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rhyde LPN

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rhyde has 40 years experience as a LPN and specializes in Nephrology/Dialysis.

rhyde's Latest Activity

  1. rhyde

    Leaving before 1 year? Don't know what to do..

    I would like to add that being a dialysis nurse is stressful as well. You may be in charge of 12 patients and the technicians that do the actual care. It seems that some people have the idea is that you just put them on and take them off and it's no big deal. Except it is. Just like you are seeing more critical patients on your floor (and I agree that 10 - 12 is too many), we are seeing sicker patients released from the hospital to dialysis and it seems like we are an outpatient hospital ward LOL! I don't want to dissuade anyone from trying dialysis - I love it and have stayed for 35 years in this field. But just be aware that other types of nursing are stressful too but in a different way. I wish you the best of luck in whatever you decide. By the way - it is not true that you cannot get a job in the hospital after being a dialysis nurse. We have had 3 new grads start here and then transition to the hospital for acute care. You have to be able to sell yourself!!
  2. rhyde

    Newbie Dialysis RN

    Beachbabe86 - I am currently in Montana. Have practiced in Washington state, done some travel nursing in Indiana, N. Carolina and Kentucky then came back and settled here. I really love it! And I have been doing this a few years so I guess that qualifies me as a pro!! Thanks!!
  3. rhyde

    What Do You Keep In Your Pockets?

    I agree. Nothing in your pockets!! We used to have 2 x 2's, tape and all that in pockets but no more. Doing inventory one night at the clinic I work at I found a bunch of alcohol wipes someone had put back in the box with bloody fingerprints all over them! This is why we don't put stuff in pockets. I go around and ask people here to empty their pockets if I see them getting stuff out of them and make them toss it.
  4. rhyde

    If I love CRRT will I like hemodialysis?

    You may really love acute hemodialysis. I would ask to shadow for a day or so before you accept a position tho. There are times when you work 20 hours (rare) or may have no patients at all. It is a challenge that you may really enjoy and knowing CRRT will be helpful for you to be able to set up machines etc. I loved acutes because I saw so many different things - each day I learned more. I have done dialysis for 35 years - mostly in center- so Acutes was a whole new ballgame. I learned plasmapheresis as well. Just remember there is call time so be prepared for that. Good luck to you!
  5. rhyde


    I often close my eyes and just feel the fistula - if I try to find it with eyes only I may miss the stick, but when I KNOW where I can feel it, I usually hit it every time. Use a tourniquet and maybe even put pressure above the area you want to stick with your finger to make that vein pop up. Don't pull the skin too taut as you can actually flatten out the fistula and make it harder to stick. The more you practice the better you get! You'll also develop what works for you to make sure you are successful. As far as removal, put the gauze on top, place a finger lightly where the needle exits the skin and pull. It doesn't matter if it bleeds a little as long as you have a finger directly over the hole. I agree with diabo, RN that pulling needles without coring the access is hugely important. Also ask for feedback from your patients. Ask them if it hurt when you put the pressure on or if you put pressure on too soon. They will tell you the truth and will respect you for asking. Vascular access is one of the most difficult part of this job and you will become proficient!
  6. rhyde

    Need advice in a sticky situation

    Most hiring managers in my opinion understand that sometimes we are not a good fit/have personality clashes or whatever at former jobs. If you put your 2 weeks notice in, I would not consider this being fired, but rather that they elected not to make you work that full 2 weeks. I would just say at the next interview that the job was no longer a good fit for me and that I chose to leave. You don't have to mention anything about why you left.
  7. rhyde

    Need advice in a sticky situation

    I would give your 2 weeks notice and if they ask you to leave early just do it. They will likely be glad you are leaving anyway. Most places (if no unions etc) are "at will" employment anyway so they'll get rid of you one way or another if that is what they want. At least you will have done your part by giving proper notice.
  8. rhyde

    Dialysis nursing pros/cons?

