mmurphy

Dialysis is chronic care, not rocket science. Any unit should have basic protocols. Taking initiatives to draw CBC's clood cultures, basic metabolic panels etc., are within the skill of an experience competent dialysis nurse. Administering meds, without protocols is another issue. Have one of the chief's write the med. (vanco) etc., as a verbal order from the nephrologist, then carry out the order.

I agree. I agree. I agree. It is not a matter of racism or bigotry, it is a matter of exploiting us, the American Citizen Nurse.

I think that this clamp issues cnme from the "fistula first " program. The suggestion was to no use clamps on newly underdeveloped fistula for fear of clotting. Comparing a developed fistula with a graft the obvious risk for clotting using clamps would be the graft. This is a great deal of lack of education among dialysis managers (particularly in hospital run dialysis clinics), and unfortunately there is often no rationale behind many of the rules in these clinics. A grest example NOT USING SITE CLAMPS ON FISTUALS COME ON!! If the clamps are used correctly the will not risk clotting an access.

Many units use heparin 1000units/ per ml , and draw up the amount needed to fill the volume of the catheter. 2ml or under is the average amount needed for each port. some current evidence suggest that just filling the lumens/ports of the dialysis catheter fwith NSS is adequate enough to keep the catheters from clotting. The important factor is to make sure you have enough solution to fill the volume of the lumens. 5000units/ per ml is an unecessarily high dose, and is not rotinely used in most dialysis units. Hospital units are more prone to use these higher does amounts, becasue hopital dialysis units have inferior knowledge re: dialysis comapred to for -profit dialysis systems; such as fresenius, or Davita.

No, so not file an incident report. Report the error to the physician. Be honest. If no harm is done to the patient do not buy the "this is a learning experience, or this is a "process analysis to aid the hospital in determining how errors occur. This may have been the mentality several years ago. However, I see honest nurses writing up IR's in attempt to follow appropriate protocols, and then they are disciplined for making even the simpiliest mistakes. It is a system, that dehumanizes hard working nurses, and continues the overall disrespct and total lack of understanding that management has for what concentious and hard working are forced to deal with on a daily basis.

It is up to you to insist to management that you have regular scheduled breaks, not doing so makes you a fool.

This "pulse" is called a thrill. It is basic nursing 101. A patent graft or fistula will have a strong "thrill" when palpated. The thrill is from the anastomosed artery and vein, if you do not feel this thrill likely the graft/fistula is clotted. When ausculatated the graft or fistula has a stong swoosh sound known as the bruit. Secondly Emla cream is widely used. 90 year old patients apply it themselves a hour before dialysis, it is not a huge deal. It should be applied over the entire access, as you do not know where the dialysis staff is going to cannulate the access. Apply liberally and cover with any type of dressing or simple saran wrap.

I have worked a a RN for 25 years. I have been a manager, a Charge Nurse and a staff nurse. Nurses are more productive when they take breaks. You are not serving your patients well, or doing yourself any favors when you don't take a break to rekindle your spirit and energ. Nurses need to stop the mauderer behviors and simply tell management, I will be taking my break at noon etc., It is the law in every state. Take a break for your paitents' sake.

Your role as a dialysis nurse is not to be a Nazi Guard. Try to understand sitting in a chair for 4 hours without food or drink. Try to understand that this treatment time is like "a job" for the patients Let alone the time traveling to and from the treatment center. do you go for 4- 6 hours without food or drink on a regular basis. Your role is not to "control" the patients.

It sounds like you only know some of the technical aspects of dialysis. that would be boring Learing the psych behnind chronic illness, the regulations for dialysis etc., I find the nurses that are bored in dialysis are the ones that are not motivated beyond lerning how to operate the machines.

I have been a nurse for 25 years. I have worked in Florida, PA, and NJ. Recruiters have been calling Hospitals and Outpatient clinics in these states for a very very long time, I would say since the late 1980's. When I was an Administrator for a Dialysis Company in the 1990's I would get at least 2 calls a week at work, and some at home. The staff would also be called at work. All that I am saying is that this has been common practice for a long time. Looking from another prospective, I think that it is a benefit for nurses to know that they are in demand, and it is beneficial for corporations to be reminded of this fact once in awhile.

In New Jersey i nurse ot 3 patients is the standard. It is defined as the standard by the New Jersey Department of Health.

