MsDorsey

Hi Kate! I sent you a email. Hope you don't mind sharing with me as well. [email protected] Thanks for being such a GREAT resource to the nurses here!!

I worked a 32/40 weekend shift at a LTC. It was difficult to say the least. I had five days off during the week, but it wasn't worth it. 2 double shifts back to back is a disaster waiting to happen. I was so tired after working those two days, that I spent the next day & half after recovering. I wouldn't recommend doubles on a regular basis to anyone.

Hi Toni, How are you? Hope all is going well with the training of your first patient. I just finishing training my 3rd and will be starting my 4th in the next week or so. Right now, I'm trying to get caught up on all the work the gets behind while I'm training. I inherited the program I'm currently working in. I'm currently up to 8 patients that I'm managing, while I continue to train new ones. My experience with Nxstage has been wonderful thus far. They offer wonderful customer support and are available 24/7. The Nxstage educators are awesome and you will learn a lot during your time together. As for machine issues (AAMI/Cultures), that's a part your responsiblity. I don't know about you but I have no biomed support whatsoever. Patients usually run on bags the 1st few days or so anyway, that way that get used to using bags and the pureflow. That way if they have problems with pureflow at home they can use bags as backup. At my clinic, I do it all (screen/train the pts, manage care, home visits, AAMI, cultures, supply ordering, AA & biomed duties, etc.) Well, hopefully you have a good patient that will stick to the program. Let the pt know that he needs to give it at least a 6 month adjustment period. Patients tend to get discouraged early on. They need lots of support in the 1st 90 days in order to be successful. I am sure you and you patient will do well. Good Luck with training and keep me updated. MsDorsey

Hi Toni, Hope all has been going well for you since completing Home Hemo class and your preceptorship. Sorry it took so long to get back with you but, things got a little busy for me. Well, have you trained a patient yet? If so, I hope everything went well. My only piece of advice to you is to set your own pace and don't take on more than you can handle. I am currently training a patient right now and managing my growing patient load. It is very overwhelming at times, but somehow I manage. Anyways, let me know what you've been up to and if you have any more questions. Talk to you soon.

Hi Toni, Training is going well with my current patient. 1st tx at home should be sometime next week if all goes well. Yeah, I was on both of those calls. As for the weekly billing, my center was one of pilot centers. All I can say is that the process only works if the patients send in their flowsheets. The patients do get a fax machine, but that doesn't help if they don't or won't use it. They did change a few things after the pilot, so hopefully you won't encounter any problems. No, didn't get the HHD workbooks. I don't know if they are any different than the one's I completed for in-center. No, haven't rolled out new lab process as of yet. I still need to take the course. It's hard to get everything done while you're training. It seems like it is going to be more work, but only time will tell. As for training itself, it's 5 days a week, same patient. Happy to hear that you have your preceptorship all set-up. Hopefully, you have a good preceptor and learn a lot. So, they have you training PD patients. That's excellent!!! I actually want to learn PD someday. It's good that you're doing that because the Nxstage system is fluid based, so the principles are the same as PD. By the way, if you love to teach, you'll love home hemo. The only obstacles you may encounter are training as you patient census grows, especially if your doing everything. If you're manager or AA are assisting you with small things, than all will work out well. Good Luck with you upcoming preceptorship!!! Be sure to let me know how it goes. Talk with you soon!!!

Hi Toni, I'm not surprised to hear the class hasn't changed much. But, at least you got to spend some time working with the machine. In my class, we literally went in and listened to the instructor talk about the machine. She didn't even set it up or let us set it up. Some people could follow her a little bit because they already worked with the machine. As for me, I hadn't even saw the machine prior to the class. The 1st time I actually got to set it up was when I went to my preceptorship week. By the way, I feel like I learned very little there also. I didn't actually get to see a patient being trained. Everything that I learned about training actually was learned while I was training my first patient with the Nxstage educator. I don't know what I would have done with out her. The educator actually trains you at the same time your training for the 1st time. The educator spends a week with you training you on the machine & pureflow. As for the ratio, I don't think it's doable, but we'll see how it goes. It may be doable if your only managing their care. If your having to manage 15 and train new patients, I don't think so. I've been told I will get some help when I get to 10, even though in the HHD class we were told that the search for additional staff should begin when the program has 6-7 patients. I have managed to train this week thus far without going into overtime, but it was hard. I was supposed to participate in an assessment of a potential patient, but my manager had to do it because I would have been in overtime. As for each training session, it averages about 6 hours. That's set-up, treatment, and clean-up. The 1st session can be shorter, because you can set-up the machine prior to patient coming and just put the patient on when they arrive. You want the 1st session to just be a good experience for the patient. Training time depends on pt and partner, if they are quick learners they will go by faster. It takes me about 20 -30 minutes to set-up machine. It may take the patient and partner 1 hour or longer. Right now, it takes my patient about 1:30 from the time I bring him back to the time tx starts. That's pre-workup, setup, cannulation, put-on, and start. I was thinking you were going to have a little bit of an advantage if your manager had trained the first patient, but I guess that's not the case. FYI, it really sucks when your the only one that knows the machine, and no one else has a clue what your doing. Do you know why the other nurse left? Are there any other Home Hemo nurses in your area that you know of? As for hours per day, how long you're there depends on what else you have to do besides train. It won't be too bad at 1st, but as you get more pts it gets more difficult. Right now my duties are as follows: Training; managing care for pts (there is a laundry list things for this alone); ordering supplies, EPO, Heparin; Clinic visits; Ensuring dialysate cultures are drawn and within range for pts on pureflow; home visits; completing various reports, attending weekly clinical meetings; being on-call; being on conference calls; etc. All of this, while the program is constantly changing. As fast as you learn to do something, they change the way your supposed to do it and you have to take a class online or have a call to learn the new way. I am happy to help you in any way that I can. I know how it felt to be new and not have a clue as to what was going on. Keep me updated!!! MsDorsey

