considering dialysis nursing, input?

shinynurse · May 6, 2008

Repetitive? Routine? Boring? Wow!!! It sounds like many of you are caught up in the wonderful life of the chronic world.

Dialysis is for nurses that love to think!!! What job could you possibly work as an RN and work with every organ in the body AND all the way down to an intracellular level? What you do effects EVERY system in the body and it's all very pt. specific. It's not just about pulling fluid, keeping stable vitals, assessing, sticking needles, or putting on and taking off catheters. You are remolding!!!! a body. How much more awesome could your job be???? As always, though, your job will be what you make of it. If you're critical and clinical thinking skills are honed in and your physicians can truly trust and depend on you, the world is yours. The professional respect level is wonderful and you'll be a hero to many!

Good luck!

happybunny1970 · May 7, 2008

I have to agree with Shinynurse -- I work Acute and the vast majority of my days are filled with curveballs and playing "mad scientist" and medical investigator. I LOVE the fact that I have a fair amount of autonomy and the opportunity to make a significant difference with these patients. My favorite are the Acute Renal Failure in ICU -- 1 on 1 bedside working hand in hand with the ICU nurses, deducing the cause of the renal failure and how what I'm doing affects the patient's improvement or decline.

I've been at it for nearly a year now, and have worked mighty hard learning from our docs and earning their trust and respect (where I am, every patient is seen by a doc at each and every treatment).

Chronic is a whole different world, and I only know what I've heard. Not really my cup of tea, but I am available to lend a hand in the OP units when they need it.

Kanani_Ikike · May 12, 2008

What I mean by routine is that you take care of a very narrow-focus patient and yes, it is repetitive: put pts on, assess, give meds, take pts off. This would be very appealing to some nurses. However, there are other nurses who will be bored stiff with this set routine.

I know exactly what you mean. I recently started a dialysis job and have been in it for about a month. I hate it! It's so boring. I am used to being on the floor and the adrenaline involved with it. Since I have been in dialysis, I have started experiencing panic/anxiety attacks. And I think it is because my body misses the adrenaline rush of med/surg. I actually think things are so slow that I cannot function. I hate the routine. The only fast-paced time is during change-over.

Kanani_Ikike · May 12, 2008

Hi everyone. I have been an RN for a little over 2 years and have worked in the ED the entire time. I have recently been approached about a job at a Chronic Dialysis clinic and to be honest I know NOTHING about dialysis nursing. I thank everyone in this forum because I have been searching this site reading posts nonstop the past 2 days. From what I'm reading it seems that people either love this or they hate it. Is that a correct assumption? Is there anything that I need to think about before making the change? Is there anyone else who has made the change?
(I like the ED, but it's kind of a burn out with the regular pts, (not to mention some of the politics which i'm sure goes on anywhere), I drive an hour each way and I work a strange midnight shift....all reasons I've been looking to change. Am I not changing for the right reasons?)
Sorry this is so long. I just really wish I had someone to talk to about this so I appreciate any response. Thanks!

I know that you are tired of the ED. Hospital politics have driven me away. But, trust me, if you have done time in the ED, dialysis nursing you will hate. It is too boring for floor nurses/ED nurses. Your body will miss the adrenaline rush and you will go crazy. Although it is less stressful, you will miss the rush. That's why I hate it. Now ICU nurses would be a good fit for dialysis, but ED or Med/Surg, I don't know. But you try it and make your own decision. I'm just talking.

redknight · May 13, 2008

Well, before becoming a nurse. I have and continue to be a paramedic, so I still get my rush, but med/surg. Tried it and found that I ways dealing with to much female BS and how you women have allowed these doctors to become such morons, I`ll never get. My younger days in Nam if they talked the way they do they new that they`d get fraged. I could`nt make it on a tele floor because of all the gossip and kisss butt that went on. Who had time for the pt. spent to much time chasing MD`s who could do the job right and fixing it. I like diaylsis, there I get to know my pt. and make critical decissions in their care.

bellacanooch · Jun 7, 2008

I'm beginning my third week of training and I think I'm going to love it. I've only been a nurse for a little under a year and I'll be doing acutes. I'm a little nervous about that, since I'm training in a chronic setting. We'll see.

:eek:

collbaby0220 · Jun 7, 2008

How long are they training you before you do acutes? All of the dialysis clinics that I have had contact with wait at least 6 months before training you for that...especially if you are new to dialysis. It is definately challenging to do acutes, where most of the time you have no one to help you, if you don't understand dialysis completely. Good luck! People are either bored doing acutes, or enjoy the free time.

Natkat, BSN, MSN, RN · Jun 8, 2008

I'm beginning my third week of training and I think I'm going to love it. I've only been a nurse for a little under a year and I'll be doing acutes. I'm a little nervous about that, since I'm training in a chronic setting. We'll see.

You really need the time in chronic before you go to acutes. You need to have everything in the world go wrong with your machine in a setting where you have other people around you to teach you how to fix it. You also need time to deal with patient issues as well.

