nurse/pt ratio?

RNonsense · Jan 20, 2003

I'm not a renal unit RN, but I have been down there a million times and it is 1:1 here. Your question looks rather panicky...do tell...?

Diva · Jan 20, 2003

Chronic units are staffed with a compliment of RN's, LPN's and patient care techs.

A patient care assigment (actually dialyze the patient) is ideally a 3:1 ratio, but many times goes to 4:1. These assignments are primarily technicians, with nurses sprinkled in.

There are always 2 nurses (RN's) without a patient care assignment to cover the unit. These nurses are responsible for charge, medications, rounds with MD, documentation, assessments, care plans, monthly notes, etc, etc, etc.

The staffing model varies from unit to unit, company to company, and state to state. I understand that Texas has the toughest staffing regulations given the nursing shortage.

TELEpathicRN · Jan 21, 2003

In our acute unit, the staffing is 1 RN:3PTS, or less. If we have to go to the ICU units to do a "remote" treatment, it is 1:1

Hellllllo Nurse, BSN, RN · Jan 23, 2003

Just today, I accepted a job in a free-standing dialysis clinic. I'm told I will have 6 weeks of OTJ training, which will be mostly films, studying, hand-outs, and quizzes. Then, I will orient on the floor w/ another RN. I'm told they will titrate up my pt load. I am expected to have 10 pts w/ 2 techs after a couple of months, and will be expected to be take my turn being charge after 6 months. I'm an RN with no dialysis expereince.

How does this arrangment sound to all of you experienced dialysis nurses out there?

Diva · Jan 24, 2003

Congratulations and welcome to the world of dialysis!!! Dialysis can always use RN's especially those with a strong nursing background.

Your orientation/training sounds like it is what it should be. I always feel that a newly trained dialysis staff person is doing well when they can do a 3 x 3 patient assignment, safely, with minimal assistance from co-workers. This usually takes 3-4 months of actually being out on the floor. Successful turnovers from shift to shift are a matter of being efficient and organized.

Taking charge responsibility after 6 months is according to the individual. Some can do it and others are stressed by it. If you feel you need more time, or more charge orientation just ask for it. It also depends on the size of the unit. I would not want a great nurse with 6 months dialysis experience in charge if it would shake his/her confidence, and possibly start second-guessing their choice of specialty.

Expect to work and study hard during you OJT, but my guess is that you will love it. Dialysis nurses are in great demand, and most don't leave the specialty. Dialysis is a small community, so set out to be the best. Again welcome and the best of luck.

Hellllllo Nurse, BSN, RN · Jan 24, 2003

Diva,

Thanks for your encouraging and positive reply!

What is a "3X3" assignment?

The unit has a 21 pt capacity. I'm told that staffing is 2 nurses w/ 6 techs for a full unit.

There are 20 dialysis machines (including one isolation) and a room for peritoneal dyalysis. I've heard a lot of positive things about dialysis, which is so refreshing in nursing.

I don't start 'til the first week of Feb. In the meantime, I ordered a book called "Dialysis Review for Nurses and Technitions" from Amazon, so I can do some reading before I start orientation.

I've been a nurse for 10 years. I was an LPN for 7, and have been an RN for 3. I was a CNA for two years, as well.

My experience is in med/surg, inpt acute care hospice, hospice home-care office and triage, LTC/SNF, rehab and psych.

I hope this would be considered a strong nursing background.

I'm hoping that dialysis will be a positive change for me, and I'm really looking forward to it!

Diva · Jan 24, 2003

You are very welcome!

A 3x3 assignment is: Dialysis patients are done in shifts. In your case, the maximum number of patients per shift would be 20. There are generally either 3 or 4 shifts of patients per day. 3x3 is when the care person sets up machine, primes dialyzer, assesses patient, initiates, monitors, disconnects, 3 patients on one shift, then strips the machines and starts all over again for another 3 patients on the next shift.

The usual course of events is that the trainee will start with one patient alone, then 1x1, 1x2, 2x2, etc, while you are getting up to speed. You are never alone, always other hands around to help.

The "Dialysis Review" is an excellent choice. Dialysis is really very interesting. To get a head start on the terminolgy and the basics will certainly help you to understand things more quickly.

