November 03, 2023
Danilo B. Concepcion, CBNT, CCHT-A, FNKF
Providence St. Joseph Hospital, Orange, CA
This article is reprinted with permission from Healio | Nephrology News & Issues, 37(9),29-30, 2023.
In my youth, the thought of being a dialysis technician never entered my mind. The start of my journey into the dialysis world was through the military.
The Navy trained me as a hospital corpsman, or medic. I served most of my military obligation on board the U.S.S. Benjamin Stoddert (DDG-22), a guided missile destroyer during the Vietnam War era.
It is noteworthy that this ship was the last military presence to leave Vietnam at the end of the war. The ship was too small to warrant having a physician on board; instead, two corpsmen provided all the medical care in place of the physician.
When I was honorably discharged from the Navy in May 1975, the only job the civilian world offered that would recognize my Navy training was that of an ambulance attendant. I saw a classified ad in the newspaper for a dialysis technician. I interviewed and the following month, I was hired and received on-the-job training. As of June 23, I am in my 49th year as a dialysis technician.
Burnout
A recent article published in the American Journal of Kidney Diseases reported on the results of a survey among dialysis technicians about job satisfaction. Laura C. Plantinga, PhD, from Emory University in Atlanta, and colleagues found 57.5% of dialysis technicians who responded to the survey reported burnout, and 52.6% reported that they expected to remain as a technician in 3 years.
“The perspectives of dialysis [patient care technicians] PCTs on burnout and their turnover intentions have rarely been directly elicited despite the critical frontline role that they play in U.S. in-center and acute hemodialysis care,” Plantinga and colleagues wrote. “[S]trategies to support and retain dialysis PCTs specifically are likely to have a tremendous impact on U.S. hemodialysis care, including reduced burden on dialysis PCTs and other staff (including nurses) and improved delivery of care and, ultimately, patient outcomes.”
In the last 5 decades, there is little that I have not seen in a dialysis center. I have been through staffing challenges, supply chain issues, administrative and schedule changes, low pay and disgruntled coworkers. I have survived personnel surveys, difficult doctors and patients and threats of work reduction.
I have survived not because of a generous paycheck. It is embarrassing for me when I hear anecdotal statements that a Starbucks employee can earn more than a dialysis technician.
It is not because of the workload, although ... CMS has not put a cap on technician-to-patient ratios and leaving the interpretation to dialysis providers allows for too much variance and ultimately high ratios.
It is not because of the long hours worked — and needing to be at the clinic at 4 a.m. or earlier. It is not because of the hectic schedule that sometimes makes us rush because of the short treatment turnaround time.
And it is not because I fear that I may transfer some contagion to my family, although the COVID-19 virus did heighten my awareness that this could happen.
- I have survived because of the following:
- I have been given and shown respect;
- I have been given the opportunity to professionally grow;
- I have been given goals and expectations;
- I have been informed;
- I have been included and I have been challenged; and
- I have been engaged with processes and shared what I learned.
My contribution
I consider being a dialysis technician as my profession and have never approached it as a job. I know the individuals on dialysis who I partner with in delivering the dialysis treatment are better, healthier and safer because of my contribution.
The article by Plantinga and colleagues points out the problem of burnout. Yet, what about the challenges for the person on dialysis? It is my obligation to them that I persevere through the different challenges that I have confronted in my dialysis profession.
I have learned to approach life with the attitude that there are no problems, just challenges. Given the tools, resources and time, I can overcome any challenge. Every dialysis provider/facility can develop this type of approach and culture that can lead to minimizing burnout, increasing retention and loyalty and job satisfaction.
Growth opportunity
Given assignments such as vascular access care, infection control audits or an opener/closer position of the dialysis clinic should not be looked upon as extra work, but as an opportunity to gain experience. If the response has been that it is extra work, then the challenge is for the facility leadership to shift the mindset and facility culture that it is an opportunity to learn and professionally grow in knowledge that ultimately will lead to better care.
I am fortunate my facility has always held dialysis technicians in high esteem. Of the 43 employees in our facility, 11 (25%) of the staff have more than 10 years of experience in the facility, 15 (35%) have more than 20 years at the facility, five (12%) have more than 30 years in the facility and six (14%) have more than 40 years of experience.
In engaging, challenging and supporting our technicians, we created the Technician Career Ladder in 2011 that offered our staff the opportunity to advance by virtue of increased knowledge, skill, hospital experience and professionalism. Program requirements include ownership of a Quality Assurance and Performance Improvement project, participation in a professional organization and the ability to demonstrate a team relationship.
A budget was created specifically for the advancement ladder and it has paid dividends, as demonstrated by our staff retention.
Another element that has helped in the journey that engages and leads to job satisfaction has been attending professional conferences and belonging to a professional organization. It is reassuring to learn what other dialysis technicians experience and to learn from each other. There are two national organizations that support dialysis technicians: the National Association of Technicians/Technologists (NANT) and the National Kidney Foundation’s Council of Nephrology Nurses and Technicians. Both organizations offer annual conferences and continuing educational opportunities.
Providers need to approach support for dialysis technicians, not as money spent, but as an investment into professionalism, job satisfaction, increased knowledge and skill, and long tenure.
New name
Our community is perpetuating the idea that the position is a job and not a profession by continually using the term “patient care technician.” It is a generic term chosen in the early years of utilizing non-licensed individuals in the kidney care specialty.
It serves no identity, nor does it warrant pride in the title. There are countless positions in hospitals, clinics and physician’s offices that use the title, and those positions do not have the scope of responsibility and job function that is relegated to a dialysis technician.
Providers and dialysis facilities should start the journey to professionalizing their PCT employees by using a name that offers identity, respect and pride. NANT is promoting the use of nephrology clinical technician and nephrology biomedical technician.
It is time for these terms to be embraced within the dialysis community.
For more information:
Danilo B. Concepcion, CBNT, CCHT-A, FNKF, is the operations manager for renal services at Providence St. Joseph Hospital in Orange, California. He is also a member of the Editorial Advisory Board for Healio | Nephrology News & Issues. He can be reached at danilo.concepcion@stjoe.org.