Is this what being an RN in dialysis is like?

[barbwire]

Well, this is my first RN job and I don't really know what to think. I started working in a 24 chair facility. We do two shifts a day, Monday through Saturday. The first part of my training has been learning the tech's job. I'm out of training now and either work as a float RN or have a station of 4 patients. The days I work vary but the hours are all over the place. Sometimes I'm in at 4 am, others at 5, then sometimes 6am, depending if I'm running a station or floating.

I'm being told that after about 6 months from my hire date I'll be a charge nurse. The charge nurse sometimes has to help put patient's on and take them off, depending on staffing.

I feel like I am a chicken running around with my head cut off. I am so tired by the end of my shift that I can barely walk when I get home. My feet hurt constantly, even on my days off. I need to exercise on my days off but I'm usually so tired trying to recover from work I simply don't have the energy. I bought a great pair of work shoes but I'm still dog tired and my feet kill me.

Going in at 5am one day, 4am the next, 6am the other is wrecking havoc on my sleep. The charge nurses usually come in at 5am so at least that would be consistent.

Does it get better? One day I feel like I'm doing great, then the next I forget to do something and the day goes down hill. Why is change over such a nightmare? We're given 15 minutes between patients to get them weighed, assessed, etc, and put on the machine. Lord help you if they have to be moved to the chair using a lift. There are maybe 2 people I work with that can get someone on in that time; they've been doing this job for several years. And that's if everything goes right with the patient.

Coworkers are scared to death to call in sick, so they come in when they shouldn't. They all say they don't want to get chewed out. I understand some people abuse taking off. I've been told by my coworkers if I call in to have a doctor's note ready to hand in.

I chose dialysis because I liked that it was a small work-place setting where you don't feel you get lost in the crowd at say a big hospital. From day one the people I work with have told me "give it at least 6 months" so I'm trying. And most everyone I work with has been wonderful and very helpful. But I have found myself the past few days not wanting to go to work and that's not me. Sorry if this sounds whiney. This is only the tip of the iceberg with my questions/concerns about my chosen career and employer. Just wondering what I got myself into.

[retiredlady]

I think this is what all new nurses feel like. It takes 6 mos to a year to become comfortable. It did me many years ago. Many a time I wanted to quit, then I got experience and the doctors would come to me to ask me what I thought about a certain patient. So, hang in there and it will get better and every job I had in nursing there was a lot of running and I was exhausted and then I had to go home and take care of my family too. That is just a part of nursing. Good Luck!

[jlynn2303]

Sounds like dialysis to me. Just think - there's some guy at the top of the food chain who wants to take his mistress to the south of France, or buy himself another yacht. So, we work short so he makes more money. Not that I am cynical or anything.

[Brookeylea]

Sounds about right!! Except we have a 3 person assignment. My clinic is chaotic right now though like that too. I just hit 6 months and am not comfortable but not getting so nervous anymore!

[barbwire]

Sounds like dialysis to me. Just think - there's some guy at the top of the food chain who wants to take his mistress to the south of France, or buy himself another yacht. So, we work short so he makes more money. Not that I am cynical or anything.

LOL!!! And it's probably the truth. Have seen so many things over the past few months that make my jaw hit the ground and I know it's all centered around the almighty dollar: pile more and more on the workers so money is saved, cut corners (with a total disregard for safety) so that people at the top make more money. Guess that's par for most every company/organization out there.

The jury is still out if I remain where I am. Which is a shame bc I actually, for the most part, enjoy what the job entails. Ok, except for when the patient passes out on you with a BP of 45/15 causing one to almost wet their pants bc this has never happened to one before. But I capped off the day with a big hug and a kiss from a patient. THAT made all the b.s of the day worth it.

[RNtobeinSoCal]

I'm in the same boat, and I'm drowning. Check your state regulations about being a charge nurse with less than 12 months experience. Those laws exist for a reason (patient safety) and I am grateful I won't be left alone on the floor for another 9 months! All the other new RNs in dialysis have the same shell-shocked faces and same complaints about preceptors not being patient enough or showing them enough/often enough. It's comforting in a way, but also tells me the company's training and precepting leaves much to be desired.

