SotaRN

Unfortunately, I actually started smoking in nursing school! I "blame" it on the stress of school combined with the fact that I had gone through a divorce after 10 years. I know how unhealthy it is and have seen first-hand the ill effects of smoking, but ask any smoker and they will tell you that that is not a deterrent! It's an addiction and each smoker has their own reason for continuing.

:roll :roll :roll :roll That made my day!!!

An FA is a facility administrator, generally an RN, who basically runs the clinic. B/c of the national kidney council, my understanding is that we can't just tell them to go elsewhere, especially considering that it was a family member that made the threat and the threat was not made directly to me. No, that doesn't diminish the fact that a threat was still made. We've contacted them and no doubt will be justified in getting them out immediately if the mom becomes disruptive again...at the very least she'll be carted off to jail. I looked into getting a restraing order against this man but found out that he would be summoned to court along with me and any witnesses before one would be issued (per the superior court office). I feel this would just antagonize the family and make the situation worse considering she's still a pt...bottom line in my opinion is that we need to get them out of the clinic period as peacefully as possible. Of course it p's me of that we can't just say 'get out and don't let the door hit you on your way out' but thx to the kidney council for that. As far as a trf to another clinic, I could probably very easily, but this is a new clinic that I've helped to grow and I'll be diddly dmd if this trash is going to scare me away from a place that aside from this pt/pt family, I love dearly. I feel backed 100% by my company, bosses and the MD's and even the other staff. We started a while back having 2 present during take on and off just for a witness since the mother had started to lie about things that were instructed. I've also been documenting on her every single day, even things that seem to not matter. I started doing this at the advice of one of the MD's about a month ago when we started to see a pattern in things the mom was saying or twisting. Generally we only doc on flowsheets/nsg notes are saved for things out of the ordinary which is different from the hosp setting.

Thanks for the great feedback everyone... First of all, I am so sorry to those who've rcvd threats worse than mine...and Fire Wolf, I can't even begin to imagine what you went through. To update the drama, we had a police officer on site Fri for their treatment...the crazy grandfather didn't show. The mom was relatively calm so our group administrator, social worker, me and my immediate boss took her into the conference room for a meeting w/the officer outside in case she flipped. Our group admin did most of the talking...as an example of how irrational this woman's thought process is, she said that she wasn't going to have us abusing her dau (which of course has never happened)...big boss said that none of this staff come in for work at 5am and work for 12+ hours to abuse anyone, we do it b/c we care to which she replied 'that's you're problem not mine'...????? She was told that if she became disruptive again we'd call the police and CPS services would be called to get her child. She had no response to that but rambled on about something totally unrelated. She said she's told her dau to not ask for any help and if she feels sick or bad just suck it up and wait til her tx is finished. I couldn't keep my mouth shut to that one & told her that both of them had a responsibility to tell staff if somethng was wrong...she said we must think we have hands of gold. Get the jist of how crazy this family is??? My biggest issue since all of this has happened is dealing w/the why...I know they're crazy though which helps make sense of something that can't be made sense of. I've been a nurse now for just a little over a year & this is the 1st time I've dealt w/a pt like this one. I suppose I'm seeing nursing for what it really is as opposed of through the eyes of someone on the outside, if that makes sense. It p's me off too as said in previous posts that we are expected to remain tolerant of this type of behavior, even taught to be forgiving of people under stress. Why is that? Would an MD put up with it? No, we cannot refuse care, but why should we be threatened, verbally abused in the process? Is this a hold over from the Florence Nightengale days or is it just a reflection of our society's over emphasis on political correctness and not calling a spade a spade? They don't teach you this crap in nsg school, that's for sure, and I see now why so many nurses would say 'don't go into nsg' while I was wide-eyed and over-eager going through school. Sound cynical? You betcha. Thinking of quitting nsg? No thx; these people won't have that power over me. I just need some time to get my feet back under me I guess.

