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NephroBSN, BSN, RN
530 Posts
Acute hemodialysis nurse= hospitalized patient with End Stage Renal Disease. Sometimes really a chronic patient, maybe in with pneumonia, total hip/knee repair, fistula placement gone awry and now inpatient. Or in ICU with MI, S/P major surgery and in Acute Renal Failure. Drug over dose.
Acute dialysis patients can truely be ACUTE or they can be less so. Sometimes they are dialyzed in their rooms but if they are in ICU they are dialyzed there. They dialysis nurse is responsible for dialysis only just as the US tech is only responsible for the ultrasound. Acute dialysis nurses are on call usually for cases in the middle of the night and weekends. Although some companies might rotate all their nurses into the acute program, even their chronic nurses.
Chronic hemodialysis nurse. Works is a chronic outpatient unit. Some hospitals have chronic units too. These patient's live in the community or in Nursing homes, etc. They are stable by and large. Some of them still work. They dialyze three times a week. Mon Wed Fri or Tues Thurs Sat.. Once in awhile they might only come two days a week.. They are usually dialyzed for 3-4 hours each treatment.
Some units also have a nocturnal program .The patients still dialyze three times a week except they do it over night for 8 hours.
An acute nurse is usually alone and must make her judgements independently. She has orders of course but an expert acute nurse knows what to do in cases that might go bad. Nephrologists many times don't really understand the process of dialysis. The acute nurse might only dialyze two patients at a time. She needs to be able to know the looks of a bad rhythm on the monitor . Some have to be ACLS certified . But the ICU nurse is still responsible for her patient. The acute nurse is just performing a treatment. Now that's not to say that the acute nurse wouldn't alert the ICU nurse if her patient was going bad.. But we can run NS in at 300-400 cc per minute. That usually brings someone back quickly.
A chronic hemodialysis nurse takes care of up to 10-15 patient in a free standing clinic with patient care techs who are trained to initiate, monitor and terminate dialysis. The chronic nurse usually has a group of patients that she "manages" on a day to day basis. Although she usually gets to know all of the patients in the unit as the chronic nurses rotate sections of the unit. Most units are in the 20-30 station range although some can be much bigger and some can be as small as 11. Usually there are 2 or 3 "shifts' of patients each day.. Chronic nurses work anywhere form 8-10-12-16 hour days. Acute nurses can work long days too if an emergency patient pops up. Acute nurses dialyze until they are finished for the day.
Chronic nurses manage weights, fluid removal, meds given in dialysis by lab values. Alert the MD if major changes need to be made. They monitor assess maturity, assess placements etc..They also remind patients of dietary/fluid restrictions, we can be social workers too sometimes.
The ESRD population has grown by about 9% every year in the recent past and shows no signs of letting up..Diabetes, hypertension, heredity, auto immune disease, drug abuse etc are some of the leading causes of ESRD. As you can see those afflictions are rampant in the USA. If you go into dialysis you'll never lack for a job. It really takes about a year to feel like you understand it all. Therefore dialysis nurses are a premium.
Find a dialysis unit near you and ask to shadow a dialysis nurse you might just fall in love. As I did back in 1986....