Dialysis Nursing

[GitanjaliRN]

Greetings!

I am new to this forum and whooo! Is it a maze of cat's yarn navigating this site! I think I have finally found the "forum" section, and I'll just go ahead and write this in "General Nursing". First of all, I am so glad a chat & advice space exists for registered nurses and students. It has been almost a year since I graduated nursing school, and one of the wildest learning curves of my life... I was fortunate to get a job right after the NCLEX, working in psychiatry, a specialty field and although I have grown to really appreciate this field of work-- unpredictable life factors are now pushing me in new, unimagined directions.

At the hospital I work at, two months ago, my father was admitted in critical condition for pneumonia and sepsis. The classic walking, talking, even grabbing a bite of dinner to eat before collapsing in the ER waiting room, story. The sepsis quickly affected his kidneys, requirting prompt dialysis (as well as a ventilator, as his oxygen had dropped down to the sixties and he has a prior managed history of COPD). Dad has been getting both dialysis and ventilator treatments now for over two months and was just transferred to a "Long Term Acute" facility last week where he is also thankfully now receiving physical and occupational therapy to hopefully wean him off the ventilator...

I guess my question is a complicated one. I have taken the maximum amount of Family Leave from my place of employment, and even had to travel out of state to get my dad set up in this new facility. His insurance will likely only cover 30 days of care here, and then I will be helping him transition to the next longer-term recovery facility (if he is still on a ventilator, then a vent specializing facility may be important). I have run into several glitches trying to arrange care for him, as he has both ventilator and dialysis needs. At the previous hospital, people kept calling him a "complicated case", but honestly I think it must be way more common than we think for someone to be both on ventilator and dialysis post sepsis. He is also 80 years old, so recovery takes longer. As far as I know, there are only a few facilities, close to home (upstate NY) that will take him with his insurance (Medicare), and even then there are caps to the length of time for care-- usually around 100 days, with the chance of "appealing" for longer stay (but this often involves a sudden, rare medical condition happening to the patient, like infection, untreatable wound, etc.). It has been so frustrating to see him be rejected from getting the crucial care he needs right now during a recovery process that really could take at least 6 months! A few doctors at the previous hospital even suggested we "give up" on treating him and just bring him home on Hospice (which is a valuable service I deeply respect), since the insurance will cover him coming home to die, but not coming home with life-saving services, like a ventilator and at home dialysis. I am still getting over the psychosocial/spiritual burn of being so pessimistically treated at the other hospital and really looking for OPTIONS going foreward. As a registered nurse, it is doubly demoralizing for me, because I work in this industry-- and at the hospital that wanted to give up on him! I feel, continuously, like I should be doing more... But I also am aware of self-care and the need to prevent role-strain during a family medical crisis.

I guess I have two questions at this time:

1) does anyone out there know of patients like my father, with sepsis-induced acute kidney and respiratory failure, (as well as feeding tube due to swallowing restrictions with the tracheostomy), who are allowed to just come home and receive visiting nurses services such as vent & dialysis care? Every @home dialysis company we called (it shockingly boils down to two mega-companies DaVita & Fresenius) told us they have "never encountered a patient on both vent and dialysis at home". I think this must not be true...

2) My second question pertains to dialysis nursing itself. This whole experience has made me interested in switching fields from psych to acute inpatient/home care. I am actively researching dialysis training for nurses, but keep being bounced between various sites that are hard to navigate and say contradictory things such as "BSN and 2000 clinical hours in nephrology setting required", for dialysis certification, or "no experience necessary, direct hire out of nursing school". Can someone recently hired in the field of dialysis nursing please comment? Thank you!

*For those in the field of dialysis nursing, do you know if it is allowed to take care of your own family member with kidney failure? This is of course my main motivation for doing the training-- which I am told can take up to 6 months. He may not even have that long, but I wanted to see if there was any way I could take care of my own father, preferably at home (as one of the reasons he was denied @home dialysis services at home (in addition to being on the vent) had to do with a local shortage of dialysis nurses, whom the local supervising nephrologist would not feel comfortable releasing for home-care when they are needed in hospitals and facilities)

I appreciate anyone reading through this very long thread. It has been an intense journey these past few months. I still have hope, just could really benefit from the experience and input of fellow nurses, as I am still relatively new to the profession. Nurses Rock! Thank You.

[Zeek, LPN]

First of all let me say that I am amazed at how you are coping with all this! You seem very clear headed and know how you want to have things go for your Dad. I am a dialysis nurse of 34 years and here's what I can tell you about it. You do not need to be a trained dialysis nurse to take care of your dad at home. Units that do home dialysis training (either peritoneal or hemodialysis) train the caregivers at the same time. Keep in mind that if the choice is hemodialysis it is about 6 weeks of training, PD is much shorter - often a week for initial training and then another few days for cycler training. If you want to work in dialysis, then just apply - we do all our own training and once you have the requisite hours you can become certified, but it is not usually required. Most have to work hemodialysis for a bit before a home training position opens up.

Visiting nurses would do your dads vent care and other nursing needs, but would not do his dialysis treatments. They just don't have the training. I have not personally seen a patient like your dad do home training, but I don't see why it couldn't be done - you will just have to be his voice to push for it. We are open to accepting patients with LVADs and Trachs etc. at our unit once deemed appropriate by our corporate office. I do not work for either of the two you mentioned. You would have to do any care he requires during the training period (while getting training).

I wish you the best of luck in caring for your father.