Dialysis nursing

barb o · Feb 3, 2018

The hours and call usually kill the nurses doing it. More and more patients are needing HD. Production line mentality in out-patient clinics, and docs who are paternalistic instead of collaborative. Working with people who don't play nice (rivalry between techs and nurses) and a boss who won't deal with it. You meet nice patients along with the nasty (few, thankfully) and can make a difference. Not enough professionalism among the nurses, I fear. Very few nurses I've worked with in 10 years of dialysis bother getting certified. But the hours, especially in acutes, are way too long and way too unpredictable. You can't have little kids and do it. And most places won't hire you for part-time. So, burn out. Yeah. I don't think the pay is up there with other specialties, either. In my experience, ICU, ED, and neonatal get all the money.

BassCatchingNurse · Feb 6, 2018

Well there are outpatient clinics and acute/hospital dialysis jobs.

I can not speak for outpatient setting as I have never worked in one.

As far as acute goes...it was really two things...not knowing when I would get off and then the "call."

We would run a 1st shift and 2nd shift pt during our "12 hour shift." If you were "in the suite" then you would run two patients at the same time 1st shift, and then run two more patients after that. If you were assigned "outs," meaning you went to the patients' room, you would run one patient 1st shift and then go to lunch, then run another one patient on 2nd shift. So, what is the problem? Well, you try to get your machine set up and running. You run to get your first of two patients from the floor. That patient wants to eat first. So, you run to get your other patient. That patient wants to wash up first. You then run back to first patient and find he is still eating. You know if you are late getting these two on..then your next two will also go on "late" which means that you will get off late. You finally get the first two on. You run each for 4 hours. You strip your machine down, get set up for the next 2 patients. You run to get the first one and she refuses to go to dialysis because "insert whatever typical excuse you have here." You try to convince her that she really needs her dialysis, why she needs it, etc. She refuses. You run to get your second patient. They are a normally compliant HD patient that just so happens to be in the hospital today. This patient is ready to go to HD!! You transport the patient to HD and hook her up for a 4 hour run. OK...the clock is going. You do not have any other patients to run. You already called the Nephrologist to let him/her know that patient "x" is refusing to run today. You have 2 more hours left on the current patient's run. After that, you will need to get the patient back to her floor, strip down your HD machine and clean it (which can take 30 minutes or more just to run the chemical/heat clean). However, you see the light at the end of a frustrating, yet typical day....AND THEN....the Nephrologist calls...patient "x" said that she will come to HD now. Yep, that is right....you now have to get that patient, with a smile on your face, and bring her down to HD...for a 4 hour run!!! By that point, you only had 1 hour left on your other patient and you would be on to clean up. However, you are now back to 4 hours left PLUS another hour of clean up/charting/etc. I truly wish this was a rarity, but it was not!! Sometimes the delay was that the doctor did not put in HD orders timely and now wants this patient on now. Sometimes the delay was due to machine malfunctions. But, there were always delays!!! Yes, sometimes you get off early d/t low patient census, but most of the time you were not.

I like to know when I am getting off and it just was not the case in acute dialysis (at least not in my unit). I also did not like the "call", especially when you are called in at 0100 because patient "x" skipped their dialysis (again, insert excuse here) and yet ate and drank as they willed...and now is in the ER and needs emergent dialysis d/t overload/high K. Many HD nurses get burned out d/t dealing with the noncompliance. That was never a problem to me though. I believe we are all adults. If they choose to make bad choices that is on them. My job is to educate them on their health condition and how to help improve that condition. The only problem I had with noncompliance was when I was called in in the middle of the night due to their noncompliance. If I were called in for an AKI, then I was more than happy to be there for them. This was just my experience. There were some "regulars" (aka: noncompliant) that the staffed truly loved, but no one wanted to be called in to run them or to leave work at 10 at night when you got there at 7 in the morning because they wanted to eat fried chicken prior to HD only to have emesis or diarrhea while on HD!!!

But...hey, that's just my experience...try it...you might like it!!