acute dialysis RN- a day in the life...

heygurlhey · Nov 2, 2009

OMG thank you! This is the most realistic and eye opening example yet! :yeah: And yet a little depressing as I contemplate my move to acute dialysis nursing. I was hoping there would be a little more freedom with the autonomy, but I guess if there is no one to cover you...

jb2u, ASN, RN · Nov 3, 2009

OMG thank you! This is the most realistic and eye opening example yet! And yet a little depressing as I contemplate my move to acute dialysis nursing. I was hoping there would be a little more freedom with the autonomy, but I guess if there is no one to cover you...

It really depends on how you see it.

The most interesting thing in my unit now is the crit-line machine. It allows us to see a second by second look at the pt's fluid response to hd. We hope that one day the Nephrologist will state that he wants us to take off a % of fluid instead of saying "take off #L" or "return to dry wt." Both of these values do not mean too much about the pt's response to fluid being taken off. Let's say the md says "take off 2 Liters," but the pt will not "give it up." And so, you are only able to take off 500ml. How did he even get to the two liters anyhow? Was the pt 2Kilos over their "dry weight"? Well what if they just had a big meal before being weighed? This would increase their current weight, but would not really suggest a need to have 2 liters off. Which is why the "bring them back to dry weight" is not really that good either. It is also not a good practice to suck out all the fluid and stop when the pt begins cramping or n/v. This will cause them to not comply with their hd treatments. With the crit-line, I can stop this from happening by not pulling more than the pt has to give. If the nephrologists get on board with using crit-line devices, this would allow more autonomy for the hd nurse. I do believe that it will happen one day. We already have nephrologists that believe in it. We also have nephrologists that do not believe in leaving that much control to the nurses. But I ask, what is the benefit in taking off 2 liters when I could have safely taken off 4 liters? What is the benefit of trying to take off 2 liters only to have the pt's sbp drop to 80, pt get cramps, demands to get off the machine, and you end up bolusing the pt with ns, all because the md wanted the control?

If you think that you would like hd, I say go for it. You may love it, you may hate it, but you will never know unless you try. If you want autonomy, become a NP as you work in HD. We have a FNP that writes orders, rounds on pts, etc. She seems to enjoy her job. Personally, with as many choices that we get in nursing, I do not understand any nurse staying in an area that they do not enjoy.

I wish you all the best. I'll be happy to answer any other questions that you may have.

Regards,

Jay

Onekidneynurse · Nov 4, 2009

The acute dialysis day in MY experience....
I arrive to work at 7am and take a look at the assignment sheet. We are either in the hd unit or doing "outs" (meaning one to one, as in an icu patient that can not come to the hd unit.).
So, I see I am doing "pt a" and "pt b" (so far, of course). The tech brings up the RO room, does the water checks, and makes the bicarb for the day. I set up my machines and prime based on the md's order. Then, I put my machine in test. At this point, I normally will get my paperwork filled out (just one run sheet, nothing major). After the test passes, I check the pH and conductivity of the dialysate (hd bath).
Now the tech may go get the pt, the tech may go and assist me in getting the pt, or someone may bring the pt to the hd unit. At this point though, I am ready to run my pts. I hook up "pt a" and "pt b."
Now, hopefully I am just in monitor mode (ie: no machine or pt problems). If so, we write down v/s and machine numbers every 30 minutes. I will also get my meds together (zemplar, epo, and na citrate or heparin for packing catheters) during this time. Most of our runs are for 4 hours, with SOME 3'15" to 3'45" runs. New starts are normally 2-2 1/2 hours. If labs needed to be drawn, I will draw them while putting the pt on. I will call labs to the md for hd bath changes if needed.
After the runs are over, I will get each pt off the machine and back to their rooms. At this point, I will either go to lunch or get my next run on (two more pts) and have one of my co-workers watch my patients. Normally, we only have a first shift run and a second shift run (that being 2 pts for the first run and 2 pts for the second run). We do have late nurses and an oncall nurse for late runs and emergencies. As someone said, you never know what's coming through the ER (overloaded, hyperkalemia) or the outpt special procedures (perhaps a declot? that has to be run). Some days you come in and your first and second shifts are already filled up; other times, you may have only one pt, and you end up waiting on the nephrologists to get there and start writing orders for your hd patients. Sometimes you are delayed because the orders state "hd after surgery" or the pt is in radiology or the pt demands that he eat his breakfast first, etc.
After the second run, I will normally go home. Sometimes, we will start a third run and the late or on-call nurse will take over when they get there.
If you are doing "outs" then the day is the same except you just have one pt for first shift run and one pt for your second shift run. You do not have anyone to relieve you, so, you will go to lunch in between these two runs. Some people love doing "outs" some people hate them. Same goes for being in the hd unit, some love it, some hate it. I like a little of both.
I hope that helps. It is my typical day, anyway.

Great set-up you have but we don't have techs. We do it all, from making bicarb, to washing blue clamps. We set up our own machines, bleach them and do it all. We have a 5 station unit for acutes who can leave their rooms. We do those patients first. Some days we only have 2 staff so we can't go to ICU etc. Until we are done in the unit. So we could do 10 patients and then go off and do 2 acutes in the ICU, CCU etc. Usually the nurse on call is the one who stays late. We have 4 nurses who take call so that means 7-8 times a month.

We do a night during the week and one weekend a month. Sat evening to 0600 Monday am. We do the weekend on our sat on. Makes for a long weekend.

That's why it's hard to say what a typical day is. Each program is run a little differently.

Kidneyguru · Jul 27, 2011

Hello, I would like to start a acute/home dialysis company. Can anyone out there lead me in the right direction. I need to know how to negotiate my prices for the hospitals. Who has the best prices on the refurbished machine, where can I get machine training for my equipment quy. Thanks in advance for your help

Tish88 · Jul 28, 2011

Hello, I would like to start a acute/home dialysis company. Can anyone out there lead me in the right direction. I need to know how to negotiate my prices for the hospitals. Who has the best prices on the refurbished machine, where can I get machine training for my equipment quy. Thanks in advance for your help

With the new conditions of coverage from Medicare, unless you are one of the Large Hemodialysis Companies, it is about impossible for independent companies to survive. That is why you hear about so many MD owned dialysis clinics being sold to DaVita or FMC.

There's more to getting into the business than just getting machines. You would also have to consider the cost of the supplies (which most are manufactured by those Large dialysis companies). The list goes on and on.

These companies have the majority of the contracts in our area and an independent co would never be able to beat their rates.