Experienced RN new to HD Sad and discourages.

[Melissaharvey913]

Hello I hope I can find some encouragement here and/or good advice. I'm going to try not to make this too long and grueling. I've been a nurse for about 12 years and I've done numerous things I spend a lot of time working labor and delivery and high-risk obstetrics. This area requires critical thinking skills,collboratiob with pvysicans, anesthesia,NICU and if be disciplins. I learned to scrub as a nursing student and spent a lot of time in the OR and ran very busy triage areas. I worked with large physican groups who learned to trust and value my skills. I have also worked, LTAC, led/surf and home health care.

I have always been interested in dialysis and applied several times. Until recently some of the big 2 required HD experience so I was never lucky enough to even get an interview. I recently accepted a position as RN Staff at a big HD provider in what I have been told is a large chronic clinic. We have 42 chairs and run two shifts. I have been in class room time combined with clinical experience. I have passed all my required test including the final nursing exam. I only scored 89 percent but did not study and just applied the info I was given.

Once I completed the test the RN educator for our clinic was called quickly and he made a visit to do my check offs. Once I was finished my preceptor stayed he reported I did very well. Bothe her and my manager stayed that was impressive coming from him and he doesn't usually give that type feed back. Because the cli,ic is understaffed and I was told in the interview I would need to run a 4 patient track independently before moving into RN training I was immediately scheduled 4 12 hour shifts.

I was informed once I was proficie,t and comfortable I would love into RN training I my manager would let me know when that happens...I was doing fine except for getting some patie,ts started 5-15 mins after their schedules on time but I was told speed would come. I have been with many different preceptors all techs and questioned charting and some issues I would have addressed as the nurse but was told that wasn't part of the job. One morning I came in late because my care had some issues and I didnt have my 45 mins of preparation I had been alotting for. In addition the tech prepaid bicarb was behind and the water was in the lines till late delaying machine testing. Needless to say patients were angry and frustrated before they made it to their seats....I became nervous and in trying to make everyone happy started rushing and reversed the lines on a patient fistula..he did not bring it to my attention but called over the acting RN whom alerted me and I corrected it. She however went to the manager who decided to after 3 weeks out me back with a preceptor.

I always always do what's best for my Katie rd safety and we'll being..I was embarrassed and explained the situation...The preceptor I am working with always finds an issue with what I am doing....During training not once, and this was 10-12 weeks, did anyone adult my charting.Now charting is being audited and I have been advised by some techs to chart this then I'll be with another that will state no chart that..I feel as if everything is being picked apart. Of I chart like I would if I was the primary nurse I am ask to take the info out. I have questioned even early in training why some issues with the Katie rd were not addressed and was told that isn't out job we only dialyze. The last few weeks I went as far as one nurse writing down what to chart and it was the bare min but we do have the charting without exceptions and the Cath care, heparin entries and set up to point click so it could work....one certain preceptor will taunt me and went as far just last week..she calls across the room your next Katie rd needs to be running in 10 mins I thanked her and said I am ready can you please just give me a review...she states yes I'll be right there but I have to do something first....she never returned..After 5 mins I retrieved help from another co-worker and got the oatie,t started...She has shared with me when patients request an early discharge she disappears and even admitted to doing the same when they request her to start their access and she doesn't want to and/ or feels like they should allow the tech working with them permission to do it...imBased on feedback from the nurse who provided me with basic charting templates I though felt tho,'s were going well...

Also currently we have 4 nurses one is getting ready to hit her 1 year date and I was told she had to spend 6 months as a tech and several co-workers stated she wanted to quit everday and. The tech who left me to drown even stated oh you should have seen how bad co-workers and patients treated her..One it he of the 4 has less than a year as a RN all together...I have worked as hard as anyone can...I am taking orders from all different people one says do it this way another do it that way....First I am confused as to why I worked 3 weeks alone after passing my exam prior to any issues be discussed, second why didn't someone address these issues before now.

Today when I went into speak with my boss I was confident the tech had relayed the same info to her...I was doing well she even made the comment I knew what I was doing now just do it...to my surprise she told her she was at her wits end with me......I know she was expecting me to throw in the towel but I refused I give safe, professional,compassionate nursing care.

If I were the primary RN I would address issues and contact the physicans office and discuss the fact his patient is taking Coumadin and was discharged from his orderi,g physician,has failed to find a replacement but is still taking the same dose...I was informed one hour of bleeding would need to occur before it's consdered increased bleeding,ideas also informed of I note this in us chart I would need to follow up with the outcome and we only administer HD..I said I was taught holistic nursing and that would inculde informs g his doctor.....

