Our outpt. unit is small ( 12 stations) so we do mix our own bicarb dailey in a big mixer, and fill the large jugs which are carried to the machines. The acid jugs we fill from barrels which are pumped to lines and spigots upstairs.. we fill these also. This job is shared amongst all of us.. nurses and techs alike.
Our staffing ratio is four pts. to one staff... be it nurse or tech. We only have one tech, so there are always nurses on hand. Our LPNs do everything the RN does with the exception of charge and taking phone orders. We have standing orders and algorythms we follow for epo dosing and zemplar, ferrilecit, etc. as well as adjusting weights and heparin boluses and/or pumps.
Our nephrologist is over an hour away up in Roanoke, so he comes down monthly. So no, we do NOT have a doc on hand except for once a month. But he knows us well and we work well together, he allows us to use our own judgement and he is always available for us to call if we need him. We have placed first in numerous area and regional awards re our facility's URR's and labs... so I guess we're doing something right !
Except for our tech, everyone has been there since before I came aboard, and that's been 6 years now ... so we all have much invested in our patients... we are like family. Dialysis even in a SMALL clinic is extremely physically demanding (due to inadequate staffing issues as per usual... the corporate greed thing again
and very hectic. Yet the day flies by and we have great fun with our patients.
It is challenging and interesting to work with the hypotension issues... juggling the adjustment of dry weights, use of mannitol or NS, etc.... after a few weeks of trial and error we usually come to some individualized resolution for each patient which is gratifying.
Many factors play into ESRD and dialysis... very interesting, challenging, rewarding when the patient is motivated and compliant (some take a year or more to become so, some never do)... and ALWAYS very sad when we lose one, as we have been together for a good while....