|On March 28, 2000, Senate Bill 111
was signed into law by Ohio Governor Taft. This bill was a result of over 5 ?
years of continuous work by a number of individuals and organizations. Most of
the work was done by the Dialysis Patient Care Task Force, which included the
ANNA – NANT -
Maryam Lyon Mark Parks
ORA – ORPA –
Debra Broadax Dr. Michael Mishkind
Deborah Tucker Dr. Emil Paganini
During the final 2 years of the process there
were on-going meetings with representatives from the Ohio Board of Nursing
including Board members and staff.
The relationship between the OBN and the
dialysis community has evolved from one of mistrust, misinformation and totally
opposite beliefs regarding the appropriate role of a dialysis technician to one
of high trust, effective collaboration and a shared vision of the value of
The law was drafted with significant input
from the renal community. Surveys were conducted and public hearings were held
on 2 different occasions and in 5 different cities each time. Various memos,
articles and news alerts were distributed. The Ohio
Nurses Association, the Ohio Hospital
Association and the Ohio State Medical Association were also involved in this
The original goal was to protect the
facilities on-going utilization of dialysis technicians with the same level of
responsibilities as they currently had. We were concerned that since the OBN and
the ONA were so intensely opposed to the utilization of technicians in general
that they might try to minimize their scope of work if they were unable to
eliminate them. We were particularly concerned about the technician’s ability to
continue to administer prescription drugs and to use catheters.
Over the course of this many year process
there has also been growing concern about the shift of tasks from registered
nurses to unlicensed personnel in response to the rising cost of heath care
voiced by legislators and reported by the press. This law will also help to
convince the public that their safety is being protected .
SB 111 basically requires 6 things;
standardization of technician
standardization of competency
creation and maintenance of a
dialysis technician registry
certification of dialysis
certification of the training
rule making authority assigned to
Under the new law the process will be as
Certified technician training providers
- All ESRD providers will have the opportunity to apply to be an OBN approved
dialysis training program provider. Providers, who meet the criteria, which is
currently being developed, will become certified for 2 years. The cost is
proposed to be $300 every 2 years.
New trainees - Once a technician has
been hired to enter an OBN approved dialysis-training program, the provider will
submit information on the first day of training to the OBN to enter the
technician into the registry.
This is when the18 month time clock begins.
The law now requires all training programs to
last a minimum of 320 hours. Programs may elect to exceed the length of the
program. While the technicians are in training they are to be referred to as a
trainee and they must be assigned to work with a preceptor until their
status officially changes.
Approximately 4 weeks prior to the completion
of the training program, the technician will need to submit a temporary
certificate (1) application to the OBN which includes a $35 fee. It needs to be
submitted at this time to allow time for the OBN to process the application and
to eliminate or minimize any waiting period from the time a technician completes
the training to when he or she can work without a preceptor.
To complete the training program a trainee
will need to pass a practical test, which demonstrates that the person can
successfully perform all of the basic procedural requirements of the job, and a
written test, to show that the tech understands the theoretical aspects of the
job. The training provider will need
to sign off, on an OBN approved form, that the
technician has successfully completed the training program. This form can be
faxed to the OBN.
Since this form is the last piece of
information that the OBN will need to complete the temporary certificate
application, the OBN will fax back documentation that the application has been
awarded. Once the facility has received this notice, the technician can now be
referred to as a dialysis technician and he or she can now work without a
preceptor. The technician will also receive a temporary certificate card from
Temporary certificate (1) - The
temporary certificate (1) is valid for up to 18 months from the date the
training began. During the next 12 months the technician is expected to gain
practical experience and to become more knowledgeable . The technician will then
have 6 months to take and pass a national certification exam prior to the
expiration of their temporary certificate. This exam is not an entry level exam.
It is intended to be a test of the knowledge a technician should have after at
least one year of experience and education.
Additional education above and beyond the
basic training will be required to pass the certification exam. This may be
provided in any number of ways such as self study, in-service education, and
continuing education programs. It will be each technician’s individual
responsibility to assure that they are prepared to pass the exam.
Technicians with a temporary certificate can
perform all of the tasks they have been trained to perform. The only restriction
is that they cannot work as a trainer or a preceptor for new staff.
