I Hate Dialysis

redknight · Nov 13, 2008

Sorry if it came across that she stated a joke. What she did say was that she would have sex with one of the techs.Iwas across the room and heard her statement and could`nt believe she said it. But. as I said I got written up because I laughed and my Mang. thought I should have not done such and it raises her concerns for my leadership abilities.But, keep in mind Iwas working in the role of tech. for the day and the charge nurse went and told the clinic mang.But as far as I know no one else had been spoken to and the whole clinic was laughing. Thats OK. I`m sure that she dosn`t like me and I have had comments from other employees that how I`m treatented with indifferance. :banghead:

soulofme · Nov 14, 2008

Lord, if they get all weirded out about that I would have been fired 1,000 x's...Im as unprofessional as they get but I keep my pts happy and laughing. I can be professional when the situation presents itself...but dialysis basically sux for the pts and they need some distraction from their time while on the machine. Sounds like you need to find a unit where the CM & CN don't have their heads up their ACES.....& I do charge 4 days a week...never had a complaint from my CM... :jester:

redknight · Nov 14, 2008

Thats the way I am too, Soul, I need to be light hearted with my days and enjoy them. This atmospher inwhich I`m in is just not cutting it. Way to anal. Its just not condusive for learning, you make a mistake and your written up. This is not what I had expected from the nursing world.It has been a hard transition for me. I was at my other job for 18 years and I regret at times of why did I leave a secure situation, but I did so wanted to be a nurse and I feel I`ve just hit one bad encounter after and other. I wounder if its because I`m older so there-fore the adjustments are harder. I have an interview with another diaylsis co. I like the work and chall.I hope they are more supportive.:bowingpur

workingmomRN · Nov 15, 2008

Redknight, since you have been a nurse for at least 18 years. you already know what professionalism is all about. It sounds like your CM and area manager are impossible to please. I have worked for someone like that in the past, and I dreaded every day that I went to work. Good nurses are too hard to find, they should be trying to encourage you & help you to learn how they want the nurses to manage the floor. As a nurse, even when you are working as a tech on the floor, you are still responsible as a nurse, which sometimes puts you in between a rock & a hard place. You need the techs to help & support you on the floor, but you still are not one of them, and you are not treated well by the other nurses it seems. I hope your interview goes well at the other dialysis clinic. I had a time about 2 years ago when I left a clinic I had been at for 5 years because of the same reason. The new CM wanted to get rid of the employees that had been there the longest because we were the highest paid (in order to keep labor costs down, increase the bottom line). So she watched everyone like a hawk & did alot of write-ups. I stuck it out for as long as I could, but eventually left, & job-hopped around for awhile because of bad experiences everywhere I went. I got very downhearted & wondered if I would ever find a home clinic. I even wondered if I needed to be a nurse anymore, but it all worked out in the end and now I have a great clinic to work in again. I hope you can find a place to call your own as well.

redknight · Nov 15, 2008

Redknight, since you have been a nurse for at least 18 years. you already know what professionalism is all about. It sounds like your CM and area manager are impossible to please. I have worked for someone like that in the past, and I dreaded every day that I went to work. Good nurses are too hard to find, they should be trying to encourage you & help you to learn how they want the nurses to manage the floor. As a nurse, even when you are working as a tech on the floor, you are still responsible as a nurse, which sometimes puts you in between a rock & a hard place. You need the techs to help & support you on the floor, but you still are not one of them, and you are not treated well by the other nurses it seems. I hope your interview goes well at the other dialysis clinic. I had a time about 2 years ago when I left a clinic I had been at for 5 years because of the same reason. The new CM wanted to get rid of the employees that had been there the longest because we were the highest paid (in order to keep labor costs down, increase the bottom line). So she watched everyone like a hawk & did alot of write-ups. I stuck it out for as long as I could, but eventually left, & job-hopped around for awhile because of bad experiences everywhere I went. I got very downhearted & wondered if I would ever find a home clinic. I even wondered if I needed to be a nurse anymore, but it all worked out in the end and now I have a great clinic to work in again. I hope you can find a place to call your own as well.

Thank you, I need to clear that I`ve been a nurse for only a year. I have been doing diaylsis for 7 months.Iwas at my other Co. for 18 years as a Phleb.

anurseadvocate · Nov 18, 2008

The small surroundings of a dialysis unit encourage a different type of culture than alot of health care settings. I have found that the dialysis-setting culture, as all businesses, etc., are unique unto themself, however, this setting is by far the most unique I have ever seen, especially with that related to staff/patient relationships.

