What do Dialysis Nurses exactly do?

schnookimz · Dec 23, 2013

I do acute dialysis in the hospital. So here we go....

Arrive in the morning, usually between 7-8am and get info on my first patient. For the most part, we do the treatment in the patients hospital room because the hospitals I travel to do not have dialysis rooms. I get all my supplies together, bags of .9, flushes, 4x4s, needles or catheter supplies, etc. I review the patients labs and orders and call the doctor to adjust if necessary.

I line my machine with the tubing used for dialysis and prime the machine. The dialysis machine also connects to a reverse osmosis machine so I get that out of storage.

Now I have my dialysis machine, supplies, RO and paperwork and I am ready to drag it all across the hospital to the patients room. Getting all this ready probably takes about an hour.

I get to the patients room and hook up my RO to the sink in the patients room. I need to wait 15 minutes for the RO to run before I can check the water and make sure it is safe for patient use. During this time I try to do my patient assessment and get report from the primary nurse.

After 15 minutes I can check my water. If it safe for use, I can begin to fill my bicarb jug and prepare it for the dialysis machine. Once the bicarb is made, I can connect it to the machine along with the dialysate and get my machine into conductivity. Once this happens, the machine performs a series of tests. By this time, likely another 30 minutes has gone by since I entered the room. Once the machine has passed it's tests and recirculated, it is ready for use.

I access my patient and hook them up and get them running. Take vitals and monitor the patient during treatment. Try to provide education and answer questions for the patient and the primary nurse. Intervene as necessary. Sometimes I need to give blood, medications, or do lab draws.

I stay with the patient during their entire treatment. They can never be left alone. Not even to use the washroom!

When we are finished, I return the patients blood and often change the dressing on their catheters if needed. Then I need to clean everything up and get it going. I do a post assessment and hand off with the primary nurse.

After this, I can be on my way to my next patient. Typically one treatment with no complications can take about 6 hours between setting up, running the treatment and breaking down and cleaning the machine.

jadabraxton96 · Dec 23, 2013

Wow! Sounds like a lot but can be done and mastered over time with good training. Thank you for the incite.

Chisca, RN · Dec 23, 2013

Schnookimz left out the part where she had to figure out what plumbing adaptor would fit that faucet because the hospital couldn't possibly standardize the sinks in the building, or deal with the flooding from a dialysis box that wasn't installed properly, or the flooding one floor down when you didn't notice the drain line had fallen out to the floor. Or the hypotension one out of four patients will develop while on the machine, the trouble shooting of a catheter that was placed yesterday but won't work unless it is flushed every 10 minutes, or won't work unless you apply just the right pressure at the hub with your finger. Or the cut and paste progress note that the doc has written which totally contradicts the treatment order that was written the same day. Or the cramping from pulling the 5 liters the patient insisted you pull against your better judgement as they now argue you should end their treatment. These and many other joys await you should you decide you would like to try to become an acute dialysis nurse.

westieluv · Dec 23, 2013

True, Chisca. Add to that finding out at the end of a tiring 10 hour day that there are two add ons waiting in ER and guess what, you are the nurse on call for that hospital for that night and there is absolutely no one else to come and run someone because two of your co-workers just quit two weeks ago because they couldn't take the on call requirement or long hours anymore.

Then there is the RO and/or HD machine that you have just wheeled all the way to the patient's room, only to find that it doesn't work properly and must be swapped out for a different one so unhook everything, and start all over again.

Then there is the patient that you want to get started because you have two more after her, only to find out that she is starving, her blood sugar was 64 that morning, and she absolutely has to eat her breakfast tray before you can start her treatment, except that breakfast trays don't come for another half hour.

I'm not trying to be discouraging, and there are also a lot of good, or at least uneventful, days in acute dialysis, but I'm finding that too many times nurses get into this specialty thinking that all they have to do is sit in a chair and relax while the treatment magically runs itself and the patient tolerates it without any problems, then they get hired by a manager who is tired of hiring more and more acute HD nurses to replace those who have quit so isn't necessarily very realistic or honest up front when hiring them, if you KWIM, which only causes the quit/hire/quit/hire cycle to continue indefinitely once the reality of the job hits them in the face. It is a good job if you can hack it, but it's definitely not for everyone.

