New Grad RN-Out Patient Dialysis

[nagab, ADN, BSN, CNA, RN]

Hi All, 

I'm a new graduate nurse from an associate degree program. My options for hospital positions were limited because basically everywhere requires a BSN. I wanted to stay within the acute hospital setting because that's where I currently work now. And yes I've heard it before if you are matricualted you can still be hired. That is defintely true but I am based in NY where we are have some pretty strict employers who adibe by only hiring the BSN nurse once the degree is (completed entirely). 

I have landed a job with an outpatient dialysis facility. I basically wanted to seek and speak with anyone regarding how I can be prepare for this new role. I have five years experience as a nursing asst/telemetry techician in a acute hospital setting. Most of our patients who require dialysis are sent off the floor to the dialysis unit. My employer is one of those that don't take ADN-RN's even if matriculated into a BSN program. 

I have seen bedside dialysis done during covid. I'm just not really familiar with it in it's entirety. However, the nurses were absolutely amazing. Gowned up for 2-6 hours in these rooms providing patient care and monitoring them. Some of the most amazing nurses I've seen. 

I have a three long month orientation coming up this September! I just want to prepare what supplies I shall need besides a good stethoscope, scissors, penlight, etc. I appreciate any tips, advice, etc. I just want to make sure I have the best mindset going forward to be a safe competent novice nurse. I look forward to working with the demographic of patients and the intricacy of renal care/dialysis. 

Thank you so much in advance ?

 

[Hoosier_RN, MSN]

No scissors, as you tear tape to avoid cross contamination; no pen light either, for the only times you need one, there should be one stocked on the crash cart. 

Get a notebook to take notes, so much to learn. Don't be discouraged when it feels like you're failing. It's a HUGE learning curve, and you'll get through it! @kbrn2002 and @Nurse Magnolia anything you can think of? 

[nagab, ADN, BSN, CNA, RN]

1 hour ago, Hoosier_RN said:

No scissors, as you tear tape to avoid cross contamination; no pen light either, for the only times you need one, there should be one stocked on the crash cart. 

Get a notebook to take notes, so much to learn. Don't be discouraged when it feels like you're failing. It's a HUGE learning curve, and you'll get through it! @kbrn2002 and @Nurse Magnolia anything you can think of? 

Awesome. Thanks for clarifying that! I sincerely appreciate it. Yes even the FA said it takes new grads about a full year to actually feel comfortable and confident. I got my books today in the mail. Boy am I feel overwhelmed ?

[kbrn2002, ADN, RN]

On 8/29/2020 at 10:02 PM, nagab said:

Awesome. Thanks for clarifying that! I sincerely appreciate it. Yes even the FA said it takes new grads about a full year to actually feel comfortable and confident. I got my books today in the mail. Boy am I feel overwhelmed ?

Gosh yes, the books! I almost forgot about that, talk about selective memory! Actually that part wasn't nearly as bad as I expected. I read through everything over a weekend off to get a general idea of what I would be learning and then re-read what was needed for each learning module as I went along. Honestly there weren't too many times I had to go back into the books for information as everything needed was included in each classes material in the big training binder. 

Maybe I shouldn't admit to this but I haven't even looked at any of the educational material provided since I passed the required tests.  Though I do plan on hanging onto it to keep passing the required annual tests. 

Just an aside as something to consider if you are so inclined. A nurse in my clinic is doing some of her required annual training now and has a brilliant if maybe edging into the cheating territory solution. She printed the tests some time ago and has all the test questions/answers at her fingertips and simply copies over the correct answers every year. I don't know where she printed the tests in the first place but she's been doing this awhile so apparently the questions don't change year to year. 

[nagab, ADN, BSN, CNA, RN]

2 hours ago, kbrn2002 said:

Gosh yes, the books! I almost forgot about that, talk about selective memory! Actually that part wasn't nearly as bad as I expected. I read through everything over a weekend off to get a general idea of what I would be learning and then re-read what was needed for each learning module as I went along. Honestly there weren't too many times I had to go back into the books for information as everything needed was included in each classes material in the big training binder. 

Maybe I shouldn't admit to this but I haven't even looked at any of the educational material provided since I passed the required tests.  Though I do plan on hanging onto it to keep passing the required annual tests. 

Just an aside as something to consider if you are so inclined. A nurse in my clinic is doing some of her required annual training now and has a brilliant if maybe edging into the cheating territory solution. She printed the tests some time ago and has all the test questions/answers at her fingertips and simply copies over the correct answers every year. I don't know where she printed the tests in the first place but she's been doing this awhile so apparently the questions don't change year to year. 

