shift change is killing us, Help!

  1. Hello everyone, this is my first post as a dialysis nurse and we need help. I am a RN at a small rural chronic dialysis center, we have 12 chairs and we have 3 shifts 6 days a week, all shifts are pretty much full except for Tues, Thurs, and Sat and the third shift is pretty small but I rarely work those days, we have a full time charge nurse 4 days a week and I fill in the one day that she is not there and she only works 8 til 4:30 so I take care of everthing like orders and problems after she leaves but I still have my patients to take care but anyway, the problem that we are having is shift change, sometimes we have 6 patients coming off at the same time and then we have 6 who need to be put on, so its like a crazy house for atleast 2 hours during each change over, we usally have one RN and 2 Lpns and 2 techs sometimes 3 and then we have our charge nurse and our unit manager but neither take patients but will sometimes help during change over but not usually and after 4:30 when the day people go home we might have 2 nurses and 1 to 2 techs but we will still have 11 pts on the machines, we are all experiecing major burnout and one of our best techs put in her two weeks notice and several of the nurses are looking elsewhere including myself, I love dialysis but I think Im burned out and not sure what to do, the techs come in at 5:30 and get the machines ready, the nurses come in at 6:00 and we start putting pts on at 6:30 and we are getting out around 7:30 to 8:00, we are having a staff meeting tomorrow night to try to figure a better way of scheduling pts and maybe staggering them so that so many are not coming off at the same time, everyone is complaining about being so shortstaffed and worked to death, but Im not sure that we are understaffed, we do have some lay time but not very much, the doc has given us so many protocols to follow according to lab and etc.. that we are writing all of the orders, he doesnt like to be bothered because he is to busy and our lpns do not like to call the doc and its the RNs responsiblity to call on all of the patients and our techs do not put on or take off, we have a couple who can do that but only when they have to like short a nurse for the day, sorry, I know that Im rambling but Im very frustrated and I just was wondering if we really have it made at our clinic and are just spoiled or if we really have a reason to be complaining and everyone has been and so were having this meeting, any advice or comments are appreciated, oh I think that I forgot to meantion that Ive been doing this for a little over a year and I really love dialysis overall and want to stay in it.
    •  
  2. 22 Comments

  3. by   Hellllllo Nurse
    Sounds like the typical dialysis clinic to me.

    We have 21 chairs. We have started staggering our pts and it has helped. We still work our butts off and run around like crazy, but it's no longer so bad that I am tempted to run screaming from the building and never come back... at least not on a daily basis.
  4. by   AmyLiz
    We've got 24 chairs, broken up into 3 sections. We stagger our patients, so that say in the second shift they'll come on at 10, 10:15, 10:30, 10:45, 11, 11:15, 11:20, 11:30. Of course sometimes we can get a patient or two in earlier than scheduled which helps out in the long run. Two techs come in at 4:30, then more techs & nurses come in by 5. We try to have 8 people working in the mornings so as to get the patients on as quickly as possible. We open our doors to the patients by 5:30 if at all possible.

    We still have our crazy times during turnover, but it's not too terrible.
  5. by   jnette
    That's dialysis, Baby !!!

    We, too, have 12 chairs... run two shifts on M-W-F. and one shift on Tue.-Thurs.- Sat.

    We have three people on the floor and one "water person", who mixes the bicarb, sets out the jugs, does waterchecks in the basement etc., and helps out on the floor during change over. We ALL (mixture of techs and nurses.. we only have one tech, though.) come in at 0400 to set up the machines, mix bicarb, etc.

    Three floor staff = 4 pts. per staff. One water person (we rotate each day, so it's fair).

    This would include the charge nurse (who is one of the three floor staff) who ALSO comes in at 0400 and stays 'til the last pt. leaves and our tech who also puts patients on and takes them off... he, too, is one of the three floor staff.

    Our patients arrive at 0430, but we start putting them on at 0500. We also stagger our patients, but there's just no getting around hte change over crazies ! It's chaos regardless of what you do. We are each simultaneously taking off and putting on four patients a piece. The "water person" runs around and help out where he/she can in between refilling jugs, etc. Our NM does come out and help during changeover, when she's there, which is not all the time, either.

    Our last patient goes on about 1045-1100 and comes off about 1400-1430. We're usually out of there by 1500, some days (like today) a bit later.

    We have done three shifts during the holidays, and yes, they can wear you out to a frazzle.
    However, from the amount of total staff you have there, it doesn't seem to be that bad.

    For example, I have my four patients, and I put them on in the morning, take them all off by myself while getting the new set of four ready to go on, and out them on inbetween the others coming off. If I'm lucky, hte "waterperson" will be available to help take one off now and then, or bring one back to get weight, vitals, etc. and seated in their chair at least. We don'thave any "techs" or anyone to set up our machines, or tear them down. We do all of this ourselves for our own set of four (eight total) patients for that day. Our only tech has his own set of four patients to worry about.

