New to Home Hemo

Specialties Urology

Published

Hello, I'm Toni

I've been hired to start home hemo. I'm curious about the hours and oncall. I need to only work 8 hours Monday to Friday. I'm afraid there is more to it than I'm being told. If there is anyone working in this area that can tell me what the oncall is like. How often do you visit the patients home after hours to assist with cannulation? Also extending treatments to weekends or working after five in the evening. This is very important to me for child care.

I'd appreciate any input. Thank You

What company do you work for? I'm assuming Davita. If so, I can answer some of your questions. A lot of the answers to your questions are based on what type of unit you working. Freestanding or attached to an in-center unit? Are you the only nurse or are there other (home hemo) nurses that are a part of the unit as well?

Thanks for replying. Yes, you are correct it is DaVita. I'll be the only home hemo nurse. This program is part of an in-center unit that also does nocturnals. I'll be sharing call with the supervisor which will mean every other week call. Honestly, I can't see working 8:00 to 16:30 and no saturdays if I am to accomodate the schedules of training and monitering patients. Right now we only have one nocturnal. How often do you need to go out to the patients home to help cannulate, especially after an infiltration. I hope I'm worried about nothing but that's not what my gut tells me. I really won't have a sitter for child care at all times, which is really my concern. I really appreciate your time and attention to my concerns. Thank You Ms. Dorsey

Ok, sounds like we're in the same boat. My center is attached to an in-center unit that does nocturnal also. I'm the only home hemo nurse. So, far I haven't had to go to patient's home to assist with cannulation. The pt's are well-trained, so I usely only get calls about things related to machine alarms. As for call itself, I'm always on-call. But, I don't mind because I don't get very many calls. How many pts do you have on home hemo? Does your manager know anything at all about the program? and do they help out? Only time I worked a Sat was in the beginning when I was working with the person I was replacing. I worked two saturdays, trying to learn what it was I was supposed to be doing exactly as far as pt management. I basically learned how to input the flowsheets, and how to do some of the monthly reports. Other than that I was on my own. I'm stilling learning and figuring out things six months later. I was kind of forced into this because the person had another job already and she worked in-center on sat at the unit to help out for a few weeks. I really enjoy the home hemo program overall!!! The program is fairly new and is constantly changed, which can be quite frustrating.

Thanks Ms. Dorsey

It's good to know you enjoy the program and you have learned all the computer programs. I will be starting up the program for the most part because we only have one pt thus far. My supervisor trained the first and only one so she will be a great help. How many patients do you have and how often do you do overtime like staying after 16:30. I'm glad you have never had to go out on a late night visit. I was nervous because everyone keeps talking about it's a big job and lots of paper work. Have you done PD and is it more or less the same amount of work and time. I really appreciate you reponses and insight. I'm be going to a retreat for my church this weekend so I won't be able to get back to you until Sunday. Thank You so much.

Toni

Dear Ms Dorsey

I hope all is well with you. I returned yesterday from a three day HHD class in Brentwood, Tenn. Have you had a chance to take that one? I do feel better about HHD now. Though I did tell my supervisor that I would not be training any patients dialyzing alone at home, not too safe in my opinion. I did take a look at the consent the patients have to sign and it pretty much covers everything. How many patients do you have? Nxstage and/or BabyK. Have you had a chance to train any patients? Sorry I came back with lots of questions. I hope you had a good week. Toni

Hi Toni,

Sorry, I didn't get back to you before now. I started training a new patient this week, so I've been pretty busy to say the least. Glad to hear you made it to the Home Hemo class. I attended the class last fall. I got some good things out of the class, but I felt it could have been more. I heard they've changed it up a little since I attended. Have you been scheduled for the preceptorship week yet? As for your questions, I have 7 patients including the one I am training now. All of my patients are on Nxstage and I have trained 1 patient prior to the present one.

As for your previous post: No I've never done PD so I can't compare. The only time I gotten into overtime was when I was training a pt for the very 1st time, but my supervisor doesn't want me to get any this time. I managed to avoid it this past week, barely!!! Home hemo is a big job and does involve a lot of paperwork. It is constantly changing, so you have to be flexible. By this I mean, you learn to do thinks one way then it changes a month or two later.

Be thankful that your supervisor trained the 1st patient. Therefore, he or she knows what your doing exactly and knows how much time it takes. Also, they can help you if needed and cover if you have to be out for some reason. My supervisor knows very minimal about home hemo and training, which puts me in sticky situation. I've been told that I will get some help when I have 10 pts (since the ratio is 15:1), but only time will tell.