When you work in acutes you are on your own. I've been working acutes for about 6 weeks and I can honestly say I wish I had spent a little more time in chronics learning a few more skills and paying more attention to dealing with the machine. I do the patient care end fine, but when the machine starts acting up it slows me down and frustrates me. It's especially frustrating because we get paid by the case. If I have to spend an hour or so dealing with an unruly machine it really cuts into my time. It doesn't help that a lot of the time in acutes you're dealing with people who are new to dialysis and they freak out about everything. So when the machine starts acting up they become nervous Nellies, watching every little thing I do and it's nerve wracking. I can usually solve the problem but I need time to think it through. Meanwhile the patient is staring at me intently and then they start in with "How come the other nurse didn't have any problems? What's taking so long? Why is that machine making so much noise?", etc. I know I'll get there eventually but it's creating a lot of stress that I wish I didn't have.

Someone is always a phone call away, and my team has been awesome withi helping me get my feet under me. Still, I wish I was more indepdent and had stronger skills.

So really, it's better to spend some time in a chronic unit getting your dialysis skills down.

happybunny1970 · Jun 8, 2008

Not necessarily true. I work in an acute setting, and we have a 16-bed unit staffed with a minimum 5 RNs and 6 techs 7a-7p Mon-Sat. We do one-on-one bedsides in the ICUs (there are 4), but other than that we bring the patients to our unit. We separated the unit into 3 bays, and each bay has 1-2 RNs and 1-2 techs (minimum combination of 3 staff for up to 5 patients simultaneously). We do have a night and Sunday call schedule, but employees are not included in that rotation for at least 6 months, or when management and the nurse feel comfortable with it.

I received all of my hands-on training in my acute unit. One advantage is that we are not under the gun to get patients on and off on as strict a schedule as outpatient -- since we have to be there anyway until the last patient is done, we can space them out if something gets squirrelly.

After a year I still learn something new every single day, whether that be about different disease processes or alarms and such on the machines. I don't think it matters whether you get training in inpatient or outpatient -- there's no way to learn every possibility and any set length of time. What's important is having a good teacher.

I understand our setup is not the same as it is everywhere... there is a sister unit in the hospital across the street (we are both Fresenius), and they do all of their cases at bedside -- but they have many fewer cases than we do, and a much smaller staff as a result. I can see where my learning process would have been greatly altered had I gone to work there rather than where I am now.

Natkat, BSN, MSN, RN · Jun 8, 2008

Not necessarily true. I work in an acute setting, and we have a 16-bed unit staffed with a minimum 5 RNs and 6 techs 7a-7p Mon-Sat. We do one-on-one bedsides in the ICUs (there are 4), but other than that we bring the patients to our unit. We separated the unit into 3 bays, and each bay has 1-2 RNs and 1-2 techs (minimum combination of 3 staff for up to 5 patients simultaneously). We do have a night and Sunday call schedule, but employees are not included in that rotation for at least 6 months, or when management and the nurse feel comfortable with it.
I received all of my hands-on training in my acute unit. One advantage is that we are not under the gun to get patients on and off on as strict a schedule as outpatient -- since we have to be there anyway until the last patient is done, we can space them out if something gets squirrelly.
After a year I still learn something new every single day, whether that be about different disease processes or alarms and such on the machines. I don't think it matters whether you get training in inpatient or outpatient -- there's no way to learn every possibility and any set length of time. What's important is having a good teacher.
I understand our setup is not the same as it is everywhere... there is a sister unit in the hospital across the street (we are both Fresenius), and they do all of their cases at bedside -- but they have many fewer cases than we do, and a much smaller staff as a result. I can see where my learning process would have been greatly altered had I gone to work there rather than where I am now.

That sounds like a great situation. We don't have an acute unit. We're mobile and do dialysis at the bedside one at a time.

I also like it that we aren't pressured to get the patient on like they do in the chronic unit. They wait on us, we don't conform to them. That's one of the things I love about acutes. I feel that we're more in control and not as pressured.

One thing that gets to me is, even in the hospital, the patient's are still always in a hurry and want to stop treatment early. I keep thinking "where are you going? You're in the hospital." I think it gets to be a habit with them.

bellacanooch · Jun 8, 2008

Thanks for commenting, I appreciate the input. I've had two weeks of classroom so far, I'm beginning one week of clinic work, stringing the machine, taking people off, etc.. I'll have two more weeks of classroom and three more weeks of clinic work. I've been told that if I'm not comfortable, I can do more clinical work. We'll see. Thanks again.

happybunny1970 · Jun 8, 2008

One thing that gets to me is, even in the hospital, the patient's are still always in a hurry and want to stop treatment early. I keep thinking "where are you going? You're in the hospital." I think it gets to be a habit with them.

Too funny! and so true! There are several 'frequent flyers' who are known to be very noncompliant as outpatients who do this. Like they think we and the docs can't tell by looking at their weights and labs. That's generally the only reason they are in the hospital -- because they skipped a treatment and went nuts with their diet and fluids because, and I have really been told this, "I figured if I had to go to the hospital anyway, I might as well really enjoy myself first!"

Now new patients and ARF patients, whole other story...