I have been all over the country I just found out my nocturnal buddies at night are now doing 6 to 1 ratio . they claim since we dont have enof patients for a 5 to one ratio so they went to 6. I have worked this shift in the past and things happen 6 to 1 ratio is totally unsafe!!! I wouldnt Dialize my Dog here now… This unit is in the Milwaukie area of Portland Oregon Please help if you know of any laws I know the staff would love to here it…
Hi Folks
Unregistered can you please registered. Your post and threads would have more meat if we could have a name. From the post below I’m not sure if your on dialysis or working in dialysis or what?
I think we (those of us that have been on this board) have try to and do use are real names.
We all know that dialysis both ““in center”” and home dialysis consumers have issues. I do home hemo on Nxstage 6 tx a wk. (nocturnal) and I not concerned with someone somewhere is spying on me while I sleep.With doing home dialysis we must take and be aware of the pluses and minuses. I fully take the risk and ( benfites?its early).
Thanks
Bob O’Brien
Hi Bob,
I think Unregistered is talking about staffing ratios for IN-CENTER nocturnal. I’ve asked Beth to see if she can find out anything and answer on the professional board (this was cross-posted). In most states, Unregistered, there are no laws affecting staffing ratios in dialysis, but I don’t know about Oregon.
i just think the patients deserve more than this taking away care is a bad way too go . There should be a law!! maybe somday it will be 8 to 1 for god sakes. And yes this is in center not a monitoring call center. Thank you Dori for helping.
Oregon does not have set staffing ratios for technicians. However, Oregon is one of the states that does require technicians to be certified. According to the Oregon regulations,
In order to meet the prerequisites, the hemodialysis technician applicant must:
(a) Provide evidence that the applicant has received a high school diploma or its equivalent;
(b) Complete a Division-approved hemodialysis technician training program;
© Complete an application for certification;
(d) Complete the required examination application within the deadlines and according to all instructions including remittance of required fee to the testing entity; and
(e) Complete a consent for a criminal records check.
http://arcweb.sos.state.or.us/rules/OARs_300/OAR_333/333_275.html
Oregon surveyors expect facilities to establish their own ratios for staff to meet the needs of their patients. Surveyors review facilities’ ratios as part of the facility’s quality assessment and performance improvement program. Whether a ratio of 6 patients to 1 technician could meet those requirements depends on a number of factors starting with the patients’ acuity (level of risk from low to high), the structure of the dialysis program, and how many RNs are on duty. The new Conditions for Coverage requires that at least one RN is present in the dialysis facility at all times while patients are on dialysis.
Patients on nocturnal dialysis are generally more stable than patients doing conventional dialysis during the day. Their dialysis uses lower blood flow rates than patients doing conventional 3-4 hour dialysis treatments. Most are sleeping while on nocturnal dialysis. The staff are responsible for setting up machines, monitoring patients pre-treatment, during treatment, and post-treatment, putting patients on dialysis if they don’t do their own needle sticks, delivering dialysis according to the physician’s prescription, observing how patients are doing during dialysis, and responding to alarms and/or problems that arise, and following state nurse practice act for division of responsibilities between technicians and nurses.
Bottom line…The acid test for surveyors is whether or not the needs of the patients are met. Surveyors determine that by observing the care provided, conducting interviews with staff and patients, and reviewing medical records.
Dori and Beth thank you for looking into this , yes I’m certified witch is one of the good things for the patients for all techs to be certified. I just think for 1400 a treatment that we all pay for should be the best and a 200 dollar shift for a tech is better then someone bleeding out. If there is a way i can help with making a mandated tech ratio I could get 10000 of signatures from techs i know all over the country and then some. We as techs can chose to do somthing else but I think we all care to be helpfull to patients with esrd. There are under 150 total techs here in Oregon Im starting to see why. thanks again
The federal government has no ratios for any staff in dialysis. The federal regulations that became effective today require that the governing body of the dialysis facility have enough staff to meet the needs of patients. Because of patient acuity, there may need to be more technicians for patients at some times of the day or on certain days than others. Typically staffing ratios come about through state regulation. Since Oregon regulates certification of technicians, you might want to collaborate with others to get a bill introduced in your state legislature to require specific ratios. There is a downside of setting a certain ratio. Under-staffing can still occur if patient needs are higher in one facility than in another.