Thanks for the responses everyone...to answer a few questions, the clinic this family transferred to us from was not very forthcoming with the truth of the whole situation prior to our taking them. Our docs didn't want them b/c she's considered pediatrics which they don't generally do. The company however is the type who really doesn't refuse anyone care which is noble and all that happy horse dookey, but real life can leave the staff fixing some major problems! This was one of those cases. We had a prn nurse come to our clinic for a few weeks & her dau worked w/this family at the old one. She told us these things and a few others just to give us a 'heads up'. From what she said, dna testing was done b/c of the incest issue...obviously it never went farther than that. And the clinic she came from is actually a children's hospital which she was in for a while. They have a center within the hospital which she went to after dc. We've tried getting paperwork from the old clinic w/no success. Granted the incest issue is heresay from a nurse who heard from a nurse, but you know how word spreads among nurses...I'm fairly certain her story is correct. In talking to my boss, my immediate supervisor wants them gone, but the one over her said we can't just terminate them as pts. The kidney council has to be notified, etc. and there are rights that dialysis pts have once they're in a clinic...our docs said we could get rid of them but we'd have to give them 30 days notice & find them another clinic...given their hx, it's hard to imagine a clinic that would be very willing to take them unless we didn't disclose the full situation as was done to us...while I'd love to do that just to get rid of them, I don't agree with not fully disclosing their hx. Considering the threat came from the g'father & he is now banned from our property, I would think that we can't turn it onto the pt & her mother...however, I will tell you that this mom is just as much a fruit loop as her father, you know the apple doesn't fall far from the tree. I thought last night about this and changes that we could make within the clinic...starting with this girl's chair. They sit sort of diagonal/behind my med station where I spend a lot of time. The mom can't sit still for long and is constantly going in and out of the door to smoke. She ends up walking behind me a lot. I want her gone from that chair and in front of me, as far away as possible. This will no doubt upset the pt who freaks out at any break in the routine, but screw them...I'm in the mood to be a little selfish at this point. Also, if the mom wants to have access to sit with her daughter, then she needs to stay with her and not go in and out, in and out. We have a locked door from the lobby & people have to push the doorbell for us to let them in...she will sit there and push the button 20 times over and over until we open it. I've told her many times that if we don't answer right away, it's b/c we're busy with the OTHER pts but she just doesn't get it (she thinks we do this on purpose b/c we're keeping her from her dau... ). We're also going to have a meeting with the mom on Monday about her behavior & give her a warning. I know that my bosses and the company are serious about this threat which is comforting, however, a crazy person is just that. I'm not the type to pack heat, never have been & never will be, but I will change up my routine. This man isn't a 20 year old fit one...he walks w/a limp & is weak to one side...and he's about as dumb as a box of rocks (I know clee...you'd say those are the words you'll put on my head stone...haha!). But I guess it makes me feel a little better that he's that way. I think I've answered most of the questions...I'll keep you posted on Friday's events! So, why did I become a nurse again? Someone remind me, please! :smackingf

