Is this what being an RN in dialysis is like? - page 2

by barbwire 12,511 Views | 30 Comments

Well, this is my first RN job and I don't really know what to think. I started working in a 24 chair facility. We do two shifts a day, Monday through Saturday. The first part of my training has been learning the tech's job. ... Read More


  1. 3
    Quote from RNtobeinSoCal
    I cannot get over how often I have cried because of this job. I cannot seem to get the time management piece down, and the only advice I get from other staff is "You have to be faster". Uh, OK... exactly how do I do that without compromising patient safety?

    Also, how thorough are your post-TX assessments? Seems like a lot of post-TX assessments are not being performed properly, and that this is the only way to get everything done in a timely fashion from the end of one shift to the beginning of another.

    Barbwire- that's exactly it! 2 steps forward, 10 backward. I have been at two clinics with the same company- they use different tubing, slightly different machines. One uses clamps, one doesn't. One enters certain data into the machine, one doesn't. I forget things I should know by now, and what kind of excuse can there possibly be?


    Seriously, does anyone have specific advice for time management??
    My first six months as a dialysis nurse were beyond horrible. I went home crying almost on a daily basis, and all I dreamed of was quitting. My friend encouraged me to tough it out, saying that it eventually gets better. About a year after taking a bay of patients 50hrs a week, I had finally gained the self confidence and skills needed to be a good hemodialysis nurse.

    Even though I'm now a preceptor, it's hard to explain time management skills. I think the biggest part is to establish a set routine, and to already expect the unexpected. I always have extra gauze at the chairside, and I watch my BP's like a hawk taking on some unstable patients every 5 minutes in order to anticipate and treat early...very early a complication. The last thing I want is to have a patient occupying a chair 20min after is off time due to low BP. So, if my patient started with a systolic of 160 and he's down to 110....I usually turn his UF off and let him recoup. I have all my supplies ready about 30min to 1hr before take off. I sometimes chart a couple minutes ahead so that after take off I can strip and clean and restring my machine while they are holding their sites. I have all my supplies and heparin ready to go as soon as my first shift is put on, and during shift change, I only document what's vital in the moment....my last line, and my post treatment vitals. My assessment and such can wait if need be.

    For me I guess, preventing complications...low BP, clotted dialyzers are my biggest "time savers" If I have someone that's a known bleeder, I pay close attention to where my gauze and finger are when pullining the needle, and even though my mind is screaming to hurry up...I stay a minute or two holding before I either clamp or pass it off to the patient. I hate bleeding....it takes forever to clean your chair and you have to get control of it and it's a time waster, so prevention is the best solution. While they're holding and I'm stringing the machine or charting, I have a hawk eye on their access. If it even hints of pink, I'm over there taking over.

    I know this is all stuff you know though, but it's how I survive, and I'm doing well, and I can even say I love my job.
  2. 1
    Quote from Vegan_RN

    My first six months as a dialysis nurse were beyond horrible. I went home crying almost on a daily basis, and all I dreamed of was quitting. My friend encouraged me to tough it out, saying that it eventually gets better. About a year after taking a bay of patients 50hrs a week, I had finally gained the self confidence and skills needed to be a good hemodialysis nurse.

    Even though I'm now a preceptor, it's hard to explain time management skills. I think the biggest part is to establish a set routine, and to already expect the unexpected. I always have extra gauze at the chairside, and I watch my BP's like a hawk taking on some unstable patients every 5 minutes in order to anticipate and treat early...very early a complication. The last thing I want is to have a patient occupying a chair 20min after is off time due to low BP. So, if my patient started with a systolic of 160 and he's down to 110....I usually turn his UF off and let him recoup. I have all my supplies ready about 30min to 1hr before take off. I sometimes chart a couple minutes ahead so that after take off I can strip and clean and restring my machine while they are holding their sites. I have all my supplies and heparin ready to go as soon as my first shift is put on, and during shift change, I only document what's vital in the moment....my last line, and my post treatment vitals. My assessment and such can wait if need be.

