New to dialysis.....HELP!

Treva · Oct 9, 2001

Welcome to dialysis!

Nephrology can be a very challenging, rewarding, frustrating, maddening career---sort of like any nursing career. I've been doing this for 10 years now and I love it (at least, most of the time)

The American Nephrology Nurses' Association can be a very valuable resource for you. They have a lot of information, local chapters, and national meetings. They have some excellent books available too. Their web site is http://www.annanurse.org.

Good luck to you!

TELEpathicRN · Oct 9, 2001

Thanks for your help, will check out the website.

3651bht · Oct 12, 2001

Good Morning,

Glad to hear you have joined us... I fell into dialysis when the hospital I was woriking in remodeled the floor I was working on. 1986. The staff were sent to various other med/surg areas and I ended up on the nephrology floor and fell in love with this population.. When an opening occured on that unit I jumped at the chance.. I eventually went to chronic outpatient hemo... As an LPN, when Epogen, first came out I was of little value to the unit ( couldn't do anymore than a tech) so I left for 10 years But I never forgot... I returned to hemodialysis in 1997 as an RN.. I have worked per diem there until August when I took a full time position.

Outpatient hemo is time-based and fast-paced but worth it.. This population comes to you SICK and after about 2-3 months you can see an improvement... Something you don't see in an acute situation.. When I worked on a Med/Surg unit for 13 years I never got the rewards emotionally that I get in dialysis.. I very rarely saw the outcomes of my and my peers hard work.. With dialysis patients the rewards happen each day.. With the patient who says my appetite is back ,, I can breathe good now... See ya on Monday have a great weekend.. These people are as interested in my life as I am in theirs.. There are so many opportunities to make their lives better.... Oh yes, there are always those who will get under your skin sometimes, but rememeber like a little kid they may be the ones who need you the most...When you work there don't be intimidated by us Time has a different meaning to a dialysis nurse.. We call it the dialysis minute.... LOL And it's not like the last two minutes of the Super Bowl....Give yourself a chance to learn your duties It is difficult to learn dialysis as there are many things that can go wrong. And you have to think outside of the box sometimes.. Talk about critical thinking.. Whew... But, to me, it is worth it.. You will learn how to spot the patient who is "crumping" ( crashing is another term we use) without a blood pressure reading You will actually look at your patient and know that something is wrong.. If you worked cardiac you won't have a problem with this.. We have a lady whose lips turn white and when I take her pressure it will be 78/40 Observation skills are highly reccomended here.. Dialysis nurses are some of the most anal nurses you will meet me included and proud of it... We like our gauze over here and our needles over there and that saline bag is on the post backwards.. and who told you to do it that way You tape your needles HOW... But remember we have a demanding job and when a patient gets a transplant we treat it like they just graduated from college with high honors.... Don't be discouraged by all the things you have to learn and maybe unlearn it will be worth it.. Have fun with all of this I think you will be glad you made the switch I know I am...

May the sun shine brightly on you, in peace, and may the wind be always at your back....

nursing04 · Aug 12, 2004

Good Morning,
Glad to hear you have joined us... I fell into dialysis when the hospital I was woriking in remodeled the floor I was working on. 1986. The staff were sent to various other med/surg areas and I ended up on the nephrology floor and fell in love with this population.. When an opening occured on that unit I jumped at the chance.. I eventually went to chronic outpatient hemo... As an LPN, when Epogen, first came out I was of little value to the unit ( couldn't do anymore than a tech) so I left for 10 years But I never forgot... I returned to hemodialysis in 1997 as an RN.. I have worked per diem there until August when I took a full time position....

Hello. I am graduating in Sept and am looking into going into dialysis. I just read your post and it is giving me a better understanding. Ever since my first clinical dialysis has intrigued me. (I had a dialysis patient- and thought it was so neat to feel the thrill and hear a bruit). Anyway, I love when I am in the nursing home and see my patient's each week but am afraid of going into that b/c all they seem to do is give meds- plus the stringent nursing home laws. So, dialysis seems rewarding b/c you do see the same patient's. Can you tell me more?? Like what an average day is like? What kinds of things do you do? What kind of person do you need to be to work in this envt?? Thanks!!

tizmonster · Aug 12, 2004

Hello. I am graduating in Sept and am looking into going into dialysis. I just read your post and it is giving me a better understanding. Ever since my first clinical dialysis has intrigued me. (I had a dialysis patient- and thought it was so neat to feel the thrill and hear a bruit). Anyway, I love when I am in the nursing home and see my patient's each week but am afraid of going into that b/c all they seem to do is give meds- plus the stringent nursing home laws. So, dialysis seems rewarding b/c you do see the same patient's. Can you tell me more?? Like what an average day is like? What kinds of things do you do? What kind of person do you need to be to work in this envt?? Thanks!!

You had a question about the day in the life of a nephrology nurse.....see if this helps. If I can help you - please send me an e-mail. I have groups that are willing to train RN's - Happy to give you that insight. It'll be fun to see you evolve.

Day In the Life of a Nephrology Nurse

For a nephrology nurse in a dialysis clinic each day is a new chance to save a life. A 12 hour shift, 12 chronic hemodialysis patients, a balance of direct patient care and administrative duties necessary to keep staff scheduled, medications in stock, insurance requirements met, and treatment plans individualized, are typical.

