SnipRN

I know this is an old thread, but I would love a copy of this cheat sheet as well, if anyone still has access to it! ?

I ended up leaving. It was not a good place to work. I miss the patients, but overall I am so relieved. Thank you for your response.

I need some advice. I've just passed my one-year mark as a dialysis nurse, and I'm seriously considering leaving my position. I love the actual job. I love my patients. But I am so frustrated by the utter lack of management and shady HR/payroll practices at my clinic. A few examples: When I graduated nursing school, I agreed to start on there as a tech until I passed the NCLEX. That meant--starting out at tech wages. I was OK with this, as I was told that all new nurses start out training as a tech, and I was guaranteed an RN role as soon as I passed the boards. I took the NCLEX roughly 3 weeks later, passed, and was immediately granted a 'title change' at my job and started working as a nurse. Great, no problem there--except that my company did not compensate me as a nurse for another 3 months. That was not part of the contract, that was due to my manager's incompetence. I had to pester him over and over, and finally went above him to corporate level, in order to get my promised wage. Just for further thought: A fellow graduate started working there about a month after I did. She had not passed her boards yet, and also had to start out training as a tech--but was granted full RN wages from the moment she first clocked in. She did not pass her boards for another month or so after I passed mine. In all this time, she was being paid nurse wages, and I was paid tech wages. Seems fair, right?! ? Now here's another thing: I have never received a performance evaluation there. Granted, this is my first nursing job, but I am not new to the workforce. In all of my previous roles, I was given an initial performance evaluation at around 3 months. At this job, never happened. Now, here I am at my one year mark, and I had to remind my manager that I am due for my annual review, plus the raise that was part of my contract. That was last month. I still have heard nothing. My contract also spelled out a $5000 sign on bonus. I have not seen a dime of it. I was also told that I would be reimbursed for my state license fees. I turned in all of the appropriate paperwork the day that I received my license. Do you think that I ever received that reimbursement? Nope. I'm becoming increasingly frustrated, and I feel that my manager just keeps sweeping things under the rug. Our corporate office is across the country, so we have no real support there. It honestly seems like he doesn't know what he's doing. The other day, I overheard one of our techs complaining that her annual review was more than 3 months overdue. In my opinion, the lack of performance evaluation is also a patient safety issue. For example-- we have two new-ish techs (started with us in January). Both of them have beena little slow to catch on, but one of them is utterly incompetent. I don't trust her to initiate treatment without direct supervision. This has been brought up to the manager multiple times--by myself, the other RNs, and a few of the more experienced PCTs. I don't know if we're just desperate, or what, but he has yet to intervene, even though there have been several very serious near-misses with this particular tech. It is to the point now that if she is assigned to work my side of the unit, I will take a pod instead, and have her stock, clean, and do basic tasks that do not require direct patient care. My point in all of this is, perhaps if the manager had actually reviewed her performance at the three month mark, he would have seen that she is not fit for the job, or at least come up with a performance improvement plan. Now, at nearly 7 months later, he is finally understanding how unsafe she is, but has to create a 'paper trail' with HR in order to remove her. I'm sorry for the long post, but I guess I needed to type that out, to give myself a little clarity. Is my clinic just very poorly managed, or have any of you dealt with these issues in your clinic? Would you stick around for this? More often than not, I am running as both a tech AND a nurse, and I often have to come in on my days off to complete my monthly charting. Is this just standard in the dialysis industry?

Same issue in my clinic! I used to feel so dehydrated at the end of my shift that my kidneys ached. We were able to convince the manager to let us store covered drinks on a small table in his office, which is just off the treatment floor. Wouldn't hurt to see if you could work out a similar arrangement.

I graduated in June last year, started working full time as a nurse immediately after graduation, and signed up for BSN courses in August. It was hard.. but worth it in my opinion. I'm down to only 2 classes left to finish my BSN this Summer. Personally, I think it is easier if you go early, to stay in that 'student' frame of mind. You should already be used to handling the assignment workload, writing papers, etc. I would think it would be difficult to get back into the swing of things once you've taken a year (or more) off from school. You have to be able to manage your time well though, and consider your work schedule when deciding how many classes to take. Online school is a LOT of written assignments. It's very time consuming. After working a 12-14 hour shift, I just physically (and mentally) cannot get any homework done... so my days off are entirely dedicated to homework. That part of it kind of sucks. ?‍♀️

I am doing the RN to BSN program at Washington State University. Many of the programs are now offering a pass/fail option, but the nursing program is not. This is because many BSN students choose to go on for a masters or PhD, and admittance is largely dependent on GPA, which cannot be adequately measured with pass/fail grading systems. I am not sure if the same is true in California, but thought I would offer my two cents. ?