Natkat, BSN, MSN, RN · Nov 18, 2008

I hear what you are saying. I`ve been at it as a new nurse for 7 mo. now. Iam an older person that took on nursing at a later time in life.But the situation that I`m in now is that, I do like the job. What I have ran into is that every mistake that I make I get written up for. The last one(which is a final written warning) was for laughing over a pt inappropriate comment. Now you have to know every one was laughing. It was more over that I could not believe what she said, that I was laughing over. It was presented to me that I need to show more control to the techs and not to lose control of the clinic. Also, Iwas working as a tech. that day and it was the charge nurse who turned me in.But, not a word was said by her to me nor any of the other staff nor to the pt. of what was said. The district manager sits in on these meetings and I tell ya she one nasty B-tch.I have not had a good exp. with Diaylsis due to these 2 women.I feel I have no recourse, but to try and stay out of trouble. So any advise from you more exp. Diaylsis nurse????//:bowingpur

I'm so sorry this happened. It sounds like you are a victim of bullying. Other people can laugh but you can't? Naw, that's silly.

As for being a tech that day, even though you are working as a tech, your major role is still a nurse, and so you will be held to a higher standard than the techs. What they are trying to do to you is silly, but just keep that in mind that that argument doesn't hold water.

I'll share a story with you about a nurse who worked as a tech. She was hired as a nurse and was paid as a nure, but didn't want to do the nurse's job. She refused to give meds, wouldn't charge and gave all the other nurses a hard time if they asked her to help. To me it didn't seem fair that she got a nurse's salary but had none of the responsibility. She just did her tech thing and sat on her butt when she was done with that. It was unfuriating. Why did she get away with it?

Really big boobs. She would rub up against all the male patients and flirt with them, so all these guys would tell the manager what a wonderful nurse she is, and how she's the best nurse they've ever had.

Anyway my point is that every place you work has politics. My advice would be try your best to get along with your coworkers and they will have your back. Nothing wins over a cranky staff like food. I had trouble being accepted by the staff at my clinic until I brought in a big chocolate cake. Suddenly I was very popular. Help them out when you see that they need help, and I'm pretty sure they'll overlook little nit-picky things that happen on the floor, like laughing at a joke. And though it may be tempting to want to pal around with the techs, I think it's better to have a little professional distance from them and assume more of a leadership role. Always, always, always treat them with respect and kindness, but take a step back.

Give excellent patient care be remain professional at all times. If they become too personal in their conversation, change the subject. Many dialysis patients have nothing going on in their lives and can become fixated on the details of your life. It's amazing to me how I told a patient something in passing, and they remembered it 2-1/2 years later. So be careful what you share with them.

Meanwhile sit back and observe. Watch your coworkers and learn. Learn who they are as people, what makes them feel important, what they're insecure about, how they interact with others, what role they play in the "pack". Are they the "alpha" dog or a "beta" or just one of the gang? Are there any splitters in the group? But once you know what makes me people tick, you'll know what to say to make them feel important and special and they'll love you for it.

Good luck.

Valerie Salva, BSN, RN · Nov 25, 2008

None of the specialties are for everybody. I am glad that Nursing offers a variety of specialties that suit the interest of different people.
What you have described here as your 'one day' of dialysis experience is very superficial. It takes months for one to have actual 'clue' of what it is. It is more than just a routine or repetition. I don't mind wiping the blood from the machine or the chair because I know this prevents cross contamination of germs. Not a single task done in dialysis is without a scientific rationale behind it. And , i guess this is what we learn in nursing school......back your actions with scientific knowledge. If you train a monkey for a few months, I am sure he will also learn how to amputate a leg but it does not make the monkey a surgeon. Wiping the machines with bleach water will never make me a housekeeper. There is so much more challenge in dialysis nursing than just wiping the machines/chairs or even just poking the patients with those giant needles.
Just my opinion, but I think you didn't give enough time for yourself to actually have a feel of what exactly dialysis nursing is. And, best of luck for your new career as LTC nurse. I doubt you will find LTC more dynamic than dialysis. your day starts and ends with passing the meds, then bandaging the bedsores, passing the lunch trays, making 3-4 phone calls to the physicians, x-rays, labs, pharmacies and family members. This is the same task a LTC nurse has to do every single day. I hope you will enjoy it.

Excellent post.

Plasma refilling, or lack thereof, watching for MAP trending, continual assessment and reassessment, constant pt teaching, a high degree of autonomy, having to make decisions and take action by yourself with no doctors or other nurses around, trouble-shooting complicated machinery, constant, proactive intervening and adjusting tx, understanding and interpreting the complicated meanings of labs, and seeing them improve month to month due to your actions, and doing it all simultaneously for a whole roomful of pts?

Very hectic, sometimes overwhelming, and nothing at all boring about dialysis.

Natkat, BSN, MSN, RN · Nov 29, 2008

Excellent post.
Plasma refilling, or lack thereof, watching for MAP trending, continual assessment and reassessment, constant pt teaching, a high degree of autonomy, having to make decisions and take action by yourself with no doctors or other nurses around, trouble-shooting complicated machinery, constant, proactive intervening and adjusting tx, understanding and interpreting the complicated meanings of labs, and seeing them improve month to month due to your actions, and doing it all simultaneously for a whole roomful of pts?
Very hectic, sometimes overwhelming, and nothing at all boring about dialysis.

