I've 30 years of nursing experience in various specialties (surgical, ER, tele) who's been in dialysis for 2 1/2 years. It's not my dream job but I work hard to help my patients make the best out of the rotten hand they've been dealt. One thing I do an excellent job at is withholding and suspending judgement on the 'lifestyle' choices my patients make. I want them to live, I want them to feel valued, and I want them to feel that dialysis is as important as breathing. If I can keep them alive and well so that maybe, one day, they'll see the light and start taking charge of their own health I'll feel like it's been worth it. Because of this I frequently get assigned the psych or addicted patients because I love the challenge and because I can usually get through to the occasional 'outlier'.
As such I occasionally will allow a patient a 'bathroom' (ahem, cough, cough) break where they'll grab a quick cigarette. I make them promise to return and they always do. I increase their UFG to accomodate the extra blood return and I've yet to have a patient not return. My manager knows what I'm doing and we both agree that complete dialysis is the ultimate goal.
The problem I'm having is with the other nurses and techs who openly disapprove of my 'spoiling' and 'giving in' to my patients. They're always going on about what my patients are 'getting away with' and how I'm letting them run the show. They're the most harsh, judgemental crowd I've ever worked with. I'm an experienced RN who's worked with all types for years. I know I'm being a bit manipulated but so what? My patients always improve their URR's and THEY SHOW UP!!!
So what do I say to these nosy Parkers who always have to have an opinion on how I treat my patients? I'm tired of them.
Working in the ED I see a lot of patients that are brought in for things related to their noncompliance with dialysis. They just don't want to go and in that moment feel like they would rather die happy than suffer with the long treatments and side effects.
I think your intentions are pure and I am glad it works for you. I think the drawback would be that the patients will want every nurse to break the rules for them. It would be nice if there was a way to come up with strategies facility-wide to increase compliance with the patients that find it difficult to tolerate dialysis.
As it has been said, it's dangerous. It also sets back the day if you are in a busy unit - every 10 minutes a patient spends smoking is 10 minutes another patient has to wait to get on later in the day. I think you will find that the more you are willing to do for people, the more they will expect from you - which is probably why your colleagues are against it. Patients with chronic diseases are not like inpatients - they need to be treated like grown ups and not children, which is why we encourage self care in dialysis patients and not the "sick role" which is what happens when we constantly make allowances for people. It's one thing to make someone feel better when they are really down and depressed, but doing regular favours for people causes nothing but trouble in the long term.
Have behavioral contracts gone the way of the dodo bird? Dialysis is a life saving treatment yet I have to beg and plead with a patient so he/she will "let" me give them a dialysis treatment. Are we dealing with adults here or children?
I agree with this post and want to add that these are the destructive behaviors on the part of patients, who are longstanding addicts and (dare I say it) gluttons on so many levels. Used to instant gratification their entire lives (bad foods, excesses of bad foods, alcohol, drugs - both licit and illicit) will eventually deprive them of their lives and they will pay the ultimate price as will their families at their loss, for which they will never stop grieving. Eventually, a dialysis patient will have to qualify (or not) for a kidney transplant and it will have to be "change or die". I am not being judgmental but am speaking from experience. My husband of 43 years died 7 months ago from similar consequences and inability to change. Bipolar, a long time crack addict and alcoholic and in the end a raging diabetic with blood sugars running in 400's on a daily basis because he would not stop eating bad food, he died of sepsis related to cirrhosis and Hep C. He could not qualify for a transplant because he could not give up the substances and chose to die rather than change. As a nurse, you are not there to be your patient's friend and help them sneak out to smoke. You are enabling them by doing this. Instead you should be listening to them and EDUCATE, EDUCATE. Use stories or whatever other means you have that will reach out to them. Brochures won't cut it for this crowd. You must let them know you are on their side, want them to live and do well but that you will not be a part to helping them do ANYTHING that will hurt them You must be strong in this. Remember all the family members who will weep, as I now weep for my husband, and don' the be one of the ones who help the behaviors to continue. PLEASE. I am an RN BSN.