By the way, I agree with you on the NOT training a pt that will be dialyzing alone at home without a partner. That's lawsuit waiting to happen if you ask me. Unfortunately, some physicians and programs allow it. But, I'm with you, NOT on my watch if you know what I mean. That's just CRAZY!!!

Dear Ms Dorsey:

Congratulations on your 2nd training. I hope you don't run into overtime on this one. I can understand on your first one because it is so much to process yourself and then adequately teach someone without a medical background. How many hours does each training session takes beginning to end? I've heard about 4.5 hours. Your input has been invaluable to me. I really was apprehensive out of the gate. I think it is because my last job was acute dialyis. These patients were the most noncompliant out there and so many were also very ill.

I believe 7 patients is quite busy for one nurse, 15:1 can that be done? I've heard nurse trying to quit when they get to 12:1. I don't mind working or paper work. I just want to be done in eight hours and know exactly what I and doing.

The HHD class has not changed much apparently. I just wasn't really given time with the Nxstage machine to learn it at all. We all helped but the lines on the machine and the pureflow was not mentioned. I wanted more hands on and how to handle complications. But it was learning styles, surveys, It solutions, townhall discussions ect. I'd would have kept most of that to minimum and stayed with the machine and complications.

I do like teaching, not having a staff to moniter like on the chronic floor, and regular hours.

Oh by the way it was not my supervisor who trained the one patient in the program, it was another nurse who left that did it. But the supervisor has been handling all the issues that have been coming up related to this patient. I hope this patients does very well with treatment, picks up fast and has a good care partner.

Toni

Hi Toni,

I'm not surprised to hear the class hasn't changed much. But, at least you got to spend some time working with the machine. In my class, we literally went in and listened to the instructor talk about the machine. She didn't even set it up or let us set it up. Some people could follow her a little bit because they already worked with the machine. As for me, I hadn't even saw the machine prior to the class.

The 1st time I actually got to set it up was when I went to my preceptorship week. By the way, I feel like I learned very little there also. I didn't actually get to see a patient being trained. Everything that I learned about training actually was learned while I was training my first patient with the Nxstage educator. I don't know what I would have done with out her. The educator actually trains you at the same time your training for the 1st time. The educator spends a week with you training you on the machine & pureflow.

As for the ratio, I don't think it's doable, but we'll see how it goes. It may be doable if your only managing their care. If your having to manage 15 and train new patients, I don't think so. I've been told I will get some help when I get to 10, even though in the HHD class we were told that the search for additional staff should begin when the program has 6-7 patients.

I have managed to train this week thus far without going into overtime, but it was hard. I was supposed to participate in an assessment of a potential patient, but my manager had to do it because I would have been in overtime. As for each training session, it averages about 6 hours. That's set-up, treatment, and clean-up. The 1st session can be shorter, because you can set-up the machine prior to patient coming and just put the patient on when they arrive. You want the 1st session to just be a good experience for the patient.

Training time depends on pt and partner, if they are quick learners they will go by faster. It takes me about 20 -30 minutes to set-up machine. It may take the patient and partner 1 hour or longer. Right now, it takes my patient about 1:30 from the time I bring him back to the time tx starts. That's pre-workup, setup, cannulation, put-on, and start.

I was thinking you were going to have a little bit of an advantage if your manager had trained the first patient, but I guess that's not the case. FYI, it really sucks when your the only one that knows the machine, and no one else has a clue what your doing. Do you know why the other nurse left? Are there any other Home Hemo nurses in your area that you know of? As for hours per day, how long you're there depends on what else you have to do besides train. It won't be too bad at 1st, but as you get more pts it gets more difficult.

Right now my duties are as follows: Training; managing care for pts (there is a laundry list things for this alone); ordering supplies, EPO, Heparin; Clinic visits; Ensuring dialysate cultures are drawn and within range for pts on pureflow; home visits; completing various reports, attending weekly clinical meetings; being on-call; being on conference calls; etc. All of this, while the program is constantly changing. As fast as you learn to do something, they change the way your supposed to do it and you have to take a class online or have a call to learn the new way.

I am happy to help you in any way that I can. I know how it felt to be new and not have a clue as to what was going on. Keep me updated!!!

MsDorsey

Hello Ms. Dorsey:

How is your training going? You should be in the 3rd week now. Were you on the HHD conference call for March on Friday plus there was a LMS on weekly billing this week? Do you think weekly billing is a better idea since patients don't always get their flowsheets in on time. I thought a fax machine was provided for the patients. I will be going to Washington to train with a perceptor in April I heard that will be a good learning experience. For me the sooner I get started the better I'll feel. Did you get the HHD workbooks from the store? I wonder if they are a good resource. I've believe they will be of help because the PD workbooks are quite good.

