acute dialysis RN- a day in the life...

Going back to the original question about leaving, I am wondering because I know some of you must have pets that you would like to let outside in the middle of 12-16 hour days. It seems like if you know you are doing at least two ICU treatments in a day, who would really care if you started the second one at 2pm instead of 1pm?

And as madwife wanted to know, can anyone give a typical day run down? Or variety of how it may be?

Thanks!

OMG thank you! This is the most realistic and eye opening example yet! And yet a little depressing as I contemplate my move to acute dialysis nursing. I was hoping there would be a little more freedom with the autonomy, but I guess if there is no one to cover you...

The acute dialysis day in MY experience....

I arrive to work at 7am and take a look at the assignment sheet. We are either in the hd unit or doing "outs" (meaning one to one, as in an icu patient that can not come to the hd unit.).

So, I see I am doing "pt a" and "pt b" (so far, of course). The tech brings up the RO room, does the water checks, and makes the bicarb for the day. I set up my machines and prime based on the md's order. Then, I put my machine in test. At this point, I normally will get my paperwork filled out (just one run sheet, nothing major). After the test passes, I check the pH and conductivity of the dialysate (hd bath).

Now the tech may go get the pt, the tech may go and assist me in getting the pt, or someone may bring the pt to the hd unit. At this point though, I am ready to run my pts. I hook up "pt a" and "pt b."

Now, hopefully I am just in monitor mode (ie: no machine or pt problems). If so, we write down v/s and machine numbers every 30 minutes. I will also get my meds together (zemplar, epo, and na citrate or heparin for packing catheters) during this time. Most of our runs are for 4 hours, with SOME 3'15" to 3'45" runs. New starts are normally 2-2 1/2 hours. If labs needed to be drawn, I will draw them while putting the pt on. I will call labs to the md for hd bath changes if needed.

After the runs are over, I will get each pt off the machine and back to their rooms. At this point, I will either go to lunch or get my next run on (two more pts) and have one of my co-workers watch my patients. Normally, we only have a first shift run and a second shift run (that being 2 pts for the first run and 2 pts for the second run). We do have late nurses and an oncall nurse for late runs and emergencies. As someone said, you never know what's coming through the ER (overloaded, hyperkalemia) or the outpt special procedures (perhaps a declot? that has to be run). Some days you come in and your first and second shifts are already filled up; other times, you may have only one pt, and you end up waiting on the nephrologists to get there and start writing orders for your hd patients. Sometimes you are delayed because the orders state "hd after surgery" or the pt is in radiology or the pt demands that he eat his breakfast first, etc.

After the second run, I will normally go home. Sometimes, we will start a third run and the late or on-call nurse will take over when they get there.


If you are doing "outs" then the day is the same except you just have one pt for first shift run and one pt for your second shift run. You do not have anyone to relieve you, so, you will go to lunch in between these two runs. Some people love doing "outs" some people hate them. Same goes for being in the hd unit, some love it, some hate it. I like a little of both.

I hope that helps. It is my typical day, anyway.