Davita RN Job/Clinical Duties

[Yayamaya, RN]

Can someone please tell me what the job duties and specifically the clinical skills required for a RN at a Davita clinic?

Thank you !!!!!

[NurseRies, BSN, RN]

Hello, this was an old post of mine that is a respond to a similar question. The other person wanted to know what a typical day was like in the clinic. I think you'll find the duties and skills listed in here as we'll. you could also look through some old forums to learn more! I love the clinic but it is hard work. Many people love dialysis, then again many hate it! I hope you find my description helpful, because i think many other outpatient dialysis nurses would agree, this is how it is! If you like a slower pace, inpatient dialysis is totally different. Here ya go:

Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.

To put it plainly, you will never sit down and you will go through about 500 pairs of gloves per day just yourself! Buy good shoes, be prepared for chaos, and if something goes wrong, it's on you. Many people quit during training. If you like it, stick with it, it can be a lot of fun, but it is very hard work.

[NurseRies, BSN, RN]

Can someone please tell me what the job duties and specifically the clinical skills required for a RN at a Davita clinic?

Thank you !!!!!

Specific clinical skills you would need could all be learned since they do the new grads. They include med administration (PO and IV), vascular access cannulation, catheter care, head to toe assessment, fluid status assessment, heart and lung auscultation, technical skills involving the machine, IV antibiotics, subQ shots, supervision of staff, dressing changes, removal of needles, and possibly blood transfusions (most outpatient clinics don't). Those are the basics. It can become quite repetitive. You will never do an IV start in the clinic, these patients have other access for IV meds. Of course, there is a crash cart and you must be up to date on CPR just in case. There is not a doctor there, and you may be the only nurse, so be prepared to be in charge and delegating tasks. You usually call 911 If someone has unexplained chest pain or sudden serious changes in condition. I would sometimes give nitro and oxygen, only did CPR once in the clinic in 3 years. Without a doctor, there's only so much you can do. You will help people with hypotension and cramps a lot. Occasionally people vomit or pass out. What will help more then anything is noticing trending and knowing your patients very well. Know what to look for to prevent crashing.

[Yayamaya, RN]

Thank you for such a comprehensive detailed response - very helpful

[Bliss911]

Do you know how long the training lasts for new grads ?

[NurseRies, BSN, RN]

Do you know how long the training lasts for new grads ?

Usually 6 months. I have seen some programd push people in 3 months. I have also seen some new grads struggle that dont finish training for 9 months or more.

[Travel_Lusting]

Hi NurseRies, that was quite the overview. Dialysis nursing is so much different here in Canada (or I should say at least hear in Western Newfoundland). Up until April our staff consisted completely of RNs. We are just now beginning to bring LPNs into the unit. What I am wondering is what dialysis techs do and what their training is. Also, you mention you may be the only RN in the clinic at times. Is this a common occurrence? I am hoping to get into travel nursing in the US specializing in dialysis. I would like to know what I am getting myself into. Thanks. :)

[madwife2002, BSN, RN]

A new grad is supposed to have another RN in the building until they are 12 months post registration, you may be working the floor 3-6 months alone but you have to have another RN in the building to support you.

The other RN could be your FA who may well be working in her office or a Clinical Nurse Manager.

If this is not happening you should have a sit down meeting with your supervisor and discuss the safety factor

[madwife2002, BSN, RN]

Normally you go through the same training as a tech, which lasts aprox 12 weeks but should have supervised practice for 6-12 months-depending on how you pick it up.

I do not believe that you can feel confident as a RN until you are doing the job for 12 months or more

[kdunurse]

Our dialysis unit has a very short orientation period - 6 weeks for new grad or experienced nurses. I agree that it takes the better part of a year to feel comfortable. Our unit structure is a lot different than most dialysis centers, however - the majority of staff are nurses, with 2 techs who mainly take care of the machines and the water room, although they are also trained to cannulate patients and start and end treatments. We have a team leader who deals with the physicians and orders, and our hospital pharmacy prepares the medications. However, since we are in hospital, we also do acute treatments and take call. Some of the nurses are also trained to do apheresis as well. That is just way too much to learn in a 6 week orientation (which is the standard length of orientation for most departments in our hospital).

[NDXUFan]

Excellent and it is the truth. :)