On comparing

Or California vs. Washington, how Washington will make you work as a dialysis tech.

So let’s compare between California and Washington.

California (and things Kim was allowed to do as a Tech):

  • Cannulations of fistulas and grafts
  • Blood pressures, temps and asking of information (chest pain, shortness of breath, hospital)
  • Monitoring pts during hemodialysis treatment
  • Administering Saline (in 200ml increments per RN), Heparin (per physician order) Xylocain (per physician orders)

Things Kim can do in the state of Washington:

  • Cannulations of fistulas and grafts
  • Catheters and Lifesites (holy shit, batman)
  • Listening to heart rhythms
  • Listening to and identifying lung sounds
  • Blood pressures, temps and asking of information (chest pain, shortness of breath, hospital)
  • Monitoring pts during treatment
  • Administering Normal Saline (up to 2 liters), heparin (per md order), xylocain (per md order)

So as you can see, I work more for my (less) money in the state of Washington.  I know the reason behind this, California state law is very strict when it comes to Patient Care Technicians, which I completely understand, as a future RN, I feel more comfortable with California’s rules and regs.  Why? Because as of right now, regardless of my training, we have not been adequately trained to listen to hearts and lungs, if I didn’t have the knowledge I do I wouldn’t know what the hell I was listening to.

Kind of scary, kind of like I better pay attention at five in the A.M. when listening to a patient, because no nurse is going to back me up. 

BTW. When I talk about work, I will not be referring to my nursing knowledge because as far as new job is concerned I am just a tech, not a student nurse.


~ by Kim on September 20, 2008.

6 Responses to “On comparing”

  1. A very difficult situation. It’s great that you have the knowledge and understanding of what your limits are, and what your capabilities are.
    Your patients are lucky to have you as their Patient Care Tech.
    Best of luck

  2. Heart and lung sounds!!!????? Holy shit!!! That is downright scary! What is most worrisome is that no nurse will back you up. That is putting you in a dangerous position.

    Of course, many nurses do a cursory exam just because they have to. Most of the time all they do is lay the stethoscope on the patient briefly and chart that the lungs are clear and the heart rate is regular whether it is or not. Maybe they will mention crackles. There isn’t time to do a good exam and think about what you are hearing. That is even more scary.

  3. Janet – I know I kept asking if Nurses rounded after us checking heart and lungs, they said no and gave me a weird look. Oh well, they also don’t put guaze over the needle after cannulation, just paper tape. It’s weird, but what am I to do?

  4. Lots of people don’t use gauze over the needle. Some people use band-aids, others just use paper tape. I think gauze is nicer.

    One way to get sticks to heal faster is to put a tiny dab of triple antibiotic ointment on the stick site after it clots. Use a Q-tip and then cover with a band aide for about 4-6 hours.

    Do you use buttonholes on fistulas?

  5. New clinic: does rope ladder technique. My clinic in CA was big on buttonhole. I like buttonhole technique, I think if it works it is the best for the patient, my opinion.

  6. […] National certification will make so that across the board we all have the same knowledge base, every state is going to have techs who are supposed to know the same thing.  This should be comforting to patients and staff alike.  Take for example me, Kim, the person who writes this blog, I moved from California, which requires it’s techs to have a state certification, to Washington state, which has a state certification but is not as, um, hard to get as California’s is.  The state of Washington also has a different scope of practice for its dialysis techs which I mentioned here. […]

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