After 1 Year I am SICK of Dialysis

Trauma Columnist · May 31, 2012

This is what I could find from CMS:How long will Medicare pay for transplant drugs?If you're entitled to Medicare only because of permanent kidney failure, your Medicare coverage will end 36 months after the month of the transplant.Medicare won't pay for any services or items, including immunosuppressive drugs, for patients who aren't entitled to Medicare.Medicare will continue to pay for your immunosuppressive drugs with no time limit if you:■ Were already entitled to Medicare because of age or disability before you got ESRD■ Became entitled to Medicare because of age or disability after getting a transplant that was paid for by Medicare, or paid for by private insurance that paid primary to your Part A coverage, in a Medicare-certified facility

Trauma Columnist · May 31, 2012

I apologize for the lack of formatting. Love my iPad, hate this issue.

SuperStarRN · May 31, 2012

traumaRUS I love that you brought that up. I had a patient tell me last week that he pays my salary (this was his bad attempt at making a joke). Excuse me!?!? You are on Medicaid and have not had a job in your entire life. Last time I checked the taxes that come out of my paycheck pay for your insurance so if you want to look at it that way I pay my own salary.

All that "put yourself in the patient's shoes" sounds all warm and fuzzy and like the right thing to say but the fact of the matter is that patients who are noncompliant with their ESRD regimen are also noncompliant with their diabetes and HTN regimens which 9 times out of 10 is what damaged their kidneys to begin with. You ever heard the expression you have to love yourself before anyone else can love you? Patients have to care enough about their own health. And once again, I did not say that ALL patients are noncompliant I said that MANY are noncompliant.

In the beginning when they get that diagnosis I can only imagine how trying that news is but when you have been diabetic your whole life and on dialysis for 5-6 years now ineffective coping should not be an excuse. We are all dealt our hands in life and we all have to make the best out of the hand that we are dealt. I do not have ESRD but I'm sure I have my own problems that are just as important to my life just like everyone here reading these posts does.

I would also like to say that I do empathize with my patients. When their kidney function does not return I am sad for them, when the PD patient has problems that forces them to return to hemo I am sad for them. When a patient learns about a new modality and gets to leave hemo and go home I am happy for them. When after 7 years a patient finally gets a new kidney I dance a little jig. And when the suffering, ragged patient moves on from this life I feel great joy for them. But the fact of the matter is dialysis is not my specialty and I'm ok with that.

Tree525 · Jun 7, 2012

SuperstarLPN, I can't agree more with your last reply to this thread. I have been an RN in dialysis for 9 months now, and I have never come across a patient population such as that found within dialysis. While some are an absolute joy to work with, I find that many are very rude and just plain disrespectful. Last week a patients BP was dropping into an unsafe range throughout his tx. He was symptomatic, so I bolused him several times throughout his treatment and lowered his goal. Needless to say, he didn't meet his dry weight. The next time he came in, he threw a fit about my care with my boss and went on to tell me and the charge nurse about how I'm a " bad nurse " and " I don't know what I'm doing. " I told him kindly that yes, it is my job to provide him with a good treatment, but it's even more important for me to keep him

safe." I went on to explain in great depth the lack of tissue perfusion that occurs with a low BP and why it is such a danger and that he needs a new dry weight. Still, I was met with " I don't care, your a terrible nurse and you clearly have no idea what youre doing . " basically it ruined my day. I dont wake up at 3 15 am to get belittled like that. These situations happen all the time in dialysis.

I have dealt with difficult patients in the past and realize that not all will be ideal, however it is as if they all are clustered in the dialysis population. They get furiously mad if you put them on 5 min late, question them about their large fluid gains and try to kindly educate them, etc etc. Like I said, not all patients in dialysis are like this, but I find that most are and it is certainly burning me out of this field in nursing.

How do I transition out of this field into a hospital setting, anyone do it with success? I don't know how much of my dialysis skills are appealing to employers other than dialysis clinics.

SuperStarRN · Jun 7, 2012

gcat after only a year I have stories for days and they all sound very similar to yours. I wish you the best of luck in finding a new position.