Dialysis, no laughing matter

leslie :-D · Apr 5, 2005

you might want to take the next step up and talk with her nurse mgr.

i can't believe the nurse laughed.....

good luck to you and your pt.

leslie

Marie_LPN, RN, LPN, RN · Apr 5, 2005

I agree, take it to her nurse manager. That nurse needs a reprimand for her lack of professionalism.

imperial · Apr 6, 2005

I work for a dialysis clinic attached to a hospital. A patient is going in to have a declot on a scheduled dialysis day. I called surgery scheduling and the surgeons nurse to let them know that I only had two available times to dialyze this pt. on that particular day as the clinic is only open 3 days/week and hours are 5:45AM-6:15PM. Explained that if we could not fit her in she would not be able to receive her dialysis at our clinic. NO HELP. They could not tell me what time her surgery would be and the nurse Laughed about it!! She asked me if I was serious!! Can you believe it?! :imbar No respect between nurse "professionals" no understanding of the importance for hemodialysis or the patient's healthcare needs!!!!!

I appreciate your understanding. Several of our clients (patient advocates we are) have said that their staff have stayed late, worked holidays etc in order to give them treatments.. and all the staff asked was for patients to come in 1/2 hour early.

ageless · Apr 6, 2005

Unless the surgery was first case that day, there is no way to give you a time of surgery. The rest of the cases for that surgeon are considered "to follow" or "on call". Estimating a time of surgery is very difficult, because of emergent add-ins and of course, some surgeries take longer than others, etc.. Not tom mention recovery time for your patient. It would have better to call the hospital's surgery central core. They deal with coordinating patient treatments before and after surgery all the time.

Perhaps, you could meet with the surgeon's nurse to create a future plan for these occurances. Ways to curtail problems are to schedual surgeries for non-dialysis days, use temporary accesses so the patient can dialyze before surgery, schedule dialysis with the acute care dialysis team. Consult with the patient's nephrologist for help with future cases such as this so they can attach dialysis orders for surgery patients needing acute dialysis care.

As a side note...was the nurse directly laughing at you or was she laughing because of the hectic unpredictability of a surgical day? When I worked in surgery, it did tickle my funny bone when I was asked for exact ETA. Not that I ever laughed at someone who asked for the information, but just like in dialysis, not many understand the nuances of each specialty.

I compare it to when my spouse (who works a 9 to 5 desk-type job) doesn't understand why I did not just take a lunch break or just say no to over-time. I smile and think "If you only knew".

Best wishes!

jnette, ASN, EMT-I · Apr 7, 2005

Anytime our patients have to go for surgical eval or declotting and are not expected to make it back in time for dialysis, they are dialyzed AT the surgeon's hospital.. no ifs ands or butts. And so it should be. There's no way you can expect a freestanding dialysis facility to stay open 24/7 to meet all these needs. That is what "acutes" are for. Does the hospital you're attached to not have an acute unit?

Dormkare1 · Apr 7, 2005

:) Thanks to all of you for you input. The nephrologist stepped in and and resolved the situation. My clinical manager was present when this happened and she took matters into her own hands. Yes, it is possible that this nurse had a hectic day, but don't we all? Treating other nurses with professionalism is always the right thing to do. If you are having a bad or hectic day there is no reason to take your frustrations out on someone else who may be having the same kind of day. RE; acute dialysis post op, I am the acute nurse also and if there is no other nurse in the clinic I am not able to do acute runs. The nephrologist is aware of this situation also and works closely with my clinical manager to prevent this event from happening although emergent situations can't be planned for. We did call surgery scheduling first and received no help, that is why we were hoping to find help through the surgeons nurse. We run 12 hour shifts three days a week and our shcedule is very tight. One adjustment can throw the whole pt. schedule off. I don't mind some overtime, but I do not wish to work another 4-5 hours because we health professionals fail to work as a team. My pt. will run on her shceduled day post op down in our clinic. Everything worked out.:) Thanks again:p I should add, if I am unable to do the acute run the pt. is sent via ambulance ( at great expense) to a hospital 1 1/2 hours away! Needless to say, our staffing situation is in need of repair. :rotfl:

jnette, ASN, EMT-I · Apr 7, 2005

:) Thanks to all of you for you input. The nephrologist stepped in and and resolved the situation. My clinical manager was present when this happened and she took matters into her own hands. Yes, it is possible that this nurse had a hectic day, but don't we all? Treating other nurses with professionalism is always the right thing to do. If you are having a bad or hectic day there is no reason to take your frustrations out on someone else who may be having the same kind of day. RE; acute dialysis post op, I am the acute nurse also and if there is no other nurse in the clinic I am not able to do acute runs. The nephrologist is aware of this situation also and works closely with my clinical manager to prevent this event from happening although emergent situations can't be planned for. We did call surgery scheduling first and received no help, that is why we were hoping to find help through the surgeons nurse. We run 12 hour shifts three days a week and our shcedule is very tight. One adjustment can throw the whole pt. schedule off. I don't mind some overtime, but I do not wish to work another 4-5 hours because we health professionals fail to work as a team. My pt. will run on her shceduled day post op down in our clinic. Everything worked out.:) Thanks again:p I should add, if I am unable to do the acute run the pt. is sent via ambulance ( at great expense) to a hospital 1 1/2 hours away! Needless to say, our staffing situation is in need of repair. :rotfl:

Glad all worked out for the best.