You do have a strong nursing background and I am sure you will do well. The technology in dialysis changes rapidly so you will continually be learning.

The nice part about dialysis is that the patients are chronic so you really get a chance to know them well.

Keep posting, I will be interested to read your experiences.

TELEpathicRN · Jan 25, 2003

That book is a great book for new dialysis nurses and a good resource to keep with you. I always find myself looking up something in that book. It is one of the books that is recommended to study for the CDN exam.

P.S. Anbody taken the CDN?? I am planning on taking it in May and just wondering if anyone had some pointers. I have all but 2 pre-req's toward my RN-to-BSN program and hope to start it in the fall and be done in one calendar year. I will then attempt the CNN.

patadney · Feb 4, 2003

That sounds like a well-staffed unit. I worked in a chronic unit for 10 years and then traveled for 5 years and am doing a little work as and acute nurse now-that is I do the treatments in the hospitals,pt in ICU or that can't be moved out of their hospital room for treatment or because there is no unit in that hospital. You will learn how to run the machines and how to manage the pt and also give iv meds. Ther is lots of research going on and new meds come out almost daily. You get to know your pt and docs very well.It's very like a new family whose members are always a little in flux as new pt come and old ones pass away,move or get transplants. It's a whole different way of life.

Hellllllo Nurse, BSN, RN · Feb 6, 2003

It turns out that the desk work orientation is actually two weeks and on the floor is 4. Three turnarounds per day, 4-6 techas and two nurses for a full unit.

they have been short=staffed alot. I've been there only three days, but the DON and staff development/orientation nurse have worked the floor every day. It's nice to know that they help out often, and do not leave the staff to just flounder on their own.

I feel good about the unit. It is such a refreshng change from LTC.

I mean, people are actually pleasant to one another and say "good morning" to each other!

I am really excited about learning new skills. Before I became a nurse, I was a machinist/production operator for years. I worked with large, noisy, but very precise machinery, that needed frequent adjustments and took a lot of skill to run. I also worked around a lot of hazardous chemicals and substances, and used a lot of safety equipment. I think that that experience will really help me in learning to dialyse pts.

I took this position over another that paid a lot more, but I think I made the right decision.

Thanks for all your input, everyone!

I will keep ya posted!

jnette, ASN, EMT-I · Mar 8, 2003

Welcome. Helllllo !!!

Your training does sound like most I have heard of, at least the way it works with OUR company. Exactly as you described.

Ours, too, is a small unit (30 pts.) .. 12 chairs.. two shifts on M-W-F, and one shift on Tues., Thurs., Sat. We have our DON (who is SUPER ! ), 2 RNs (but not there together every day), 2 LPNs and a tech. Again, it varies according to whose day off it is, etc. Often we only have one RN working, and at times, that might be our DON. The RNs do everything the others do.. work the floor.. including our DON, when another RN is off that day. And the LPNs do everything the RNs do, except hang blood. We all do our own assessments, meds, etc., etc. We set up and tear down our own machines, do our own ccare plans, nursing notes, etc. We have a 1 staff to 4pts. ratio. Gets hectic sometimes, but we're a great team and we work well together. Very little turnover. The others have been there 10 years and more. Our tech is the newbie, and he's been with us two years. Small clinics are SO great because as posted by Diva, you really get to know and love your patients, and they treat you like family.. they really get attached (as do we.) We usually start by 0500, and sometimes earlier.. leave there by 1530- 1600. That's on our "long" days. The "short" days (one shift) we come in at 0430 and go home by 11 a.m. We work 4 days a week, either 3 long and one short, or 2 long and 2 short. Closed Sundays.

I, too, am a new RN, but have been there 6 years (was one of the techs).. just took my NCLEX on Monday and am anxiously awaiting the results. And I'm staying right where I am ! Couldn't be happier. :) DON says she wants me to be able to do charge in 6 mos., so I have much to learn there yet..from the RN perspective. I've been working as RN Applicant since I graduated, so have already absorbed and practiced a lot of what I'll be doing from here on out.

Let us know how it goes ! Hope you enjoy it as much as I !