Hi kbrn,

Can you explain to me what the training looks like? My facility for training is different than my home base location. Is training in classroom with preceptorship? or does it bounce back and forth as well? thank you in advance

 

[Hoosier_RN, MSN]

5 hours ago, kbrn2002 said:

A nurse in my clinic is doing some of her required annual training now and has a brilliant if maybe edging into the cheating territory solution. She printed the tests some time ago and has all the test questions/answers at her fingertips and simply copies over the correct answers every year. I don't know where she printed the tests in the first place but she's been doing this awhile so apparently the questions don't change year to year. 

I'm curious to how she does it as well. The questions don't change, true. It's all in LMS peoplesoft, not sure how she would even be able to print it out? My educator is curious as well as this would be a big help

 

[kbrn2002, ADN, RN]

13 hours ago, Hoosier_RN said:

I'm curious to how she does it as well. The questions don't change, true. It's all in LMS peoplesoft, not sure how she would even be able to print it out? My educator is curious as well as this would be a big help

 

I'll ask her when I am at work and I'll let you know

[kbrn2002, ADN, RN]

15 hours ago, nagab said:

Hi kbrn,

Can you explain to me what the training looks like? My facility for training is different than my home base location. Is training in classroom with preceptorship? or does it bounce back and forth as well? thank you in advance

 

I had the same situation. My classroom training was all in the clinic the educator was based out of as that clinic has a good size dedicated classroom with everything you need right there including training machines. The classes will be with all the people in your hiring class, I had a pretty small group of 4 so there was plenty of individual attention when we needed it.  I usually went there for the virtual learning classes that weren't scheduled on a day I was working as that clinic had the most quiet environment in the training areas. If the educator had another class during that time I used her office.  

The clinic training was all with a preceptor, first with a PCT for 10 weeks that stretched to 11 weeks just because of scheduling issues as my nurse preceptor was on vacation the week I was supposed to switch to that.  The pre-COVID training was supposed to be 12 weeks of PCT training but they shortened the program a bit to get more staff up and running sooner. 

During that time if I had a virtual learning class I just came off the floor for that. Plus this was in a small 8 chair clinic so I had plenty of time to leave the floor for the computer LMS courses. I was the only one in our hiring class that had all the required computer LMS courses done with time to spare. 

When I switched over to the nurse training that was also with a preceptor and I moved to my home clinic.  So training was spread out over 3 clinics but they are all within 10 miles of each other so drive time was minimal. 

For the practical exams either we all went to the training clinic if it was a class were we could use training equipment. For the practical exams where the educator observed  us on the clinic floor she came to whatever clinic we were scheduled in. 

[Duncan6]

Training can really vary by clinic and region.  Your CM/FA should be able to give you details.  I traveled from central PA to Pittsburgh over several weeks for classroom training and some initial training on machines/cannulation.  I'd be in my home clinic 1-2 times per week and worked with a PCT preceptor first, and then an RN after that.  Some nurses don't like being trained by a tech, but you really need to know their job to be able to help troubleshoot (whether machine or pt access) and jump in and assist when things get busy.   I work in a 12 station clinic and we are often short so the nurses sometimes fill in as techs- it's really helpful to be able to set up and tear down machines efficiently, and be able to cannulate effectively.   It also gives me an appreciation for how hard the techs work!

 

[DiamondRN45]

Love the great info. I'm also a new grad and will be starting my first job in dialysis in a few days. I'm super nervous but also excited to start ☺️

[Amy Giles]

I work for a privately owned clinic so our policies and practices may be different than where you will be. When I started a year ago, I was on the floor in my clinic 4 days a week with a nurse preceptor and 1 day at a different clinic for class. I knew very little about dialysis, so there was a huge learning curve. I felt like a brand new nurse again. On the floor I started learning everything from the RO system  and machine internals to cannulation, cath troubleshooting, initiating and monitoring treatment and patients, time management, medications, patient flow, turnover and so much more. In class it was principals, theories, Chemistry, physics, infection control, calculations, adverse effects and interventions of meds and of treatment, policies, procedures, etc. The first time I set up a practice machine it took 30 minutes and I almost cried before I got done.  It has taken a year for it all to come together and I don't feel completely incompetent anymore. This is a world of it's own so be patient with yourself and be ready to ask plenty of questions. Good luck.