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madwife2002, BSN, RN Guide 109,591 Views

Joined Jan 17, '05 - from 'Ohio'. madwife2002 is a Director of Nursing Services. She has '26' year(s) of experience and specializes in 'RN, BSN, CHDN'. Posts: 10,273 (21% Liked) Likes: 6,106

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  • Aug 30

    QUOTE=jdub6;8720120]Oh good, renal/dialysis is my weak spot for sure. I have tons of questions...trying to think of what I need to know the most...
    1. Can you describe the dialysis procedure, what you do when the patient arrives (assume outpatient unless you don't know about that) until you send them off

    This is a huge question, one that takes about 6 hours from start to finish-When a patient comes to treatment you would do vital signs, the RN would do head to toe assessment looking for signs of fluid overload, they would be weighed and the target amount of fluid calculated. Arm if fistula is used would be cleaned and needles inserted, pt’s prescription would be dialed into the dialysis machine and then the lines would be connected and dialysis commenced. Pt should be monitored every 30 mins vital signs taken, access site visualized at all times. Once tx has finished the patient is disconnected from machine, needles are pulled, access is held until hemostasis occurs, then the sites are covered with either a bandaid or gauze. Pts vital signs and weight is taken and pt is discharged home.

    2. What is ultrafiltration and why/for whom is it used?
    Ultrafiltration is defined as controlled fluid removal by manipulation of hydrostatic pressure. Ultrafiltration in dialysis is the removal of sodium and water from the blood. Dialysis patients have ultrafiltration; some of the patients need more fluid removal than other patients.

    3. How do you access an AVF? What type of needle do you need? Is there a difference between the venous and arterial access equipment? Are the venous/arterial access points all in the same place each time and if so what landmarks do you use? What are things that would be indications of problems, reasons not to use a fistula or to stop using it, etc.? What would you see in a fistula that is clotted? Any considerations for the first time you use a new fistula?

    You access an AVF with fistula needles; there are different size needles used on average a 15 gauge needle is used. Needles have blue and red wings for venous and arterial identification. Where you place the needles depend on what method of cannulation is being used. Each treatment the AVF should be examined looking for signs of infection, feeling the AVF for thrill and listened to the AVF for the bruit. If there is no thrill or bruit the fistula should not be accessed as absence of these could indicate the fistula is clotted. Lots of considerations for first use of fistula-experience technician, one needle, size 17 gauge needle, lower blood flow rate.

    4. What do you dialysis nurses consider to be the best/easiest form of access to use (which type of catheter, fistula, etc) and which type or protocol of dialysis is best and easiest for you and the pt?

    The best access without question is the Fistula. I don’t understand what you mean about protocol

    5. When people refer to arterial and venous ports/needles for dialysis, and when we see what I think of as a typical dialysis cath with two lumens, usually one red cap and one blue, are those lumens or (or needles for a fistula) actually one in a vein and one in an artery? My impression is that fistulas are mixed arterial/venous blood. Honestly, I don't know exactly where the catheters end. Do the red and blue caps indicate arterial and venous, as in other parts of medicine? And, again, does the arterial port/line actually end in an artery, or a vein?

    Catheters end in the heart. Red and Blue in dialysis indicate venous and arterial

    6. Can you explain how you use the catheters i.e. do you flush them prior to access and if so with what, which port do the inbound and outbound/return lines go to? After use, how do you flush the lines?

    There is a whole process for using catheters, and accessing catheters. Many steps are involved, what in particular do you want to know about accessing them although it may differ from company to company. In bound and outbound lines are really called venous and arterial lines. The venous side of the catheter attaches to the venous line and the arterial-to-arterial line. The arterial line takes the blood out of the body to the dialyzer (kidney) and the venous line returns the cleaner blood to the body. After use you flush the lines with Normal Saline

  • Aug 26

    I do feel for you, but the mistakes you have made could have potentially serious consequences. Have you asked this other nurse for help? Have you identified that you have problem with medication administration.
    I can understand the nurse you are working with having concerns especailly as recently i worked with somebody who made similar mistakes and in the UK she is not only practicing on her own registration but on the charge nurses registration, if that nurse knows of the problems and does not report it, then they made loose their right to practice. There is a person who trusts and relys on us to look after them and they tend to be very vunerable. I suggest when you are giving out meds you take your time and double check and ask for no interuptions.
    How we solved this problem was by the use of supervised practice which meant she had to do meds with another trained nurse until it was deemed she was ready to go it alone.
    We also implemented that the nurse who was giving out medication does not get called to phone or interupted for anything other than an emergency.