Have you rolled out with the new lab process yet. It does sounds OK and you can add labs for individual patients as needed. I don't know if I mentioned I am splitting my time with PD and HHD. I'm training PD patients currently yet the cycler is still a area I can still use some training myself. For me I think it would have been so much easier to just do one thing. I understand that my time has to use effeciently until the HHD program get off its feet.

I know you are busy with Epogen, labs, heparin, flowsheets, water cultures, clinic visits. When you are train 6 hours a day that leaves you with 2 hours to get all that done. Do you train 5 days a week on the same patient or 3 days a week. I really like to teach so I hope that will also be the same for HHD.

You are really doing a good job getting out without overtime during a training. Thank you so much I look forward to hearing for you. By the way there is one HHD nurse no 2 but they are out of my general area I have meet them at different events. They seemed to be reasonably happy with their positions. Unlike PD I almost had to go in on Saturday to give an IV antibiotic it turned out that is wasn't my week to be oncall.

Again thank you it means a lot to hear from you. I pray your training goes well.

Toni

Hi Toni,

Training is going well with my current patient. 1st tx at home should be sometime next week if all goes well. Yeah, I was on both of those calls. As for the weekly billing, my center was one of pilot centers. All I can say is that the process only works if the patients send in their flowsheets. The patients do get a fax machine, but that doesn't help if they don't or won't use it. They did change a few things after the pilot, so hopefully you won't encounter any problems.

No, didn't get the HHD workbooks. I don't know if they are any different than the one's I completed for in-center. No, haven't rolled out new lab process as of yet. I still need to take the course. It's hard to get everything done while you're training. It seems like it is going to be more work, but only time will tell. As for training itself, it's 5 days a week, same patient.

Happy to hear that you have your preceptorship all set-up. Hopefully, you have a good preceptor and learn a lot. So, they have you training PD patients. That's excellent!!! I actually want to learn PD someday. It's good that you're doing that because the Nxstage system is fluid based, so the principles are the same as PD. By the way, if you love to teach, you'll love home hemo. The only obstacles you may encounter are training as you patient census grows, especially if your doing everything. If you're manager or AA are assisting you with small things, than all will work out well. Good Luck with you upcoming preceptorship!!! Be sure to let me know how it goes. Talk with you soon!!!

Dear Ms Dorsey:

I sorry I didn't get a chance to respond before I left for preceptor class. I have returned from a one week perceptorship. I had the opportunity to see a patient from the beggining start training. I did get a chance to see the Nxstage in actual working mode. It isn't very complicated if the patients follow the instructions. However one must have a good working fistula or graft. I'm not to crazy about catheters though, I have seen too many patients become symptomatic in the chronic unit that appeared fine before their run began. The nurse was awesome she gave me alot of information to get started and her training notes which I thought were wonderful. I'm still quite nervous about doing a training alone. I meet the Nxstage nurse she will only be with me for the first 8 days and then its up to me to finish on my own. Tell how did that go for you? How is your patient you trained is he/she flying solo now? Did it take you 3 weeks to train completely. The couple that started were educated but they had long way to go in 2 weeks but I don't know how in depth the teaching can be. In PD we teach so much anatomy, dialysis(osmosis and diffusion), anemia, bone disease, epogen injection,heparin, adequacy, diet, complications, the actual manuel exchange and the cycler, fluid volume management, asepsis versus sterile man I'm getting my self tied up just thinking about how much more patients need to know cannulation, BLEEDING and how to handle it, multiple alarms, clotting lines, infiltrations. Do the patients leave training knowing all these things? I quess I'm getting worked up because class is over and its time to know enough to teach it. I sure you started off the same way you learned then turned right around and taught the patient. What was your background before HHD. My perceptor said it isn't a difficult job if you are not training a patient but the paper work can be overwhelming. I noticed she used that word overwhelming a couple of times. There are a few things easier than PD one you don't have to search for vein to give iron and take blood. You don't even draw the labs yourself. You only need to schedule the clinic visit once a month and not the MD visit as well. You have fewer patients, therefore you can get to know them better. But, there is that use if supplies I don't see why they can't order gauze, needles, pads, ExSept like they order their supplies from Nxstage the PD patients are responsible for ordering all their supplies.

Well, I understand that HHD is in its infancy for this company so in the next couple of years we should see a lot of positive changes. This Friday I should be getting and ideal of the first patient I am to train we work with many MD so I have a list of about 19 patients that have shown interest I don't know how many are still interested or how many are good candidates so I imagine that number will be about half which is a large number to get trained. I just have the jitters I could go on here for awhile so I'm going to wish you a happy belated Easter and hope I hear from you soon.

Toni

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