New to dialysis

[jmtmom]

Hello everyone!

First let me say that this is an excellent forum. I'm very grateful that there are so many nurses out there to talk to and learn from.

I'm a new nurse (graduated May 2002), and went directly into ICU. Intensive care is OK, but I don't think it is THE place for me. It's not that I'm not handling ICU; I feel pretty comfortable, and some days I enjoy it. In the course of my job, I get to speak to nurses who come in to dialyze the patients. It seemed interesting to me. So I took the plunge and accepted a position in an outpatient dialysis clinic. I don't actually start until the end of this month.

I'm very open to any suggestions as to how to make the most of my orientation. Any books I should read besides the materials supplied to me in orientation?

I'm very excited about my new position. After reading this forum for the past several months, I find it interesting that dialysis seems to be one of the few areas of nursing where the nurses are positive and like their jobs!

Thanks for any input you can offer. :)

[Hellllllo Nurse, BSN, RN]

Hey JMtMom,

Well, I am officially done w/ my orientation. I am going on a trip in the am, and will be on my own when I return to work in a week!

But, there is always someone around to help, so thankfully, I won't be totally on my own.

I think getting to know the machines is about the hardest part. Also, it's hard to think sometimes w/ all the noise. My unit is very noisy.

Understanding if a pt's EDW (estimated dry weight) is really accurate for them, takes some good assessment and thinking. Not really hard to do, but there is a learning curve to it.

Here is my list of "always" and "nevers"---

Never leave your pt when you are returning blood.

Never leave your pt when you are just starting their tx.

Never allow a pt's access to be covered by a blanket, etc.

It must always be visible.

Always remember to double clamp your saline.

Always check your clamps- Is what should be clamped really clamped? Is what should be unclamped really unclamped?

Organization and time mgmt is important, as it is always is.

An example-

If you have several cath pts who need their dsgs changed, get them on the machines and have their tx going first, then go back and do the dsg changes after everyone is already on tx.

When taking a pt's needles out, have a sharps container w/ you. A couple of times, I've pulled a needle out, I am holding pressure on the site w/ one hand, and realize I don't have a sharps container w/ me. I have a bloody needle in one hand and am holding pressure on a site w/ the other.... So, I've had to call out for a co-worker to bring me a sharps container.

At my unit, only Hep B pos pts are in isolation. We have HIV pos and Hep C pos pts, whom are not dialyzed in isolation. Always treat all pts as if they were pos- Always wear your gloves, apron and face sheild. Sounds basic, but I am surprised at how many of my coworkers I see not wearing their face sheilds. There is a lot of blood in dialysis work.

I had dialyzed one pt w/ LifeSites several times before I learned he is Hep C pos. I'm glad I always wear my PPE! (personal protective equip).

Another nurse was taking him off yesterday. She didn't wear her face sheild, and some of his blood splattered all over. Luckily, it didn't get on her face.

As a nurse, I am used to always feeling competant and knowledgable about what I'm doing.

Well....dialysis is so different and there is so much to learn, I've been feeling like a real novice.

My ADON tells me that she's had several ICU nurses quit before completing their orientation. She told me the reason for this is that ICU nurses are so used to reacting fast, and knowing exactly what to do- and then they start dialysis and don't know what to do when something happens, and it throws them.

When I told her a couple of times in my orientation that I was feeling overwhelmed with it all, she told me that it is perfectly normal and par for the course for a new dialysis nurse.

I had a pt this week throwing up during tx. Another nurse told me this is normal for this pt. Well, I checked, and he was eating potato chips during his tx. Had them hid in his blanket, lol. Did some teaching w/ him, re: K+, Na+, and eating when nauseated!

Had a pt this week, B/P kept dropping during tx. Questioned him and he told me his nurse at the nursing home insisted he take his am B/P med.

I called, and asked them to note it in his chart and MAR that dialysis pts (generally) are not to take any meds that have an anti-hypertensive effect before dialysis tx. This is really important for dialysis pts.

Well, I envy you moving to AZ. I left AZ about two years ago. I really miss my home state!

I hope you enjoy your new job in dialysis. I know that I am really excited about learning this specialty.

I really needed a change in my career, and I think that dialysis nursing was the right choice for me.

[jmtmom]

Hi Helllllo nurse!

Thank you so much for your input. I will take heed to everything you said.

Okay, ICU nurses start reaching for the vodka when something goes wrong and they don't know what to do about it. But, doesn't everyone? How have you dealt with this situation of not having the slightest idea about what to do?

Another question: How kind are the patients to new staff? Are they nice to you or do they huff and puff and say, "get somebody over here who knows what they're doing".

What part of Arizona are you from? I can't wait to get out there. Where did you move to? Just curious. Maybe it's none of my business.

Well, have a good trip! And good luck with your first day on your own.:)

[jnette, ASN, EMT-I]

Hi jmtmom ! :)

Helllllo was wonderful in her advice. Right on the money.

My suggestion to you is to NOT expect too much out of yourself for a good while, and do NOT be bummed if the learning comes slowly. Just learning to set up the machines takes a good while in itself... it REALLY does !!! Our DON always tell new staff to give themselves a good year before feeling really comfortable with things.

So don't think you're a slow learner or get down on yourself, and don't let anybody "rush" you !

We don't allow our patients to eat while on the machine. First, there's too much bloodhazard...second, if they eat, there is already so much blood out of the body, that what they do have left then goes to the digestive system, and they drop their pressure quickly. So our docs say a big fat NO to eating while on the machines ! We do allow them to suck on hard candy, if their mouth is dry or they are thirsty. Lemon drops work nicely. We have our sharps containers attached to the side of the machines, so they are always handy.

We use mannitol if they really lose their BP, and hypertonic saline (10ml) if they are cramping badly.

If a "in" weight seems odd compared to the previous "in" weight, or the patient's last "post" weight, have them reweigh... double check.

Hellllo pretty much covered everything, though. When you start, I know you'll still have a million questions, so we'll just be right here for you !

Where exactly will you be going now in Az. Have you decided on a clinic there yet?

Be sure to keep in touch and let us know how things are going for you, OK ? And remember... don't get discouraged... you WILL learn this !!!

Take care !

:kiss

[jmtmom]

Hey Jnette!

You guys are so sweet!!! I really apreciate everyone's support.

I won't be moving to AZ for another two years. It will be Phoenix area, but not sure which town (Mesa, Chandler, Glendale, etc.) Therefore I have not settled on a clinic. I'll narrow it down more as the time gets closer for the move and we find a house. Travel time is a factor. Don't want to have to make it to work in Litchfield if I live in Gilbert. So we'll see. Hoperfully I'll find a clinic I like that's not too far form the house we buy.

My husband and I have been lookikng around out there, and I'm pretty sure we'll settle in the east valley. But who knows? A lot can happen in two years. I might end up in Tucson for all I know.