day in life of dialysis RN? please describe

OnEaglesWings · Dec 10, 2010

Hello,

I would love to hear about working in a dialysis clinic. Any RN's out there who work dialysis?

What is your day like?

Thanks,

Sue

BloodCleanerRN · Dec 10, 2010

Funny you should ask. Today is actually my last day as a dialysis RN. I've been doing Acute Hospital Hemodialysis and it's very much different from chronic clinic dialysis.

In chronics, you see a lot of the same patients from week to week. It is very much about routine....almost an assembly line at best. I don't mean that to sound bad. Some people really enjoy that kind of work. Most dialysis nurses work four 10 hour shifts. Dialysis days also start EARLY. If you are an early riser...then it could be the job for you! Many clinic dialysis nurses get to work between 4:30-5:00 AM. There is a lot of risk of exposure to blood (obviously), more so than in hospital nursing. There are many sharps, especially those 15 gauge needles used to stick fistulas and grafts.

Generally, there is a 1st and 2nd shift. Patients can have treatment times ranging from 3-6 hours. When 1st shift is complete, then the machines are turned over as quickly as possible and set up for 2nd shift.

Then, there is the water system you need to learn as a dialysis nurse. There are DI systems and RO systems, and different checks for each. One common check is chloramine check every 4 hours.

There is a lot to learn. It's definately a specialty that has it's own unique demands. As I've heard, and found out, people either love dialysis or they hate it.

Good Luck!

SLA2011 · Dec 10, 2010

Go to the Specialty tab, then Nursing Specialties, then to Dialysis/Renal/Nephrology. Some pretty interesting posts that give you a good idea of what to expect.

AsatruRN · Dec 22, 2010

I have been working in dialysis for the past 4 years as the nurse in charge. It's been my only experience so far as an RN so unfortunately I don't have much else to go by. I have recently secured a job in Oncology because I didn't want to become "pigeonholed" as a dialysis RN. I needed some new experience because I wanted to grow my knowledge base. There's several differences that nurses have described in the dialysis setting as opposed to other venues.

First is patient familiarity. You will see the same patients three to four times a week indefinitely. This can be good or bad. Of course you will learn about them; you can tell by looking at them if there is something acutely wrong. They will develop a trust relationship with you which you may not find with other venues where your patients rarely see you. They will learn your name. This can suck because some tactless patients will say "wow you've gotten really fat" or "you look tired today" or "you have an attitude today." You may see them at the mall or at the grocery store, or they may live in your neighborhood. If you were their ICU nurse they may or may not know your face however as their dialysis nurse not only will they recognize you they will call your name. Some nurses will be uncomfortable with this. Some patients are very noncompliant...and as you tell them the same thing day in and day out for years after a while you want to strangle them. Noncompliance can only make your job harder and affect their health in an ill way.

Second is more than likely it will be a nurse led clinic. This means you may have to schedule dialysis related appointments, fax treatment sheets, call hospitals and nursing homes for follow up. You may even have to file documents directly into charts. In a larger setting there will be more aides to do this for you but sometimes in the dialysis clinic if you want a job done right you have to "do it yourself."

There's a water treatment system to learn, and hemodialysis machines to learn how to operate and troubleshoot. You will have to keep an eye on infection control because there's several patients in the clinic, and it's harder to remember to wash your hands and keep the clinic clean and safe. You'll have technicians and LVNS working under you of course however I like to know inside and out how to perform my job.

You can wake up very early and have 3 16 hour shifts if you want and basically have 4 days off with overtime.

It becomes very routine sometimes it is a highly specialized field, there's only 3 medications you will routinely give and maybe 10 PRN medications. I've been doing this for 5 years and I'm getting bored. However I've had a microwave catch fire during my shift and I had to evacuate a clinic of 20 patients and 10 teammates on a dime and then pull fistula needles on the patients outside in the parking lot during inclement weather. Hemodialysis isn't very nice to a patient's cardiovascular system so I've had some patients have MIs, CVAs, etc on the machine so the patients require your quick response. As soon as you fall asleep something may wake you up.

There's a huge need! I've swiped from Starship Troopers before and called it "Bodies for the Grinder." Very few specialties hire new nurses like HD can, some can't handle it I think because they look at the entire clinic full of patients, see their responsibility, and get overwhelmed. Definitely apply and it may be the perfect job for you! :yeah:

OnEaglesWings · Jan 4, 2011

thank you for your detailed response. I think I will try a shadowing experience to see it firsthand. Just considering different areas of practice.

THANKS!

channo92 · Apr 7, 2017

I know I am late to the party, but I am a dialysis tech (going into my BSN program now) and have lots of info, if anyone is going into the dialysis field!

Chisca, RN · Apr 15, 2017

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finallyRN7, BSN · Apr 20, 2017

Hello Channo92,

I'm curious about dialysis' hours. I've seen chronic clinic hours for Fresenius as 9a-5p M-F. Are those hours realistic for nurses looking to apply for a position, or are those hours for public patient information? Thanks.

EmVn · May 24, 2017

At my clinic we have 12 chairs and 3 shift each day. Depend on the clinic some time you work from open to closed so you are looking at 5a to 8p or 9pm and work 3 days a week or if you split up the shifts and have extra help then 5a to 3p then ur reliever will come from 10 or later until closed then u will work more like 4 days a week week

channo92 · May 10, 2018

These are all great answers. I have something to add. I was a dialysis tech for 2 years in the chronic clinical setting, and as a nurse there, you are not very hands on. The techs do the prep, bicarb/acid prep, sticking, machine set up, running, monitoring, discontinuation, and tear down. The nurses are documenting almost ALL day and doing follow-ups. They are in meetings, answering phones, doing care plans, and administering meds/doing foot checks when they are interacting with patients. The tech will usually be the one to calculate the amount that will be pulled, but the RN will make sure that they are doing enough/pulling less if the patient is around their dry weight. The nurse will also be closely monitoring the dry weights (where homeostasis occurs) frequently to see if they need it adjusted. The chronic setting, as said before, is MUCH different for RNs than the acute setting. Acute settings, you will be working with inpatients and patients just starting on a CVC. I learned SO much as a tech when I was one, and it has helped me tremendously in school, skill and knowledge wise. I never thought I would say this, but I am looking into an acute dialysis position as my first position out of school. Such an amazing field. PLEASE treat your techs well if they are doing their jobs correctly. You will need each other, and trust between people makes things work out just so much more nicely for everyone, including the patients.

Hoosier_RN, MSN · May 10, 2018

finallyRN7 said:
Hello Channo92,
I'm curious about dialysis' hours. I've seen chronic clinic hours for Fresenius as 9a-5p M-F. Are those hours realistic for nurses looking to apply for a position, or are those hours for public patient information? Thanks.

Those are not the hours that the clinic runs for nurses. Treatments generally start at very early am (some places 4:30a) and can go til 10 at night. Those are posted hours for contacting. You would need to job shadow to find out specific clinic hours