I was just thinking that myself. If you are bored in dialysis you're not doing your job.

bluefabian · Nov 30, 2008

You got to understand that centre based hemodialysis job

versus

hospital based renal dialysis, while similar - is world's apart. I've experienced both. And guess what? The first one made most of my boredom and my hate for it.

Hospital based settings sounds as if they do more things for the pt - more labs, hemodiafiltration, single needle and ready access to doctors when needed. Sometimes acute cases in critical care units. But most of the time, we are serving chronic pts. Yet I discover that none of that matters most if there is no dynamic between the pt and their compliance or cooperation with healthcare workers. In fact I can say very well that I've seen more pts coming in to ER or to the unit for extra dialysis, in the hospital setting.

However, centre based dialysis units tried to serve their best with the least of things and resources. Doctors come once in a while, they have less machines, less opportunity to do certain procedures. But I must say I've seen some of the most determined, compliant and optimistic pt in my life there.

Now, if I am to say why I hate dialysis... The reason will be the same:

1 - routine. Same thing, same patient, day in, day out. No matter if at times I am doing CVVH or plasmapheresis or instilling TPA on a blocked lumen.

And there's also the staff factor that goes bad when routine is predictable. Cutting off time to finish early. Obsessing to reach dry weight without reviewing it for months (and wondering why pt is cramping or SOB). And sometimes being too close to a pt that it can impair your judgement (nurse, I want to extract 5 L today?).

2 - Not actually seeing my patients getting better. They do, but very, very few. Transplant recepients - how many of them get it anyway? And the older ones - deteriorates more and more before finally succumbing one day. Hb that goes up and down, even transfusing blood is a temporary approach. I know a lot of you will hate me for this, but dialysis seems nothing more than hospice.

And that might be the most profounding reason why I hate dialysis.

Valerie Salva, BSN, RN · Dec 1, 2008

You got to understand that centre based hemodialysis job
versus
hospital based renal dialysis, while similar - is world's apart. I've experienced both. And guess what? The first one made most of my boredom and my hate for it.
Hospital based settings sounds as if they do more things for the pt - more labs, hemodiafiltration, single needle and ready access to doctors when needed. Sometimes acute cases in critical care units. But most of the time, we are serving chronic pts. Yet I discover that none of that matters most if there is no dynamic between the pt and their compliance or cooperation with healthcare workers. In fact I can say very well that I've seen more pts coming in to ER or to the unit for extra dialysis, in the hospital setting.
However, centre based dialysis units tried to serve their best with the least of things and resources. Doctors come once in a while, they have less machines, less opportunity to do certain procedures. But I must say I've seen some of the most determined, compliant and optimistic pt in my life there.
Now, if I am to say why I hate dialysis... The reason will be the same:
1 - routine. Same thing, same patient, day in, day out. No matter if at times I am doing CVVH or plasmapheresis or instilling TPA on a blocked lumen.
And there's also the staff factor that goes bad when routine is predictable. Cutting off time to finish early. Obsessing to reach dry weight without reviewing it for months (and wondering why pt is cramping or SOB). And sometimes being too close to a pt that it can impair your judgement (nurse, I want to extract 5 L today?).
2 - Not actually seeing my patients getting better. They do, but very, very few. Transplant recepients - how many of them get it anyway? And the older ones - deteriorates more and more before finally succumbing one day. Hb that goes up and down, even transfusing blood is a temporary approach. I know a lot of you will hate me for this, but dialysis seems nothing more than hospice.
And that might be the most profounding reason why I hate dialysis.

Is this dialysis in Malaysia?

In many states, the RN has the authority to change the dry weight order, and heparin orders at her discretion. Done correctly, there should never be cramping, N/V, low BP, tachycardia, SOB, or extreme fatigue during or after tx.

I find that many nurses just go with the basic training given to them by the big dialysis companies, and never educate themselves further. The training provided by these companies just touches the tip of the iceburg.

These nurses (and techs) think that nausea, cramping and crashing are a normal part of dialysis. Well, these things are normal in bad dialysis, but not in proper dialysis.

workingmomRN · Dec 20, 2008

I previously worked with one group of doctors where you absolutely did not change a EDW, heparin dose, or anything at all without calling the doctor on call. At the clinic I work at now, the nurses can review EDW's ,heparin, etc and make adjustments as needed. It took a little time for me to get used to being able to do these things on my own because I had gotten chewed out so much before over these things. I have to say that I like having the autonomy to be able to make these adjustments when they are necessary.

I also have times when it is very depressing to see my patients decline over time, knowing that they will never get better. I also remind myself that we are giving our patients years of life with their family that they would not have without dialysis.