Advice

[Lacie, BSN, RN]

I have been at this particular site for around 2 months now. I realize chronic dialysis clinics depend a great deal on thier PCTs and I highly respect this stance. I came from a back ground of CVICU/Trauma and practiced mainly Primary care nursing. Once I am off my orientation period I will most likely be the only licensed person other than the FA when she is there. I am currently orienting under an LPN whom I have the greatest respect for and has been at this facility for almost 20 years. I dont want to rock the boat so to speak but I see a great deal of short cuts which may seem minimal to some but to me are significant. Things such as follows: Bringing in the pt before I have indicated I am ready to take that pt on ( why make them sit there while the machine is still in recirc?); failing to do the conductivity/ph testing and documentation prior to placing pt on; if you dont get to them fast enough they will place the pt on thier tx and also push the heparin bolus; wrong dialysate running for almost an hour to 1 1/2 hours into tx; not getting the discharge assessment and letting them on the run to hit the scales then home. Help as I really dont want to rock the boat but hey it's my license on the line. I have been disciplined before for as simple as allowing my tech in ICU ensure the pt took mylanta for me as I ran out of the room to tend to the next pt that pulled out his trach and coded. They got me for allowing an unlicensed person to administer meds although I dispensed it, took it to the bedside and bam I got a code. As the only RN I ran out and asked the tech to please ensure Mr. So So took his mylanta. I lost my license for 4 months and 2 years probation not to mention the $500.00 civil penalty and all the other bs that followed that will follow my license the rest of my career. ( Yes this was a co-worker whom I had terminated at a prior position as his supervisor who made the complaint, didnt matter to the BON) How can I approach "hey, this stuff needs done as I refuse to put my license on the line". It may sound minimal but I suffered over "minimal" before. Help, most of these persons have been there over 10 years! I'm the "new kid" on the block. Also the most experienced in the entire facility in relation to Nursing. I love this job but.........

[s9283]

If you are not comfortable with talking with the techs and other people working under you license you need to talk with your manager. I have a lot of the same issues in my clinic. Most of the same mistakes (wrong dialysate flow, BF, forgetting to set goal or turning it on, etc) are made because of the fast pace environment that the techs are in. A lot of the time I will only have 4 techs on the floor, 1 charge RN, and one new staff nurse on the floor for 22 pts. The nurse is responsible for everything the techs do, so you just have to double check everything that they do. Make rounds soon after each pt is put on to make sure assessment is complete, and machines are set correctly. If you see things that are not being done right, you need to pull that person aside and talk to them, you dont have to be rude. Just acknowledege that you know that they may feel like they are being rushed, but tell them the importance of the dialysis perscription, and the reason it needs to be set per orders. I really encourage the techs that I work with to make rounds on the pt after they are put on the machine to make sure everything is set correctly. I tell them to come to me if they are feeling rushed so I can help them in anyway possible. Maybe since you feel new and uncomfortable you should talk with your manager, or bring it up in a nursing meeting or staff meeting.