Always know where the line is drawn, and that line is found within your company's protocols (and common sense).
Blur those lines too much and too often and you are not only inviting trouble for patients, but for yourself, your coworkers, and your company.
I completely understand the empathetic side--life on dialysis can be so miserable, even for those patients that do everything "right."
Some here have alluded to the fact that many on dialysis are on dialysis because of poor life choices in the first place. True, dialysis doesn't (usually) make their choices better, and those of us that have been in the game for many years often see the reverse is true. That said, I see a bit too broad of a brushstroke being painted here. Dialysis patients cover a large spectrum of socioeconomics, class, coping skills, and disease etiologies.
OP, when a patient wants to dart outside for a break, it's on you. While we try to grant patients some indulgences--anything that helps them get through the treatment-- just remember that the ultimate choice is theirs as to how they do or do not follow guidelines. Don't let rule-bending (we all do it on occasion to some degree) bite you (or others) in the butt.
P.S. toTankweti, I am sorry to hear of your loss. Big hugs to you.
Maybe if you offered compensation for giving a transplant, it would not be an issue. Why do third parties believe they have the right to make decisions for other adults?
So, we owe you lifetime employment? I have never, ever seen an industry where the customer is treated so badly. Residents in a retirement facility pay $4,000 for an apartment in a swanky facility and they are treated like gold. Hundreds of thousands of dollars are paid in the name of the dialysis patient and how are they treated? Thiry has a great job, he makes $62 million per year in total compensation and he is allowed to treat his customer base like trash. He can blame the patient for diabetes, disregarding that the academic nephrologists do not know what causes diabetes......
Davita just lost a court case, where Thiry and crew, my buddies, claimed that they owned the patients records, not the patient. Basically, they were laughed out of court. I guess that is what happens when you have been unaccountable for many years, you tend not to live in reality, like the rest of the real world. If I was one of the judges, it would have been hard to keep a straight face.
I hate to inform dialysis management, that the new generation is not going to tolerate such nonsense and abuse. Here is another example of dialysis management arrogance:
Kent and Greg,
It appears that you continue to dictate the terms of the patient, knowing that it is illegal. The patient is not allowed to have an advocate, you dictate the terms. A patient who has been badly abused at your Clinic at 5650 W. Greenbay.Wi. She also wants the paperwork that you have denied her to be present in this meeting.
You have been aware of the harassment that continues with constant pleas, even having a nurse chase her down to the bathroom and state she is going to be terminated if she does not sign a paper. Not allowed to go to another clinic, denied her records and they state that the patient is not going anywhere, which is happening. Harassed as she was leaving the clinic, and last of all taking her right away from the right of having an advocate unless I was in person.
This patient is at undue risk, with CMS staying silent and not taking a stand on what is right. So, after much thought. Ms. Smith will be represented in person by one of the Civil Rights Groups that are working with us.
I am going on the record that not being able to have me, as you have denied her and others this right. Her records are her's and she has a right to an advocate on the phone. This you have denied.
So please give Ms. xxxthe proper form, as Ms. xxxxxxx will be her advocate for us. I cannot let this patient go into a meeting and harassed and possibly terminated, cause you don't like her. wish I had Ms Smiths strength for all you put her through, and CMS and Davita should be ashamed of yourselves.
Demonstrations in Louisiana are being planned. The word is getting out and we are on an International show tomorrow night.
These terminations and lack of Civil Rights are going to end.
Gabby-RN
165 Posts
Working in the ED I see a lot of patients that are brought in for things related to their noncompliance with dialysis. They just don't want to go and in that moment feel like they would rather die happy than suffer with the long treatments and side effects.
I think your intentions are pure and I am glad it works for you. I think the drawback would be that the patients will want every nurse to break the rules for them. It would be nice if there was a way to come up with strategies facility-wide to increase compliance with the patients that find it difficult to tolerate dialysis.