• “Rustout” exhibits as emotional exhaustion, detachment, apathy or loss of interest in learning new things.
• Managers should provide challenges and recognition to combat rustout for dialysis technicians.

The inclusion of nonlicensed individuals as dialysis technicians into the renal community dates back to the early 1970s.

The Medicare End-Stage Renal Disease (ESRD) Program, passed by Congress in October 1972, resulted in an influx of patients that came with treatment demands that overwhelmed the existing available pool of registered nurses. To meet the demands and avoid treatment rationing, dialysis clinics turned to hiring nonlicensed workers who were provided on-the-job training in cannulation, setting up the machines, treatment monitoring and performing vital signs.

Results from the US Renal Data System 2023 Annual Data Report indicate there are 44,376 full-time and 5,760 part-time dialysis technicians, totaling 50,136 workers. Analyzing the data, approximately 34,000 have been working in dialysis for more than 5 years. Most dialysis technicians hold a high school diploma or equivalent.

Corporate and independent providers still employ dialysis technicians as the primary caregiver to perform the treatments. As it was in the early 1970s, today dialysis providers still rely on dialysis technicians to “put on and take off” and maintain the schedule. The function of priming, cannulating, answering alarms and performing environmental disinfection is so repetitive and frequent that it becomes second nature.

The impact of COVID highlighted the issues with burnout. Severe emotional, physical and mental exhaustion were some of the effects of the excessive demands, lack of control, high pressure, changing and ambiguous expectations, fear and mistrust of that period. Dialysis technicians were not immune. Their well-being and ability to maintain attendance was a critical concern.

Burnout remains a universal concern, but there is a less-discussed syndrome that is equally damaging for dialysis technicians, a descriptive and occupational concept used by psychologists and career experts called “rustout.”

Burnout is well recognized and is a result of excessive demands under heavy pressure, overstimulation and lack of rest. Rustout is monotony that results from lack of variety, challenges and opportunities for growth. Rustout exhibits as emotional exhaustion, detachment, apathy or loss of interest in learning new things.

The primary function of dialysis technicians has changed little in the 6 decades of our existence. Significant changes have not occurred in the method of training, role and duties. There are limited opportunities for advancement, continuous learning and skill-building.

Supply gathering, priming, vascular access care, and initiating, monitoring and discontinuing treatment, as well as environmental disinfection and setting up for the next treatment, are routine tasks repeated approximately 7,488 times a year by the dialysis technician (4 patients x 3 shifts x 3 days x 4 weeks x 52 weeks). The dialysis unit is set up like an assembly line that gives the caregiver the ability to prime one machine, then easily move to another machine, then another. The repetitiveness and frequency become second nature and offer little challenge. Too often have I heard that the best technician is the one who can prime the fastest, cannulate the fastest and get the patient on in the required schedule slot.

Our relationship with the person on dialysis is much more than that of patient and caregiver. In fact, this relationship is a motivating factor that mitigates the feeling of rustout.

Working to do the right thing emanates from the closeness that grows with interacting with people on dialysis 7,488 times a year — it is one of the main reasons we stay in this industry. In my opinion, rustout can result in disengagement; hesitation to learn new things; reluctance to join a professional group and to volunteer for assignments; and being disconnected from the culture and mission of the facility.

We are much more than “put on and take off” help. We have so much more capacity. We need intellectual engagement, appreciation, recognition and creative challenges so we do not stagnate.

At the recent Renal Healthcare Association annual conference held in September, Marshia Coe, chief operating officer for Health Systems Management, presented a topic titled, “The Org Chart is FLIPPED! It starts with the TECH!!!” Her presentation aimed to awaken all administrators/managers/leaders to a new day in which dialysis technicians must be embraced as professionals, rather than the helpers.

Some of the things I implore leaders to do are these:

• Create growth pathways and invest in the dialysis technician.
• Foster open dialogue.
• Regularly check in with staffers about their level of engagement and challenges.
• Engage with everyone, give praise and recognition.
• Build challenges into the position, not just tasks.
• Be visible and present.

Six decades and where are we? As Maya Angelou, American memoirist and essayist, put it, “We aren’t designed to be static.”

Editor’s note: Oct. 12 to 16 is National Dialysis Technician Recognition Week.

Danilo B. Concepcion, CBNT, CCHT-A, FNKF, is a Healio | Nephrology News & Issues Editorial Advisory Board Member. He can be reached at renallogic@gmail.com.