Dori:
The decline of dollars available to pay nurses is directly responsible for the increased use of unlicensed personnel (techs) in dialysis centers. For-profit dialysis companies are businesses that have to project earnings and report profits and losses to Wall Street, and with fixed payments (that lose money each year) from Medicare, the industry has to cut back on more costly staff to stay profitable.
Although there are some excellent pcts in dialysis, I feel that licensed nurses who are as good at dialysis as their pct counterparts (not everyone with the title nurse is talented at dialysis) are more proficient as they have education in the human anatomy and can make often split second decisions for care in respects where a pct is lacking. However, if the dialysis industry makes more will that ensure the hiring of licensed staff?
Dori:
Technician training varies considerably–some techs are excellent, others are subpar. About 11 states require tech certification; the rest don’t. Nurses may have training ranging from a 2 year college program to advanced practice training with graduate degrees. In general, though, more nurses = better care. But dialysis must compete with hospitals, nursing homes, public health, industry, schools, etc. for scarce nurses–and centers’ hands are tied when they can’t pay more money or hiring bonuses.
I have not encounterd one nurse in dialysis who knows the full scope of how to deliver a dialysis tx. Nurses are trained just like pcts without a full depth of understanding of how to fully deliver a dialysis tx as the companies’ goal is to speedily get one patient off and another patient on to fill that seat. I have had nurses who were lousy to nurses who are very caring. When a unit has a good purportion of caring nurses, there is at leaste a sense of safety although there are still many unnecessary mishaps due to lack of appropriate dialysis education of nursing staff. The question is, if companies get paid more will they use it to hire more nurses and will this ensure that nurses are competently educated in dialysis?
Dori:
Bill is right that supporting bills like HR1298 and S635 is one of the best ways to help improve the care in dialysis centers. This is one reason why many groups, including MEI, have been working on behalf of these bills.
Where are the safeguards in these bills that the dialysis industry “must” hire more nurses, must educate them competently, must educate patients, must cease the violations, must protect patients who wish to file a grievance? Without effective oversight a bill can say anything, but it is just words on paper. The networks have all the right words on paper re patients’ rights, but obviously they are not carried out. I don’t personally believe that annual increases of reimbursements guarantees improved care/conditions unless accompanied by strict oversight. The dialysis industry seems to be a self- fullfilling prophesy on you get what you give. Cheating and cutting corners may be the very thing that has held the industry back.