A nephrology nurse is a highly specialized registered nurse, having undergone extra training to be able to help care for a patient population growing increasingly older and sicker, in need of a complex therapy that lasts three to four hours, three days a week, every week of the year.

Pre-Dialysis

Before anything can be done with a patient, the artificial kidney machine and the artificial kidney, or dialyzer, must be set up. Water treatment systems must be checked for a number of parameters, all related to patient safety. The dialyzing fluid, or dialysate, must also be prepared and tested for safety and to ensure and effective treatment.

Because kidney failure affects every system in the body, preparing for dialysis is a delicate balancing act. Each dialysis treatment starts with a pre-dialysis assessment of each patient. A number of parameters are evaluated:

Weight o Since most dialysis patients cannot eliminate fluid from their body, they gain "water" weight between treatments, from fluid and food they ingested. A pre-treatment weight gives an indication of how much fluid should be removed during the treatment.

Blood Pressure, temperature and vascular access o The nephrology nurse checks vital signs as well as the vascular access. The vascular access provides access to the patient's blood for the treatment. Is it clotted? Or flowing? Infected? Is it cleaned enough to prevent bacteria from entering when the fistula needle breaks the skin? Patient education on how to keep the access clean is an important part of the nurse's job. That vital opening is the Achilles heel of hemodialysis because infections there can lead to treatment failure. Nurses remind themselves to use good aseptic technique when assembling the needles so as not to become the unwitting agents of infection.

For the diabetic patients (diabetes being the leading cause of adult kidney failure) the nurse checks blood sugars and performs foot checks, watching for foot sores which, if unchecked, can lead to infection and, even, to amputation.

Dialysis Begins

Once the morning's meticulous preparations are done, patients are connected to their dialysis machines using a large gauge fistula needle. Heparin is given to prevent clotting, intravenous, bioengineered EPO to stimulate red blood cells and IV iron. Sometimes IV antibiotics are used.

Besides medical care, a nephrology nurse also tends to the emotional and social needs of her patients. For many, these problems are the most daunting. Do you have a ride home? Can you afford your medications? How's your appetite? (A critical question when nausea, the body's imbalance, and dietary restrictions make malnutrition and anemia all too common). Let's go over the list of foods that are low in potassium and phosphorous. Remember that you can only drink one quart of water a day, including juice and Jell-O and ice cream. Is it easier to swallow those new capsules? Is the boss more cooperative? Is something bothering you today? Want to talk?

Some days there are potentially "catastrophic events" -- on dialysis for a time, someone's blood pressure drops; someone else becomes short of breath; a blood line disconnects. A nurse must act quickly to adjust the therapy and prevent recurrences. Constant vigilance is necessary for proper administration of this complex therapy.

Nephrology Nursing Today

The caseload for a nephrology nurse is increasingly complex as well. Today, patients with end stage renal disease are older and sicker than they used to be, struggling not only with the effects of the primary diseases that caused their kidneys to fail (predominately diabetes and hypertension), but also with the myriad conditions that aging brings. Nurses monitor all of these diseases and their treatments, watching for medical contraindications and the implications for dialysis. In addition, nurses must follow precautions against exposure to patient-borne diseases, such as hepatitis and HIV, which could kill them.

Besides the high pressures of the job itself, nephrology nurses are keenly aware that the dialysis care sector as a whole is pressured by increasingly inadequate reimbursements from Medicare. As the only health care sector without a method to receive increased reimbursement on an annual basis to reflect rising costs, dialysis clinics are often unable to pay nephrology nurses as much as they could earn in hospitals or other settings. The national nursing shortage and pay differentials have cut deeply into the pool of nephrology nurses, necessitating the training and supervision of more technicians for some tasks nurses used to do, even as the number of patients and the complexity of their illnesses increase.

Still, despite these challenges, nephrology nurses have been part of a sector that has implemented constant quality improvements. Safety improvements have increased on the machines, particularly with the ability to remove and assure the accuracy of fluid removal. Years ago, all of the calculations of pressure, fluid level, blood flow, had to be done and set by hand, all of this is calculated automatically today. There is much less chance for error. New dialysis products that are more biocompatible with the patient, or gentler, promoting better cleansing, reduced rates of infection, and fewer adverse events. Some new improvements that permit greater removal of water from the blood have also reduced patients' nausea. In addition, artificial kidneys called dialyzers are now available in different sizes, permitting nurses to fine-tune the circuit to the size of the patient.

Every day nephrology nurses link their patients to more than just a dialysis machine, they provide a link to a longer, healthier life.

Hope that helps.

ktwlpn, LPN · Aug 12, 2004

I have just accepted a position in a chronic dialysis clinic. Will recieve 6 weeks orientation. Just wondering if any of you "seasoned" dialysis nurses have any advice?? Any books, websites that you recommend? Have been doing Tele for about 2.5 yrs and welcome this change, always been interested in dialysis. Thanks in advance.

THis forum is very informative-also look for posts from jnette-she is a great resource and always happy to help........She can hook you up.....

nursing04 · Aug 12, 2004

You had a question about the day in the life of a nephrology nurse.....see if this helps. If I can help you - please send me an e-mail. I have groups that are willing to train RN's - Happy to give you that insight. It'll be fun to see you evolve.
Day In the Life of a Nephrology Nurse...

Thank you so much for the information!! I am definitely going to look into this career path further. It seems so interesting and challenging.