    Remember it is easy to make a mistake we are human

  • Jul 30

    My hospital and my previous hospital didn't allow usage of IV phenergan anymore. It is banned here

  • Jul 28

    I was once called when I was moving from Arizona to Ohio to see if I could work!

  • Jun 27

    Remember if you didnt document you didnt do it!

    You should be happy somebody is auditing the charts and calling you to remind you to do it!
    You will feel a lot worse if in a few years time you get called to a court room because the patient or family decided to sue because you didnt inform them about the restraints.

  • Jun 27

    Remember if you didnt document you didnt do it!

    You should be happy somebody is auditing the charts and calling you to remind you to do it!
    You will feel a lot worse if in a few years time you get called to a court room because the patient or family decided to sue because you didnt inform them about the restraints.

  • Jun 18

    Moving from one state to another can be as easy as ABC, providing you plan and make it a nice smooth transition.

    There are certain variables which you are able to control and there are certain ones you can't.

    It is certainly easier to transition if you have a job to go to.

    After you have decided to move states, you have picked where you want to live, the first step should be to secure your nursing license for that state.

    It is important to remember that many jobs will not look at applications from RN's who are not licensed in the state they are applying for.

    So my advice is to obtain a license sooner rather than later. If you go to the State board of nursing sites you can find information which will give you an idea of how long it will take to obtain a license there. Remember this can take anything from a couple of weeks to a couple of months.

    At the bottom of every page, you will find a link to each state Boards of Nursing to obtain license endorsement information .

    Unless you do not need to work, I would not hand in my notice and leave my current job until you have the license you need for your new job.

    If you have a compact state license and want to work in another compact state, then the process is simpler. Go the NCSBN website to view which states recognize Nurse Licensure Compact At the moment 24 states are compact states, so only another 28 to go!

    When looking for a job in another state, there are some good web sites which you can go to, you can post your resume online and often recruiters will contact you.

    If you know where you would like to work then go to the hospital of choice web site and look under job opportunities.

    Often if you are coming from another state or live a long way from the hospital, they will do a series of telephone interviews.

    Some companies will fly you out for interviews. New technology such as video conferencing and webinars can make the interview process easier, and much more cost effective than paying for flights.

    Often companies will pay some of your relocation costs, especially if you have skills they want.

    Wages and relocation costs can be negotiated after a successful offer of employment.

    Just because you want to move for your own reasons doesn't mean companies aren't willing to reimburse some of your expenses. The worst thing they can say is no. Most companies have budgeted relocation costs but if they don't have to pay them, then they won't.

    If they do pay some of your relocation expenses prepare yourself for a sign on contract of about 1-2yrs. Normally money will have to be paid back if you do not stay the required period of time.

    When I moved across country from AZ to Oh it cost in excess of $9000, so do not sell yourself short!

    Even if you don't get any expenses paid, you can put it against your taxes.

    So now you have a license and a job, what next?

    You have to find somewhere to live; this is probably the hardest part of the whole
    process because unless you know the area you have absolutely no idea what you are getting yourself into.

    Do not rush into accommodation and sign yourself up for a long term lease, unless you or somebody you trust says it is a nice area to live.

    If you can fly out and view the areas then go and look around, if you can't then you will need to find storage for furniture and rent somewhere furnished on a week by week contract.

    The journey! Plan it well, are you travelling in 1 car or 2? Are you going get one of your cars transported? Or are you going to travel in convoy with your other family members?