    For me I guess, preventing complications...low BP, clotted dialyzers are my biggest "time savers" If I have someone that's a known bleeder, I pay close attention to where my gauze and finger are when pullining the needle, and even though my mind is screaming to hurry up...I stay a minute or two holding before I either clamp or pass it off to the patient. I hate bleeding....it takes forever to clean your chair and you have to get control of it and it's a time waster, so prevention is the best solution. While they're holding and I'm stringing the machine or charting, I have a hawk eye on their access. If it even hints of pink, I'm over there taking over.

    I know this is all stuff you know though, but it's how I survive, and I'm doing well, and I can even say I love my job.
    This sounds a lot like what I do on a daily basis!!! Organization is key as well.... Now I am in school for my RN (I'm currently an LPN) I ❤dialysis .. It's perfect for People with ADHD lol
    Vegan_RN likes this.
  3. 0
    Quote from mrscseaton
    This sounds a lot like what I do on a daily basis!!! Organization is key as well.... Now I am in school for my RN (I'm currently an LPN) I ❤dialysis .. It's perfect for People with ADHD lol
    I love it too!!
  4. 0
    Oh!! And I started as an LPN in dialysis too!!! I graduated with my RN this past May.
  5. 0
    I believe there is job security in dialysis. It's so specialized that any other nurse can't just walk in & take over. I'm concerned as to what obama care will do for dialysis reimbursement.
  6. 2
    There is a lot of job security. It's a high burn out job and is very specialized.
    sweetnurse786 and Marisette like this.
  7. 0
    Hmmm - we must look to what Obamacare will mean though for dialysis - however, probably something best suited for a different thread.
  8. 1
    Quote from barbwire
    LOL!!! And it's probably the truth. Have seen so many things over the past few months that make my jaw hit the ground and I know it's all centered around the almighty dollar: pile more and more on the workers so money is saved, cut corners (with a total disregard for safety) so that people at the top make more money. Guess that's par for most every company/organization out there.

    The jury is still out if I remain where I am. Which is a shame bc I actually, for the most part, enjoy what the job entails. Ok, except for when the patient passes out on you with a BP of 45/15 causing one to almost wet their pants bc this has never happened to one before. But I capped off the day with a big hug and a kiss from a patient. THAT made all the b.s of the day worth it.
    If you like what the job then stick with it. The work flow gets easier and things are changing in the industry. Quality is becoming the main focus for upper management, this has a lot to do with changes in the payment structure, but that would be to long of a post. There is lots of opportunity in nephrology for an RN, or someone whom wants to be one.
    sweetnurse786 likes this.
  9. 0
    Pretty typical at my clinic. The staff is worked to death. We have three shifts, 6 days a week. Up to 24 patient per shift. On our feet constantly and constantly running to meet patients needs. The pay to me is sub standard for what we face on a day to day basis. I know I might sound cliche with nursing and saying this, but the clinical manager and charge nurse are two that are nice to your face to get what they want in regards to the clinic goals but are nasty, lying deceiving "witches" who get ALL week ends off. At Christmas time they both took off two weeks including weekends while the rest of the staff suffered and worked our butts off like usual. I know that nursing can be a humbling experience but the way we are treated is humiliating. I've been told by staff members to find employment elsewhere but I do like alot of the staff.
  10. 0
    Any corporate type who wants a truly sick Nurse to work with a dialysis consumer, I am going to take my old police night stick and bash them over the head, a few times. Then, when I get sick and have to go to the hospital and suffer, when I am well, I am going to give that corporate type a major beat down. I have a very strong immune system and sadly for that corporate type, I will be coming back. One company sent a pregnant woman to deliver my NxStage machine. I told her to sit down and I would take the machine into the apartment. After giving her a tip for trying to help me, I called that delivery company and ripped them a new you know what. I told them if they ever wanted my business again, they would stop that foolishness. Sending a truly sick person or a highly pregnant woman to work, really makes me ticked off. Having used to wrestle heavyweight, karate, and boxing, I am able to put the fear of God in mean and nasty people, being almost 6'3" and 250, does not hurt, either. Yes, my weight is mostly muscle mass.


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