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You Only Have 7 Seconds to Impress Your Patients

After that, they already know what they think about you

Adapted from: Suneel Dhand, MD’s, Medpage Today, May 8, 2018

A clinician is working down their long list of patients, powering through the day, striving to use their skills to provide much needed care. Some of the patients will be long standing CKD patients who they already know; others will be brand new patients, who they are meeting for the first time. Of course, the job of any clinician is first and foremost to provide good patient care. That’s what all the training was all about: to get them to a position where they can safely and competently do this. But the crucial aspect of healthcare, which is notoriously under-taught, is how to communicate with your patients. That’s most of what any clinician does, and a fundamental universal truth in healthcare. The ability to communicate well is everything.

On that note, what could be more important than making a great first impression whenever a clinician meets a patient for the first time? As technicians and nurses, it should be our absolute goal to start building a relationship of trust right from that very first meeting and get off to a really good start. Because if a patient doesn’t develop that feeling of trust, and yes — also likeability, towards you, you may never be able to reach them and help them cope with this new life they are embarking on. It’s human nature, and we don’t have very long to make a good impression. Did you know, research actually suggests whenever we meet someone for the first time, that judgment about the other person will be formed in only the first few seconds? Yes, about seven seconds to be precise. This happens with anyone, even a random person on the street, but is especially important for a caregiver to keep in mind. In those first several seconds, we as humans are primed to judge the other person’s friendliness, cooperation, and competence. This happens at an entirely subconscious level, and is believed to go back to caveman days, even before speech started when we had to make snap judgments about the other person very quickly.

So for any clinician, what types of things can you do in those first prescious seconds to make a better impression on your patient? Here are just three:

  1. Facial expression. This is obviously the first thing that someone will notice when they look at you. Few things could be better received than a genuine smile (known as a “Duchenne smile”) and a facial expression that conveys friendliness. Of course, smiling doesn’t come naturally to everyone but is the most simple thing you can do if you want to appear approachable or trustworthy. The opposite of this would be looking stern, closed off, or worst of all, uninterested in the person in front of you.
  2. Eye contact. Maintain constant eye contact in those first few seconds. Don’t glance at the patient and then look away at the chart, this action tells the patient they do not have your full undivided attention at this low point in their lives.
  3. Body posture and movements. Does your body posture and the way you first greet the patient display an aura of calmness and competence, or does it do something quite opposite? If you are clearly in a rush, hurried or looking tense yourself — your patient will sense that in a second. Even the way you walk upright and confident versus slouching and hesitant will get processed in an instant. Your goal is to radiate that you are calm and a good listener.

These are just three brief things you can do to make a great first impression that says you are a friendly, caring and competent clinician.

Why you should join NANT

Why you should join NANT

Why should a Dialysis Technicians join the National Association of Nephrology Technicians/Technologists, affectionately known as NANT. NANT promotes education and advances the professional. I would like to give you a couple of good reasons why I think all dialysis technicians should belong to NANT. . .

Professional Development:

NANT members receive monthly electronic newsletters, a copy of the quarterly NANT News which includes association news, information on industry trends and articles regarding pertinent issues in the field. NANT also offers complementary subscriptions to nephrology magazines, discounts on publications, and access to free quarterly webinars for contact hours.


NANT members receive discounts for the Annual Symposium held in March of each year, which offer educational opportunities at every stage of your professional development. They also offer an opportunity to mix and mingle with others in the field, meet experts and exchange ideas. NANT’s Career Center offers members new employment opportunities where you can post an anonymous resume, view jobs and access your own personal jobseeker account.


Why join ANNA

Why you should join ANNA

Why should a dialysis-trained registered nurse join the American Nephrology Nursing Association, affectionately known as ANNA. I have been an ANNA member for many, many years and I would like to give you a couple of good reasons why I think all dialysis nurses should belong to ANNA.

Professional Development:

ANNA members receive the bimonthly Nephrology Nursing Journal, the monthly E-News updates, weekly RenalWeb E-News letters, have access to the ANNA online library and access to free CNE’s monthly. They also have access to scholarships, grants and awards, and get this you can write off professional development activities on your taxes.


ANNA members receive discounts for annual conferences, which offer educational opportunities at every stage of your professional development. They also offer an opportunity to mix and mingle with others in the field, meet experts and exchange ideas. There are always recruiters, product manufacturers and pharmaceutical reps in the conference center at booths to visit. You can learn about what’s new and what is coming from the experts. I have made many life long friends from ANNA meetings and they give me an opportunity to catch up with old friends who happen to attend the conference.

So . . . Why am I telling you this now? In honor of Nephrology Nurses Week ANNA’s new membership campaign “Score with Four” is offering new members a $10 ANNA cash voucher code to redeem in ANNA’s Store or Online Library, and the member who recruits the most new members will receive an ANNA publication package that includes the Core Curriculum for Nephrology Nursing, 6th Edition, 2015, Contemporary Nephrology Nursing, 3rd Edition, 2017, Nephrology Nursing Scope & Standards of Practice, 8th Edition, 2017 and the Nephrology Nursing Certification Review Guide, 5th Edition, 2016 which I would love to add to DTI’s library!

If you would like to join this awesome organization log on to and enter Cheryl Falconer in the box that asks “Who asked you to join ANNA?”