    Take into account gas prices and hotel accommodation along the way.

    Estimate how long it will take you to get there, try to allow enough time to travel and recover from the travel before you start your new job.

    There are lots of options for getting your furniture from A-B, and all options come in a varied amount of cost.

    You can move yourself, look out for the hidden costs of one way moving. Many moving companies will charge mileage and they will charge for the cost of the removal van going one way and not being returned to place of pick up.

    Another option is to lease part of an 18 wheeler which can work out reasonable, as they will negotiate their empty space if they are going in your direction.

    Often if you lease part of an 18 wheeler, it doesn't cost you much more to have one of your cars put inside too, and think of the gas you will save plus the wear and tear on your vehicle.


    If your move depends on your job, then make sure you have an offer in writing!

    The travel expenses they are paying are normally paid up front, do not travel unless you have both.

    Good luck

  • Jun 4

    Continuing with the series of 'Top ten reasons we get fired' Number 4 comes in as "Poor Performance" at work.

    Problems with performance can result from any number of factors. Organizational change, new technology, inexperienced nurses, issues outside work or even a run of "bad luck" can all affect performance, even for the most assiduous of professionals.

    Managers should be able to say that they have the right person in the right job, sometimes they get it wrong.

    Everyday we hear about co-workers who have performance issues, some of the time we have already identified the co-worker who has performance issues.

    We know they have problems because the patient has informed you about something that has or hasn't been done. Or you have followed them onto the shift, found numerous issues or problems that have either not been identified or have not been dealt with correctly and you have to pick up the slack.

    I am going to hazard a guess and say that everybody on the floor has been discussing the problems with this staff members performance, we all have a story to tell

    What do we do about helping a co-worker improve their practice? Is this our job? or should we just leave it to management because that is what they are there for!

    Poor Performance

    So what constitutes a poor performance?

    • Poor time management
    • Insufficient attention to details
    • Inability to multitask
    • Missing orders in chart
    • Signing off but not completing orders
    • Completing wrong orders on patient
    • Med errors
    • Poor documentation
    • Judgment errors
    • Lack of timely interventions
    • Lack of knowledge and not seeking help
    • Not reporting changes in conditions
    • Not noticing changes in conditions
    • Not being able to self identify
    • Blame others

    What can organizations do to help?

    Numerous errors and mistakes add up to a dangerous nurse and if every thing possible has been done to help the individual including but not limited to:

    Support for manager to manage a poor performance

    Identify areas of concern

    Discuss issues with staff member in a clear concise way

    Improvement plans with clear outlines, realistic time to complete

    Ensure they understand what the expectations are


    Increased mentoring

    If everything has been done, then HR may have no other alternative but to terminate your employment, they have a duty to protect the patient, and if fear that harm could occur because of poor performance then there is normally no alternative.

    Patient safety is of the upmost importance and if it is compromised in any way, action has to occur. Now with this being said we need to identify quickly the near misses and work with a risk management team to ensure that this doesn't happen again.

    How to protect yourself and your patient

    Reflection of your shift and self-identification of areas of weakness could help the poor performer. We need to know when to ask questions, when to ask for help and when to go to your manager to discuss your education needs.

    Do not undertake, a task on a patient if you have never done it before, ask for supervision. No manager worth his or her salt would allow a procedure to be done on a patient if the staff member was very inexperienced.

    Don't bring outside issues into work, leave them at the front door and pick them up on the way out. You think this is not possible, well it is and you have a responsibility to your patient, if you cannot function in this capacity then you need to stay home.

    Learn from experienced nurses their good habits, not their bad ones
    Organize your day in a structured manner
    Know where the policy, procedure and protocols are, these are there to help and guide you.

    Learn from your mistakes and the mistakes of others

    For the experience nurse, help your co-worker you were new once! Offer to show them the right way to do something. Don't ignore their cry for help, spend 5 mins now with them, and avoid clearing up the mess later on.

  • May 23

    If you are sick you are sick I really dont want you round me
    If you are calling off because you dont want to work I dont want to know, just say you are sick, why dont I want to know because if we do not find cover you are sticking it to your co-worker and I do not think it is fair.

