orientation plan for acute care dialysis units

[Sharon Niemi]

I have years of critical care expereince and have recently taken a new position in an acute care dialysis unit. We dialyze patients in the critical care units: CCU, ICU and CVICU yet the orientation plan currently does not include the care of these types of patients. I may be biased but I believe our plan should include some critical care orientation to provide at least a basic understanding of ventilators, pressors, swans etc and physical assessment. Nurses are currently required to take basic Dysrhythmia and ACLS. If you work in an acute care dialysis unit and travel to critical areas to perform dialysis please give me your insight into this. What does your orientation plan include? Thank-you. Sharon

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[Amy Morrow]

Sharon, I work in a small acute unit where on days that we don't do dialysis, we "float"and usually to CCU or ER. All of us have experience with vents, swans etc. so in our case it's a necessity to be familiar with all those things and then some.

[nancy bajc]

i work in a fairly big unit where we do go out to these units to do acute care patients.

the icu or cca nurse must take care of her machines as well as the patient but we do have cardiac monitoring that we do so if something is up there we call our doctors for direction

[kaffenoir]

Sharon,

I work for a large university hospital, and the dialysis nurses are required to have BLS, and we encourage ACLS. A nurse must have a minimum of 1 yr. of on the floor dialysis experience, before being aloud to dialyze an ICU patient one on one. They must also go to the ICU 3 times with an experienced dialysis nurse. However when dialyzing ICU patients of any type it is the ICU Nurse's responsibility to care for the patient. The dialysis nurse is there to focus on one thing and one thing only the dialysis of the patient. The nurse should be able to recognize when the patient is having difficulties, and be able to notify the ICU nurse of changes in the patient's condition. The purpose of dialyzing the patient in the ICU is so that the ICU nurse can continue the care of the patient, and the patient can be monitored closely, otherwise the patient would be brought to the dialysis unit. Dialysis is the same as any other ancillary service, if ULtrasound or neuro-med came in to perform a tx or scan on the patient while in the ICU, they would not assume the care the of the patient, and the same is true for dialysis. The ICU NURSE must maintain the total reponsibility of the care of the patient.

[nursingisok]

I work in acutes and no i do not believe that one should be familiar with the machines and etc, we are there to dialyze but the ICU and CCU nurses are still the primary RNs in charge of their care. When we come they don't leave, they check in on us and sometimes monitor the patient the whole time as is their job.

Even if we were to learn the machines in the ICU i'm sure it would not be in our dialysis contracts to even touch those ventilator machines. If something wrong were to happen the hospital would blame the dialysis RNs for messing with ICU equipment......at least thats what I would think.