Any dialysis nurse out there?

dishes, BSN, RN · Dec 14, 2011

madwife posted an interesting article on american dialysis nursing, the stats will be different for canadian dialysis patients but I think the potential problems will be similar https://allnurses.com/nursing-blogs/dialysis-nursing-you-650701.html

Fiona59 · Dec 14, 2011

I'm a qualified dialysis nurse. In my province there is a training programme for RNs and LPNs that want to work in the Renal Programme. Written exam at the end of it. About 50% of the nurses who start the education fail to complete it or remain for less than a year.

In all honesty, it was boring work. A lot of it depends on the unit you work on because management styles play a big role in how smoothly the unit works. Many nurses stay because in outpatients dialysis there are no night shifts, Sundays, or worked Stats. Acute Dialysis is 24/7.

We were expected to be in 15 minutes before shift start to help the NAs get the machine ready. A chunk of the education was spent in getting you familiar with the machines on the unit. How to string them, how to clean them, understanding the warning signs, monitors, etc.

So once you've beaten the air out of your dialazyers (carpal tunnel syndrome is a risk of working there) you had to pick up your charts and ensure the correct solutions were running for your patients (usually three).

Meet weigh, assess your patients. Calculate how long the run will last. Check blood sugars. Access fistula or CVC, attach patient to machine. Monitor run.

While patient is on machine you then had to get the solutions and charts ready for your next three patients. Monitor your patients while on machines.

Usually the runs are 3-4 hours. So you would start the second group around 1100-noon and they would be finishing around shift change which meant you'd be trying to take some off and do chairside handovver.

Depending on your unit if one of your patients became incontinent (not rare) you are responsible for pericare, etc.

Demented patients usually do not have caregivers stay with them, so you have to vigilient they don't remove their lines and bleed out.

Renal patients are different. They want in and out pronto. So it's not unusual to have all three runs ending at the same time and they all want to come off first. Holding three sites to ensure bleeding stops is impossible. They don't really make chitchat like the "floor" patients.

Then you have to assist the NAs to clean your machines, string for the next set of patients.

Very routine work. The same thing every day.

I'm glad I had the education because it transfers over to other areas but I stayed less than a year.

I think you are a people person and like changes and challenges, so go to Emerg.

itsmejuli · Dec 14, 2011

Thanks for that post Fiona, now I know I really don't want to be a dialysis nurse.

Fiona59 · Dec 14, 2011

Juli, don't get me wrong, some nurses spend their entire career there. But it just wasn't for me. I'm a fairly organized person who likes a certain amount of routine so I thought it could work for me.

Watching some of the nurses there open a sterile tray is a hoot. They've turned it into a fine art.

Staff nurses usually get all fistulas, CVCs usually go to the student who are training or the UNEs who work shifts there. Some patients refuse to have a "new face" touch them and demand "their nurse".

Then there could be huge power struggles between the unit manager and the RNs. In my city there are at least four outpatient clinics and there has been a sweep of managers over the last couple of years so hopefully things have changed.

What I'd be interested in finding out is how they can justify the RN numbers they have in outpatients. LPN scope has changed drastically since I changed with us being permitted to IV push in some areas.

Honestly, that was the dividing line for RN/LPNs, who could push one drug on return of blood. Some the LPNs I knew that worked in rural settings said they just administered it subq when there was no RN on the floor and it was permitted.

denisk · Dec 14, 2011

Hi Fiona thanks for the thorough response I appreciate it. What was the nurse patient ratio? Was your day tiring compared to other units you have worked at? Did you get your breaks?

The place I work at right now is less physically demanding than ER but when it gets busy especially in the winter, we barely have time to go to the bathroom. In ER it's crazy but at least we get our breaks and I learn something new everyday. I'm really contemplating about going back to ER but at the same time I want to go to a unit that is less physically exhausting but learn and be appreciated at the same time.

Fiona59 · Dec 14, 2011

In theory it's 3patient/nurse but can go upto four.

Containers of solution are heavy. You'll move at least six a day.

All breaks were taken on time.

It's hard to say how physically tired you'll be. You stand a lot. You have to transfer the heavier patients, assist those in w/c and with walkers, canes. It's less physically demanding than a surgical or medical unit.

But your brain hurts. The training that I had was classroom for around six weeks full time. Exams on the renal system, on how the machine works. Then you have your preceptored shifts which leave you drained. Depending on the patients you are assigned you can be mentally drained.

Looking back, I prefer the exhaustion of floor nursing to the exhaustion of a dialysis unit.

itsmejuli · Dec 14, 2011

I have a .6 line in a medical rehab unit, I really like my job. Our patients come to us from acute care, usually after some kind of surgery, and are in need of longer term PT and OT.

The work isn't usually heavy and I'm not often run off my feet since we each have 7 patients. We are guaranteed our breaks. We work as a team so when we get admissions whoever is coming in on the next shift completes any unfinished paperwork.

I like watching my patients recover and go home.