Sorry, should have mentioned that my clinic is also well covered as far as PPE goes. Plenty of gloves, masks, gowns, full face shields. Right now we are using surgical masks, but we do have a supply of N95s should a patient screen positive for COVID. Dialysis patients are a high risk group, so we have been taking a lot of precautions. Visitors aren't allowed in my clinic right now. Everyone (including staff) is screened every day upon entering the building, and everyone has to wear a mask. We have not had any positives yet, but it has also only recently shown up in my area. Still, I feel that my facility has the right policies in place to minimize risk to patients and staff.

I'm not sure why you think you'll be bored in dialysis, as opposed to OR. I suppose the cases would be interesting to watch. I did enjoy my OR rotations in nursing school because I thought the surgeries themselves were fascinating. But as far as nursing duties go.. there was a lot of standing around. That, or running for supplies. At least, that is what I observed. Plus... I'm not sure where you live, but a lot of places have cancelled or postponed elective surgeries for the foreseeable future. I have a few friends that work in the OR who have been on low census for the last couple weeks. You will literally NEVER have this problem in dialysis. I do tend to be a bit biased though, because I love my job in dialysis. ?

I'm at American Renal Associates. I think you're right-- with this company it's a year minimum, but I think I could probably find per diem/ contact work in acutes.

Following! I am interested in learning more about acutes as well. I currently have 8 months of chronic hemodialysis experience. I was told that I would need at least one full year of experience before I could transition to acutes.

I'm an RN to BSN student at Washington State University. As of today, the school has cancelled all clinical rotations through the rest of the semester. They are looking into online simulation-type hours to make up for it.

I am sorry to hear about your mother, I hope you've seen some improvement in the last couple days. My first thought was disequilibrium syndrome. It's pretty rare, but can happen during/after the first hemodialysis session. Basically, rapid removal of urea and ultrafiltration can create a greater concentration gradient in the brain/CSF than the rest of the body, leading to accumulation of fluid and increased intracranial pressure. If this were the case, however, I would think that the CT scan would have shown cerebral edema. Might also consider uremic encephalopathy.

Awesome! Good luck with your first day on the floor, I think you'll have fun with it! Definitely sounds like you've got the right attitude going in, and you are clearly no stranger to hard work! ?

Hey there! I'm assuming that you've probably already started your new position by now, but if you'd still like to talk, I'm up for it! I'm totally a newbie nurse compared to you (just graduated last June), but have been working in chronic dialysis for the last 8 months. It is a very demanding job, and I am often physically exhausted at the end of the day...but I totally love it! If you haven't started yet, you can expect that training will begin with you learning the role of the patient care technician first. In fact, you might even train UNDER a tech, to start. It seems weird, but you can't direct what you don't know, and the PCTs have a lot of responsibility in dialysis. You'll learn how to build the machines, how to troubleshoot, what the different alarms mean, and how to intervene. You'll get lots of practice cannulating fistulas and accessing catheters. There is a lot to learn, just on the tech side. I'm not sure about other facilities, but my company requires skills testing and several written exams throughout the training period. Once your fully comfortable with safely running a pod (usually 4 patients) from start to finish, you'll begin training as a nurse. It is quite the process. Ideally, the techs are responsible for initiating treatment, but you should expect to be right out there with them, in the thick of it. If a patient has a difficult (or new) access, you will be responsible for cannulation. *Most* days (because we are chronically understaffed ?), I am running a pod (as a PCT) in addition to being the primary nurse for another 10 patients. It is almost like having two full time jobs, but only being paid for one. That is a definite con. But there a lot of pros also! The biggest for me is the relationships I get to build with my patients. You also can't beat the schedule, and the pay (even as a new grad) is pretty good. My current nurse/patient ratio is 1:12. With you coming from LTC, I would bet that you are already used to having a large patient assignment--but the pace is going to be a lot different. It is go-go-go all day long. Personally, I love this aspect of the job--but some people have a hard time keeping up. I think this is where a lot of new employees get overwhelmed and quit before they are even fully trained. I'm not trying to scare you off, its just the reality of the situation. Some people love dialysis, others hate it. It's not for everyone. Anyway, let me know if I can answer any questions for you! I think dialysis is a great field, and the patients are *truly* wonderful. You can't imagine the level of dedication they have, and it is really rewarding to be part of their journey.

Sorry, haven't checked this thread in a while. Absolutely. ?