Some veteran nurses tell me I won't like dialysis and will leave within six months, some say I should stay in dialysis for the steady hours. There seems to be a common complaint of PCTs running the show, making decisions that they aren't qualified to make, or don't understand the implications. When BP drops, they just dump saline without considering fluid overload, or that a renal patient should not get a lot of fluid at once. They may not understand that a patient who is vomiting, or has a slight drop in BP is not the same as a BP that has bottomed out and a patient that has passed out or is passing out.

I've had a bad couple of weeks so far and pray they get better. It was hard enough to get a job as a new grad, I don't want to be unemployed again!

Does anyone have advice for new RNs in dialysis? I'm really drowning.

[madwife2002, BSN, RN]

In my company unless you have minimum 12 months experience as a RN you cannot be in charge in dialysis.

Today I am a manager of a dialysis facility and I am going to another center to 'babysit' a new dialysis nurse so she can do her job with support

Dialysis is a hard job!, but once you have learned how to be a hemodialysis nurse you will find it a lot easier.

The patients make it worthwhile for me, they are so complicated and you can really get to know them, and their illnesses

[barbwire]

Drowning: that's a very good description. I took my lunch break today, sat in my car and cried, then cried on the way home. This frantic pace isn't new to me so that's not the issue. Every day I feel like I take 2 steps forward, and 10 backward. I learn something new, but screw up something I should have down by now, or had down last week. I tried to slow down a little bit today because I make more mistakes when I go fast, but then I got so far behind with stuff I didn't think I'd ever catch up. Can't win for losing.

I do know if it weren't for my coworkers I probably would have already quit. The tech's, LVN's and other RN's (that work stations too) have been extremely helpful and supportive. I do know what you're saying SoCal about pumping people full of saline. Have seen it done a few times and thought to myself that's not a reason to give saline. But all the things I've read about tech's running the show, I haven't seen. They are extremely knowledgeable about the patients and are always willing to step in and lend a hand.

It's just nothing like I thought it would be. I'm hanging in because I know as I get more familiar w/ things that it'll get better. But not liking the hours at all. Not liking how exhausted I am after only 10 hours of work. And there are A LOT of issues w/ the company itself.

It is very helpful to hear from others. Thank you!! Now to go soak my aching feet...

[bluekat1]

That sounds about right. I went to inpatient, hospital dialysis after working 30 yrs. We have erratic schedules. I know when I go to work. Do not know when I come home. We have to take call for 24 hr. coverage. Our day does not end until the work is done. You can have a 4 hr work day or one that lasts for 22 hrs. You can work for 16 to 17 hrs. get home, crawl into bed, & get called back in for someone whose K+ is 8.8. My long time employer hospital sold us to a large dialysis corporation. I literally feel worked to death some days. On the other hand, it is a job. Many people do not have jobs. I do NOT get bored. There is always something new happening. The patients depend on us. If we did not dialyze them, they would not be long for this world. It isn't a job that someone else wants to take away from you. Something about that blood spinning around in a circle just scares most people. The large corporation has been extremely helpful to my immediate family in terms of assistance with getting a kidney transplant, moving to a different state. Large companies are able to do a lot for the patients that small individual hospitals or clinics can not do. I am paid well. Health insurance costs are reasonable. With the current economy, dialysis is one job that is not going to disappear.

[RNtobeinSoCal]

I cannot get over how often I have cried because of this job. I cannot seem to get the time management piece down, and the only advice I get from other staff is "You have to be faster". Uh, OK... exactly how do I do that without compromising patient safety?

Also, how thorough are your post-TX assessments? Seems like a lot of post-TX assessments are not being performed properly, and that this is the only way to get everything done in a timely fashion from the end of one shift to the beginning of another.

Barbwire- that's exactly it! 2 steps forward, 10 backward. I have been at two clinics with the same company- they use different tubing, slightly different machines. One uses clamps, one doesn't. One enters certain data into the machine, one doesn't. I forget things I should know by now, and what kind of excuse can there possibly be?

Seriously, does anyone have specific advice for time management??

[Vegan_RN]

I cannot get over how often I have cried because of this job. I cannot seem to get the time management piece down, and the only advice I get from other staff is "You have to be faster". Uh, OK... exactly how do I do that without compromising patient safety?

