Outpatient Renal Care RN Responsibilities

NurseRies, BSN, RN · Mar 12, 2013

Hi all,
I'm considering a change from psych nursing to dialysis nursing, but I wanted to see what clinical skills are expected to be a quality dialysis nurse providing OP renal care.
The job description seems VERY vague: "The registered nurse is responsible for performing patient assessments, establishing care plans, advising patients and their families, implementing and evaluating nursing treatment, and administering medications."
What's a typical shift like? Do you start IVs or do most patients have their access already? Is it more being able to monitor vital signs and understand fluctuations from baseline?
I'd love to hear what a typical 8-hour OP Dialysis RN shift might be like (granted, I understand no two shifts are the same!)
Thanks in advance :)

Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.

To put it plainly, you will never sit down and you will go through about 500 pairs of gloves per day just yourself! Buy good shoes, be prepared for chaos, and if something goes wrong, it's on you. Most people quit during training. If you like it, stick with it, it can be a lot of fun, but it is very hard work.

nurseREA · Mar 13, 2013

Simply put, for me dialysis nursing is controlled chaos. Turnover can be crazy and you must be a master at multi tasking in order to get through your day. I always keep a list of things i need to do and then prioritize. You do have to supervise the techs, some closer than others, to make sure they are not cutting corners in order to save time. As the charge nurse if something goes wrong it is all on you. While dialysis nursing can be stressfull I find that it is also very fulfilling seeing the same pts 3 days a week. You become a part of their lives. I love knowing that I have such an impact on so many people's lives. Not only do you provide a life saving treatment but you also really get to know the pts and their families. Dialysis patients spend so much time together that they become a "family" and working there with them, for me, is a privilege. While dialysis nursing is not for everyone, if you can handle a fast pace environment and love interacting with patients i would recommend it.

enchantmentdis, BSN, RN · Mar 13, 2013

Well, most dialysis positions are 11-14 hour days. I very rarely see 8 hour days. But anyways, a typical day if you are the opening nurse would be to arrive between 4:30 and 5:30 am depending on your clinic. You would get there and verify the water system with the tech before any patients come inside.as charge nurse, I would unlock the doors, print out necessary paperwork, count meds, draw up 15 vials of heparin for each morning patient, and once everything seems ready and safe, give the go ahead for the first few patients to come in. This would all happen in the first 30 minutes. In a matter of 10 minutes, you need to do 3-4 patients assessments for pre dialysis, document, and then push heparins after the tech has stuck the patient. After the first 4 patients are on, it's time to verify that the tech did everything correctly and treatments are safe. Don't sit down yet, the techs are now bring in 4 more patients to put on the machines and its only 15 minutes since the first 4 came in. You repeat again. You do 4 rounds of this in 1 hour until all 16 patients are running on the machines. Now it's time to verify safety on everyone. Keep in mind vitals signs must be recorded on all 16 patients every 30 minutes. If you're lucky, the techs are responsible and will do this. Now you need to push medications. Usually there are 3, epogen, iron supplement, and a vitamin d supplement. Make sure you give all 16 patients their IV meds safely. The phone will be ringing off the hook for you. The MD may round between 8-9am. You must follow all his orders and are responsible for adding them into the computer. Coordinate with secretary to make cardiac appts, schedule surgeries, etc. you hopefully can take a breakfast break after everyone else has gone. Keep in mind, you've got 16 patients to watch, who are bottoming out on BP, asking to take a bathroom break, complaining about how cold they are, asking for water, etc on a constant basis. Just as you come back from break, it's time to get ready for the first "turnover". All 16 patients will start coming off the machines in 15 minute intervals, and 16 new patients will be in the lobby cranky and wanting to get on the machine at their exact scheduled appointment time. So you've got techs returning blood, while you're running around verifying that the post assessments are good and patients are stable to go home. You should already have your heparins drawn up for 2nd shift. A tech might have a time frame of 30-45 minutes to flip a chair, meaning get patient out after they're done bleeding, clean machine, re- setup new machines, and get next patient in. Get next patient on the machine fast because their other patient is about to come off the machine in the next chair over. The tech will have 30-45 minutes to flip that chair, and so forth. You better hope nothing goes wrong! And it does, all the time. You as nurse will be expected to ensure safety of all patients, you may also have to flip a few machines yourself since the techs get caught up with problems and difficult patients. You will work faster then you ever thought possible. The changeover lasts about 3 hours of nonstop chaos. After the chaos subsides, you can get ready to do your second med pass. In the later afternoon, you may be able to do some assessments or education, but usually you end up picking up the slack work since the techs have other duties in the back that need to be taken care of. You will be doing vitals signs, returning blood, making phone calls, etc. you will be wearing a plastic gown all day, no exceptions, and usually a face shield and mask.
To put it plainly, you will never sit down and you will go through about 500 pairs of gloves per day just yourself! Buy good shoes, be prepared for chaos, and if something goes wrong, it's on you. Most people quit during training. If you like it, stick with it, it can be a lot of fun, but it is very hard work.

