Building Bridges
Linda Bethea

Linda Bethea, RN, CNN,  is Facility Administrator, DaVita Shreveport Home Dialysis, Shreveport, LA. She is President-Elect of ANNA’s Acadiana Chapter.

Recruitment and retention of qualified patient care technicians is a continuing challenge to the dialysis community. Rare Sunday scheduling and major holidays off enhance recruitment, as does the fact that dialysis technicians’ jobs pay better than certified nursing assistant positions. However, this doesn’t always equate to attracting the best candidates.

In the interview, it is difficult to judge a candidate’s aptitude for providing excellent patient care in a sub acute setting while mastering the technical skills requisite to the dialysis environment. Group interviews can be helpful once you educate the interview team. A multidisciplinary approach is less threatening and provides several viewpoints. All candidates should be asked the same questions so a valid comparison can be made.

Once a candidate is hired, the challenge begins. In addition to the formal education, a new patient care technician must be paired with a dedicated, well-trained, meticulous preceptor. The schedule should be aligned so that the new employee is not cast to the wolves on the preceptor’s day off. I have had orientees report non-preceptor staff telling them “I don’t get paid to teach you.” or “That’s not the way we really do it.” or horrifying, but true, “Don’t talk to me. I don’t want to mess with you!” I have, unfortunately, had orientees walk off the job after being snapped at, and, on one occasion, found training materials sitting in front of the door early in the morning. Other employees reported seeing an orientee sitting in her car crying and then leaving without coming into the clinic. A kind word might have saved this very-promising patient care technician, but no one offered support. This cost us a patient care technician, and also probably a nurse, since she was a nursing student.

Retention of patient care technicians is a team effort requiring regular support and input from the dialysis manager, educator, and the preceptor. The manager needs to establish expectations in staff behavior, with the educator and preceptor providing regular updates on progress. I have developed a slide presentation to be presented at staff meetings to remind everyone of the need to support and nurture new staff and each other. It is good to encourage the staff members to invite orientees to have breaks or meals with them and to remind the staff that it is in their best interest to retain new employees rather than having a revolving door situation.

Aside from retaining the orientee, we must also develop and support our existing staff. As an educator, I regularly scheduled vendors to provide lunch with inservices for all staff, and relieved them so they could all attend. We made sure that patient care technicians knew they were invited to American Nephrology Nurses’ Association meetings and workshops, and we encouraged certification. I frequently reminded patient care technicians that they are sometimes in much closer communication with patients than nurses, and can alert nurses to important health status changes. Also, the patient care technicians have the patient’s ear and confidence.

It is very important to foster development of patient care technicians. Quite often, due to their life circumstances, their education may have been interrupted or their opportunities inadequate. Management personnel and educators should encourage all staff to take advantage of tuition reimbursement at work and scholarship opportunities in the community. I have helped many staff-members do successful internet and community scholarship searches. Recruitment and retention would be much less of a challenge if we remembered to grow, cultivate, and nurture our own.