New to Home Hemo

What company do you work for? I'm assuming Davita. If so, I can answer some of your questions. A lot of the answers to your questions are based on what type of unit you working. Freestanding or attached to an in-center unit? Are you the only nurse or are there other (home hemo) nurses that are a part of the unit as well?

Ok, sounds like we're in the same boat. My center is attached to an in-center unit that does nocturnal also. I'm the only home hemo nurse. So, far I haven't had to go to patient's home to assist with cannulation. The pt's are well-trained, so I usely only get calls about things related to machine alarms. As for call itself, I'm always on-call. But, I don't mind because I don't get very many calls. How many pts do you have on home hemo? Does your manager know anything at all about the program? and do they help out? Only time I worked a Sat was in the beginning when I was working with the person I was replacing. I worked two saturdays, trying to learn what it was I was supposed to be doing exactly as far as pt management. I basically learned how to input the flowsheets, and how to do some of the monthly reports. Other than that I was on my own. I'm stilling learning and figuring out things six months later. I was kind of forced into this because the person had another job already and she worked in-center on sat at the unit to help out for a few weeks. I really enjoy the home hemo program overall!!! The program is fairly new and is constantly changed, which can be quite frustrating.

Hi Toni,

Sorry, I didn't get back to you before now. I started training a new patient this week, so I've been pretty busy to say the least. Glad to hear you made it to the Home Hemo class. I attended the class last fall. I got some good things out of the class, but I felt it could have been more. I heard they've changed it up a little since I attended. Have you been scheduled for the preceptorship week yet? As for your questions, I have 7 patients including the one I am training now. All of my patients are on Nxstage and I have trained 1 patient prior to the present one.

As for your previous post: No I've never done PD so I can't compare. The only time I gotten into overtime was when I was training a pt for the very 1st time, but my supervisor doesn't want me to get any this time. I managed to avoid it this past week, barely!!! Home hemo is a big job and does involve a lot of paperwork. It is constantly changing, so you have to be flexible. By this I mean, you learn to do thinks one way then it changes a month or two later.

Be thankful that your supervisor trained the 1st patient. Therefore, he or she knows what your doing exactly and knows how much time it takes. Also, they can help you if needed and cover if you have to be out for some reason. My supervisor knows very minimal about home hemo and training, which puts me in sticky situation. I've been told that I will get some help when I have 10 pts (since the ratio is 15:1), but only time will tell.

By the way, I agree with you on the NOT training a pt that will be dialyzing alone at home without a partner. That's lawsuit waiting to happen if you ask me. Unfortunately, some physicians and programs allow it. But, I'm with you, NOT on my watch if you know what I mean. That's just CRAZY!!!

Hi Toni,

I'm not surprised to hear the class hasn't changed much. But, at least you got to spend some time working with the machine. In my class, we literally went in and listened to the instructor talk about the machine. She didn't even set it up or let us set it up. Some people could follow her a little bit because they already worked with the machine. As for me, I hadn't even saw the machine prior to the class.

The 1st time I actually got to set it up was when I went to my preceptorship week. By the way, I feel like I learned very little there also. I didn't actually get to see a patient being trained. Everything that I learned about training actually was learned while I was training my first patient with the Nxstage educator. I don't know what I would have done with out her. The educator actually trains you at the same time your training for the 1st time. The educator spends a week with you training you on the machine & pureflow.

As for the ratio, I don't think it's doable, but we'll see how it goes. It may be doable if your only managing their care. If your having to manage 15 and train new patients, I don't think so. I've been told I will get some help when I get to 10, even though in the HHD class we were told that the search for additional staff should begin when the program has 6-7 patients.

I have managed to train this week thus far without going into overtime, but it was hard. I was supposed to participate in an assessment of a potential patient, but my manager had to do it because I would have been in overtime. As for each training session, it averages about 6 hours. That's set-up, treatment, and clean-up. The 1st session can be shorter, because you can set-up the machine prior to patient coming and just put the patient on when they arrive. You want the 1st session to just be a good experience for the patient.

Training time depends on pt and partner, if they are quick learners they will go by faster. It takes me about 20 -30 minutes to set-up machine. It may take the patient and partner 1 hour or longer. Right now, it takes my patient about 1:30 from the time I bring him back to the time tx starts. That's pre-workup, setup, cannulation, put-on, and start.

I was thinking you were going to have a little bit of an advantage if your manager had trained the first patient, but I guess that's not the case. FYI, it really sucks when your the only one that knows the machine, and no one else has a clue what your doing. Do you know why the other nurse left? Are there any other Home Hemo nurses in your area that you know of? As for hours per day, how long you're there depends on what else you have to do besides train. It won't be too bad at 1st, but as you get more pts it gets more difficult.

Right now my duties are as follows: Training; managing care for pts (there is a laundry list things for this alone); ordering supplies, EPO, Heparin; Clinic visits; Ensuring dialysate cultures are drawn and within range for pts on pureflow; home visits; completing various reports, attending weekly clinical meetings; being on-call; being on conference calls; etc. All of this, while the program is constantly changing. As fast as you learn to do something, they change the way your supposed to do it and you have to take a class online or have a call to learn the new way.

I am happy to help you in any way that I can. I know how it felt to be new and not have a clue as to what was going on. Keep me updated!!!

MsDorsey