Tips for new grad starting Davita dialysis houston

corky1272RN · May 4, 2009

Don't do anything that will compromise patient safety. Also do what you feel is right not what others say. Ex. A pt had a 47 HR chronicly, then comes in one day and during dialysis has a 35 HR, I wanted to send out to ER but FA ( also a nurse) says not to or MD says "no". :sstrs:I sent him out to ER anyway and he got a much needed pacemaker. Do what you feel is right in your heart. Someone in my unit has previously told me to start tx without heparin (against prescription and could lead to clotting) or to cut someone's tx time (so we won't be there late). This person was actually not a nurse. But bottom line don't just do something because a boss has said to or MD has said to because if it ends up in court, do you really think that you will be backed????? NO!:grn:

dRN1 · May 4, 2009

So, how do you know to or not to do these type of things? Do they train you and teach all about that in the "classroom" component?

dRN1 · May 4, 2009

I too am starting at davita. TOMORROW in fact. I haven't put in written notice at my current job yet. I still don't know about the whole thing. I will get a better feel tomorrow, I HOPE!

ET04 · May 4, 2009

Yea I'm a bit concerned about that also. I'm a new grad so it might be hard for me to know the right thing when everyone else is telling me otherwise. Sure they teach me in school about all these things. But seriously though, you learn to be a nurse on the job. I only had one rotation into dialaysis and the dialysis nurse just basically gave me a book and said, "here read this." Not much of a good learning experience. So hopefully during my orientation they teach me the right things so I won't just go with the flow and do whatever everybody's doing.

Lacie, BSN, RN · May 4, 2009

There are somethings they just cant teach you in a classroom. I am and always will be what some of us old schoolers call a "gut" nurse. In other words my gut directs me when I think something isnt right and usually I'm right. You get to know your patients well and seeing them as much as you do you know when there's a problem although it may be something you cant just put your finger on or a name to it. This comes with experience. What I have found in chronic dialysis is too many nurses and pcts become too "tunnel vision" and dont look at the pt as a whole or what other co-morbities are there. They concentrate too much on just meeting the numbers required by corporate and not the patient. Most I have worked with couldnt tell you what a murmur sounds like or be able to identify afib without a monitor. I was surprised how many pcts dont know how to do a manual b/p or how to do a manual pulse!!!! I have only one pct for instant on my staff that actually can do a manual blood pressure. Some places even have the pct's doing the assessments rather than the RN. My clinic was that way until I took over as manager. I was appalled. Sometimes you have to be a risk taker and stand up for your patients even if it means putting your job on the line.

dRN1 · May 4, 2009

I read a post a month ago that someone wrote that said they decided not to go wit DaVita because they had a bad feeling inside the clinic. So, later that day they said they drove past the clinic and saw an ambulance there. I said to myself briefly "if there is an ambulance there when I get there I am leaving" today I pull up for my first day and guess what! AMBULANCE.. So I get out of the car, go inside. I waited in the lobby about 20 minutes. The whole time I am listening to patients bad mouth the place and so on. I am getting ansy.. I still couldn't shake that gut feeling I have had ever since I accepted the positon 4 weeks ago. I looked through the treatment window and heard the loudest voice "this is not the place for you" What r u waiting for, and why are you here on your day off. ( worked 5 -12 hour shiftsout of the past 7 days).. I am not secure in my own knowledge as a nurse with only 4 months of experience to venture out yet. So- I got up, left and called my recruiter to tell her I decline the job at this time. THAT is what my GUT told me to do. I feel so bad but I feel good at the same time....

Lacie, BSN, RN · May 4, 2009

Good for you!!! Sounds like you made the right decision. Stay in the hospital setting for abit and get your feet wet. You'll find you nitch when your ready :)

dRN1 · May 5, 2009

Thank you Lacie, that was good confirmation. It may have just boiled down to right opportunity, wrong time...

nursingisok · May 5, 2009

Goodluck. Davita sucks! Once you start you will know what i'm talking about. there is so much ******** associated with that company.

Valerie Salva, BSN, RN · May 6, 2009

There are somethings they just cant teach you in a classroom. I am and always will be what some of us old schoolers call a "gut" nurse. In other words my gut directs me when I think something isnt right and usually I'm right. You get to know your patients well and seeing them as much as you do you know when there's a problem although it may be something you cant just put your finger on or a name to it. This comes with experience. What I have found in chronic dialysis is too many nurses and pcts become too "tunnel vision" and dont look at the pt as a whole or what other co-morbities are there. They concentrate too much on just meeting the numbers required by corporate and not the patient. Most I have worked with couldnt tell you what a murmur sounds like or be able to identify afib without a monitor. I was surprised how many pcts dont know how to do a manual b/p or how to do a manual pulse!!!! I have only one pct for instant on my staff that actually can do a manual blood pressure. Some places even have the pct's doing the assessments rather than the RN. My clinic was that way until I took over as manager. I was appalled. Sometimes you have to be a risk taker and stand up for your patients even if it means putting your job on the line.

I agree totally.

Most of the time when a pt requires an ambulance at an outpt dialysis clinic, it is because staff have that "tunnel vision" that is so common in dialysis, and staff are reacting to problems rather than preventing them.

corky1272RN · May 6, 2009

Valerie, I must disagree with your post. Although there are always exceptions to everything...have you ever tried to get something done for a pt but can't? Such as an access: It's not working correctly, they are referred to an access ctr, the "report" comes back that everything is A-ok, well he decided to get a second opinion and the second surgeon found blood clots. If he wasn't a serious advocate for himself, he would still be dealing with this. :crying2: What about an infection of a CVC: antibiotics have been given time and time again, md called multiple times, blood cultures and swab culturette taken, even finally got the md to refer pt to local hospital to get the cvc replaced and an access put in arm, finally when the pt was convinced to go, she goes and was turned away for who knows why:angryfire Anyway i feel like i am ranting, but what I really am trying to say is that alot of issues don't get missed but ignored until it is necessary to call the ambulance. The other reason for the ambulence is if a pt states they have chest pain and I am unable to get it to stop (even if I feel it is a cramp) I WILL be calling 911 since there is no md there and I will not use my clinic as a little ER. Just because I am ACLS certified doesn't mean I really want to use it:D.