hemorn1

It is extremely hard not to have some type of relationship with patients in the chronic setting, however, I agree this has gone too far. I have seen patients basically "stalking" their PCT or Nurse when they misinterpret the relationship. It can be very harmful to all involved, and scary. All dialysis staff needs to set firm boundaries with the patients. This can be done and continue to be empathatic and caring. I do not agree with patients having personal home numbers of their dialysis caregivers, ever. As far as your wife coming home and discussing this patient with you, I'm surprised no one has brought up the ugly "HIPPA" word yet.

I chose to get my ADN, the difference in classes between ADN and BSN was a chemistry and 12 hours of humanities, and I did not think that would better prepare me to be a nurse. (oh yeah, there was one hour micro lab credit difference too) We all take the same test. Since ADN's are "educated" enough to take the same licensure exam as BSN's, maybe they should make the BSN's exam longer and harder since they are better "educated". Because someone has 12-15 extra credit hours does not mean they are more educated. I have worked in nephrology for the past 10 years, and have met nurses in this field from ADN's to Masters. All of them said they did not get Nephrology training in college, outside of a snippet about ESRD and basic A & P. You learn the most about your specialty after you get out of school. I have actually had home health BSN prepared nurses tell my patients to drink more water, sending bananas and oranges to treatment with them as snacks, ect. I also had a resident at the hospital pumping 1000cc of saline/hr into one of my patients. She looked like a balloon, and the resident said she thought she was dehydrated. I think it is a safe bet to to assume that resident had more hours of education than most BSN's. Its not about which degree you have, its about critical thinking skills and IQ.

I was working for Gambro and we actually recruited some RN's from India a few years ago. They worked as PCT's until they took their licensure exam in the US. I live in Oklahoma, and I think RN's in dialysis make a little more than staff nurses in hospitals. However, nurses (at hospitals and acute dialysis) can make $30-40 an hours if they are willing to work doubles on the weekend. Some give sign on bonuses, most have good benefits which they consider part of your compensation package. Insurance runs pretty high, especially if you are insuring your whole family, not just yourself.

Not all patients are covered by the Medicare ESRD act. They are only covered if they "qualify" for Medicare. I agree that you would not have to work in a hospital before joining a dialysis facility. Most facilities would be thrilled to get a nurse with experience!

I'm in Ok. At my facility we had 1 nurse and 1 PCT for 8 patients. The nurses set up machines, put on patients, and passed meds too. Basically 1 to 4 patient staff ratio.

My SW and QI Director were discussing the case. It didn't happen in my network, so I don't have any more details. I've heard a lot of dialysis horror stories, but luckily nothing ever happened in my clinic.... at least that wasn't caught. We had a pts venous needle dislodge and stick in his chair once, the alarms never did go off and it just kept pumping blood into the chair. Luckily the PCT was watching him closely because he tended to squirm around alot, and that was a concern.

Well it can, and has, there were two exsanguinations in the last couple of months in the USA (not sure which states) although they were not from flipping the fistula needle. They were both buttonholes that went all the way through (don't ask me how) and the patients bled out at home. I don't have all the details, but I know it happened, kid ya not! Scary huh?

I love nephrology nursing too! I started in cardiology, then moved to dialsysis. It was very overwhelming at first, and the techs can make you feel very inferior due to lack of speed and technique. They are very good when they have been doing it for 10+ years! I just asked tons of questions to the other RN and if I couldn't get an answer from her I called the nephrologist. It does take about a year to get comfortable with patient care. I moved into the management position after 3 years, and now I work with ESRD Network. I miss the patients most, but now I'm in the roll of helping facilities optimize their outcomes. It is very interesting and I have been amazed at the political side of dialysis. As far as cannulating goes, buttonholes are great if done correctly, one person must establish the buttonholes before moving on to the dull needles. You can contact your Network for a Button Hole technique video. I would not suggest trying it without training. When using sharp needles to cannulate, flipping the needle is a very dangerous practice, very old school, and should not be done. If it is a practice in your clinic, it should only be done by someone with very good cannulation skills with years of experience. If the bottom of the graft or fistula is sliced, the patient could easily bleed out. One of the best things about being a nephrology nurse is the autonomy. But that is also one of the reasons a nurse needs some background experience before going in to dialysis. Most clinics do not have a lot of support to call on in an emergency or critical situation, and the RN must be able to use critical thinking and deal with the situation quickly. And yes, the days are long, but if you work a MWF schedule, that 4 days off a week. That is something else I miss.... now I work 5 days a week!