What You Should Know About Social Media

What You Should Know About Social Media

A new phenomena has reached our industry and healthcare professionals should be aware of the possible ramifications. Facebook, and Instagram are the most prominent outlets for social media today. With widespread use of iPhones, Tablets and Notebooks, people are documenting everything, absolutely everywhere, all the time.

As I see it, there are two primary issues with this sharing of social media, first what is being shared, and second who may view it. There are no gatekeepers as to what is being shared, and there arepotential consequences for what a person does or says in their private life, and its potential effect on their professional life are very real.

My point is this, social media is a public forum, people are very open, they say and share virtually everything, in real time, and once it is out there, it is permanent and accessible. Employers, and even more importantly potential employers may check you out on social media. I became aware of this when a colleague of mine told me that she was concerned about a staff member because of what she saw on her Facebook page, she also shared that she friends all her subordinates. Perhaps it is time for us all to take a step back and reconsider what we share on our social media!


HemodialysisHemodialysis is the most common form of life sustaining treatment for kidney failure worldwide. Most people receiving hemodialysis go to out-patient dialysis centers for treatment (3) times each week, or approximately every other day. During hemodialysis approximately twelve ounces of blood is pumped through a special filter that removes excess fluid and waste from the blood. Treatment times vary but are generally between 3 to 5 hours in duration, at which time the patient goes home.

Hemodialysis treatments performed in dialysis centers are routinely performed by dialysis trained RN’s and Certified Hemodialysis Technicians. The patient may choose home hemodialysis treatment because of its increased flexibility in scheduling with a trained partner. The days and hours of treatment may be as frequently as short daily treatments of 2 to 3 hours, or long nocturnal treatments run overnight (3) times each week for 6 to 8 hours.


Diabetes is a chronic condition associated with carbohydrate intolerance. Characterized by high blood sugar levels, diabetes affects 29.1 million people according to the National Diabetes Statistics Report, 2014. That equates to 9% of the U.S. population. Worse yet, 28% are undiagnosed. One study estimates that the number of people living with diabetes in 2025 will increase by 64% to 53 million.
Type two, or adult onset diabetes can be managed with weight control, a healthy diet, regular physical activity and, or medication. People with diabetes are at increased risk of serious health issues. Risks associated with poor blood sugar control from undiagnosed or uncontrolled diabetes include retinopathy and may lead to blindness, and micro-vascular disease leading to heart disease, stroke, chronic kidney disease, amputations of toes, feet and, or legs, and premature death.

So . . . What does diabetes have to do with dialysis? Diabetes Mellitus is the number one cause of kidney failure in the United States today. In 2011 Diabetic Nephropathy was listed as the primary cause of kidney failure in 44% of all new dialysis starts. Some 300,000 diabetic Americans are living with chronic kidney failure today and unless something changes, that number will likely increase!


BUTTONHOLEFor many years the accepted method of cannulating an AV fistulas for hemodialysis has been the “site rotation or rope ladder” technique. Rotating needle sites was thought to prolong the life of the fistula and minimize aneurism formation.
In the last few years the “buttonhole or single site” cannulation technique has gained popularity. Once healed the buttonhole is similar to the tunnel created in a pierced ear. Less pain with needle insertion, ease of use to promote self cannulation for home dialysis, and use in patients with short fistula lengths are the intended benefits of this technique.

As use of the buttonhole method spreads, the benefits and risks are becoming all too apparent. Historically, AV fistulas were known to have very, very low incidence of infection and as more facilities adopt the buttonhole technique, fistula infections and serious septic infections related to AV fistulas are on the rise.

Okay, here’s the deal, I don’t know which technique is better! There are proponents on both sides of the isle with very strong opinions about this subject. All I do know is that having dealt with several septic infections caused by infected buttonholed fistulas is, I think we need to rethink this method. Perhaps new and improved is not always better. So . . . buyer beware!


With hospital space at a premium, more and more dialysis centers are being built as out patient facilities in strip malls, professional buildings near local hospitals, and even an occasional old bank building, gone are the days of basement dialysis centers, down the hall from the hospital morgue. In California, the majority of dialysis nurses and technicians work three, twelve hour shifts each week, for example Monday, Wednesday, Friday or Tuesday, Thursday, Saturday.
During a shift, each technician will care for 4-6 patients at a time, with three shifts of patients each workday. Patient shift turnovers last 1.5-2 hours and are busy times in the facility. Once all the patients treatments have started, the staff monitor their vital signs, and equipment until it is time to return the patients blood and begin again with the next shift of patients. Nurses on the other hand spend their day assessing patients, administering medications, coordinating care, communicating with physicians, and monitoring the technicians work. Each nurse will supervise 2-3 technicians providing care to 10-12 patients each patient shift.

The work is rewarding, long term relationships exist between dialysis patients and the staff who provide care for them in the dialysis center. Over time, the dialysis staff help patients and their families understand their disease process, the renal diet and routine medication requirements. We celebrate their success and help them cope with losses. I have to say there have been many memorable days for me as a working dialysis nurse over the years, but hands down the best days were the ones when we “got the call” that one of our patients had been transplanted. When I look back, all those years ago, when I was a young nurse receiving my first pay check, my first thought was, wow! I can’t believe they are going to pay me to do such rewarding work. If I hadn’t been so poor, I probably would have framed that first check. I believe there is a common thread between healthcare workers, we are caretakers by nature and have a real need to care for others. Isn’t it marvelous to be rewarded in so many ways for doing something that makes us feel good inside.