OP, I would really recommend you start out working in a chronic dialysis unit before moving to acutes if you do decide to pursue this field of nursing. Chronic is very busy too, but it is more scheduled and predictable. I have been a nurse for over 20 years, and I have never had a job as unpredictable as working in acute dialysis. Your day can change drastically, say from 10 hours to 16 or more hours, with one phone call. You will never know when you leave the house in the morning what time you will be coming home, so you basically can't plan anything on your days to work. At least in a chronic outpatient clinic they have to close sometime, but hospitals are open 24 hours. Also, the patients in the outpatient unit are obviously more stable than patients who are acutely, many times critically, ill in a hospital, so it is less likely that they will crash. In the event that they do, you call 911 and they are transported to the hospital and you are done with them.

Good luck with whatever you decide to do!

schnookimz · Dec 23, 2013

Lol you're both so right. I didn't want to scare her!!!

Guttercat, ASN, RN · Dec 31, 2013

Schnookimz left out the part where she had to figure out what plumbing adaptor would fit that faucet because the hospital couldn't possibly standardize the sinks in the building, or deal with the flooding from a dialysis box that wasn't installed properly, or the flooding one floor down when you didn't notice the drain line had fallen out to the floor. Or the hypotension one out of four patients will develop while on the machine, the trouble shooting of a catheter that was placed yesterday but won't work unless it is flushed every 10 minutes, or won't work unless you apply just the right pressure at the hub with your finger. Or the cut and paste progress note that the doc has written which totally contradicts the treatment order that was written the same day. Or the cramping from pulling the 5 liters the patient insisted you pull against your better judgement as they now argue you should end their treatment. These and many other joys await you should you decide you would like to try to become an acute dialysis nurse.

I LOL'd!! :) I kept nodding yup, yup, and yup as I read through.

Don't forget when the connector breaks free from the water source and you get drenched from head to toe. :)

NurseRies, BSN, RN · Jan 1, 2014

I LOL'd!! :) I kept nodding yup yup, and yup as I read through. Don't forget when the connector breaks free from the water source and you get drenched from head to toe. :)[/quote']
I like how when you get splashed with water, or the machine is alarming, or other random complication, the nurse can walk in and stares at you like, "umm are you new to this?" And sometimes patients too. Machine alarms and automatically we are clueless? I think not! I also get lots of "umm who the heck are you?" Looks when I walk around the nursing unit during report at 7. I even get some rude remarks, "can I help you?" Spoken with an attitude. Just another day in the autonomous and solitary world of acute dialysis. At least we can text our coworkers about our days and we know SOMEONE understands us.

sissiesmama, ASN, RN · Jan 1, 2014

Oh WOW! I don't know how y'all manage it! I don't think I could ever learn all that - my hats off to u dialysis nurses!

Anne, RNC

pookyp, LPN · Jan 1, 2014

Is there extra training for this?

NurseRies, BSN, RN · Jan 1, 2014

Is there extra training for this?

They usually give ppl 6 months training if you are brand new to dialysis. But if the program is really short staffed and you are an experienced RN, they may push you through in 3 months. Which is why many people prob quit. It was an easy transition from working outpatient dialysis to inpatient bc I knew how to troubleshoot machines, catheters, fistulas, and complications. Since I already understood principles and concepts of dialysis I felt comfortable. But unfortunately, the only way to learn how to troubleshoot is to have issues or problems. In the clinic, I saw 30 treatments a day, 4 times a week for 2 years before switching to inpatient where I may only do 2-3 treatments per day. So I saw a lot of weird occurrences and stuck a lot of fistulas. I don't recommend going into acute dialysis as a new grad or without some relatable experience. You will be all alone, no coworkers in house, maybe someone at a phone calls reach, but you've got to have a strong foundation knowledge of how dialysis works. It is embarrassing to show up to do a treatment and you can't stick the fistula. I have been called by someone new to travel to another hospital to stick someone. It is just frustrating for everyone. Anyways, I could ramble on and on. I love my job but it is only because I'm comfortable and confident in my skills.

As they all say, you will either love it or hate it.

shimaih · Feb 21, 2014

i cant imagine myself beig hooked up into the idea of being a dialysis nurse..all i really thought was so different from what you guys posted..thank u very much, a very informative and enlightens me much..kudos!