terrified infact!!! BUT I know that only I will know my arm best.

[Epoman]

I am scared to stick myself too .. I mean .. terrified infact!!! BUT I know that only I will know my arm best.

I was scared at first too, just try it. When you stick yourself you are in complete CONTROL. The patients at my old center were so impressed by me sticking myself, but I would tell them it's the simplest thing IF you have a developed fistula. Do Epoman a favor angie and try just once, NOTHING bad will happen. 

[Hawkeye]

I know I am not an employee, however I know the answer in a word: CROSS-TRAINING

The techs get rotated so they can learn to stick everyone in the center and get training in learning to stick different levels of fistula development, and if a tech calls in sick someone can cover they section smoothly. It is you right however to request a certain person. Ask nicely first and if they so no way, then demand it. Or do what I have been telling you all along, learn to stick yourself, once you do it yourself you will never go back. I promise it isn't that hard.

Things you have to watch out for in a dialysis unit is special treatment and inappropriate relationships forming. In dialysis, unlike other nursing, you have the same patients (for hopefully) years and years, not just in a day or two in the hospital then gone.
Speaking from a managers point of view, you have to be careful to not let people become too close. I know that sounds horrible, but you have to watch it. If tech 'A' sticks Patient 'B' all of the time, they develop a friendship that becomes more than a tech/patient relationship should become. I can quote two cases...

1. PCT developed very tight relationship with patient. Patient had a lot of different pain meds. The PCT asked patient for pain meds. Pateint brought in pain meds several times. Other staff found out, Manager found out... PCT fired and was banned from any other Gambro/DaVita employment.

2. PCT (female) became very close with male patient who she had in her section every treatment. Friendship developed into dating. Dating became serious. Patient had to transfer from a FMC unit to a DaVita unit because staff are not permitted to date patients. Now in this case, they did do the right thing and patient moved.

Its a shame that you can't allow friendships to develop and mature, but there are just too many things that can and do go wrong.

Your both right on this one.  All the staff needs to learn how to treat the patients and about their "Quirk's" so to speak.  This way if someone should be sick or change employment locations there are other staff that can step up to the plate and know what to do and what to look for.  Most places have a rotating schedule.  Every so often the staff change stations for a while and learn a new patient base.  After that same time they change again to a different station.  The other thing besides patients getting too close is that you have to be careful of developing favoritism.  Fresenius for example has policies about what kind of relationships we can have with patients and vendors.  We are not supposed to give or receive gifts from patients or vendors because this could be conceived as favoritism to someone in exchange for gifts.  If everyone knows that George the patient gave John the tech candy every day, and they also believe that John takes care of George better because of this John could lose his job.  It's a very sticky and fine line in what can and can't be done, but I'm sure you all get the jist of it.

[angieskidney]

I am scared to stick myself too .. I mean .. terrified infact!!! BUT I know that only I will know my arm best.

I was scared at first too, just try it. When you stick yourself you are in complete CONTROL. The patients at my old center were so impressed by me sticking myself, but I would tell them it's the simplest thing IF you have a developed fistula. Do Epoman a favor angie and try just once, NOTHING bad will happen. 

I will try when they finally start teaching me the teachnique And when I do I will think of you lol 

Thank you

Fresenius for example has policies about what kind of relationships we can have with patients and vendors.  We are not supposed to give or receive gifts from patients or vendors because this could be conceived as favoritism so someone in exchange for gifts.  If everyone knows that George the patient gave John the tech candy every day, and they also believe that John takes care of George better because of this John could lose his job.  It's a very sticky and fine line in what can and can't be done, but I'm sure you all get the jist of it.

Hmmm.. never thought about that when my mom gave me some Halva to give to our favourite nurse.

In my unit the nurses usually go back and forth working in the hospital dialysis unit and then back to my Self Care dialysis unit. I don't get to see my favourite nurse for months at a time.

[livecam]

If you have a preference let it be known.  You are the customer and it is your life.  Since there is so much at stake here shyness isn't a virtue.

[Rerun]

I WANT favoritism (stomp foot).  I want to give candy and be treated well!  I don't want to be just a number!  AHhhhhhhhh

[kitkatz]

I WANT it MY WAY!  I WANT it right now, too!   I agree with Rerun. I want a tech I know sticking me, it is not as bad when they remove the needles.

