Advice for a new dialysis CN for acutes in an LTACH

NurseRies, BSN, RN · Apr 3, 2013

Hi,
I'm an RN and have worked the chronic floor both as an LVN/LPN and as an RN. I recently accepted a position as an acute CN in an LTACH. I would appreciate any and all advice as I begin this journey. Thank you so much!

This is copied and pasted from a previous response I wrote for a similar question- might help some! i think i have another one that may help too. heres the first;

Make friends with your techs, don't walk in acting like you are too good to clean up a spill or assist a patient from the waiting room. Try to come into the unit being very pleasant because these patients and coworkers are going to be your new family. You will see them 3-4 times a week for hours at a time! A good first impression with go a long way in this environment. Also, you will prob not get to do "nursing" stuff for first 6 weeks. You will most likely be trained on the machine first. Don't get upset about that, it is necessary and all new nurses get trained as techs too. The technical aspects of dialysis are vast and there is a lot to learn. You won't be able to be a good nurse there until you understand the machine and the importance of water testing, etc.

I have seen new nurses walk around muting and resetting alarms without knowing why. Just be cautious at first! Sticking a patient may not happen for 2 months. Most of all be a team player and don't whine! There is no time for sitting down usually, unless documenting or on the computer. Have fun, make jokes with the patients. Patients have seen so many new nurses come and go, they will want to see if you have what it takes to stay! Some patients, depending on culture there, will try to test you and even might try to make you nervous. Be strong! Be polite, but assertive. I saw a few nurses quit bc patient so and so hated them or said something mean. You may have to grow tough skin. This patient population will say all kinds of things!

Once you get to know the patients, it can be the most rewarding career for a nurse! I loved being in center. Good luck!

NurseRies, BSN, RN · Apr 3, 2013

Hi,
I'm an RN and have worked the chronic floor both as an LVN/LPN and as an RN. I recently accepted a position as an acute CN in an LTACH. I would appreciate any and all advice as I begin this journey. Thank you so much!

Here's the other response which was a question someone had about a typical day in an outpatient dialysis position: it may not help because you are inpatient, but just in case you ever think about outpatient:

Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.

gardenwalker · Apr 4, 2013

All of the above is what I do daily except I have 3 shifts of 15 patients or 45 patiens a day. I agree that I never thought I could work so fast - but safety of the patient, and me, is my highest priority. I have just left my old company where I was the only RN on the floor to a competing company where it is a larger unit but I only have half the floor, 12 patients. What a difference that will make and another nurse to run questions/ideas by.

Dialysis nursing is great; though not for the faint hearted!