Frustrated

Trauma Columnist · Dec 18, 2014

Hi and welcome to AN - the largest peer to peer nursing network! This is a pretty active forum and others will be along soon to help sort this out.

Chisca, RN · Dec 19, 2014

Are any of the other nurses more efficent than you? Or are they quicker because they are taking shortcuts? If your clinic is one that the director is going to tolerate cutting corners to achieve productivity you are pretty much screwed. Continue to do what you know is right for patients, do not take shortcuts, and realize that it takes about 10,000 hours to become a master at anything.

NurseRies, BSN, RN · Dec 19, 2014

It takes a long time to become quick and efficient in a dialysis center. There are plenty who cut corners, but there are many who do not. There are corners that are being cut that do not directly affect patient safety and then there are those that do. In the nursing world, it is often shocking to new grads that many experienced medical professionals do not always follow all the rules. You will see plenty of nurses AND doctors who rarely use gloves, this is not just in the dialysis field. If you truly believe that patient safety is affected, then you can bring it up to the manager. I recommend doing things the way you were taught, follow the policy and procedure, get a routine, and speed will come with time.

If there is someone at the clinic that you particularly respect, ask them how they learned efficiency. Often times in the dialysis clinic, it is about having a very organized routine. Stay 3 steps ahead of yourself at all times. When I used to run a pod of patients, I would set out all neccessary supplies for changeover long before it started. I anticipated needs before they were asked, like I know one lady needed IV benadryl right away. When I saw her walk in the door, I would go draw it up and be prepared. Playing catch up or being in the weeds all day is certainly chaos and no fun. I do believe that there are those that thrive on being busy and those that do not. Multi-tasking is a must and you must make priorities. Can one patient wait an extra 5 minutes to get his tylenol so that you can get another patient finished up and taken out to the lobby? Probably.

May I ask, what kinds of things are getting missed or not done? What are your biggest concerns with co workers? Do things the way you were taught and then when they get on your case about being slow, you simply respond, "there's a fast way and a safe way, and I am only comfortable doing things the safe way". Remember, this is your job, your license. You must work at the pace you feel safe about. Don't let timing and appointment times pressure you. Speed comes with time.

seppuku · Dec 21, 2014

Here is what I know. The field of nursing does not allow time for everything to be done by the book, it is impossible. EVERYONE does shortcuts. Shortcuts such as drawing all your meds at the start of the day, using clamps on every single patient, rinsing back patients the fast way, etc... I think it's good to know the right way of doing things AND know all the shortcuts. Time management is the single most important trait a nurse can have. NOT the ability to do everything by the book. Always know how much time you have for each task and do that task as closest to the P&P with that amount of time. If you have to shortcut, as one of the posters above said, make sure it is still safe for the patient. There is ALWAYS more than one correct way to do things. Look at your situation as a whole and do what you think is best. The last thing you want is have patient crash on you because you ran off to change gloves and wash your hands with soap and water for 15 seconds going between patients.

SmilingBluEyes · Dec 23, 2014

I think you are being way too impatient with yourself. I have been a dialysis nurse 3 years and it took me at least a year to get a "routine" down. 10-12 patients are a lot to keep up with. You will get to know them better and better and be able to anticipate potential complications and issues ahead of tie.

I agree with those saying to stay 3 steps ahead or you will fall behind. As you know dialysis, and your patients better, you will be become more adept at anticipating and working ahead. Shortcuts are not good for obvious reasons and you will have to give yourself time to get it all done. Don't be afraid to ask questions and ask for advice. BUT go easy on yourself. You are still quite new and it will take time to get it all. At 3 years, I have 12 patients and 3 techs working with me. We have a great team going and support each other. Those techs can be your best friends on the floor. Do take the time and energy to cultivate good working relationships with them; they will save your butt many times.

I am very organized and rarely fall behind. I can tell you, that is from plain old experience and learning. It just takes time. In a year, you will feel much better! Trust me.

SmilingBluEyes · Dec 23, 2014

Also, it could be your patient schedules making it hard. Turnover can be rough if there is not sufficient off/on time between patients. I always found turnover to be so stressful until I just got used to the routine and was able to get things done. Again, 4 months is not long; you need no less than a year to get it all down.

moojie · Jan 27, 2015

It's hard. It takes time. I remember when I first started I would freak out when a patient arrived and the machine wasn't primed, tested, and ready with supplies. I'm now at the point where if this is the case, it's likely because this patient takes a while to set up his/her things, wash the access, go to the bathroom, weigh, etc. You learn how to manipulate the shift and manage your time as you learn the craft and your patients. There will be times when no matter how punctual you are, a wrench is thrown into the schedule because of a patient emergency. Also, do not be afraid to ask for help (from PCTS, CNs, and even the CM if it gets crazy) and do not be afraid to say no, or ask someone to wait. Two patients coming off at once? See this ahead of time and warn them. They will appreciate the heads up when you are running back and forth changing ur gloves, rinsing back, removing needles. Never cut the corners you feel are necessary. With time you will get better at incorporating them in a timely manner. I know right now it may feel like you cant keep your head up to see the big picture, but soon enough you'll be calling patients in early and finding some breathing space to maybe even do some patient education or

progress notes. Best of luck! I would like to hear an update! (Ps- I have 4 classmates that went into HD after RN school, and each and every one of us felt we couldn't hack it, but we all did).

TNValley · Jan 28, 2015

From the viewpoint of a fledgling dialysis "lifer" (13+ years in this love it/ hate it specialty) ... don't compromise on P&P. You MUST know P&P as well as you know how to breathe or blink or stare blankly into space etc. Speed comes with repetition; when you do things the right way over and over, it'll become second nature to you ... and when the state surveyors show up you won't break a sweat