Patient ratio

westieluv · Jul 26, 2016

Well, I work for Davita in a chronic unit and when I come in in the morning, I have 16 or sometimes 17 patients to manage. I rarely have to put any of them on, so what I start out doing is as each patient walks in the door I go over to them and do their assessment (lung sounds, heart sounds, check for edema, change in LOC) and ask them during my assessment if there is anything new going on with them since their last treatment. Then, I try to enter my assessment in chairside while the tech puts them on before I go to my next patient and do the same. I sometimes have to come back to do my machine checks, as the techs don't always have the patient on before I get to them and our chairside won't allow me to chart the machine check until the treatment is running.

Ideally, I have time to look through lab results, fistulagram reports, etc. that came into our printer and fax machine overnight before any patients get on so that I can see if someone has, for example, a K+ of 6.0 and they start their treatment at 5:45 am I can quickly call the doctor and change their bath or make any other needed changes before the patient gets on treatment.

After I do all of my assessments, checking labs, etc., I start my med pass, which involves drawing up Hectorol, Epogen, and Venofer for everyone, as well as their protein supplements as indicated.

After all of that, I take a much needed break! During the duration of their treatments, I take care of setting up MD appointments, calling in prescriptions, reviewing hospital discharge papers, etc. as well as helping the techs if someone has a problem with hypotension or some other issue, and then begin helping with turn when the first shift of patients starts coming off. I take patients off to help the techs as needed and start the above process all over again with the second shift of patients.

I like this job, but it is definitely not an "easy" nursing job, as some people will try to tell you. I run my legs off all day long. I wear a Fitbit and I always have my 10,000 steps in by the end of my shift and then some.

Best of everything to you! Twelve patients doesn't sound too bad. It will feel overwhelming at first, but once you get over the hump of getting to know your patients and what to expect from them and becoming familiar with the meds and dosages, it will get so much easier. The key is to stick it out during the learning curve and keep telling yourself that it will get better a little bit each day and that you will be comfortable and up to speed soon.

thelittlenurs · Jul 26, 2016

Thank you for your reply and the advice! I am nervous and excited at the same time. I have been told it is a very fast paced nursing job and I'm not scared of hard work , I just want to be safe and efficient. I'm in the Houston area, the demand for hemodialysis is high, there are not enough clinics to cover the need. The position I applied for is for 14 hours x3 days a week.

pdoylern · Jul 30, 2016

I'm an RN hired by Davita in Houston,TX in April. I am not working as an RN and will not be working as an RN for about 6-9 months, or so they tell me. I'm being trained as a Tech and RN and will be working as a Tech for 6-9 months before I can work as a nurse. I'm currently rethinking my decision to work in dialysis.

nutella, MSN, RN · Jul 31, 2016

I'm an RN hired by Davita in Houston,TX in April. I am not working as an RN and will not be working as an RN for about 6-9 months, or so they tell me. I'm being trained as a Tech and RN and will be working as a Tech for 6-9 months before I can work as a nurse. I'm currently rethinking my decision to work in dialysis.

To be honest : that is the right approach. I think they did not word it clearly so it makes sense to you. The problem for RN new to dialysis is that they have to get proficient in the technical aspects of dialysis first before they can really fulfill the RN role without getting a nervous breakdown, overwhelm, or make questionable decisions. They are doing you a huge favor by having you trained as a technician first and work in this role until you are comfortable and can manage all aspects of that that without additional stress. Dialysis is highly specialized and unlike other jobs. When you work chronic unit, you need to be able to do everything the dialysis technicians do including set up, strip down, cleaning, learn how to mix, test the water, check the machine and so on and forth. Davita has an organized approach of how they orient new nurses because they want you to succeed. It does not mean they do not value you or do not think you would be a good RN. By training you as a tech first they actually set you up for success.

Once you are comfortable in all the technical aspects of HD and you are able to handle "situations" and passed the knowledge competencies and so on and forth, they will transition you to the RN role and you will learn that aspect. The advantage is that by that time you will be hopefully proficient in dialysis itself and have gained a deeper understanding of it and that will result in more smooth work flow. So the addition of the RN role will most likely overwhelm you less because it requires a lot of time management and knowing the ins and outs of dialysis.

The other advantage is that because you will be trained by dialysis technicians as well and perform that work part, you will gain more acceptance within the team and hopefully develop a good relationship with the technicians. There is a huge amount you can learn from the HD techs! When I was new to dialysis, I started out in acutes and was trained in a hospital that has a large inpatient dialysis room with up to 8 or so patients. The dialysis technician who was a trainer not only taught me the ins and outs of dialysis, he was also patient and explained everything I needed to know. Later on I worked with a HD technician who had been a tech for decades - she was one of the most valuable team members ! You work together closely as a team, in HD the team work between techs and RN is essential to make it a successful and good day!

Of course if you do not like HD - by all means look for something else. But if it mainly because you think they do not value you as a RN due to the training approach I would re-think.

westieluv · Jul 31, 2016

I couldn't agree more with nutella's post. You do NOT want to be an RN in a chronic dialysis unit without being comfortable putting patients on and taking them off of treatments or understanding the machine settings and water system, trust me. You will have crazy hectic times when you are down a tech unexpectedly or the tech is on break and it will be up to you to put someone on their treatment or take them off. If you can't or won't because you weren't trained well and are afraid to, it will be hard because you have to be able to do those things, it's just part of the job.

Being thoroughly trained as a tech before learning your RN role is the greatest gift that Davita can give you and will make you a successful dialysis RN. As nutella said, they are actually setting you up for success by doing things this way. Not training you to be a proficient tech first is setting you up for frustration and failure.

Jen, RN · Aug 3, 2016

I have been contemplating applying with Davita. I do not have any dialysis experience. I am good with being trained as a tech and then as an RN to learn all aspects of the job. Do you get paid as an RN for the 6-9 months of training or only as a tech till you complete the training? I am about 2 hours from Houston and was wondering what the starting pay range is in that area? I also want to work in a place where there is an opportunity for advancement and Davita seems to offer that opportunity.

Guttercat, ASN, RN · Aug 3, 2016

I'll just echo what others have said. Learning the tech aspect is imperative and that is a great approach that DaVita has in place.

Back before techs were allowed to perform dialysis, it was RN's that did everything: the tech portion in addition to nursing responsibilities. Also, by training as a tech first, you will gain a much greater grasp of your patient population and their individual nuances. This will translate very nicely into the RN role and help you make a smooth transition.