Any Canadian Dialysis Nurse Out Here?

12sonrisa, BSN · Feb 25, 2018

Welcome to dialysis! I've been in community dialysis for four months now (first job post-grad). From what I've read on here, it's pretty different from the states! At least in Alberta. It's similar to other units in that there is a charge nurse with a mix of RNs, LPNs, and NAs on the floor.

In my experience, there are usually 4 pods with 5 patients. Each pod has an RN and an LPN. Some units leave it at that and it's very team-oriented in caring for those patients. Some units go a step further and split the pod in two where one nurse has two patients and the other has three and then after that run they switch spots to keep the workload somewhat even. Even in that system, the other nurse is still your buddy but you are basically on your own unless you go ask for help.

On my units (I work PRN/casual on four of them), there are three runs per day (AM, PM, HS).

AM start times are 0715, 0730, and 0745.

PM start times are 1245, 1300, and 1315.

HS start times are 1815, 1830 and 1845.

Depending on the Unit, our shifts either run 0700-1515 and 1500-2315 or 0645-1500 and 1445-2300. Only one unit in my area has nocturnal and it's similar to inpatient/acute dialysis in that they won't let you do it until you are proficient with community/outpatient.

The NAs get there around 6 (I think!) and they prepare the machines. Once the nurses get there, we double check that we have the right supplies, assess our patient, check for medications and labs, program the machine parameters based on the dialysis prescription, put on the patient (needles or CVC) and then do it all again with the next patient. Throughout the run we are right near by and monitoring them at least every half hour as well as doing medications and dressing changes, etc. And we take them off the machines at the end and make sure they are ok to leave.

The NAs really know the machines better than the other staff so I ask them questions often when there are alarms! They also get blankets, keep supplies stocked on the Unit, put patients on and off the bikes and get the machines cleaned and ready in between patients to name a few things.

12sonrisa, BSN · Feb 25, 2018

I missed part of your question in my original post!

Yes, I got 4 weeks of full-time classroom and practical on-the-unit training followed by a 2 week preceptorship and a short exam based on the theory.

From what I have seen, you don't usually get charge-trained until you've been working on the unit for about a year.

Feel free to ask more questions! :)

peripateticRN, BSN, RN · Feb 25, 2018

Wow!! Great info Sonrisa! Thank you so much! I have no idea really what to expect and was getting a little worried hearing post after post about Davita. I've been dabbling in a bunch of areas since graduating and the science of HD is intriguing to me.

I'm also in Alberta (Edmonton Specifically)- interesting to hear that they do nocturnal HD here. An MD friend of mine mentioned that her mom worked in a nocturnal dialysis unit in Ontario and I had no idea they existed. Its cool that patients have options!

Are you at one facility/hospital or float to several? You mentioned multiple units, are there typically more than HD unit at a hospital? (Feeling pretty ignorant to all this - when I worked med, the porter came to get the patients, they went... somewhere... and came back 4-5 hours later... )

Glad to hear I won't get thrown into charge right away. I was reading in the US often there is only one RN in the facility and that's it... yikes!

Thanks again

12sonrisa, BSN · Feb 25, 2018

Haha yeah when I started in HD I read the posts here and was basically terrified from what I'd read! Have you heard of home hemo? It's fantastic! One of the best options for patients who can manage it!

From what I've seen, there is only one dialysis unit in each location. There are two hospital units (one has nocturnal and both do inpatient and outpatient). The one with nocturnal also has an outreach program where after you have plenty of experience, you can be on call for the other two hospitals since they don't have dialysis units at all. Those outreach patients would be ED or ICU patients.

Then there are two outpatient units in urgent care buildings and two outpatient units in malls. It is very strange going to work in scrubs in a mall!

I assume Edmonton is similar but we are Southern Alberta Renal Program and I know there are some differences from the Northern Alberta Renal Program.

12sonrisa, BSN · Feb 25, 2018

Don't worry about feeling ignorant! Dialysis seems like a well-kept secret! I had no idea about any of it until I did a practicum in community dialysis in school!

peripateticRN, BSN, RN · Feb 25, 2018

Interesting - I wonder if in the NARP you are shared between facilities like that. They didn't mention that in the interview (They did say I could do some stints in Fort Mac if that was of interest.. ohhh ahh). Either way... the flexibility of casual is going to be nice where ever I end out!

Did you do your preceptorship in Dialysis? That is super cool - we did not have that option at the UofA. Not that dialysis would have been on my radar at all at that time... but still.

12sonrisa, BSN · Feb 25, 2018

I'm not sure! Here, you are assigned to one unit as your home unit and then after 3 months or so you can start picking up casual on other units. You just have to ask the admin coordinator to schedule you for an orientation shift on that unit. It's so hard to get a line that it's really nice to be able to pick up on extra units!

Yeah, dialysis was my final focus. I asked for outpatient clinic but was not expecting dialysis! It was a good placement though. I don't want to do dialysis long term but there are aspects of it I really like and I'm also just happy to have a nursing job at all!