A Step By Step Plan To Conquer Debt

What a wonderful idea Miriam! The funny thing is that I was in the clothing manufacturing business for years, and never thought about doing that! Now if the other problems can get resolved that would please me no end. Any thoughts would be appreciated.

Tomorrow, Saturday, we will again have only one tech. This time it will be the trainee. With an 8-1 ratio a very unsafe situation in my opinion. Perhaps the call I made to the "corporate hotline" with change things at the clinical level.

In researching other clinics accross the country I discovered that most clinics operate with a 4-1 tech to patient ratio with one nurse, but none operate with a 7,8-1 tech to patient ratio with one nurse. In fact what I discovered was that a 3-1 tech to patient ratio with one nurse was the norm. Our area manager told me today that our current ratio of 8-1 tech to patient with one nurse is perfectly OK. I don't think that staff at the clinic would agree with her. In fact I know they don't agree with her. In speaking with her own corporate offices yesterday they don't appear to agree with her. E.S.R.D. Area 7 tells me it is a 4-1 ratio as well.

This comes from www.allnurses.com and there are many more complaints just like it.

"Dialysis Staffingby CocoaGirl

Does anyone have any ideas or suggestions on where to find the guidelines for staffing ratios or how to have them changed? I have called the Renal Network for my area & was told to check with the board of nursing. I had no luck there either, I have looked for info from CMS and can't find the regulations. We currently work a 4:1 PCT / pt ratio, with one RN. It is horrific. A neighboring state less than 5 miles away has a mandatory 3:1 ratio. Both of the clinics are owned & run by FMC and we do share staff. The problem is that no one wants to work in the 4:1 ratio clinic when they can work a 3:1 ratio for the same amount of pay. We have tried to talk to our regional manager (who has no medical background) about this issue & it got us absolutely nowhere. Now, to make matters worse, techs are working off the clock in the morning to get their assignments ready because the regional mgr told them they aren't allowed to clock in earlier than 6am. The first patients come into the unit at 6:45am, it is not enough time unless we start to cut corners & not follow policy. I know that this is not legal for FMC to do this, but this is a big company with lots of $$$$$$. Please any suggestions would be helpful, everyday feels like we are hanging on by a thread & the patients are the ones who are paying the price. HELP!!!!!"

Yesterday, Saturday, at dialysis we had eight patients, two techs, even though one was a trainee, and a nurse. Perhaps my conversation with the area manager had some effect after all. Either that or she realized that the trainee wasn't as close to completing his training as she thought he was. The trainee ran into several problems on Saturday that he needed help with. Thank goodness there was adequate staffing to prevent a disaster. If we still have two techs on Tuesday then I will know that the problem has been corrected.

[There is no doubt in my mind, Michael, that your call to alert the corporate offices had an impact, as it is clear you were in the right, elspecially when you quote relevant literature regarding what is consideed standard of care in regard to the patient/staff ratios. Also now, as CMS is determining rules for ESRD payments, the industry doesn't want to look bad. Good for you!

Thank you Miriam for the encouragement. The way I am feeling these days I can use all the encouragement I can get! After four failed fistulas, and now a graft that seems to be working, I suffer from pain in my hands that brings tears to my eyes for hours after dialysis. Even the pain meds don't seem to help much. The day after dialysis the pain subsides somewhat, and I get a little relief.

You have my empathy regarding the hand/arm pain. I have steal syndrome, too and it is quite unpleasant. I am having another fistulagram tomorrow and hope maybe somthing that be angioplastied open for relief.

Best wishes,
Miriam

Our head nurse told the ESRD #7 representative that during the 8-1 ratio the tech who is on break is just around the corner, and can hear the patients if they call. In order for that to be true a patient would have to scream very loudly in order to be heard. Since two of our patients that I know of suffer from dementia, and one is a stroke patient, they would never be heard. Especially the stroke patient who has much difficulty with communication in general. It only takes a minute for a patient to "bleed out" if a needle should happen to fall out. Many of these patients are in constant movement, and that possibility is very real.

Today we had a 6-1 ratio. The tech being the trainee. When I looked at my dialysis machine I discovered that it wasn't properly set up. The tubing wasn't set into the clips. In fact the person sitting accross from me his tubing wasn't clipped in place at all. A dialysis nurse told me a while back that if not clipped properly the blood cells going through the tube are damaged. My guess is that the "new tech" set up all the machines today, and didn't have any idea what he was doing. There was also a third machine that had the same problem.

Have you ever thought about taking photos with your cell phone when you see a problem and documenting the problems?

michaelnewman says...
Today we had a 6-1 ratio. The tech being the trainee. When I looked at my dialysis machine I discovered that it wasn't properly set up. The tubing wasn't set into the clips. In fact the person sitting accross from me his tubing wasn't clipped in place at all. A dialysis nurse told me a while back that if not clipped properly the blood cells going through the tube are damaged. My guess is that the "new tech" set up all the machines today, and didn't have any idea what he was doing. There was also a third machine that had the same problem.

Have you thought about changing providers, or having all the patients change providers. It may be a medical service, but it's still a business. They are not the only people that provide dialysis treatment.

Miriam says...
Have you ever thought about taking photos with your cell phone when you see a problem and documenting the problems?

I have taken pictures, however the quality on my cell phone is very poor, and I get a picture that is blurry at best. I have considered getting a new phone. The other problem would be that if I send the pictures to ESRD #7, or another agency I could be in violation of the HIPPA laws. Perhaps not if no patients are photographed. I'll have to ask my attorney about that one. FOX news is contemplating doing a story on me based on my trials and tribulations at dialysis. They consider it newsworthy, and the details are currently being worked out. I hope all went well with your fistulagram, and you got some relief in your hands from the procedure.

barry Kiker says...
Have you thought about changing providers, or having all the patients change providers. It may be a medical service, but it's still a business. They are not the only people that provide dialysis treatment.

The other provider isn't much better. At least with my current provider I know who to complain about when needed. I would also have to change doctor groups if I changed providers as my doctors do very little with the other group. It is always better to observe your adversaries weaknesses, and then use those weaknesses to change things. Getting a group of patients to change providers would be impossible. Not only would you have to deal with the patients, but their famlies as well, and then there would be the paperwork involved, etc...etc.

My provider has to play by rules their corporation has set for them. Me on the other hand don't have to play by those same rules. By thinking outside of the box at all times I will win this one eventually.

I am going to take a few pictures on Thursday, and if it is OK with you Miriam send them to you via email. This way you can observe the clarity of the pictures, and let me know what you think. Perhaps the camera only needs some adjusting, and I can play with that today.

Another real danger at dialysis is when your provider has a "trainee tech" set up dialysis machines prior to patients starting dialysis. I discovered that three machines werent set up properly one of them being mine. Since I operate my own dialysis machine it was easy for me to correct the problem. As for the two other machines I had to keep hands off. One of the machines tubing was coming out of the "veinious line",and wasn't in any of the guides that were provided for it on the machine. This presented a two-fold problem one being damage to blood cells flowing through the tubing, and the other the possibility of the tubing breaking off with no support at all. Any "tech in training" needs follow-up observation, and training, and can?t be turned loose until his or her training is completed.

It should be interesting to see if any corrective action will take place at dialysis tomorrow. My guess is that are going to do nothing to correct the pervasive problems.

I wonder if it will take a fatality to finally get these pervasive problems corrected at the clinic?