[prometheus0219]

I'm a new nurse in an outpatient dialysis center, less than a year. We are short on regular nurses in the unit and sometimes I'm the only nurse opening the unit with 3-4 PCTs for 24 patients. The other nurse comes in 2-3 hours later or the other nurse calls out. I'm not comfortable with that and I have told my nurse manager many times already. Is it alright to wait for the other nurse before putting patients on the machine?

[traumaRUs]

Whew! What do you do now? I'm a new APN in outpt dialysis and I know that sometimes with 32 pts, we have 1 nurse with 4 techs. However, there is a nurse manager in the building as well as me (though I know nothing of how to put people on or off). I can handle emergencies fine though.

[prometheus0219]

If the nurse manager is there, there's no problem. But when he's not there then that's the problem. Just last week, I opened the unit by myself with 3PCTs with 1 orientee nurse for 2 days. To top it off, 2 of the patients were in distress and I also had to handle all patient related phone calls. I really had a rough morning that day. I might need to talk to my nurse manager again.

[tired dialysis nurse]

ARE YOU A NEW NURSE FOR LESS THAN A YEAR OR A NEW HEMO NURSE ? REALLY, WHAT YOU DESCRIBE SOUNDS VERY, VERY DANGEROUS AND I WOULD MAKE SURE THAT THE NEXT TIME I VOICED MY CONCERS TO MY NURSE MANAGE THERE WOULD BE A FORMAL, WRITTEN RECORD . ARE YOU EXPECTED TO DO ALL THE ASSMENTS AND PUT PTS ON? I HAVE OPENED BY MYSELF WITH 3 TECHS FOR 20 PTS, BUT I HAVE 6+ YEARS AS A HEMO NURSE AND ALL OF THE TECHS HAVE BEEN THERE SEVERAL YEARS. AS A NURSE WITH A YEAR OF HEMO , THERE ARE PLENTY OF DIALYSIS UNITS THAT WOULD HIRE YOU ON HE SPOT--THE NURSING SHORTAGE IS REAL AND ITS NOT LIKE AN AGENCY NURSE CAN COME IN AND HELP US OUT, Y'KNOW? BE CAREFUL AND COA----TRUST YOURSELF AND DON'T MAKE THEM MAKE YOU THINK THAT YOU ARE LESS OF A NURSE, OR BELIEVE THEM WHEN THEY TRY TO MINIMIZE YOUR CONCERNS BY SAYING..."YOU ARE SO GOOD, YOU WON"T HAVE ANY TROUBLE...YOU ARE A VERY GOOD NURSE!" OR WHAT OTHER BS THEY TELL YOU. TRUST YOUR GUT!!!!!! TDN

[prometheus0219]

I am an new hemo agency nurse with one year experience in hemodialysis from my country employed by this facility. I'm a new nurse here in the U.S. During my first months here, I also voiced my concern to the medical director and he told me that if I don't feel comfortable opening up by myself, then I should wait for the other nurse. But I also don't want the patients to wait that long.

[iriskkerry]

Fresinius??????

[trvlnRN]

Check out your state guidelines for safe staffing. Go to the internet. I'm an experienced agency hemo RN....and I would NOT open a clinic with 24 patients alone! This is NOT safe! You're headed for trouble! Check the laws and governing boards in your area...it may not be legal to do so. Check out the state agency responsible for surveying dialysis facilities in your area....find them through the department of health and they will be able to inform you of local regulations. I would definately....put my conserns in writing immediately! ie...TODAY! If they brush you off again....send copies higher up the ladder. If it were me...not only would I put it in writing....but I'd refuse to put on more than say 16 patients at a time if I'm alone. That will get their immediate attention. Then they can call someone like me....a hemodialysis traveling RN....to come help you out! Or they will get another nurse to open with you...period! Where are you located?! What company?

[trvlnRN]

Check out the web site: NCSBN.org It has links to all of the nursing state nursing boards and from there you can usually get to the state laws for staffing at dialysis clinics.

[prometheus0219]

I'm in Bronx, NY. yes, i'm expected to do the assessments on top of putting on patients. If there's any problem on the unit, am expected to be able to solve them until the charge nurse comes.

[TBROOKS550]

I have been a hemo nurse for 10 years. The staffing that you guys are discussing is appalling. I would not put myself into a position to work for a clinic with such negligent patient staff ratios. Regardless of whether or not the nurse manager is in the unit (they usually don't count in clinical staffing numbers) the clinic should not be staffed with only 1 nurse for that many patients. Max patient staff ratio should be 4:1. In my clinic there is 1 nurse and 1 tech for 8 patients. We also have the clinical manager and a charge nurse. If you are unable to get satisfaction from your manager regarding your concerns, I would go over their head. Also, it doesn't hurt to talk to the nephrologist that is in charge of the patients. They have alot more pull in the units than most people think. Also, for the person that remarked that they are "really good" in emergencies: there is nothing like a code in a dialysis unit. That is the best time for other patients to go bad. You may be able to handle the patient that is having an emergency, but can you handle the other 20+ patients who are freaked out by the situation? Good luck, makes me feel lucky for the clinics that I work in!