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sweetnurse786 2,567 Views

Joined Jul 10, '12. Posts: 58 (34% Liked) Likes: 31

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  • Apr 2 '13

    I started as a new grad rn in an outpatient chronic dialysis unit 2 years ago. I was also trained as a patient care tech for the first couple months and then became charge nurse after my first year. For me the first 3 months were the most trying as dialysis is a specialty, there was a whole lot to learn from the water, machines, patient complications, and work flow. It was at about 6 months that I began to become more comfortable with the job. I have to say that the support of the other nurse you're working with is critical, they can either make it or break it for you. As far as energy is concerned, I do get pretty tired by the end of the day and sometimes just want to pass out and go to bed when I get home. Nowadays, I am still tired but it's manageable. Invest in some great shoes, the lightest weight stethoscope available, eat healthy, drink plenty of water, and pressure stockings have helped tremendously.

  • Apr 2 '13

    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.

  • Apr 2 '13

    There is a lot of job security. It's a high burn out job and is very specialized.

  • Apr 2 '13

    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.

  • Apr 2 '13

    That sounds about right. I went to inpatient, hospital dialysis after working 30 yrs. We have erratic schedules. I know when I go to work. Do not know when I come home. We have to take call for 24 hr. coverage. Our day does not end until the work is done. You can have a 4 hr work day or one that lasts for 22 hrs. You can work for 16 to 17 hrs. get home, crawl into bed, & get called back in for someone whose K+ is 8.8. My long time employer hospital sold us to a large dialysis corporation. I literally feel worked to death some days. On the other hand, it is a job. Many people do not have jobs. I do NOT get bored. There is always something new happening. The patients depend on us. If we did not dialyze them, they would not be long for this world. It isn't a job that someone else wants to take away from you. Something about that blood spinning around in a circle just scares most people. The large corporation has been extremely helpful to my immediate family in terms of assistance with getting a kidney transplant, moving to a different state. Large companies are able to do a lot for the patients that small individual hospitals or clinics can not do. I am paid well. Health insurance costs are reasonable. With the current economy, dialysis is one job that is not going to disappear.

  • Apr 2 '13

    I think this is what all new nurses feel like. It takes 6 mos to a year to become comfortable. It did me many years ago. Many a time I wanted to quit, then I got experience and the doctors would come to me to ask me what I thought about a certain patient. So, hang in there and it will get better and every job I had in nursing there was a lot of running and I was exhausted and then I had to go home and take care of my family too. That is just a part of nursing. Good Luck!

  • Apr 2 '13

    Sounds like dialysis to me. Just think - there's some guy at the top of the food chain who wants to take his mistress to the south of France, or buy himself another yacht. So, we work short so he makes more money. Not that I am cynical or anything.

  • Apr 2 '13

    Quote from NurseRies
    Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.

    To put it plainly, you will never sit down and you will go through about 500 pairs of gloves per day just yourself! Buy good shoes, be prepared for chaos, and if something goes wrong, it's on you. Most people quit during training. If you like it, stick with it, it can be a lot of fun, but it is very hard work.




    Oh my God!!! Hats off to you. You are very brave indeed.

  • Apr 2 '13

    Simply put, for me dialysis nursing is controlled chaos. Turnover can be crazy and you must be a master at multi tasking in order to get through your day. I always keep a list of things i need to do and then prioritize. You do have to supervise the techs, some closer than others, to make sure they are not cutting corners in order to save time. As the charge nurse if something goes wrong it is all on you. While dialysis nursing can be stressfull I find that it is also very fulfilling seeing the same pts 3 days a week. You become a part of their lives. I love knowing that I have such an impact on so many people's lives. Not only do you provide a life saving treatment but you also really get to know the pts and their families. Dialysis patients spend so much time together that they become a "family" and working there with them, for me, is a privilege. While dialysis nursing is not for everyone, if you can handle a fast pace environment and love interacting with patients i would recommend it.

  • Apr 2 '13

    Quote from nicholaa2
    Hi all,

    I'm considering a change from psych nursing to dialysis nursing, but I wanted to see what clinical skills are expected to be a quality dialysis nurse providing OP renal care.

    The job description seems VERY vague: "The registered nurse is responsible for performing patient assessments, establishing care plans, advising patients and their families, implementing and evaluating nursing treatment, and administering medications."

    What's a typical shift like? Do you start IVs or do most patients have their access already? Is it more being able to monitor vital signs and understand fluctuations from baseline?

    I'd love to hear what a typical 8-hour OP Dialysis RN shift might be like (granted, I understand no two shifts are the same!)

    Thanks in advance
    Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.

    To put it plainly, you will never sit down and you will go through about 500 pairs of gloves per day just yourself! Buy good shoes, be prepared for chaos, and if something goes wrong, it's on you. Most people quit during training. If you like it, stick with it, it can be a lot of fun, but it is very hard work.

  • Apr 2 '13

    I am just starting as a dialysis nurse, and let me tell you.... thank goodness for the training! And my preceptors! I don't know what I would do wothout them... I have learned how to string a machine, use CVC caths, fistulas and grafts.... dialysis is an amazing specialty and I am enjoying every second of it... although I have a feeling I will continue to learn for years to come. Best of luck to you and I hope you enjoy it as much as I do!

  • Apr 2 '13

    Actually usual meds are epo, zemplar, heparin. No controlled substances are available.

  • Apr 2 '13

    Hi vegasmomma,
    I'm a dialysis nurse and as a nurse you have to supervise the techs. You have to pass meds. You have to do a lot of critical thinking and prioritize as it is a busy world in dialysis. You also need to know how to connect the pts. to the dialysis machines. You will learn a lot when they train you.

  • Apr 2 '13

    Quote from robeanorn
    I work in Boston in an acute hospital setting and they pay scale ranges from $27- $67 based on years of nursing experience. I fall in the middle at $50. Would love to live somewhere warm. Any suggestions. Want to stay in an acute setting and work for the hospital not an outsource (Davilta / fres.
    California paying similar amounts.. Good luck finding a place that doesn't outsource though!

  • Apr 2 '13

    I work in Boston in an acute hospital setting and they pay scale ranges from $27- $67 based on years of nursing experience. I fall in the middle at $50. Would love to live somewhere warm. Any suggestions. Want to stay in an acute setting and work for the hospital not an outsource (Davilta / fres.


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