Need help with interview for a Acute dialysis RN job with limited dialysis experience

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Hi all! I have an interview next week for a position on a Kidney/Apheresis unit. I graduated nursing school last December and have only 5 months of Chronic Hemodialysis experience in an outpatient setting (I had to leave this position due to relocating across country for my husband's job). I also have 4 years of nursing assistant experience in a busy hospital.

The responsibilities of this job include chronic hemodialysis, which is where my experience is, but also includes other interesting areas such as acute hemodialysis, apheresis, and photopheresis for CTCL.

Does anyone have any experience working on this type of unit that they can share with me like what a typical day for you entails? Also, any advice you can give me to stand out in my interview would be much appreciated. What questions can I expect to answer? What do you think the manager is looking for in a candidate?

I really want this job because I would like to learn more about other areas of dialysis and someday specialize in the field. I know it will be a lot of work but I am motivated!

Thank you in advance!

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If it is inpatient it is all "acute dialysis" though not all pat are new starts. A lot of them are usually pat who have been on HD, got admitted to the hospital and need HD while there. But of course you also have the acutes that are really acute and new starts...

Ok - to your question:

This kind of job requires cross training because the machines used for HD and apheresis are not the same, the procedures are different, different protocols.

So your training should include :

- acute HD including 1:1 in critical care areas, regular rooms and HD room (of larger hospital). Training to use mobile water tx machines...

- apheresis /different indications (for example Cobe machine) plasma pheresis, stem cell collections ...

- if they are also doing blood exchange you need to get trained (in that case ---> some pat who get regular tx have a VAD and there are special super large non coring needles for those ports to use with apheresis...)

- CRRT (for example with NxStage)

A typical day will depend on planned procedures - apheresis are usually planned and scheduled unless it is some kind of emergency plasma pheresis.

HD in acutes can be very acute or planned.

Usually the clinical coordinator or charge nurse will have the schedule and plan your day. So after you are trained you could for example start your day in apheresis with planned procedures, be send to do an acute HD in critical care (for example lithium overdose or high K or what not), after that be send to check on a CRRT to help the staff, perhaps give other people a break and cover their tx, and so on and forth. You will also be responsible for machine cleaning and so on.

In acutes with apheresis you will be busy, usually scheduled with on call, on call also for holidays and nights. Days can be long - I have worked 20 - 22 h days..(with next day off ). If you are hired for an outsourced company you are a vendor but if you are hired directly to the hospital you are on of them, which makes it easier.

You will need to know how to transfuse, you may have to give all kind of meds iv, know how to use epi pens, you should get an ACLS cert (in my opinion though most people have BLS). You need to really follow protocol to the dot! Know all infection control - NO short cuts (hepatitis B in acutes ....).

In that position you have to be detail oriented, able to work independently, good communicator, organized, know that in doubt you will clarify anything that appears not clear, good calculation skills, follow policy to the dot - heavily regulated, know all emergency procedures, huge amount of critical thinking skills. Be prepared for the unusual, stay calm in all situations (can't lose your head if your pat drops a pressure to 50 s systolic...or anaphylactic).

Hope that helps !

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Thank you so much for such a great response nutella! This job is at a University hospital for a Kidney/Apheresis Unit so I would be working directly for the hospital, if hired.

How long were you trained in acutes and Apheresis? This job also involves Photopheresis too. Did you learn that as well? I haven't heard of it before applying to this job. What is it?

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Thank you so much for such a great response nutella! This job is at a University hospital for a Kidney/Apheresis Unit so I would be working directly for the hospital, if hired.

How long were you trained in acutes and Apheresis? This job also involves Photopheresis too. Did you learn that as well? I haven't heard of it before applying to this job. What is it?

no - never did photopheresis.

Acutes - the training should be probably weeks because you have to learn how to dialyze somebody who is brittle /unstable, learn the technology of the critical care - I used to be a ICU nurse, so a lot of things came easy to me but you need to know some tricks.

Apheresis depends on your comfort level and how many modalities but probably also months.

It is all very technical and having worked in chronic you will be probably very good with the regular HD.

Funny enough - all those machine spin the blood outside of the body - but apheresis is not as fast as HD.

The most valuable piece of information I got from an old very experienced HD nurse in acutes who told me to never HD a patient with extensive cardiac faster than 300/min blood flow. Those pat get chest pain easily when they are sick ...

Anyhow, it is also good to mention that you are striving for a specialty certification once eligible (check out the nephrology nurses association), become a member of the professional organization. In the hospital you also need to deal with all the regulations and should know if the hospital is magnet status or not and such.

I think it sounds like a good job for a young, energetic, responsible person! And the good thing is that your patients do not stay forever ...

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Specializes in Dialysis.

The most valuable piece of information I got from an old very experienced HD nurse in acutes who told me to never HD a patient with extensive cardiac faster than 300/min blood flow. Those pat get chest pain easily when they are sick ...

The myocardial stunning and decreased blood flow to the heart are not related to dialysis blood pump speed. Drops in mean arterial pressure that up to 30% of all patients experience while on dialysis do have a dramatic effect on myocardial blood flow. Never let your patients MAP fall below 60.

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The myocardial stunning and decreased blood flow to the heart are not related to dialysis blood pump speed. Drops in mean arterial pressure that up to 30% of all patients experience while on dialysis do have a dramatic effect on myocardial blood flow. Never let your patients MAP fall below 60.

Low BP/low MAP can of course cause ischemia with chest pain/syncope and so on and forth.

I also want to point out that there are thoughts about the blood flow rates and some doctors actually do think that BF rates are directly connected to organ stun. In any way - of course when you dialyze counter current (as it is usually done unless you have a special order to do otherwise to avoid disequilibrium syndrome for certain new starts) the BF rate also directly influences how many elytes are being exchanged.

Home Dialysis Central | Don’t Flog the Fistulas: Slow Hemodialysis Blood Flow!

  • "The greater the rate of contraction of the circulating blood volume, the greater the dimension of organ "stun"...and this affects more than just the heart!"

In any way - I have never dialyzed in acutes with a BF of more than 350 ml/min ...

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