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
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.
i feel for u dear, i noticed that too in our clinic when they hired an EXPERIENCED nurse they only trained her for 3 days and also without a preceptor which is very risky! specially in your case, you don't have a background in dialysis right? and re: your co-workers, that's really hard to deal with since your new in the facility they should be more understanding and instead of helping you, looks like they back bite you.
i remember when i was new, at first some of my co-workers didn't like me specially the senior ones(PCT/LPN) but when went to work on my own(without a preceptor) i noticed they're not annoying anymore and we clicked and suddenly we get along! although there are still 2 nurses that's really annoying, even if you warm up to them they will not do the same. LOL
I realized, maybe that's really the nature or culture in dialysis, THE MANAGEMENT will make it hard for the employees because it's all about the profit so they always wanna save money! but at the back of my mind i always ask myself, how can you hook a patient in less than 10 minutes if some of my patient's need a HOYER lift, i can't just rush the 350lbs patient going to his chair because he's also weak. and some patients are too slow to walk or in a wheelchair and we have to weigh them, make sure they washed hands and their access before getting their vital signs etc.. there was also a time that i have to take 5 patients instead of the regular 4 patients per PCT protocol. but we can't do anything because we are UNDERSTAFFED or we have LOW CENSUS that time so FA will make sure 1-2 staff PCT/LPN will go home early to save up money. we always have to deal with getting mandated NO 10 hour sleep and do a 16 hour shift if one of our co-workers call in sick.
I totally agree with you when you said: There isn't time to assess patients, identify needs, and the come up with a plan.
that's usually what HD nurses end up, not enough time to assess and take care of them because the facility wants us to finish early to save money.. tsktsk
i suggest maybe try for 1 year as an HD nurse, you might get used to the culture and love it in the end(you'll never know :)).. as you've said you always want to be an HD nurse. I'm just wondering why you didn't apply as an HD nurse in the hospital? i think it's easier to be an RN there than in the clinic. because in the clinic you have 24 patients total per 8 hour shift... so it's really stressful! i think in the hospital they only have maximum 2-4 patients right?
but for me once i get my RN license i really want floor nursing(i know it's hard) but it's what interests me. though i still want to be on call even as a tech or LPN just to help our clinic to give back or repay the experience i gained through them. i love my work in our dialysis clinic, i just don't like culture they made.. if only they can change the system..
I just want to start off by saying, this is a really wonderful site. I have been so blessed to receive all the encouragement and feed back from people with so much knowledge and experience. Kind words,sincere concern and care in their hearts,just like you. Thank you for taking the time to share so much it really does help. I have had a bad experience but also learned a lot. The best part of joining Allnurses, has been discovering that yes dialysis is a tuff place and the culture is different than any I have experienced. But wonderful caring nurses are out there in the dialysis clinics too.
In my clinic the PCT s were gathered around and one said,"Only the strong survive here". So remember all you ladies and gents out in the field of HD are some tough cookies...kudos...Keep making a difference.
Also,does anyone have experience with the big two clinics. Can we say names on this site? I was hoping to get input on Fresenius vs Davita. My manager advised me the Davita culture trains their nurses differently. Any input would help.
liamia
9 Posts
i feel for u dear, i noticed that too in our clinic when they hired an EXPERIENCED nurse they only trained her for 3 days and also without a preceptor which is very risky! specially in your case, you don't have a background in dialysis right? and re: your co-workers, that's really hard to deal with since your new in the facility they should be more understanding and instead of helping you, looks like they back bite you.
i remember when i was new, at first some of my co-workers didn't like me specially the senior ones(PCT/LPN) but when went to work on my own(without a preceptor) i noticed they're not annoying anymore and we clicked and suddenly we get along! although there are still 2 nurses that's really annoying, even if you warm up to them they will not do the same. LOL
I realized, maybe that's really the nature or culture in dialysis, THE MANAGEMENT will make it hard for the employees because it's all about the profit so they always wanna save money! but at the back of my mind i always ask myself, how can you hook a patient in less than 10 minutes if some of my patient's need a HOYER lift, i can't just rush the 350lbs patient going to his chair because he's also weak. and some patients are too slow to walk or in a wheelchair and we have to weigh them, make sure they washed hands and their access before getting their vital signs etc.. there was also a time that i have to take 5 patients instead of the regular 4 patients per PCT protocol. but we can't do anything because we are UNDERSTAFFED or we have LOW CENSUS that time so FA will make sure 1-2 staff PCT/LPN will go home early to save up money. we always have to deal with getting mandated NO 10 hour sleep and do a 16 hour shift if one of our co-workers call in sick.
I totally agree with you when you said: There isn't time to assess patients, identify needs, and the come up with a plan.
that's usually what HD nurses end up, not enough time to assess and take care of them because the facility wants us to finish early to save money.. tsktsk
i suggest maybe try for 1 year as an HD nurse, you might get used to the culture and love it in the end(you'll never know :)).. as you've said you always want to be an HD nurse. I'm just wondering why you didn't apply as an HD nurse in the hospital? i think it's easier to be an RN there than in the clinic. because in the clinic you have 24 patients total per 8 hour shift... so it's really stressful! i think in the hospital they only have maximum 2-4 patients right?
but for me once i get my RN license i really want floor nursing(i know it's hard) but it's what interests me. though i still want to be on call even as a tech or LPN just to help our clinic to give back or repay the experience i gained through them. i love my work in our dialysis clinic, i just don't like culture they made.. if only they can change the system..