    Instead why don't you ask for a PLB day off so plans can be made to cover you.

    I guess I will get grief for saying this but if everybody thought they would just take the day off because they cant be bothered to go into work then it would be a huge mess.

  • Apr 29

    Hands up, how many of you actually hate your boss? I can imagine a fair few will be nodding their head in agreement that they hate there boss.

    I search google with the words 'I hate my boss' and with that simple sentence I found 12,800,000 results.

    Change the wording to 'I hate my manager' and the results add up to 58,600,000.

    I am sure if I delve deeper I would be able to find more results, so what does this tell me? It tells me that we in the nursing profession are not alone in 'hating' our bosses, we are not the only profession who feels we employ idiots to 'run' business's

    Who do we define the term boss?

    Boss an individual that is usually the immediate supervisor of some number of employees and has certain capacities and responsibilities to make decisions. The term itself is not a formal title, and is sometimes used to refer to any higher level employee in a company, including a supervisor, manager, director, or the ceo.

    But did you know that a boss can also be defined as...

    Boss 3 (bs) n.A cow or calf. [perhaps ultimately from latin bs; see bovine.]

    There are books on...

    • How to manage your boss
    • How to kill your boss
    • Get back at your boss

    There are over 10,000,000 I hate my boss jokes!

    Bosses are also being blamed on causing marital problems too!

    That bad marriage – it could be the fault of your abusive boss

    So there is lots of information on hating your boss. Does this make me feel better? No!

    It is also laughable that if you do further education past your bsn in management or business and throw in a msn for good measure you are now eligible to go for middle or upper management! Doesn't really matter if you are good at it, have any people skills, or even a lot of hands on nursing care, you are now considered to be management material.

    I have nothing against further education but some of the strangest people have msn, I do not think that having a masters in anything means you have common sense.
    Most people who go onto obtain further education have access to money! We know it is not cheap to get further education.

    You have to have good credit scores and have to be dedicated to working extremely hard in your studies and normally at the cost of other parts of your life.

    My boss has every known degree known to mankind yet I still question her decisions, I feel her hands on experience is minimum and I wonder if she ever worked as a frustrated staff nurse.

    I think doing time spent as a frustrated staff nurse makes you understand the problems and issues that everybody experiences first hand on a busy floor.

    This in turn helps you have a human approach to management, that is what I believe is missing these days. You have to know how to turn things around in a crisis. You have to have very good understand how your specialty works. How to troubleshoot.

    You cannot tell by watching staff how busy they are! Most rn's aren't running around like headless chickens, they are calm, confident and have excellent time management skills, so they make it look easy!

    That doesn't mean to say they are having an easy day, eventually after a certain amount of experience on the floor you grow to realize running around like a headless chicken serves no purpose. You use up energy and brain power you actually need to be effective.

    A lot of management staff in health care have stood still for very little time before they have climbed the ladder very quickly.

    I am sure if you ask your bosses how long they worked as an basic rn on a unit, they will barely have 5 years or less!

    Most of them have planned their career very carefully and always seem to find themselves in the right place at the right time.

    These days I have seen advertisements for charge nurse positions with only a minimum of 1 year post grad experience under their belt. This concerns me because 1 yr is barely enough time to get your feet wet let alone have the experience and know how of managing staff and the unit.

    When I was a newby staff nurse I could turn to my charge nurses and managers and they knew everything. It always amazed me.

    I bet in some cases this is not true anymore.

    I still hate my boss and I have to learn how to channel this emotion towards something more positive as the negativity is 'killing' me.

    I have got to the stage that I worry about every single interaction between us, I suspect she is 'out to get me', I imagine she has a different agenda to me and if I don't agree she 'is out to get me'.

    I have become paranoid and this emotion bothers me! I ask myself why do I really think she is out to get me?

    It is a personality clash? Or is it simply 'i dont like being told'

    Remember, it takes two to tango.