[angieskidney]

too bad in Canada it is not the same way. We are not paying customers .. per say .. because OHIP covers us. Well .. at least in Ontario 

[mightbeusoon]

I think that there are many good answers to why you can't have the same person putting you on every day.  But , I also know it is human nature to want what is good for you.  No one wants the person who can't hit the broad side of a barn, and neither would I.  I just feel for the patients that have a hard fistula/graft to get and get a very poor sticker!  I want to do the best thing for the paitent too, and I want to step in when they are having trouble with a pt.'s access.  It is very hard for me because you create enemies with your coworkers if you happen to be good at sticking, and the pt. request you over every one else.  The other workers feel jealous and then they take it out on me, which is wrong but they still do.  I even had a RN scream at me on the floor because she thought that I was talking the patient into not letting her stick him.  It was a messy situation for all of us.  In the end she wouldn't speak to me, and the patient got me to stick him every time after that but it made me miserable the rest of the time that I was at work.  I find that a lot of coworkers are jealous if you are good, they say bad things about you.  But, if I was a pt..............I know that I wouldn't let someone stick me that I didn't want to.  I think the pt. already has to take a lot of crap just coming to dialysis, let alone getting your access mutilated by someone who is bad at sticking!!!!   

[angieskidney]

My fistula is very (what the nurses call) "Snakey" .... and I find that 50% of the time when the nurses stick me (hardly ever the same nurse) it blows


I am tired of having my arm being always purple. But I can say one thing for this... I am getting so used to this that the stares from other people on the streets don't bother me anymore

[kevno]

After I typed A leaflet about way way I felt about the needles. I nearly  always got the same three nurses the most experienced too put me on the machine. Even if there were in the different rooms on the unit. I was always told which nurse was going to put me on. Plus if a nurse I did no know was going to put me on, one of the three nurses would stand by and tell the nurse how to needle me.

Attch File.

[kitkatz]

Kevno:  I hope one day the little ones inside of you will find peace and comfort.  Remember they are not being treated anymore, the adult is the one taking the sticks and needles.  The adult is brave and strong and will protect the little ones from anything happening to them.  They do not have to be present at any dialysis treatment anymore. Give them a safe place to go to in your mind when things are happening to the adult. 

Just a piece of what I have learned over the years.  I always wondered why doctors offices made me nervous.  It was flashbacks to smells and memories of treatments as a child with reflux into the kidneys.  They believed in doing intrusive testing in the 1960s-70s.  I do have a little understanding of where you are coming from.

[angieskidney]

for me it is more a fear of competence as I am used to hospitals and have no fear regarding them. It is just that I worry the nurses are making my arm worse by not following any ladder pattern on my fistula but grouping the cannulations.

[Black]

... I worry the nurses are making my arm worse by not following any ladder pattern on my fistula but grouping the cannulations.

I am so sorry this is happening to you.  I have no experience w/ being a patient in a dialysis clinic so maybe my question is too simplistic or outrageous -- but ...  what would they do if you chose the site for them to stick and insisted that they use it, OR if you insisted on trying to stick yourself?  After reading your descriptions and seeing the pics I don't see how the result could possibly be much worse.

[Bajanne]

Just a piece of what I have learned over the years.  I always wondered why doctors offices made me nervous.  It was flashbacks to smells and memories of treatments as a child with reflux into the kidneys.  They believed in doing intrusive testing in the 1960s-70s.  I do have a little understanding of where you are coming from.

This is quite interesting.  You see, my daughter thinks I am strange, because I am very comfortable in a hospital (and I have had to be there often in my life).  Most people hate the very idea of a hospital.  But it is not like that with me.  I realize it is because the first time I was hospitalized (appendectomy at 10), I had a ball!  I was the only child on the ward at the time and I was petted and spoilt (an extension of my home life - I was the last of 13 and seven years younger than #12).  When my family came to visit, they would bring all kinds of great stuff.  Nurses would come and stay with me until I went to bed.  They liked talking with me because I was a very precocious chatty 10-yr old.  I remember crying the day I had to go home. I think that has coloured how I feel about hospitals.  I don't usually let people know this, because everyone has an instinctive aversion to hospitals.  (so keep this on the qt )

[angieskidney]

... I worry the nurses are making my arm worse by not following any ladder pattern on my fistula but grouping the cannulations.

I am so sorry this is happening to you.  I have no experience w/ being a patient in a dialysis clinic so maybe my question is too simplistic or outrageous -- but ...  what would they do if you chose the site for them to stick and insisted that they use it, OR if you insisted on trying to stick yourself?  After reading your descriptions and seeing the pics I don't see how the result could possibly be much worse.

