LTC to Dialysis

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I'm a new RN who started in LTC about 6 months ago but recently got an offer to work in a dialysis center doing acute post training, are there any nurses here who have been in this situation if so what to expect in a dialysis environment compared to the LTC environment? Anything would help me greatly. Thanks:)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's like NIGHT AND DAY---- the differences in the two. I did LTC before coming to dialysis. You will need to really brush up on your assessment skills (not that you do not have them in LTC, but in dialysis, decisions regarding tx processes are based heavily on your ability to perform a very quick and yet thorough assessment). You will need to know your lung sounds well, and be able to assess edema, etc. You will be in charge of 3 or 4 technicians working under you who will depend on you to make decisions (sometimes on the fly) when pt conditions change during treatment. You will also have to closely supervise those technicians to ensure no errors are made on their part before, during and after tx. It's just a different skill set than LTC or other nursing jobs.

It will take you likely at least a year to feel comfortable with your day to day work in dialysis, so be prepared to be patient with the process and be willing to seek advice, learning and help from more experienced coworkers. You will work very hard, just like in LTC, but the pace is different. You are very busy when patients are coming on and treatment is being initiated, which is about 2 hours of solid, on your feet, work. Then, there is a bit of a lull, for a couple hours until your patients start coming off treatment. Then, you will once again, assess their condition on termination of tx and chart. During the lull, you will be smart to draw up your medications for the next shift, but not before about 3 hours before they are due on. Medications you draw up are prepared and refrigerated until use. Epogen,which is a medication to stimulate blood cell formation by the bone marrow (most dialysis patients are anemic to some degree d/t their kidney failure)-----it's outrageously expensive, so you will draw that up only when your patients show up to be sure you don't waste any.

Once everyone is on and running, you will be busy giving medications to each patient, but it's NO WHERE near as bad as in LTC, where it seemed all I did was crush and push pills on residents. My morning med pass in LTC took easily 3 hours or more; this is not so in dialysis, thank goodness.

Dialysis patients are very pedantic, particular and picky about their care, for good reason. Dialysis and their accesses, (AV fistulas, grafts and catheters) are their lifeline. When things go wrong, they develop complications and issues that are very difficult to deal with. Believe me, they know what is going on. They do know their bodies (most of them) very well, know what works and what does not and will be very free to tell you what they think (especially when it's negative). At first, they won't likely trust you. It will take a bit of time to build rapport with your patients and get to know their ins/outs and idiosyncracies. You will feel better once you do. These guys, some of them, have been on dialysis for years and years, and believe me, can teach you a lot about dialysis, if you really listen to them. Approach your patients respectfully and even asking them advice and details about their treatment; this will win you respect and the patients will more likely confide in you and keep you in the loop.

Knowing my patients intimately, I can see at a glance if they are having a bad day, feel poorly or are in poor condition. You will be able to observe from across the room when a patient in struggling with his/her treatment, or is about to "crash" (precipitious blood pressure drops, SOB, etc) and prevent them from happening by intervening early. Prevention of complications is huge; you want to avoid them before they become manifest and create problems. Again, knowing dialsys, and the patient intimately is key.

You will likely be responsible for at least 12 patients each 4 hour run.(24 total in your day). So you will have to do their assessments, prepare their meds, check machine settings, be sure tx that day is appropriate to their condition, and give those meds (meds are given IV in their saline lines on the machine). At first, just as in LTC, you will struggle with time management and getting it all done efficiently. Any given day in dialysis is very busy, but just let 1 or 2 patients develop complications, and now, you are bound to get a big behind. It will just take time and experience and patience. As mentioned, you will likely be supervising the treatment and condition of 24 patients in a given day in dialysis (some more, some less).

So you want to know:

How many patients will I be responsible for at a given time?

How many technicians am I supervising?

To whom do I report problems/breaks in the system of patient care (besides the manager)?

How long will I be on orientation, and if I am having trouble, can it be extended?

Who will precept me, and how much experience does he/she have?

It goes on and on. I have only scratched the surface here for some semblance of brevity. I would be happy to answer specific questions you have, just PM me or post here.

There is a thread here that addresses "what a day in the life of a dilysis nurse is like" . I would review it, because those posts are excellent in explaining how things work and what you can expect.

I can't outline everything we do in a given day, because that is a long, lost list. But you get the idea. You are busy in dialysis and often go home just dragging. The hours may not help either, esp if you are on first shift. Mine begins at about 0445 and does not end til after 1400, 4 days a week. Some are 12 hour shifts at certain clinics. Ours are 9.

Understand, like every area of nursing, dialysis is challenging, frustrating, rewarding, and at first, difficult to master. You will either love it or hate it; I have never, ever met anyone who felt indifferent to the job. It will take time to love it, so don't be discouraged if at first you don't "love it". You need to stick it out no less than one year to be sure.....after a year, you will either love it or not.

I wish you the very best in any direction you choose to go. I can say, I love dialyis much more than LTC for many, many reasons that would take forever to elucidate here.

GOOD LUCK!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

above: Not a "big" behind, but a " bit " behind, LOL, darn autocorrect.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I did just re-read your post about being "acute"....so you are going to be doing dialysis in a hospital? If so, that is quite different than an outpatient chronic unit. Hopefully , if that is the case, another member will be along to explain acute dialysis.

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Thank you so much for your input, yes I love dialysis but I heard it's very hard and demanding but LTC is hard as well so I don't think I'm crazy to leave my LTC job for a dialysis job, I really hope I get it quick

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And for the training it's 6 months to a year straight before I get to be on my own, but about the time is it really though to find time to chart?

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Smiling blue eyes, at first I'll start in the outpatient clinic before doing acute

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ok then all the words posted apply to you. And no I never said LTC was easy----remember I came from there. But you WILL find dialysis challenging with a whole new skill set to learn.

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Ok thank you, I'm excited to start this new journey

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I wish you much luck. If you need anything just let me know.

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Ok thanks a lot

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