During this review my preceptor never sit in when I explained my confusion and her feedback with me she was called in. I do know the clinic has an enormous turnover rate. When I started I was informed it was because the patients were mean and when I received my survey call from HR on training I needed to let them know..In the end I explained it did not matter my opinion because I wasn't being heard..I also included that obviously I was just stupid and not capable of doing this job...with the reply from all parties in the room I was very intelligent and that was obvious ...how can you be both...I have seen yellow lights on for consecutive treatments were patie,ts goals were not meet yet nothing was done...

My manager stated with my experience and knowledge her plan was for me to be one of her strong floor nurses but she didn't feel comfortable allowing me to run my own track again and I needed to prove that skill prior to movi,g I to my nurse training...again I stated it didn't matter what I thought because she was only listening to this preceptor...

The end plan is I am going to another clinic for three days consecutively were the nurse manager will observe my skills and determine my skills. My manager stated that I could get an unbiased opinion and that mAybe they were being bias and no matter what I did they trainer would still think the same...I have been with several other preceptors who did not feel the same...

If your still reading please help...should I just design? I love this job and the patients I am consistent in education and believe the huge lack of is part of the problem in healthcare. I feel I can bring some positive impact to patients at my clinic and with time be a good educator and mentor for new nurses were I am at now....I am I just stupid and need to move in? I would appreciate any help. Thank you

[SmilingBluEyes]

Please, break this down in paragraphs. I simply can't follow one long stream of thought paragraph. thanks.

[nurseontheway]

Dialysis is a grueling field. I have learned that you either love it or hate it- it had to grow on me. The patient population can be difficult and stubborn. It can take them years to come around. The staff can also be difficult until they get to know you. You sound like you are very experienced with different specialities and dialysis is a very specialized field. I think that you should give it some time. If you need someone to vent to feel free to send me a message. I've been through all types of situations.

[traumaRUs, MSN, APRN]

I edited the post into paragraphs for easier reading.

I'm a nephrology APN for 10 years now and did not have any dialysis experience prior to coming to this position. It is very technical type of nursing. However, once you have the routine down, you will be set. There is a steep learning curve. Please don't be too hard on yourself.

[Chisca, RN]

Because the clinic is understaffed....

You have identified the problem and it is not you. Depending on how much you want this dictates your next move. Unless you just can't stand it I would stick with it. I have yet to meet the nurse that can't be trained to perform dialysis.

[nutella, MSN, RN]

Ok - the fact that you will work at a different clinic and be evaluated by somebody else makes me wonder if they consider letting you go. Nothing is ever "unbiased" Clinic managers and staff know each other within the same area.

HD is an area that is not for everybody.

Forget about holistic. HD is more like a "service" and highly regulated. You focus on that service and do not get involved in all kind of other things. Because it is also financially driven like all other aspects of healthcare, it is important for the company that certain goals and standards are met.

The usual thing is to get the HD tech training down first and if the nurse is able to manage and practices safely they get trained in the nurse portion. It is normal to struggle around with the HD tech part for at least 6 months. But there needs to be supervision and sufficient training.

The first priority is safety in HD. And that means that you have to follow all steps and protocols all the time. If you get rattled and rushed you will make mistakes that can kill a patient. You need to focus and don't get distracted by other stuff.

Reversed lines is of course not good - the patient was right to point it out to the nurse. Patients know what the standard is and they will tell the trainer or manager when staff does things wrong because it can be dangerous.

Of course if your lights are yellow it means that your Kt/V is not within target and that also means that the patient does not get the cleaning they need and further the numbers reported will be not good, which will result in other problems from medicare - the clinics have to show that they are able to provide a good service (value). If you do not do something to correct a yellow line situation it shows them that you do not understand how it all works and /or do not think it matters.

It seems that they do not consider you as a safe worker at this time. Also it seems you are causing some ruckus by questioning how dialysis works.

Perhaps dialysis is not for you.

[Chisca, RN]

Let us know how it works out for you.

[Melissaharvey913]

Well I appreciate your honesty. I actually have been the one pointing out the yellow lights and if I were the primary nurse would contact the doctor to make them aware....I keep hearing about safetly which absolutely number one. I understand what your saying the cost involved, the clinic is making money solely on providing treatments and this is the task at hand..I am asking here was I wrong in accessing the oatie,t and trying to uncover why his access took excessive length of time to clot? Should I have just had some one hold it and once it did wrap him up and say ....get yourself a new doctor to manage your Coumadin dose and moved on? Should I have left out the increased bleeding part of my note...because I was asked to remove it. I have since discovered from my education department the policy states bleeding greater than 20 mins should be investatgated.