Once the technician receives confirmation that
they have passed the certification exam, then they will apply to the OBN for a
Certified technicians - The certificate
is valid for up to 2 years. The OBN will be developing a renewal schedule
whereby all certificates will be renewed bi-annually for a proposed fee of $35.
Renewals will also require 15 contact hours of continuing education and a
minimum of 10 must be in nephrology.
Once a technician is certified, then he or she
will be classified as an Ohio Certified Dialysis Technician and
can use the initials, OCDT.
Temporary certificate (2) - Technicians
who can not successfully pass the certification exam during the first 18 months
may be able to apply for a non-renewable temporary certificate (2), provided
they can enroll or re-enroll in a technician training program. This temporary
certificate is only valid for up to 6 months. The proposed fee for this
certificate is $25. During this 6 months the technician is expected to learn
what is required and to pass the certification exam.
If the technician successfully passes the exam
then he or she will then apply for the certificate.
Temporary certificate (3) - If the
technician does not pass the exam, after what is now 24 months from the date
they began training, then they can no longer work as a dialysis technician since
their certificate has now expired and it cannot be renewed. The only way this
person can ever work as a technician is Ohio is to stay out of the field for at
least 12 months. At that time they can enroll in another training program and
apply to the OBN for a temporary certificate (3) which is only valid for 6
months. If the technician cannot pass the national certification exam during
that time period they can no longer attempt to work as a dialysis technician in
Experienced dialysis technicians with more
than 12 months experience -
Technicians with more than 12 months of
dialysis experience as of
June 27, 2000 will need to apply for a
certificate. They may or may not need to take the national certification
exam. (The BONENT exam will meet the OBN requirements.) If the technician took
and passed a national certification exam within the past 5 years then they will
not need to be re-tested. If they took and passed the exam more than 5 years ago
and have maintained their BONENT certification, they also will not need
to be re-tested. The rationale for this is that they earned at least 45 contact
hours of continuing education every 4 years to remain certified.
All other technicians will need to pass the
certification exam and are expected to meet the criteria for certification by
December 24, 2000. Applications for certification will be available in early
Dialysis technicians with less than 12
Technicians with less than 12 months of
experience as of June 27, 2000 will need to apply for a temporary
certificate. This will be valid for a specific number of months not to
exceed 18 months. This will be calculated by subtracting the number of months a
technician has been employed (since their first day of hire/first day of
training) from 18 months. All new technicians will have at least 6 months to
pass the certification exam once they meet the 12-month experience
RESTRICTIONS: The only prohibition in
the law is to limit the list of approved medications that can be administered by
the technicians to 4, saline, lidocaine, heparin and dialysate. Technicians will
be able to mix specialty baths. However, concentrate including bicarb, can only
be prepared by a dialysis technician, nurse or physician. Any type of technical
aide, assistant or equipment technician will no longer be allowed to mix any
type of concentrate since it is a prescription drug. Preparation of medications
can not be delegated to anyone who is not permitted by law to perform the
Since law now protects the role of the
dialysis technician, nurses and physicians are not permitted to delegate the
tasks performed by the technician any other type of unlicensed worker.
March 28, 2000 - Governor Taft signed SB 111
June 27, 2000 - Most sections of the law
become effective. This is when the 180 day (6 month) clock begins for
technicians to pass a national certification exam.
December 24, 2000 - All experienced dialysis
technicians need to meet the certification criteria by this time.
The OBN must have adopted all rules by this
time. Applications to technicians will be sent after this date.
June 27, 2001 - The OBN will have full
authority to enforce the law and rules at this time. Therefore if a technician
decides that they don’t want to pursue
certification, they can no longer be employed
in Ohio as a dialysis technician as of this date.
SUMMARY - The Ohio renal community
should be proud of the work that has been accomplished to raise the standards so
that we can better protect the public safety and to continue to utilize
technicians. One of the significant accomplishments is the ability to maintain
facility flexibility in the use of technicians.
The 30-year track record, which demonstrates
that dialysis technicians can be extremely valuable members of the
multidisciplinary team, is now protected by law.