  • Apr 28

    After 20 years I have worked on a lot of different types of floors and some of the easiest bored me senseless.

    I have to say for me personnally the best places I have worked are the place where there is a good working atmosphere where you feel supported by staff who are educated and informed.

    Where there are students who keep you on your toes, and keep you up to date with the latest research.

    Where 'the open door' is really open and you can bounce idea's off your manager and feel supported and encouraged.

    Where you get up in the morning and are actually looking forward to going into work and not feel sick at the thought.

    and lastly a place where you feel valued, respected.

  • Apr 13

    Quote from FransBevy
    I have never worked so hard in my life! Repetition? What repetition? I'd LOVE some repetition. I love it but no two minutes are ever the same here and you have to be A&OX3.
    I agree it is hard work in a Chronic Unit, I dont think all RN's are prepared for the amount of work involved.

  • Mar 29

    PS keep your own notes on this incident-Time and dates etc

  • Mar 13

    Sleeping while on duty is the number 3 in my top ten of reasons nurses get fired.

    In 1910, we slept for an average of 9 hours; by 2002, the average dropped to 6.9 hours per night. Early studies indicate that those Individuals who work nights and rotating shifts rarely obtain optimal amounts of sleep; they may have 1-4 hours less sleep.
    This could all add up to a sleep deprived night worker, which could cause a night nurse to nod off while on duty! Or even fall asleep while driving home.

    Complications of sleep deprivation

    Sleep deprivation can have serious consequences for both the nurse and their patient's safety.

    Impaired decision-making, slower reflexes and motor skills, and heightened stress levels are all potential side effects of too little sleep.

    Health issues such are diabetes and heart disease could be more prevalent, depression and mood alteration issues are well documented for night shift workers.

    Patients could suffer serious consequences from sleep-deprived nurses for example medication errors, slower responses to critical incidents, and even death.

    Consequences of sleeping while on duty

    For some nurses no matter how much sleep they get during the day, they are unable to stop themselves from 'nodding off' during their night shift.

    This causes many co-workers to feel angry and upset, they feel the need to report the napping co-worker to management. In some health care facilities even nodding off on your break time can be considered grounds for termination, the expectation is you should be alert and available to be called upon at any time.

    Some will argue that nodding off on your unpaid break should be allowed, unfortunately this argument maybe something your management team will not tolerate.

    Suspension, termination and being reported to the Board of Nursing, may occur if you sleep on duty. In some occasions where sleeping or nodding off have caused harm to patients, nurses may end up in court.

    Tips to help you stay awake

    Caffeine is probably the number one crutch night workers use to stay away. Coffee, diet coke and the 5-hour energy drinks: Be careful you don't become addicted to too much caffeine, try and use it moderately and sensibly.

    Get up stretch, walk briskly around, sprint 100 yards if you can which will refresh you immediately.

    Drink plenty of water.

    Don't remain seated when you feel that overwhelming tiredness, find yourself physical work to do. Computer charting can increase the desire to close your eyes

    Eat healthy food; reduce the carbs and high sugar food, which can make you feel sleepy. Try to have small frequent meals if possible rather than one large heavy meal.

    Talk to your co-workers, have interesting lively debates.

    Sit in an area which is brightly lit.

    Try to get as much sleep in the day as possible, use black out curtains and eye masks to reduce the light in the room.

    Turn off your phone during the day

    If you struggle on night duty, you may need to find a day job.

    Current research for night duty nurses

    Newer studies support 20 min napping on your break could prevent some of these errors and revitalize the night nurse.

    Hospitals around the world are starting supporting this research, although it may be years if ever before U.S. hospitals will set up sleep rooms for nurses!

    "Several studies support positive outcomes for on-duty napping for health professionals," noted a 2011 study in Critical Care Nurse, the journal of the American Association of Critical-Care Nurses.

    Further suggested Reading

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
    Chapter 40. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety Ann E. Rogers

    Sleep Rooms can Benefit Nurses on the Night Shift

  • Feb 24

    How can they take money from your bank account I would have thought that was illegal?