New Conditions of Coverage

Kelly_the_Great · Jan 3, 2009

Wow, Renal Ruth, I'm surprised no one has replied, for my unit these changes have really been a challenge!

We put out a little flyer that we gave the patients, explaining that the chairs & machines have a 10 min. dry time between patients & that the tape has to be prepared in a separate area, thus, increasing transition times. Otherwise, we're getting our information from administration.

The POC (plan of care) & IDA (interdisciplinary assmt) have turned out to be a real nightmare.

Trauma Columnist · Jan 3, 2009

And...its now almost impossible to discharge a patient!

Kelly_the_Great · Jan 4, 2009

And...its now almost impossible to discharge a patient!

No doubt, traumaRUs! It's kind of frustrating that in this day of paradigm shifts towards patient empowerment, there is absolutely no patient accountability within the realm of the ESRD network, in relation to the standards by which we are being judged.

I dunno, I wouldn't want to be a nazi when it came to patient compliace, like I hear it is in some countries - for instance, if they have an unexcused "absence" they are no longer allowed to dialyze & someone else takes their slot. However, there should be some patient accountability, you know?

Have any of y'alls facilities made adjustments towards treatment man hours? As far as I know, ours hasn't (however, what I don't know is IMMENSE...lol). I've only just started in September.

It seems accommodations will have to be made in order to ensure staff compliance with all these regulations. All I keep hearing is that it's a "business."

Are any of you members of ANNA or other professional renal organizations? I'll be joing in hopes of advocating for the safety of patient care (primarily through adequate staffing).

It's my understanding that in Texas the ratio used to be 3:1, it's now 4:1.

Lacie, BSN, RN · Jan 4, 2009

I agree as the guidelines dont enforce pt's to be accountable for thier own care. I cant tell you how many ama's I get signed or how many "no shows" I document a week. Or the "I dont feel good, cut my treatment time" or the phos level of 8 with the pt saying they adhere to thier renal diet but have 2 bags of McDonald's sausage and biscuits with a large coke sitting at thier chair. Or the "oh you cant take 4kg off I wont tolerate that only take 2" then complain how sick they feel. Our doctor doesnt enforce complaince at all, as his attitude is "I cant help what they shove in thier mouth or if they dont show up". I feel more of a maid, waitress or luggage handler than a nurse many days with the put my shoes on or fold my blanket, dont forget to get my cookies and juice. Oh I spilled my coke so dont forget the mop while your at it!" It's more about if the tab on the tape is on the left or the right or dont stick me there you can only do it here (although it's the same site the last 10 times). I'm currently looking to get back into case management and leave the chronic dialysis world. Working with a full house and only 2 pcts and being the only nurse on the floor plus the hat of being the DON on top of it just isnt working for me. If a tech calls in on my day off I'm the one who has to come in. I have one part time RN and she has no interest in doing the new careplans and assessments. Now with all the additional paperwork of which we are not a computerized clinic (ughhhh) is just too overwhelming. I'm already doing med changes and many of my careplans at home rather than work as I'm on the floor not the office. CrownWeb in a small non computerized clinic makes it even more complicated. I was hired for acutes but got stuck drafted into the chronic unit as the acting DON even after in the interview of being very clear I hate chronic dialysis and never wanted to be a manager again. Well that's been a year now and I'm still there LOL. They havent even approached getting the pct's ready for certification and havent even told them it's going to be required yet. Bet they wont pay for that either. They already cut back by not paying holiday pay (of course as the manager I worked every one of them and no time/half for doing so nor comp time) and cutting pto time down. Cut our insurance benefits and raised my premium and co-pays. It's just not worth it and then working with people who dont care enough about thierselves to help thierselves. Bet they still getting thier profits though. We also cut heparin/saline and cvc dressings to once a week. They cut out ordering many supplies such as kerlex and 30cc syringes to start. I've been told if I use alcohol preps on a site dont use betadine or vice versa. We use one needle to draw up all our heparins and one 10cc syringe to draw up all our ferrlecits. Dont use 2 that's a waste much less think of using one for each pt draw. Kt/v's increasing now with the heparin/saline cuts. I'm seeing a few dialyzer reactions due to no uf in recirc now on dry packs. Told to not use the larger dialyzers on larger patients........jeez, what's next. Oh we buy our own cotton lab coats now and no more disposables. I went through 3 in one day this week due to blood splatter. In the long run it's costing me more to work for them lol. In my state it's 4:1 ratio and the rn part of that number so I have 12 chairs with 2 pcts, I take pts and charge the floor/plus handle all the management issues. Acuity levels are higher and it's always "we cant afford it" some staff havent had raises in over 3 years now.

Kelly_the_Great · Jan 5, 2009

((HUGS)) Lacie, sounds like you're in an impossible situation!

Is there anyway you can get into acutes?

soulofme · Jan 5, 2009

Jeez Lacie...what a nightmare...what co. is this?

Trauma Columnist · Jan 5, 2009

Lacie - I'm so sorry. I'm an advanced practice nurse and I never ever would consider working as a nurse in chronic hemo for many of the reasons you list out. Take care.