    So yes.. it get hairy. But ya know what? I STILL love it !!! Even after today, which was one of those "alarm days from hell"... the ones where none of the caths want to run and the new fistulas are crappy, and you spend all your time running to readjust the needle or flush the cath and get behaind on everything else ! Yeah... you know ! :chuckle

    I love what I do, and I love my patients. I jsut tell them AND myself I can only be at one place at one time... only put on one patient at a time or take one off at a time, and that's just all there is to it. I used to freak out and get all rushed and panicky, but no more. You can only do what you can do.

    Maybe someone here has some good suggestions for you... hope you can get it worked out ! (((HUGS)))
    Last edit by jnette on Jul 7, '04
  6. by   jnette
    Oh ! Forgot to add... on our "short days" (T-Th-Sat) we still have 12 pts. (although just the one shift) and only THREE staff period ! So we all have to pitch in with the water, bicarb/acid mixing and jusgs, etc., etc.. etc... stocking, taking out the biohazard trash, etc.... AND care for our full load of pts. Just the three of us. No "waterperson" those days.

    Who ever is charge for the day takes and makes all the calls to the doc, etc. and does validation and med report at the end of the day. The charge still has her full load of pts. as well in addition to all the other responsibilities.

    Yep... dialysis is rough. You either love it or hate it.
  7. by   kelluvanurse
    Thanks to everyone who replied, I was thinking that what we were experiecing was probabley the norm, gee, I usually have 4 patients but I do have a tech that helps with tearing down and setting up the machine for the next person, anyway, I appreciate the comments and I will try to hang in there.
  8. by   Hellllllo Nurse
    kelluvanurse,

    Maybe you can talk to your boss about staggering the pts. It really does help.

    I like dialysis, too. But, I hate working sooooo hard every day. It would be nice to have slow day once in awhile.
  9. by   Farkinott
    your jobs sound like h**l! that kind of workload would not be tolerated in oz! and as for starting work at 0400hr? forget it! noone would take on a job that starts at such a ludicrous time!
  10. by   AmyLiz
    Quote from farkinott
    your jobs sound like h**l! that kind of workload would not be tolerated in oz! and as for starting work at 0400hr? forget it! noone would take on a job that starts at such a ludicrous time!
    i'm at work at 4:30, but pts don't come in until 5:30. the reason we start so early is so we're not there all night. sometimes our late shift workers are there until 11pm or so. imagine if we didn't open our doors until 8am! :uhoh21:

    edited to add:
    i actually like my 4:30am-5:00pm shift. it gives me time to do things in the evenings. those at our center that work 8-8:30...they miss out on their entire day. at least i get a few hours to do what i want in the evenings.
  11. by   Dormkare1
    Hello! I'm new to this site and have just been hired on in a dialysis unit. New to this also. I wonder, in a small unit ( not sure how many chairs) what is the usual shift for nurses? Have not even started training yet. Was so excited I forgot to ask some improtant questions
    Last edit by Dormkare1 on Jul 15, '04
  12. by   jnette
    Quote from Dormkare1
    Hello! I'm new to this site and have just been hired on in a dialysis unit. New to this also. I wonder, in a small unit ( not sure how many chairs) what is the usual shift for nurses? Have not even started training yet. Was so excited I forgot to ask some improtant questions
    It all depends on the unit or facility.

    Ours is considered a "small" unit... 12 chairs. We do two shifts on M-W-F, and only one shift on Tue-Thurs-Sat. Closed on Sundays.

    Some small units do up to three shifts 6 days a week... some only do two shifts and only three days a week period...... so it really depends on what the needs are at your facilty.

    Hope that helps... and welcome !
  13. by   Dormkare1
    HI Thanks for the welcome and I am sure glad to hear ( read) your voice!! Yes, that info does help Could you give me an idea of the shift times in general? I should have asked but again was to excited!!
  14. by   jnette
    Quote from Dormkare1
    HI Thanks for the welcome and I am sure glad to hear ( read) your voice!! Yes, that info does help Could you give me an idea of the shift times in general? I should have asked but again was to excited!!

    Again, that depends on your particular unit.. they vary, but you can figure on it being quite early. Our first patients go on at 0500, meaning that we are htere by 0415-0430 to get the machines ready and tested, bicarb and acid out, etc.... Running two shifts, we are usually done then and leaving by approx. three pm.. if all goes well.

    Some clinics start a bit later. like 0600... but that's the latest I know of any starting.. still means you'd need to be there a good half hour earlier.

    You might want to go back and chat with them and get all the details... or give them a call and make notes.

    Wish you the best.

close