Dialysis nursing, continuing ed for dialysis

[HazyAutumnStar]

I've been in dialysis since I graduated in May and sat my boards in June. Trained as a tech first and learned the routine with the machine set up and tear down. Was taught how to cannulate AVF/AVG and dealing with catheters (after being licensed.)

From the very beginning it has been a highly stressful job. I was feeling overwhelmed when in clinic because I was trying to take in days of learning machines all at once and then trying to also keep up with the "school" work from our class days. I was very fortunate to have a tremendous tech preceptor and RN preceptor. After getting the hang of the machine alright, I moved on the RN preceptor. Both of them were very helpful and would pick me up when I fell behind.

I'm sure that 85% of the stress stemmed from the fact that management has been a shortcoming in my clinic. Finally, we got a new manager about 5 months into my stent and then things seemed to get even more out of whack. RNs and techs that had been in the facility for 15+ years were leaving because of discord with new management.

I've looked for other employment opportunities and was actually offered two positions in two different hospitals. Neither of the two could compete with my hourly wage in dialysis. So, I opted to stay on with dialysis and keep plucking away and make it work. I don't hate dialysis, but I feel like I am missing out on keeping up to date with the skills I have learned in school.

I want to find at least a PT position at the local hospital so that I can keep up to date with skills and have been unsuccessful at the hospital in my town. Every time I apply they politely tell me that I am not qualified. Now, here's where that rubs me raw, they were willing to interview me prior to sitting the boards. I had a successful first interview and had lined another interview up for 2 weeks later. In that in between time, I interviewed with the dialysis clinic where I am currently employed. Long story short, I took the dialysis post and called the very same day and cancelled the follow up interview with the hospital with over a weeks notice. Now, that continually tell me I am not qualified.

So after having said all of that I have two main questions:

1) How do I stay up to date with my skills learned in school? I know it's "use it or lose it." Any suggestions?

2) As a dialysis nurse what resources have helped you feel more accomplished in your role as a dialysis nurse.

Again, I don't hate dialysis nursing, I just hope that I won't be in the same spot 15 years from now. Any positive advice is most welcome!

[CFrancine, BSN, RN]

Sounds like you've been there at least 6 months. So here's my advice. You need to decide if you want to stay with dialysis or not. I don't know of any place that will hire an essentially new grad RN part time. You WILL NEED orientation. Fortunately, with 6 months working experience, you might find it easier to find work. So if you want to work on your bedside skills, I advice you leave dialysis now or after 1 year at the latest. It'll always be there if you ever want to return. Heck, I'm sure they'd be happy to keep you on as part-time or PRN after investing a year in training you. I'm not saying no one will hire you down the road. But you're right, you'll have lost a lot of skills and knowledge and they expect more from an experienced RN. There are exceptions though. Some specialties, like OR and dialysis, hire nurses knowing full well they will have to train them so they don't care too much about your background.

[HazyAutumnStar]

Thank you so much for your feed back. I am approaching my one year threshold in May. What you have said makes complete sense.

[southernbelle07]

Maybe you can switch to doing Acute dialysis in the hospital if being on-call doesn't bother you. There is usually shift differential in dialysis in acute setting as opposed to chronics. I get paid a few more dollars per hour in the acute setting and dialyze patients in the ICU and dialysis suite which is a 10 bed dialysis unit. I'm only going on 2 years of dialysis experience as an RN and prior to that I was working in pediatric home health. In the acute dialysis setting you are exposed to other patient issues besides just dialyzing the patient. I like it so far and it would be perfect if I didn't have to be on-call once a week. Any questions feel free to ask!

[Chisca, RN]

Join ANNA, the electronic version of their magazine is worth the price of admission and they offer free CEU's. The link below is from the latest edition. They also have an open forum to ask questions about dialysis.

ANNA News Service - March 30, 2017

[jlautier]

its hard to do any nursing when sh*t is hitting the fan at your clinic. Nursing skills you speak of sound more like "tasks" urinary catheters, dressing changes, wounds, etc. Those are all tasks. Nursing skills are assessing patients and keeping them safe. those translate to any unit (non-dialysis). you can learn tasks at any age, patients manage tasks at home w/o nurses to help them.

Dialysis nurse stuff i have done in a chronic unit: manage anemia; adjust doses of iron and epogen w/ an algorithm (assess patients for anemia--i can spot an anemic patient a mile away), staff scheduling--a valuable tool, managed mineral management w/ zemplar/ hectrolol, worked w/ dietician to improve patients lab work to met goal, EDUCATE the sh*t out the patients so they stop drinking dark soda's and oranges. What CVC's sites for infection, i can spot a septic patient a mile away; get an order for vanco, draw troughs, adjust the medication. You got experience if you look for it.

Once your clinic gets a good work flow goin you can start to do more nursing stuff and think less like a tech and just to get the patients on and off the machine. the big butt here is: you need to make it your experience. If you just pulling fluid of patients than you need to reevaluate what your doing. What comorbids do your patients have? how does that effect the treatment you are giving them?

I worked free standing for 3.5 years; floor RN -- charge RN; anemia management, mineral management, scheduling (patient and staff), loved every notch in my belt. I left for an acute dialysis gig w/ a large inner city hospital that is owned by the hospital--a learning curve to the cardiac monitor and some other acute care things giving insulin, titrating heparin drips (sorta like the vanco troughs or epogen i used to titrate outpatient).

Dialysis is rewarding but you can only make as much as a difference to your patients as your willing to seek. You ever get a patient worked up for transplant? thats case coordination, in my 3.5 years, 5 of my primary patients got transplants. you can rock it !

[HDRN1, RN]

You are right to want to expand your experience base. Dialysis is actually quite a narrow field of practice, and I think the more experience you get in different areas the more understanding you have of any condition your patients will present. A few good points have been made in previous posts, in that dialysis will always be there to come back to if you want, also that there is actually a lot you can learn on dialysis as most hd patients have co morbidities. The problem being if there is a lot of unrest on your unit, chances are that your opportunities to dig deeper might be limited.