Dialysis Nurse Day to Day
This article summarizes one nurse's dialysis experience. It invites the reader to share their own ideas and reactions.
I fell in step with my friend Terry, as he walked down the hospital hall carrying big bags of peritoneal dialysis fluid. Arms full, he responded to my question about where he was headed, indicating a room near by. “Just getting that patient all set up.” When he finished up, we talked for a few minutes, and I asked more questions about being a dialysis nurse and what was involved.
How did you get into the field?
I started as an aide and worked my way through school. Once I became an RN, I worked in the ICU, the PACU, the ER and even wound care before starting to work the hemodialysis unit in the hospital. I eventually moved to outpatient dialysis where I now supervise and coordinate the hemodialysis center along with the home peritoneal dialysis (PD).
What do you recommend for someone that might be interested in working with dialysis patients in some capacity?
Start out by getting some critical care experience—that is sort of a good starting point. It’s really a great field for people who like or need stable hours—especially the dialysis center work. Many places you can start early and finish up early. It requires staying up-to-date with continuing ed. And the pay tends to be good. There are clinical ladders, special certifications and a variety of ways to move up. It’s also an ideal field if you enjoy seeing the same patients repeatedly and getting to know them. With the hemodialysis centers, patients come in three days a week and often you can really get to know them long term.
What are special challenges for nurses working in the hospital hemodialysis centers?
In the hospital, you have the patients who are already on dialysis that need to have their treatments while receiving care for whatever their diagnosis is, and you also have patients who have emergent needs related to trauma. These short term dialysis treatments can allow that injured kidney to heal and hopefully, it doesn’t turn into a chronic dialysis situation. As you would expect, when patients are sicker—as they usually are in the hospital—everything is more complicated and requires the nurse to be on top of a more critical situation.
How long are patients usually on dialysis?
It can be for a number of years. It really depends on them and how compliant they are with their diet and fluid intake and other metabolic parameters. We see our patients in the center three times a week and our home PD patients two times a month. If they are compliant, they do well. Otherwise, you watch them fade away. But it can be as much as 20+ years. We keep track of their fluid, potassium, phosphorus, calcium, blood chemistry and other co-morbidities such as diabetes or hypertension. The main thing sounds simple but is so true: they have to keep showing up. That is really hard to do long term. A certain chronic fatigue with the whole process can set it. And, of course, we always work toward the ultimate cure for dialysis: the transplant—helping them get where they need to be so that can happen.
[According to the latest U.S. Renal Data System Annual Data Report, more than 660,000 Americans are being treated for kidney failure, also called end stage renal disease or ESRD. Of these, 468,000 are dialysis patients and more than 193,000 have a functioning kidney transplant.]
Since Medicare pays for hemodialysis and they are encouraging more people to change to home dialysis. What is that like for patients?
Patients can do very well. Often it depends on if they have a caregiver or health partner situation that is positive. The more support they have, the better they will do with any type of dialysis. We do CAPD (continuous ambulatory peritoneal dialysis) and CCPD (continuous cyclic peritoneal dialysis) more and more often; we are also moving into home hemodialysis and that has been increasingly popular for patients. Home dialysis can be significantly cheaper—maybe 40% cheaper—and also more convenient for patients. But whether or not they are good candidates for it really depends on many factors.
With CAPD, sometimes patients can develop a fistula or a membrane failure and will need to take a break from that routine.
With home hemodialysis, it takes 2.5-3 hours and 45 minutes setup and take down each time. They do it 5x per week instead of 7x for CCPD.
What would you want to tell a nurse that is considering entering the field of dialysis nursing?
It’s a little intimidating and technical at first. But as with most , after a while, it becomes familiar and more accessible and less stressful. Working in this field we have special infection control concerns, especially with the amount of body fluid that we are always around: potential exposure is always a risk. The work involves being on your feet a lot and we are always, always teaching. Each visit, whether in the center or at home, we are going over access care, infection control, diet, fluid management.
Learning more about nursing in the dialysis field brings up questions about others’ experiences in caring for patients with kidney disease. If you work in this field, what is that that you love? What is particularly challenging for you? Would you encourage other nurses to pursue training to become dialysis nurses?
Joy is a part time Parish Nurse. She stays busy helping care for her three grandchildren.
Joined Jan '15; Posts: 242; Likes: 824.Aug 17As a nephrology APRN for the last 11 years, this is definitely an accurate description of a dialysis nurse's job.Aug 17Quote from traumaRUsThank you for your kind comment! You made my day. JoyAs a nephrology APRN for the last 11 years, this is definitely an accurate description of a dialysis nurse's job.Aug 25I loved your article and enjoyed your perspective. It was a dialysis nurse, in 1965, at Los Angeles Mt. Sinai Medical Center who taught me my first lesson in doing dialysis, from the Travenol Twin Coil dialyzer, the dry concentrate and an oar to stir the dialysate in the huge tub, to the care of the, then state of the art, Scribner shunt, and this launched me on a 50 year career as a nephrologist. This is the right medium to say thanks to the absolutely indispensable profession that makes the care of more than 400,000 patients with ESRD possible, in the USA alone, and more around the world. In a day of increasing depersonalization of care, of the rise of industrial strength medicine, and large corporations, it is the nursing profession, at the patient's bedside, that keeps the flame of professionalism alive. Thank you all for your devotion to patients, all those hours of the days and nights, and those emergency runs on holidays, for fluid overload and hyperkalemia, and the time you gave to your patients when you wanted to be with your family. Hugs to you all, the nephrologist's best friends!Aug 26Thank you so much for your wonderful comment and for the historical perspective that you share here. Your words warm our hearts and offer encouragement. "In a day of increasing depersonalization of care, of the rise of industrial strength medicine, and large corporations, it is the nursing profession, at the patient's bedside, that keeps the flame of professionalism alive." In fact, it would be great to read more from you about how we have moved forward since 1965--the personal experiences you have would be so interesting to read about. Thanks again, Joy
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