Hi Toni, Sorry, I didn't get back to you before now. I started training a new patient this week, so I've been pretty busy to say the least. Glad to hear you made it to the Home Hemo class. I attended the class last fall. I got some good things out of the class, but I felt it could have been more. I heard they've changed it up a little since I attended. Have you been scheduled for the preceptorship week yet? As for your questions, I have 7 patients including the one I am training now. All of my patients are on Nxstage and I have trained 1 patient prior to the present one. As for your previous post: No I've never done PD so I can't compare. The only time I gotten into overtime was when I was training a pt for the very 1st time, but my supervisor doesn't want me to get any this time. I managed to avoid it this past week, barely!!! Home hemo is a big job and does involve a lot of paperwork. It is constantly changing, so you have to be flexible. By this I mean, you learn to do thinks one way then it changes a month or two later. Be thankful that your supervisor trained the 1st patient. Therefore, he or she knows what your doing exactly and knows how much time it takes. Also, they can help you if needed and cover if you have to be out for some reason. My supervisor knows very minimal about home hemo and training, which puts me in sticky situation. I've been told that I will get some help when I have 10 pts (since the ratio is 15:1), but only time will tell. By the way, I agree with you on the NOT training a pt that will be dialyzing alone at home without a partner. That's lawsuit waiting to happen if you ask me. Unfortunately, some physicians and programs allow it. But, I'm with you, NOT on my watch if you know what I mean. That's just CRAZY!!!

Ok, sounds like we're in the same boat. My center is attached to an in-center unit that does nocturnal also. I'm the only home hemo nurse. So, far I haven't had to go to patient's home to assist with cannulation. The pt's are well-trained, so I usely only get calls about things related to machine alarms. As for call itself, I'm always on-call. But, I don't mind because I don't get very many calls. How many pts do you have on home hemo? Does your manager know anything at all about the program? and do they help out? Only time I worked a Sat was in the beginning when I was working with the person I was replacing. I worked two saturdays, trying to learn what it was I was supposed to be doing exactly as far as pt management. I basically learned how to input the flowsheets, and how to do some of the monthly reports. Other than that I was on my own. I'm stilling learning and figuring out things six months later. I was kind of forced into this because the person had another job already and she worked in-center on sat at the unit to help out for a few weeks. I really enjoy the home hemo program overall!!! The program is fairly new and is constantly changed, which can be quite frustrating.

What company do you work for? I'm assuming Davita. If so, I can answer some of your questions. A lot of the answers to your questions are based on what type of unit you working. Freestanding or attached to an in-center unit? Are you the only nurse or are there other (home hemo) nurses that are a part of the unit as well?

Hello Lameka, My name is Katina and I currently reside in Lithonia. PM me if you have any questions.

Yes, it may indeed be timing. It also seems as if the recruiters are slow to respond or are just plain unavailable. It is unfortunate though because there are a lot of nurses out there willing to work. I am a new grad ADN, but I have LPN experience. I having been applying for jobs since I passed boards in March without success. The problem is that there weren't any new grad positions to apply for a few months ago, now that they're available there is more competition for them. Most places are looking for experienced nurses, so you shouldn't have a problem finding something soon.

Have you considered Northside (www.northside.com) I heard they have one of the best NICU's in Atlanta. According to their website, they have a 3 full-time positions and 1 part-time. They're night shift though. It also looks like they have a supervisor position open also. Go to their website and looking under nursing-special care nursery in the careers section. Also, take look at Dekalb Medical (www.dekalbmedicalcenter.org), Grady(www.gradyhealthsystem.org), Piedmont (www.piedmonthospital.org), Emory (www.emoryhealthcare.org), or what about Henry Medical (www.henrymedical.com) which is in Stockbridge. They have a few positions listed in L&D, Women's Services, as well as PRN in the NICU. Hope this helps. The job market around here seems to be pretty stiff for some reason or another. You may have to find out names and numbers of the nurse recruiters at the facilities you are interested in and call them directly. Good Luck with the job search

Check the hospital's website www.piedmonthospital.org They had some nurse extern positions awhile back, but they probably already hired those that they need for the summer oositions though.

Don't be frustrated!! The endorsement process took approxiamately 3 weeks for me. The board received my info on 4/3 or 4/4. My license was issued on 4/20, but it took about 3-4 days for number to actually show up on the online verification site. The process actually was quicker than I thought. I thought I would have to wait until the board meeting which is 5/16 - 5/18. Be patient!! Their probably receiving lots of applications right now with everyone graduating. Good Luck and hang in there.

I am happy to announce that I passed the NCLEX-RN. A weight has finally been lifted off of my shoulders is all I can say. This was my 2nd attempt at the exam. I was an absolute, nervous mess. I got 265 questions both times. Talk about stressful. Like a few others have mentioned in the last few days, I too got a lot of medication and prioritization questions. Lots of meds I hadn't even heard of. It also seemed like I got a few questions over and over again. Anyways, I want to say good luck to those out there still preparing. Thanks to everyone who posted helpful tips. Those tips, Saunders, NCLEX made incredibly easy, and Kaplan 2005-06 all helped me to pass the NCLEX-RN.