If you believe the health and safety of patients is jeopardized with the current ratio at a dialysis clinic, talk with the administration of your clinic and present your points in a logical well considered way. Have there been problems on the shift where the ratio is 6:1? If yes, share the events with the administration. If not, point out why you believe the 6:1 ratio could be dangerous for patients. No one wants patients’ health or safety to be jeopardized. If a patient is harmed, it has the potential to cost the clinic financially.
If your clinic administration does not listen to your arguments, be aware that surveyors interview staff when they visit facilities. You and your colleagues who work in dialysis have the opportunity during those interviews to provide surveyors with specific cases where events occurred that put patients at risk. If those events are documented, they will be able to verify this through medical record review or interviews with patients and other staff.
As a patient, I have seen it all as far as what goes on in-center and I very much share your concern for patient safety through safe ratios. If anyone doubts what sort of things occur, because staff are stretched too thin or otherwise don’t watch their patients carefully, they need to get educated. Otherwise, be glad you haven’t seen the mishaps I’ve seen that often times almost cost a patient his life.
I currently do txs at home. It is such a relief to be trained on my tx so I know how to handle most tx issues and because I have caregivers that really watch over me if I miss something or can’t handle something. It’s a bigger risk than some realize to entrust care to dialysis staff that are stretched too thin or who are overworked or just don’t care about their patients. If family members would of seen some of the incidents I’ve seen in-center, they would be totally freaked out for their loved one’s safety!
So, concerned tech, it is nice to hear that you and other techs are proactive in trying to effect change in the system. Go to my thread on enforcement. Contacting legislators, getting laws passed, forming state advocacy associations etc are ways to bring change. Speak out on the net, to civic groups etc whenever you can. It is never an easy task, but I’m an optimist that believes good overcomes evil.
Hi Folks
The stretched too thin is pretty much everywhere in the medical world. If you have been in a nursing home ,or a hospital floor. It is the same in the rest of working USA. The company my wife works for has cut back (we don’t need 5 workers 2 can do the job, tons of OT) That why I left my Dr after 15 yrs. he refused to bring in more help, but still wanted to work only 4 days a wk. 9;30 to 6. Book 4 people for 4 exam rooms at the same time. The thinking two might not show one will be late,so I’ll only have one. But everytime you went office it was packed and everyone waited an hr. And if you complained the wait could be longer. My new GP is in a group and everything is high tech. I have to drive a bit more ,but I get there and I’m in exam room, with the nurse plugs in a code on a computer up comes my info, then the Dr comes in and the same thing.
For me it not a question of how many, as it is how are techs trained and do they take the job with needed mind set? But then it how a person is treated by the rest of the staff in a center. If the Drs, social worker, nurses don’t treat a person right why should techs.
In my first center you have 32 chairs right next to each other(8 in a pod, one tech each pod) each chair also had a large screen TV. Once the techs got the people on they would disappear to get a smoke or eat a snack or call someone on cell phone. So you have machines alarms, TV blaring, techs yelling back and forth. So it wasn’t a question of techs to people as it was the techs complained about working too hard and not getting payed more, the nurses complained about the techs having to much say in the making of hrs. And also that techs took the jobs from them. Everyone pointing the finger at each other. I now need to do the same as Plugger. Find someone who is in my state capital who might listen.
Are people who work in dialysis not permitted by law or company protocol to sign in on any of the message boards? A screen name could help someone in the dialysis world talk on what they see and hear? If they could stay on point? I think it would help break down the dialogue?
thanks
Bob O’Brien