    I'll be the voice on the other end of the spectrum. I have been a dialysis nurse for 34 years now. Took me some time to find this specialty but I was hooked! Instead of working for the big 2, try to find a hospital based unit or not for profit provider. I have worked for both for profit and non-profit providers in both in center chronic hemodialysis and acute settings and prefer the not for profit unit. The thing I love about this choice is that I have used my assessment skills to find DVT's, suspected bowel blockages and cardiac issues like a pericardial friction rub. I don't take any day for granted. You can have a patient be fine one day and flip into AFib the next. It goes without saying that I have worked with great dialysis technicians and nurses and some not so great. Like anything else it takes about a year to feel really comfortable. You may also be able to train for home therapies which is a whole different ball game. I wish you luck and hope you will try dialysis.
  9. rhyde

    Dialysis Nursing

    First of all let me say that I am amazed at how you are coping with all this! You seem very clear headed and know how you want to have things go for your Dad. I am a dialysis nurse of 34 years and here's what I can tell you about it. You do not need to be a trained dialysis nurse to take care of your dad at home. Units that do home dialysis training (either peritoneal or hemodialysis) train the caregivers at the same time. Keep in mind that if the choice is hemodialysis it is about 6 weeks of training, PD is much shorter - often a week for initial training and then another few days for cycler training. If you want to work in dialysis, then just apply - we do all our own training and once you have the requisite hours you can become certified, but it is not usually required. Most have to work hemodialysis for a bit before a home training position opens up. Visiting nurses would do your dads vent care and other nursing needs, but would not do his dialysis treatments. They just don't have the training. I have not personally seen a patient like your dad do home training, but I don't see why it couldn't be done - you will just have to be his voice to push for it. We are open to accepting patients with LVADs and Trachs etc. at our unit once deemed appropriate by our corporate office. I do not work for either of the two you mentioned. You would have to do any care he requires during the training period (while getting training). I wish you the best of luck in caring for your father.
  10. I basically have them do a competency test at the beginning to identify areas of weakness which we then do training on. Everyone gets a skills checklist yearly. Experienced staff are with a preceptor and I spend time with them going over P & P's and showing them how we do things etc. The Bio-med techs take them into the water area and complete a skills checklist there as well. I usually allow no more than a month for orientation - usually 2 weeks is the norm unless they've been out awhile. I do the same thing with travel nurses and techs but maybe faster.
  11. rhyde

    Help!!!Accesses covered compliance

    I have had the same thing happen - hence the need to have them uncovered. A few years ago a unit in my state was cited and had to complete a huge plan of correction AND a second site survey due to this issue. I don't like dealing with surveyors at the best of times so a second visit might be a way to get patient and staff compliance. I start with staff, but also put signs up for the patients letting them know why we are focusing on this. Make it a monthly education topic type of thing. I wish you well - sometimes the only way things change is when a problem occurs.
  12. rhyde

    Looking up patients on Facebook

    We see our patients frequently in the area I work in and one nurse in particular "friends" patients on Facebook. I think this is a professional boundary issue - these patients then request special treatment. In addition one patient accused this nurse of "smoking a bowl" with him at his house. If that had gotten to the nursing board it could have ended her career or at least gotten her on a diversion list. Not gonna happen to me!!
  13. rhyde

    Renal Telemetry Unit Interview

    Some things you might expect are s/s of hyperkalemia including tented T waves, assessments for fluid balance (edema, lung sounds etc) and what could be done for each. Also anything related to post dialysis care - vascular access etc. Good luck
  14. rhyde

    Current RN pay scale?

    Pay rates seem to be lower here than in many other states, I am fortunate in that I have years of dialysis experience so I make a bit more. However, before you move here, please check out the area you want to live in and the cost of living. Some things are way cheaper and some are more expensive so factor that into what you are expecting to receive as pay. Montana is awesome to live in - I can grab my horse and trailer for 10 minutes to ride for hours. You really do get awesome outdoor experiences in this state! I truly love that it has 4 real seasons ( maybe not so much when it is really cold like now!!!) and that I can find recreation close to home. Good luck in finding what you are looking for in this wonderful state!