I agree.. we already are working 12-13 hours, and the scheduling for patients is what it is for a very sound reason. It can throw the entire shift and the other patients' appointment times totally out of whack when patients are late or rescheduled. We cannot accomodate variences or delays of this nature.

Are there no other acute nurses at your hospital? You work both outpatient and acute? You have no backup nurses for the acute unit? Doesn't make sense.. what about your schedule? How do you work both? If you work outpatient, and happen to have an acute brought in that night, what then?

What we HAVE done in the past, if there's time.. is to change appt. times with our patients.. ie., ask if a patient would switch appt. times for this one time with the other patient. Often that works out well. But you have to know a day or two ahead what the circumstances will be, so you can ask another patient to switch.

Glad it all worked out in the end for ALL of you. :)

Dormkare1 · Apr 7, 2005

We are a freestanding clinc but attached to a hospital with no affiliation. In the morning, first thing, I call to find out if there are any acutes to run. If there are, I go do them and the clinical manager works the floor. However, on the days she is not in the clinic the pt.s in acute are forced into having to be sent to another hospital 1 1/2 hours away. The powers that be are aware of this but I have heard of no resolution to this dilemma. I guess I am in demand there. WOW what a popular girl I am:rotfl: We do not have alot of acutes to run as we only have 27 pt.s in our clinic. I like doing the acutes, interesting and gets me away from the hectic clinic enviornment for awhile.:)

jnette, ASN, EMT-I · Apr 7, 2005

We are a freestanding clinc but attached to a hospital with no affiliation. In the morning, first thing, I call to find out if there are any acutes to run. If there are, I go do them and the clinical manager works the floor. However, on the days she is not in the clinic the pt.s in acute are forced into having to be sent to another hospital 1 1/2 hours away. The powers that be are aware of this but I have heard of no resolution to this dilemma. I guess I am in demand there. WOW what a popular girl I am:rotfl: We do not have alot of acutes to run as we only have 27 pt.s in our clinic. I like doing the acutes, interesting and gets me away from the hectic clinic enviornment for awhile.:)

Wow...I would think if there is a unit in the hospital to RUN acutes, that they would also have some acute NURSES.. not just yourself... (as much as you love the popularity and being in such demand) :chuckle

If they have the means to run acutes in this hospital, why not hire a few acute nurses so you don't run into these dilemmas? Our local hospital doesn't have dialysis, period. All our patients are sent by ambulance 1 and 1/2 hours off to the next hospital also, if they have an emergency of some sort and need to be dialyzed. That is because our local hospital does not have a nephrologist.

I've often wished our hospital did, and that we could do acutes there.. I'd be their first job applicant !!!

Dormkare1 · Apr 7, 2005

This hospital does not have an "acute unit" I run the pt. in their room on the med/surg floor or in ICU. Wherever they happen to be. Usually have to call maintainence every time because I can not unscrew the faucet head to attach the RO. I do not know why they do not hire an acute nurse, if they did the nurse would have to be casual and "on call" which I think would stink. As I am sure you are aware. Administrations insight and reality are two very different things so I do not know how they plan on resolving this. If a pt. comes to ER and needs stat dialysis ie; high K+, the pt, must be sent out because I do not work on call and never will. I would quit first.:)

jnette, ASN, EMT-I · Apr 7, 2005

This hospital does not have an "acute unit" I run the pt. in their room on the med/surg floor or in ICU. Wherever they happen to be. Usually have to call maintainence every time because I can not unscrew the faucet head to attach the RO. I do not know why they do not hire an acute nurse, if they did the nurse would have to be casual and "on call" which I think would stink. As I am sure you are aware. Administrations insight and reality are two very different things so I do not know how they plan on resolving this. If a pt. comes to ER and needs stat dialysis ie; high K+, the pt, must be sent out because I do not work on call and never will. I would quit first.:)

hmmmmmm... so you have a machine or two stored at the hospital that you can pull out and use as needed for acute cases? Interesting.

So why not call in a nurse from a "pool" of acute nurses.. the nurses do nothing BUT acutes, and stay rather busy actually, going from hospital to hospital. They are not even affiliated with your hospital, but with a comapny that hires only acute dialysis nurses.