Oh my God!!! Hats off to you. You are very brave indeed.

DialysisRN12 · Mar 14, 2013

NurseRies so dead on lol.

DialysisRN12 · Mar 14, 2013

I forgot what chronics was like after having been in acutes now but your post reminded me :)

NurseRies, BSN, RN · Mar 14, 2013

I forgot what chronics was like after having been in acutes now but your post reminded me :)

Haha, @DialysisRN12 I have actually been doing acutes on my assignments and haven't done chronics since August. Just reading my post made me wonder if I could really go back to it. Can I still hang? It might take me a week to get back into the routine. It was chaos, but that is where I thrive. I actually miss it. At least I never looked at the clock and we always had a few laughs throughout the day. If you have a good team, it can all be worth it. And not to mention, the patients were hilarious. I miss them.

dialysisnurseLC · Mar 15, 2013

@nurseries you are dead on! That is exactly what A day in dialysis is like except I'm passing Meds doing my assessments and the tech's in the pod next to me as well as an LPN I have only charged a few times that I can count on my hands but I feel I need to know because I will be an RN in a few months

NurseRies, BSN, RN · Mar 16, 2013

@nurseries you are dead on! That is exactly what A day in dialysis is like except I'm passing Meds doing my assessments and the tech's in the pod next to me as well as an LPN I have only charged a few times that I can count on my hands but I feel I need to know because I will be an RN in a few months

Good luck! It's not so bad if you know which patients to watch. I always am keeping a right eye on certain patients who tend to suddenly pass out or cramp up. The main thing for me is checking target goals and making sure that person can handle it. 3L goal for a tiny lady with low BP just isn't gonna cut it. That's why I make rounds often. Nobody would be passing out on my watch, it's not worth it. I would sooner have them come in for an extra treatment day to remove excess fluid, even though that seems to upset everyone involved, it's safer.

It's also very important to be a team player in this environment and you really have to get your hands dirty. It makes such a difference when you have just one lazy person working. The whole day is a nightmare. But I think for me, it's frustrating to be an RN when you have techs that don't understand how much other stuff we have to do. They don't understand why I can't get up and take vital signs when we're both at the computer. Sure I can, but I'm busy charting about an emergency we had earlier today. That is more important then an education module. I've also worked with some really lazy nurses. There's always drama at these clinics. I try to do my job and stay out of it. Listening to people talk about eachother all day is more exhausting then the work itself. I hope someday to find the perfect team.

dialysisnurseLC · Mar 17, 2013

Lol @nurseRies about the perfect team!!!! A team that works together is everything! Yes there is always drama...but the girls at my clinic keep the atmosphere fun... We really enjoy working together although I wish we could talk things out more... Our clinic is going they a rough patch right now... But over all I love dialysis