You must be a fairly new nurse. This has been common practice for many years.

I totally agree with you 1989.

As long as you guys continue to put up with this the moneymakesrs (Administration and Docs) will keep you going at this pace and work you like dogs

I agree. Why was the bath so importnat on such a busy day? Why was the Doc concerned about the bath? 30 years of nursing.. i have never seen a Doc worrying about a patient's bath. Give yourself a break, you won't make the same mistake again. Next time things are this hectic forget about a bath on a citically ill patient, that is in more need of a procedure than a bath.

Why is the world would you think that you would neeto take the NCLEX exam after obtaining a BSN? Do the nurses with BSN's practice nursing differently than the ASN nurses? ave you been working a A RN? A NP functions differently, than A RN ( diagnosis, prescribes meds. etc.) they take a different exam for their NP License.

our units draw PT/INR's from cath patiens this way. We place the patient on the machine after aspirating 5-10ml of blood from each cath. lumen. We then flush the lumen with NSS and begin the dialysis. We then withold the heparin oading dose for 10 minutes at the beginning of the treatment. After 10 minutes, we draw the PT/INR or PRR from the arterial line. After the blood is drawn we begin give the heaprin loading dose and begin the infusion as ordered. This sems to work for us. However, the only way to get an accurate PT?PTT froma cath patient would be to do a peripherdraw. Our patients go through enough. And this procedure of described above seems to be a fair compromise. If we get a questionable result, we then do a peripheral stick for the PT/PTT pre dilysis.

Surely you aren't serious. Poor eating habits are bad for your health. Perfumes/Hairsprays can cause symptoms in the allergy prone/asthmatic individual. I do not smoke, however, this is not communist China. Your opinion leads me to believe that you have been much too indoctrinated by a current media hype against smoking/second hand smoke. Try to think rationally not emotionally. Anti-depression medications (widely consumed by nurses and physicians) actually do at times alter thoughts and judgements. Where do you want to draw the line?

The statistics that I am aware of bear out the opposite. First Borns are rarely RN's as nursing is a subservient role. First borns are usally Doctors, Lawyers and enter fields that are generally more respected than nursing. The exceptions, would be if you are the first -from a family that is lower than middle class on the socio-economic scales. For example- the first one in a family to have any education beyond high school., or the first born from an abusive family.

I agree 100 percent. Magnet means nothing. It means the hospital can afford to have administration spend hours fluffing up deceitful paperwork to gain a bought status.

I work per-diem for 3 different hospitals. One of theses hospitals is a "Magnet" Hospital. In my 25 years of nursing experience, the "Magnet" is bull. The Magnet hospital delivers the worst nursing care of the 3, is constantly short staffed to a dangerous level, and generally treats nurses like endentured servants. Oh, but the "Magnet" Hospital is very top heavy with "Administrative Nurses" that are clueless of state regs., and are constantly out of compliance with regulations and medicare guidelines. However they did put on a nice show when they were being surveyed to obtain the Magnet Status". No, I do not believe the Magent Surveyors see beyond the lies, fluffed up paper work for appearance sakes and the general bull. In my opinion "Magnet Status" is something that is bought. It means nothing.

There is absolutely nothing to enjoy about nursing. If a nurse is a manager, supervisor, educator, or administrator; in order to function he/she must be devoid of moral character. These jobs are nothing but political bull, they talk patient care at meetings, but in reality anyone with any brains, in the above mentioned positions soon realizes that "care" is the last priority. There is an occasional reward when a patient "feels gratified" or you may feel that you have made a little difference in someone's life. But these rewards come only at the direct care level. The rest of the time nurses working in direct care positions are lied to by administration, belittled by busy doctors, overworked, not respected, demoralized and put to the impossible tasks oof balancing the "paperwork bull****", with the impossible physical and time demands of real time care delivery. I would not recommend nursing to my worst enemy.

In some states it is mandated that any dialysisn training must be with the oversight/direction of a RN. This means that a RN must train both PCT's and RN's to dialysis. I would check your state regulations for Dialysis Facilities.

I was told a long time ago that the complete opposite is true. First borns are rarely nurses, however a lot of physicians are first born children. The explanation was that this is due to the authority of a first born child, and the subserviant nature of following children.