Hi all, I'm a charge RN at a chronic hemodialysis unit for a major dialysis group. We have a pt who's 16 with not only a slew of health problems but also some major psycho-social issues that extend to her mother and grandfather (who was found to actually be her father through dna testing at their prior clinic). To paint a clear picture of this family would take a while, so I'll cut to the chase. The grandfather today stated to 2 of our patients in the lobby that I would not be at that clinic past September and that he was going to bring in a gun and shoot me. This was after appx 1 hour of time spent by myself and my administrator talking with the mother and grandfather...talkng is actually too nice a word...this was more a pointless rambling by both about everything from our request that the mother remain in the waiting room during the pt's put on and take off to their mistrust of the black nurses in the facility. Both the grandfather and mother are those types of people we as nurses dread dealing with b/c they are completely irrational and skip from topic to topic...they are definitely not operating with a full deck, not to mention the whole incest issue. They've been disruptive to other patients and have bad mouthed the care received at our clinic to the transportation drivers, other pts, anyone who will probably listen, which has no basis at all...all of our other pts love our clinic and look forward to spending time with our staff. We've gone out of our way to accomodate the special needs of the pt and the family since their family dynamic is such a complicated one, all with the best interest of the 16 yo pt in mind. Anyway, after I was told of this threat by the pts who he told, I immediately told my FA, the MD medical director, and the FA who's over ours and 4 other clinics. She contacted risk mgmt...we were told this afternoon that the police dept was contacted and a complaint filed, the mother and grandfather were contacted separately & told that the g'father was banned from our clinic/parking lot/grounds, etc and that 911 would be called immediately if he came onto our property, an armed security guard will be in our clinic on Friday and all next week. Of course the g'father denied the threats. However, he is so off his rocker, he is just the type of loose cannon that you'd see on the news. These people are just plain crazy. My question is, how do I deal with this?!? The g'father stated to our senior FA that he thought I was a 'jellyfish' b/c I was letting a newly hired FA 'run all over me' (who is black)...she's not running all over me, she's the boss! This is the same reason he gave to the other 2 pts for killing me. I am scared and hurt b/c I just do not understand his screwed up rationale...I know you can't try to understand the thought process of a crazy person, but I just don't get it. I have never done anything to this family and have bent over backwards to accomodate them and their screwed up situation, have listened when I was ready to pull my hair out, and still been nothing but kind. So I'm hurt as well, I suppose. Also, what are my rights as a nurse? Do I have the right to refuse to interact with them or does that go out the window when you're the charge nurse? Should I take advantage of the ECP counseling thing or whatever it's called lest this come back to rear it's head with me 5 years down the road? Any input is appreciated here...sorry for the length...

Thanks for the great info! I've been using it more and more & really paying attn to the results, then educating pct's on which pt's do best on profiling...I've been mainly using #2 with mostly good results. We have hypertonic in our clinic but I don't like to use it b/c when I started an MD was raising a huge stink over a nurse that was using it all the time...now that I've learned more, I understand the many negatives to using it. Our PCT's will generally give 200ml NS for cramps & turn UF off then give more NS if no results (policy/procedure!)...many times pts leave only 1kg under what they came in at which is frustrating. Seems much better to set the machine at the beginning & avoid cramping if possible all together. I'd also rather just reduce the goal then turn UF off completely, especially considering we're giving them fluids. Wow, I never knew there was so much to dialysis! In school all they really teach you about it is that it exists! Maybe if they taught more about the physiology behind it which is truly amazing the field would attract more nurses! Thanks for sharing w/a newbie!!!

I graduated last March & started on a cardiac floor and lasted 4 months...it wasn't true M/S but a real mix of pts in just for acute cardiac problems as well as those w/a laundry list of problems including cardiac problems...many docs just admitted them to our floor b/c they got more monitored care (tele). I learned a lot of things in a short time, but bottom line was that I hated it! I'm now in a dialysis clinic & am enjoying it far better than the cardiac floor. I asked nearly every nurse I came into contact w/during clinicals, on the street, etc. that same question about the year of M/S before specializing and did find that more experienced nurses recommended the year vs. newer nurses saying that you don't need the year and shouldn't waste your time on something you're not interested in. If you don't know which specialty you'd like to go into I think it's a good starting point to get experience while you decide. If you know what you're interested in though, I say go for it. A lot of what I heard from others was that working M/S first builds your time management & critical thinking skills, but I don't think that if you specialize they don't develop. Much of what they don't teach you in school you'll learn on the job. So, I don't regret my time on the floor b/c I learned a lot and I have the highest amount of respect for those nurses who are M/S b/c it is so difficult...but if it's not what you want to do, then follow your gut. Good luck!

