RN duties at your facility

  1. I am very new to dialysis only being in it for the last 3 months. I was just wondering what the RN's duties include at the different facilities. Where I work, when I get there at 630a, I am responsible for setting up machines with the tech in the pod we are in for the day. At 7a, the patient's arrive and I must assess them before the tech puts them on but I am also responsible for putting on patients. I also do all the charting and meds. One thing that I was really wondering about was the fact that the techs are allowed to put on catheter patients and do cath care. Granted, they are not allowed to do the heparin dwells at the end. Before I became an RN, I was an LPN for 20 years and was not allowed to touch a catheter! Just seems odd to me. Where I am at, basically, I do everything the tech does from cleaning machines to garbage. Just wondered if this is standard practice.

    Thanks in advance for the responses.
  2. 18 Comments

  3. by   Lacie
    Depends on the state and company policy. When I was with Davita, pct's did cvc's but did not do cath care. Where I am now the pcts can do neither. They can rinse back but that's it. As an RN, I come in set up machines, do all the assessments, give all the heparins and other meds, do all the lab checks and reviews, call the doc, make rounds with docs and take patients dependant on staffing. I also do the initial assessment paperwork on new patients and the monthly care plans and med changes. Did I mention the only RN on the floor also lol. Yep that's dialysis!!
  4. by   pricklypear
    I think its just totally dependent on company policy. My company allows techs to do catheter care (everything including heparin packing) after 1 year on the floor and some training. I was surprised by that when I first started, coming from a hospital career where techs didn`t go near anything IV.

    My fellow nurses and I also do everything else that is needed - putting on, taking off, cleaning machines. It`s really a team effort or everything would fall apart.
  5. by   Tish88
    As per the pct's, it depends on what state you are in and what your company policy states. My pct's put cath patients on, do cath care and instill heparin post treatment.
    As far as RN's, they assess patients in and do "some" put ons and take offs..I primarily have the pct's do "most" of all the put ons and take offs. The RN passes meds to 20 patients. (ratio 1:20), sign off orders, call in refill prescriptions, call MD's when needed, pt med reviews, quarterly care plans and medication protocols.
    The pt acuity level in my facility is pretty high.
  6. by   pricklypear
    Tish88- geeze, with a ratio on 1 RN to 20 patients, I'm surprised you have time to do anything!! You're a braver girl than me!! We have 16 chairs, 2 RNs and 4 techs.
  7. by   Tish88
    You just have to learn a routine! and try not to get distracted.
  8. by   corky1272RN
    Quote from tish88
    as far as rn's, they assess patients in and do "some" put ons and take offs..i primarily have the pct's do "most" of all the put ons and take offs. the rn passes meds to 20 patients. (ratio 1:20), sign off orders, call in refill prescriptions, call md's when needed, pt med reviews, quarterly care plans and medication protocols.
    the pt acuity level in my facility is pretty high.

    all of you are soooo lucky. i have 1:12 ratio. one rn (me), 2pcts, 1lvn. i have to do all of the above and the pcts can't do any cvc care at all. not even rinse back the blood. when i first started here, the pcts could at least rb the pt when the tx was completed but several months ago that was changed. the lvn is able to do everything, so that helps, but he has his own 4 pts to care for. right now it is just toooo much to do. plus we have a few new employees so i have to help alot in turnaround. very stressful and tiring!
  9. by   Tish88
    It would be nice to have a ratio of 1:12. I have a ratio of 1:20 with 5 pct's.
    It gets a little crazy when you are trying to hang all the IV irons and push all the other meds.
  10. by   Niecystewka_RN
    In my clinic we have 24 chairs 3 pods and 2 shifts on TTS. We have 2 nurses and we both have 12 pts each. Each pod will have 2 techs working together. Our techs are allowed to pull up pts heparin boluses and infusions up, they are able to changed CVC dressings, check glucometers for high/low levels, able to fill pts jugs depending on prescription, but not allowed to spike any of them without a RN doing it for them, techs set up all pts machines, they put on pts and rinse the pts back, they make packs or the MWF shifts if needed, check BPs q30min, and stock the carts at the end of the day.
    RNs duties is to pass meds, recheck techs machines to make sure they are correct, assessments, spikes baths, notify MD if any issues, phone calls, round with MD when around, help techs with turn over if needed, teach patients w/ whatever they have need.
    I can't imagine having to pull up heparin for pts for the entire clinic and change dressings all the time. Some pct's aren't allowed to rinse back pts?!?! How do you have the time to do it?!?! My clinic gets nuts and sometimes I have a hard time getting what my usual stuff I need to get done ... done.
    Go you nurses!!
    Last edit by Niecystewka_RN on Jun 3, '09
  11. by   corky1272RN
    yeah, it is really hard to get everything done in a timely manner. in fact most of the time my main charting on pts has to be done when all the pts leave and everything is calm :tbsk:. ok not that calm but distractions are minimized. it also seems like every week more is added on to the rn. sometimes i would like to say, "what the techs were good enough last week to do that, now all of a sudden it is an rn duty only, what happened? " i just wish at least the pcts were able to rb the blood, you just don't know how much that one little thing would help.
  12. by   Lacie
    Forgot to mention I am also the clinical manager and doing the floor!! But in light of it all today was my very last day in dialysis!!! :wOOt: Someone else can beat their heads in the wall I'm cooked lol.
  13. by   corky1272RN
    Wow Lacie, where are you going? doing? I am looking for another job. I interviewed today for med-surg at a main hospital in my area. lsebeg: I need outta here too!!!! I am even going to take it if it means a pay cut (hopefully not toooo drastic).
  14. by   kanadianwannabe
    WOW...compared to all of you, I have it easy! We have 5 pods, 4 of the 5 have only 6 pts, the other pod has 9pts. The pods with 6 have a nurse and a tech. The big pod has 1 nurse and 2 techs. So, like today, I was in the big pod. The techs and I each brought in pts and I assessed while they put on. I just kept bringing them in and assessing. Then I go around and give all the heparins, make rounds, put in all the assessments, give meds, draw up heparin for next shift. By then, it's time for take off. I do take off more than I put on since there are no assessments. M-W-F, I only work until 1 or 2pm so I help put on the next shift until the next nurse gets there. Then chart and I'm out of there...haha. So, I guess I don't have it so bad. I will be sure to pass this on to all my fellow nurses when they start complaining!