Heck! I am too new at this to have any sites established that I could pick out for them

Just a piece of what I have learned over the years. I always wondered why doctors offices made me nervous. It was flashbacks to smells and memories of treatments as a child with reflux into the kidneys. They believed in doing intrusive testing in the 1960s-70s. I do have a little understanding of where you are coming from.

This is quite interesting. You see, my daughter thinks I am strange, because I am very comfortable in a hospital (and I have had to be there often in my life). Most people hate the very idea of a hospital. But it is not like that with me. I realize it is because the first time I was hospitalized (appendectomy at 10), I had a ball! I was the only child on the ward at the time and I was petted and spoilt (an extension of my home life - I was the last of 13 and seven years younger than #12). When my family came to visit, they would bring all kinds of great stuff. Nurses would come and stay with me until I went to bed. They liked talking with me because I was a very precocious chatty 10-yr old. I remember crying the day I had to go home. I think that has coloured how I feel about hospitals. I don't usually let people know this, because everyone has an instinctive aversion to hospitals. (so keep this on the qt )

I don't mind hospitals as well. I mean .. as a 9 year old in a children's hospital there were games and the nurses didn't make me go to bed if I could not sleep and gave me popcorn

[Epoman]

... I worry the nurses are making my arm worse by not following any ladder pattern on my fistula but grouping the cannulations.

I am so sorry this is happening to you.  I have no experience w/ being a patient in a dialysis clinic so maybe my question is too simplistic or outrageous -- but ...  what would they do if you chose the site for them to stick and insisted that they use it, OR if you insisted on trying to stick yourself?  After reading your descriptions and seeing the pics I don't see how the result could possibly be much worse.

After a few months on dialysis, before I learned to stick myself I ALWAYS told them where to stick the needles. It is MY arm NOT theirs. I never let them choose, then as I learned to stick myself which took just 1 time. I never had to worry about infiltrations ever again. I had not infiltrated myself for 7 years then on the first day of nxstage training I let them stick me and guess what happened!  

[angieskidney]

After a few months on dialysis, before I learned to stick myself I ALWAYS told them where to stick the needles. It is MY arm NOT theirs. I never let them choose, then as I learned to stick myself which took just 1 time. I never had to worry about infiltrations ever again. I had not infiltrated myself for 7 years then on the first day of nxstage training I let them stick me and guess what happened!  

My fistula is too "snakey" for me to even know where to tell them to stick me. It is very difficult and I can understand why the nurses have such a hard time with mine

[Epoman]

After a few months on dialysis, before I learned to stick myself I ALWAYS told them where to stick the needles. It is MY arm NOT theirs. I never let them choose, then as I learned to stick myself which took just 1 time. I never had to worry about infiltrations ever again. I had not infiltrated myself for 7 years then on the first day of nxstage training I let them stick me and guess what happened!  

My fistula is too "snakey" for me to even know where to tell them to stick me. It is very difficult and I can understand why the nurses have such a hard time with mine

Mine is more "snakey" than yours, I saw the picture of your fistula. I honestly think you are just scared and rightfully so. But your fistula is HUGE and should be a VERY easy stick.

Yeah if the nurses are infiltrating that fistula, then they must REALLY suck at their job or they really dislike Angie. From the looks of that fistula it should be a VERY easy stick.

Is what I said in this thread: http://ihatedialysis.com/forum/index.php?topic=1010.msg11122#msg11122

[angieskidney]

Mine is more "snakey" than yours, I saw the picture of your fistula. I honestly think you are just scared and rightfully so. But your fistula is HUGE and should be a VERY easy stick.

Yeah if the nurses are infiltrating that fistula, then they must REALLY suck at their job or they really dislike Angie. From the looks of that fistula it should be a VERY easy stick.

Is what I said in this thread: http://ihatedialysis.com/forum/index.php?topic=1010.msg11122#msg11122

You seem to think I don't read everything you type I saw that part in italics the first time

Mine is more snakey than it looks in the picture and only that first part is huge. The rest is easy to trace but that is not where they have a hard time. What they have trouble with is I have so much scar tissue in mine and it has so many bumps because of it and hard parts and curves and when they infiltrate it they tend to hit it inside and it blows. I can feel it even with the Emla cream and I tell them they have to pull the needle out and they do. I have learned to accept this will be common but I am not too happy and am open to ANY advice you can give me Epoman!

I really am desperate for any advice right now. 

I have never seen a pic of YOUR fistula but now I want to see it! Show me! I am waiting