I've been a nurse for a year now and can tell you that even if you do decide to go to school, there will be days when you really question your sanity & wonder what the heck ever possessed you to become a nurse! :selfbonk: I don't really think that any of us can give you a true idea of what it is like to be a nurse b/c it is such an all-encompassing career. And as posted before, there are so many different roads that you can take once you have that piece of paper in hand. Nursing is A LOT more than wiping butts, but that is certainly in the job description! You're a healer, a confidant, a problem solver, an advocate, a supervisor, a pharamacist, the doctor's eyes, a shoulder to cry on, a motivator...that's just the tip of it! I think of it as a craft and something far beyond what you do with your hands. Nursing is very hard work both physically and emotionally, and there are no easy nursing jobs. Nursing school is not easy and takes tremendous commitment and motivation. A nurse once told me before I went into nursing school that if I was doing it for the money, don't do it b/c you'll never truly get compensated enough for how hard you work...and that's been very true. It's a comfortable living for sure, even just out of school w/o experience, but it's not easy money! I say these things not to discourage you but to be honest with you...do your research first...if you have friends or friends of your family who are nurses, ask to shadow them one day, one FULL 12-15 hour day. I agree that it wouldn't be wise to quit your job now until you're absolutely positive. Good luck!

Hi Viv, How long have you been in dialysis? Do you charge or work the floor? RN or LPN? I have been at a dialysis clinic for about 6 months now. I felt too that I would lose my skills but then had the opportunity to start charging and am feeling like my skills are growing again...my assessment skills have gotten pretty sharp & I've learned how to clue in on the abnormal very fast...my critical thinking has grown by leaps and bounds too. The company that I work for (major...just took over another large company) doesn't utilize their lpn's to their fullest ability which I think is a shame...most of the lpn's I've worked with call themselves glorified techs, so I'm curious to know which licensing you have. As far as dialysis being an easy job, I beg to differ...granted you're not wiping butts but I think you're still stretched incredibly thin, running your legs off & responsible for clinical outcomes, meds, pt safety, staff, etc. I think the benefit to being a dialysis nurse is seeing the pt more than once & getting to know their histories & feeling like you're part of their care. That is part of why I like it. Maybe you should ask yourself if you really like dialysis or not or if you are just ready to try something different. If it's just a matter of skills, you could always try to pick up some prn work. One of the lpn's I worked with just quit our clinic to go work med/surg after 18 years of dialysis...she was burnt out and ready for something new. That's the great thing about nursing...you always have options! That's my 2 cents...good luck! :icon_roll

I'm new to dialysis and work in a clinic w/Fresenius K's that have Na Modelling & UF Profiling available. I've not been able to find much info on the UF profiling, especially which profiles work best for which pts, etc. Is there any good info out there to read? Any advice? Thanks!

I'm also a recent grad, graduated in March 05...I worked on a cardiac unit in a large hospital for 4 months & hated it. On a whim, I applied for a job in a dialysis center & was hired. I was very overwhelmed at first & thought I'd never learn...just learning how to operate the machines and troubleshoot when problems arise is overwhelming b/c there is so much to think about at one time, and that's just the machine! On top of that, you have a patient attached to the machine to always be aware of. It took me about 2 months of just plain old repetition to get to the point where I could do things with some level of comfort & confidence. Now, I'm charging at a new clinic & absolutely love it. Typically, you should have minimum 2 years experience before being in a charge role, but due to limited staffing, I was given the opportunity & have done well with it. I've learned so much...my assessment skills & critical thinking skills grow every day...I've learned to key in quickly on the 'something not's right here'. I'm constantly figuring out new ways to manage my time which is crucial (and they just don't teach you time mgmt in school). I love getting to know the patients & their histories and learning their baselines vs. the hospital setting where you might have a pt once and then they're discharged. I feel like I'm really involved in their care as opposed to the hospital where I felt like it was just a rat race. The PD in the hospital is nothing like the hemo in a clinic, so I don't think that what you've seen is a good indicator. You really should consider spending a day in a clinic just to see what it's like. A positive attitude is key and you have to be willing to learn b/c there is lots to learn. I would say too that if you decide to go into dialysis, pay attention to how the staff acts before you agree to take a job...the attitude of the staff can make or break a clinic in a heartbeat b/c dialysis is truly a team effort...from the PCT's to the nurses to the administrator to the MD's. Dialysis is VERY fast paced and VERY hard work (but what in nursing isn't?!) and at the end of the day I feel like I've run a marathon, but I have much more of a feeling of satisfaction at the end of the day and don't question why I ever decided to go into nursing like I did when I worked in a hospital. Feel free to write me if you have any questions & good luck!!!