"We learn while doing": informal training experiences of critical care nurses managing dialysis technologies in...

Acute kidney injury (AKI) is among the most prevalent life-threatening complications in intensive care units (ICUs), with continuous renal replacement therapy (CRRT) being the primary mode of renal support for haemodynamically unstable patients. Despite the technical complexity of CRRT, formal training programmes for ICU nurses remain inconsistent across healthcare settings. This study explored the informal training experiences of critical care nurses managing dialysis-dependent patients in Al-Ahsa, Saudi Arabia.

A qualitative descriptive design was employed, guided by reflexive thematic analysis as described by Braun and Clarke. Semi-structured in-depth interviews were conducted with 20 purposively sampled ICU nurses with direct CRRT management responsibilities across healthcare facilities affiliated with King Faisal University, Al-Ahsa. Data were analysed through six iterative phases of thematic analysis. Ethical approval was obtained from the Institutional Review Board of King Faisal University.

Four overarching themes were generated: (1) "Figuring It Out on the Floor", nurses described learning CRRT management primarily through observation and immediate bedside practice; (2) "The Colleague Is the Textbook", experienced peers served as informal educators, transmitting practical knowledge through demonstration and narration; (3) "Anxiety Behind the Machine", nurses articulated persistent fear of error that gradually transformed into competence through repeated exposure; and (4) "Gaps the System Does Not See", participants identified a systemic absence of structured CRRT training and called for formalised competency frameworks.

Critical care nurses in this setting rely heavily on informal, peer-mediated learning to acquire CRRT competencies in the absence of standardised institutional training. These findings highlight an urgent need for structured simulation-based CRRT education, written protocols, and competency assessment frameworks. Nursing leaders and ICU educators must recognise and address the informal learning burden carried by frontline nurses to safeguard patient safety and support workforce development.

Not applicable.