I did step out of the nurse role and just learned the machines. Then was told it's my job to check charting of the techs as licensed personel and needed to know what should be included. I ask many times and most out the very minimal some nothing at all. I did start reading some checklist for RNs today and noted the specfics of what need to be verified. I am very confused at how things run. It would be nice if someone could just say you don't have time for that. I am comi,g to learn that nursing has changed so much. I feel like I'm not just dialysis but in other areas facilities tech one process and have very specfic policy to lay out the right way to do things but in the end it's all about the dollar and basic safety. There isn't time to access patients, identify needs, and the come up with a plan. I am seriously starting to doubt this profession is for me at all anymore. Thank you for the info.

[Melissaharvey913]

Well I appreciate your honesty. I actually have been the one pointing out the yellow lights and if I were the primary nurse would contact the doctor to make them aware....I keep hearing about safetly which absolutely is number one. I understand what your saying the cost involved,, the clinic is making money solely on providing treatments and this is the task at hand..I am asking here was I wrong in assessing the patient and trying to uncover why his access took more than the average length of time to clot? Should I have just had some one hold it and once it clotted, wrap him up and say ....get yourself a new doctor to manage your Coumadin dose and moved on? Should I have left out the increased bleeding part of my note...because I was asked to remove it. I have since discovered from my education department the policy states bleeding greater than 20 mins should be addressed

I did step out of the nurse role and just learned the machines. Then was told it's my job to check charting of the techs as licensed personel and needed to know what should be included. I asked many times and most techs charted the very minimal some nothing at all except clicked treatment started. I did start reading some checklist for RNs today and noted the specfics of what need to be verified. I am very confused at how things run. It would be nice if someone could just say you don't have time for that. I am starting to think nursing has changed so much it's not what I learned in nursing school. I feel like not just in dialysis but in other areas. Facilities teach one process and have very specfic policies to lay out the right way to do things but in the end it's all about the dollar and basic safety. There isn't time to assess patients, identify needs, and the come up with a plan. I am seriously starting to doubt this profession is for me at all anymore. Thank you for the info.

[Mpagnano]

It sounds like you are in a challenging clinic. Often tech don't trust new people and aften do the old sink or swim. It takes a year before you start to feel comfortable I say stick it out and do not conform to negative peer presure. Continue to think of patient first. What's the harm in following up with the post treatment bleeding if doctor says nothing you can still chart that and cya. Change is not easy but you could be that change. If you set higher standard others will follow you just have to prove that you are worth following

[liamia]

i can relate to your situation. although i'm only a PCT in our dialysis clinic i have a staff nurse(medical-surgical private hospital) experience in another country.

Im still waiting for my authorization to test and i hope i will get my license because i think dialysis is really not for me! it sounds like we have a time limit per patient, They want us to hook each patient for 5-10 minutes and then go to the next patient. it's all about rushing! now where is the patient's safety there? i cannot practice compassion or empathy because we always have to rush. lol

PCT's in our dialysis clinic also act as BIOMED, we do the bicarb mixing at the back while doing patient care and shut down the clinic(rinsing the large tanks, closing it) if you have the 2pm-10:30pm shift. every saturday we also have to do the bleaching of the large tanks at the back so we have to work 2pm-11:30pm.

sorry for ranting here, maybe i was just used to floor nursing in our country that's why i don't like the way of the dialysis clinics here. we use to have 14 patients per nurse back home and it's a private hospital, not even government, it was hard but i was still able to manage because there is no time limit, though we have to act fast too. i've only been working for 1 year in our clinic but somehow i got use to their technique. also the good part in our clinic are my co-workers and patients, they're all friendly and nice, i love them!

but i'm still hoping i can get a hospital job someday(although i know it's more hard in the hospital) and i really think it depends on the interest where we can excel.. :)

[Melissaharvey913]

Thank you so much for sharing. You will get your nursing license hear. I am not familiar with the entire process but several RNs I have worked with have given some grueling info lol hang in there. I love this job and enjoy all the different aspects,but not having co-workers to embrace you and encourage ti,gmakes it difficult. They tell me one tho g to my face and then say silly things to my manager. Never have they brought in my preceptor with me to discuss things. She goes in alone then at some point I am called into to discuss progress. Idk Ian letting go and sitti,g God handle it...I don't know if this is were I am suppose to be. Thank you again.