Also, how thorough are your post-TX assessments? Seems like a lot of post-TX assessments are not being performed properly, and that this is the only way to get everything done in a timely fashion from the end of one shift to the beginning of another.

Barbwire- that's exactly it! 2 steps forward, 10 backward. I have been at two clinics with the same company- they use different tubing, slightly different machines. One uses clamps, one doesn't. One enters certain data into the machine, one doesn't. I forget things I should know by now, and what kind of excuse can there possibly be?

Seriously, does anyone have specific advice for time management??

My first six months as a dialysis nurse were beyond horrible. I went home crying almost on a daily basis, and all I dreamed of was quitting. My friend encouraged me to tough it out, saying that it eventually gets better. About a year after taking a bay of patients 50hrs a week, I had finally gained the self confidence and skills needed to be a good hemodialysis nurse.

Even though I'm now a preceptor, it's hard to explain time management skills. I think the biggest part is to establish a set routine, and to already expect the unexpected. I always have extra gauze at the chairside, and I watch my BP's like a hawk taking on some unstable patients every 5 minutes in order to anticipate and treat early...very early a complication. The last thing I want is to have a patient occupying a chair 20min after is off time due to low BP. So, if my patient started with a systolic of 160 and he's down to 110....I usually turn his UF off and let him recoup. I have all my supplies ready about 30min to 1hr before take off. I sometimes chart a couple minutes ahead so that after take off I can strip and clean and restring my machine while they are holding their sites. I have all my supplies and heparin ready to go as soon as my first shift is put on, and during shift change, I only document what's vital in the moment....my last line, and my post treatment vitals. My assessment and such can wait if need be.

For me I guess, preventing complications...low BP, clotted dialyzers are my biggest "time savers" If I have someone that's a known bleeder, I pay close attention to where my gauze and finger are when pullining the needle, and even though my mind is screaming to hurry up...I stay a minute or two holding before I either clamp or pass it off to the patient. I hate bleeding....it takes forever to clean your chair and you have to get control of it and it's a time waster, so prevention is the best solution. While they're holding and I'm stringing the machine or charting, I have a hawk eye on their access. If it even hints of pink, I'm over there taking over.

I know this is all stuff you know though, but it's how I survive, and I'm doing well, and I can even say I love my job.

[dialysisnurseLC]

My first six months as a dialysis nurse were beyond horrible. I went home crying almost on a daily basis, and all I dreamed of was quitting. My friend encouraged me to tough it out, saying that it eventually gets better. About a year after taking a bay of patients 50hrs a week, I had finally gained the self confidence and skills needed to be a good hemodialysis nurse.

Even though I'm now a preceptor, it's hard to explain time management skills. I think the biggest part is to establish a set routine, and to already expect the unexpected. I always have extra gauze at the chairside, and I watch my BP's like a hawk taking on some unstable patients every 5 minutes in order to anticipate and treat early...very early a complication. The last thing I want is to have a patient occupying a chair 20min after is off time due to low BP. So, if my patient started with a systolic of 160 and he's down to 110....I usually turn his UF off and let him recoup. I have all my supplies ready about 30min to 1hr before take off. I sometimes chart a couple minutes ahead so that after take off I can strip and clean and restring my machine while they are holding their sites. I have all my supplies and heparin ready to go as soon as my first shift is put on, and during shift change, I only document what's vital in the moment....my last line, and my post treatment vitals. My assessment and such can wait if need be.

For me I guess, preventing complications...low BP, clotted dialyzers are my biggest "time savers" If I have someone that's a known bleeder, I pay close attention to where my gauze and finger are when pullining the needle, and even though my mind is screaming to hurry up...I stay a minute or two holding before I either clamp or pass it off to the patient. I hate bleeding....it takes forever to clean your chair and you have to get control of it and it's a time waster, so prevention is the best solution. While they're holding and I'm stringing the machine or charting, I have a hawk eye on their access. If it even hints of pink, I'm over there taking over.

I know this is all stuff you know though, but it's how I survive, and I'm doing well, and I can even say I love my job.

This sounds a lot like what I do on a daily basis!!! Organization is key as well.... Now I am in school for my RN (I'm currently an LPN) I ❤dialysis .. It's perfect for People with ADHD lol