New to HD

MJB2010 · Sep 13, 2011

I am an RN and have twenty years of experience in acute care settings but am new to dialysis. I am working for one of the big companies at a HD clinic. I have had twenty 8 hour shifts of orientation and have nine shifts of orientation left. Neither I nor my preceptor think that I am going to be ready to take an assignment at the end of orientation.
I'm asking for suggestions on how to improve my performance and also some idea as to long it took you experienced nurses to become proficient.

Are you in a chronic clinic? I did not feel ready when I finished training either and they left me alone as the only RN in the building! Yikes! I say ask for more time. If they have invested this much time in training you already a little more should not be a big deal. When you have your own assignment how many patients will it be and will there be any other nurses there to help if you get stuck? Are the techs experienced? They are a wealth of knowledge.

gigi2010 · Sep 14, 2011

MJB2010 - Thanks for taking time to reply. It is a chronic clinic that I am in and we do have experienced techs. I won't be the only RN but the concern is that I won't be able to pull my own weight. I'll never have more than four patients and I'm sure that I eventually will be able to handle them by myself, just not yet.

So how long was it before you were comfortable with a solo assignment?

MJB2010 · Sep 14, 2011

For me I had to get thrown in and it just plain sucked for the first few weeks. When you are new, you have to be able to accept help, and you will not be able to carry your own weight for a little bit. Everyone will just have to help out and be patient. I had one tech that was like the meanest person in the world, she loved to see me fail and made an effort to make things harder on me. Aside from her, everyone else was really kind and helped a lot. And as time goes, you will need less help and less help..... It gets better! Hang in there and don't be afraid to speak up and ask for help in the morning. Tell everyone to keep an eye out for you and try to help if they can. You will be fine! Some things just take time and practice.

gigi2010 · Sep 15, 2011

Thanks a lot for your words of encouragement. I actually had a good day today and very slowly it's all starting to make sense and come together.

Chisca, RN · Sep 15, 2011

What you are bringing to the table is 20 years of ICU experience which will be invaluable in a chronic clinic. You may be working with nurses who have never even been in a code. If they are smart they will allow you to grow into the position. If not, any acute unit would love to have you.

madwife2002, BSN, RN · Sep 18, 2011

We have an RN who after 6 weeks cannot managed to dialyze a pt so I cannot imagine how long she will need to look after the 20 chair unit we have. This RN told somebody she felt it was a cake walk to work as an RN

Trauma Columnist · Sep 18, 2011

I work in several FMC units and their company policy is that a new nurse is never left alone in the clinic for an entire year.

In the bigger clinics (>20 chairs), the RNs don't have an assignment, they do all the meds, assessments, etc., but no direct care.

In the smaller units (5-15 chairs), the RNs do help but again have no assignment.

IMHO if you are the only RN present in the clinic, you should NOT have an assignment as you are the one responsible for everything.

MJB2010 · Sep 18, 2011

I work in several FMC units and their company policy is that a new nurse is never left alone in the clinic for an entire year.
In the bigger clinics (>20 chairs), the RNs don't have an assignment, they do all the meds, assessments, etc., but no direct care.
In the smaller units (5-15 chairs), the RNs do help but again have no assignment.
IMHO if you are the only RN present in the clinic, you should NOT have an assignment as you are the one responsible for everything.

This policy is not followed in my clinic. I can personally attest to that, I was alone after 3 months. Also I work in a smaller clinic and the RN does have a section of our own to put on and off. There is no way I should have been left alone and I begged not to be. It did get much better but it was so stressful and scary in the beginning. I spoke up about it, but not to the right people.

I agree that if you are the only RN in the clinic you should not have a section, but no one listens to me. I still have one.

I really do enjoy working there now. But I can tell you I don't get the warm fuzzy feeling from or for the company.

Trauma Columnist · Sep 18, 2011

Oooh very concerning. What happens if a pt codes?

MJB2010 · Sep 18, 2011

If it happens in the morning when the techs are there, one calls 911 and the other helps me with the code. If it is in the afternoon when it is just me and one tech, we are in trouble. One to call 911 and one to code, although I don't think that would be super successful. It has happened before in my clinic to another nurse. I was off that day. The patient did not make it, although no amount of staff could have saved him in my opinion.