Dialysis Nursing as New Grad?

[SNgirl21, BSN]

Hi there! I'm a new grad RN with my BSN. I have 2 months experience at a med-surg position but that didn't end up a good fit. It was a combination of the facility didn't seem to invest in the training of new grads and I was very anxious and was struggling with undiagnosed ADD in addition to the nervousness of being in a new role.  Now, those are both controlled a bit better. But my question is, in my search for a good fit, I don't really think med-surg is for me. An opportunity came up at a facility as a dialysis nurse. They are willing to train and certify nurses and provide further education in dialysis. They prefer 9 months experience, but it's not required. In clinicals, I honestly had no experience with dialysis at all. I am a complete newbie and know nothing. I'm wondering if there are any dialysis nurses here or any nurses who have experience in this who can speak to whether this is an appropriate/good opportunity for a new grad and what your day to day in a job like this might be like. As a side note, through nursing school, my Community Health Nursing rotation was one of my favorites and I like working with people over longer periods of time with a variety of issues. I have thought of going back and becoming an FNP, but that's just a little thought in the back of my mind and I'm not really sure where I might end up. That would be way down the road if ever. Thanks!❤

[John2018]

I have colleagues who started as a new grad in dialysis clinics. They say that it's a good experience and fast paced. The facility provided her with complelte and thorough traning and so the transition as a new grad to dialysis is not that overwhelming. 

[traumaRUs, MSN, APRN]

I'm a nephrology APRN. I have never been a dialysis RN but these are some of my observations:

1. In an outpt hemodialysis unit, the pts are chronically ill. They all have life-limiting illness.

2. Dialysis pts dialyze usually 3 times/week for 3-5 hours each time. They either dialyze MWF or TTS

3. Dialysis units vary by company. CUrrently I see pts in both Fresenius and Davita units - these are the two big players in the US

4. They also vary in size: from 6-8 chairs on up to 32-34 chairs.  At Fresenius units, RNs have to have at least one year of experience prior to being left alone in the unit. 

5. The hours typically run anywhere from 0430 - 2300. However, one RN doesn't work all those hours!  The hours vary tremendously

6. It is fast paced but not nearly like a med-surg unit or ICU where you are on your feet the whole shift

7. It's very specialized nursing care - so the skillset takes awhile. 

 

Best wishes - If I can answer anything else, I'll be glad to help if I can. 

[PhilodendronPrinceofOJ, LPN]

I want to stress what traumaRUs said. It'll take time. I'm an LPN, but I'll try to help as much as I can to describe outpatient dialysis.

Each facility is different with the way they handle their patients' scheduling. In my facility we have 6 pods with 4 patients in each. Typically there are two RNs working who are given 3 pods each. On a good day we will have 3 RNs. The day normally starts around 0515. Two PCTs will come in at 0400 to set up the machines for the first shift and to mix bicarb. The opening RN will come in around 0445 to make sure the orders are in for any new patients, draw the heparin, and prepare for the morning. A fourth person (usually PCT/LPN rarely an RN) also comes in around 0445 to help open the clinic and they will be in a pod. Every four hours we have to check water for total chlorine to ensure the water that the patients are exposed to is safe. We set an obnoxious timer to go off every 3 1/2 hours to give us enough time and be early in case things get busy. When patients start coming in, they wait in a line getting their pre-weights at the scale. They will then go to their assigned seat. The RN will start treatments for patients with central venous catheters. If none are present, they will make their way throughout the room assessing patients. RNs who are comfortable cannulating will even cannulate arms. The other half of the staff comes in around 0545/0600. This process of starting treatments continues until 0700. By then typically the people who opened the clinic will go on break for an hour. During this time one RN is on the floor with 3 coworkers (typically PCTs and an LPN). Every half hour we have to take vital signs, and we chart that on the machine. After the hour is up, the second group  goes on break. The nurses typically give the medications as the patients come in if they have time. I usually give all of mine after all of my patients' treatments have started. By 9AM, people are ending their treatments. We are getting the last set of vitals as well as a standing BP for those who walk out of the clinic. We remove needles and ensuring that when the patient lets go their fistula that no blood is seeping through the gauze. The RNs are able to remove needles if they have time, but they will also end treatments for CVC. As an LPN, I get the honor of doing it all. We then get a post-weight for the patient. When the patient is stable and out of the chair, we are allowed to disinfect the chair as well as machine with a bleach solution that one of the techs mixes. Then we have to make a new set-up for the next shift.

We pretty much do the process for three shifts. The techs who open in the morning typically leave at 1830. The RNs, however, usually stay longer. Some stay until 1900 or 2000. It really depends on the day.

On the bright side we typically work 3 days a week. One of my coworkers is an RN and would be working 5-6 days a week because coverage would be needed in other clinics. So there's OT available, if you're ever interested in that. We're off on Christmas day, New Years day, and Thanksgiving day. The eves we're working, but we try to have people come in earlier so we get to leave by 1730 or so. We're typically closed Sunday unless those holidays are on a day other than Sunday or if there was inclement weather. Only twice since I've started working have we had to open a fourth shift and that was four years ago. We were open until midnight because of a blizzard the next day.

There will be times where everything is dragging because nothing chaotic is going on. I embrace that. Then there are other days where you are just busting your butt all day long until you leave. I can't say that dialysis is for everyone. There was an RN who worked in the hospital for years and wanted a different to try something different. She worked at the clinic for about half a year and left. Some new hires left after training. But I also had a coworker who was a PCT for many years. She graduated and got her RN. She worked as an RN at the clinic for about a year and a half and is doing well. Everyone is different. This field is specialized, so don't beat yourself up if something doesn't click instantly. Remember to breathe and give yourself time to feel comfortable in your role as the RN. If you feel you need more training, tell your preceptor, clinic manager, or the educator.

[traumaRUs, MSN, APRN]

Great explanation!!

[scratchgolfer]

I was in HD for 2.5 years and would discourage a nurse early in their career from choosing this path. While HD is very easy, there are a lot of senior nurses with a personality and attitude that result in a toxic work environment. Additionally, most patients are going to die within 1-2 years which is tough to see. For example, in 2.5 years over 250 patients have died on my 45 station unit. 

So...

Pros:

Easy physically

Lots of OT

Good hours

Cons:

Toxic coworkers

Toxic patients

Boring

This is me being transparent and it is only my opinion of 1 HD unit in a major hospital in Canada