81Bubbles

Rivier University has one Rivier University - Acalog ACMSâ„¢[27]=BIO&filter[29]=504&filter[32]=1&cpage=1&cur_cat_oid=98&catoid=98&navoid=1467&search_database=Filter&filter[exact_match]=1&print=1&expand=1

Here is the AAP's breakdown of the Level of Neonatal Care it might help with understanding the differences of III and IV Levels of Neonatal Care

In my agency I email the house supervisor overnight with any non-emergency changes needed. I usually also CC the clinical coordinator, the case manager and the daytime nurses if I have their e-mail addresses

I really liked the Dansko Marcelle and Marah Mary Jane style clogs, before that I used to wear Nike walking sneakers. They seem to have stopped making them and I am having a hard time finding something new that I like

There is less family interactions on nights, particularly if your facility has designated visiting hours but pace usually isn't any slower and you might have a larger patient load than during day shift. Maybe look into an out-patient ambulatory care setting?

Faith4ce~ I would not do it then if I were you. Personally I 110% believe you need a good year under your belt of dialysis before you should be completely alone. Yeah when you are in the ICU you have the ICU staff round but more than likely you are the only one who has any idea about dialysis itself or the machine. There are lots of trouble shooting issues that you can't really prepare for with the machines until they come up. Also no disrespect meant towards you but if you are left alone too soon with no one to help or correct you there is a good chance you will develop some sloppy/un-safe habits that you may not even know are bad.

OK this is dangerous and a pt can not force you to remove more fluid. I don't understand why you don't just set the goal for the Rx EDW. "Kids" said it right above, I think you are failing to see that you could be charged with malpractice for removing more than the Rx allows. This women needs a interdisciplinary meeting with the dietician, SW, Nephrologist, CM, and Medical Director (Everyone).

Honestly, wow you are luck to have found a chronic unit only open 3 days a week and less busy than a Med/Surge unit that is not the norm around here at lest. @Faith4ce~ Honestly the majority of acute dialysis is very slow and low key and boring, but when it is not boring all heck can break out and fast. However, I am wondering are you going to be on your own in the hospital or is this a dialysis unit in the hospital? If you are going to be left alone after a preceptorship and have no dialysis experience I highly recommend against it. If you will be in a dialysis unit with other experienced RNs and PCTs then it would be a great learning experience.

Next month will be 3 years as an RN for me (I've been doing dialysis with fresenius in all shapes and forms) and I still have not been able to get into L&D or any obstetrics nursing. And not for lack of trying, ugh. I currently have applications out with 4 local hospitals and have yet to hear back from any of them. Going to make another round of calls to recruiters

In theory that sounds super but in reality that would be crazy dangerous. Just becuase someone is incontinent doesn't mean that their not all "swapping Bugs". Besides it does not touch the danger of moving them around while hooked up with needles or their catheter open. The absolute safest thing to do is keep it contained until their treatment is over and they return to their facility they came from. I know you people mean well. But there is no way to make changing a diaper on dialysis the better option. The risks are too great. The risks that come from changing a diaper are deadly, the risk to keeping it on are sad and uncomfortable. People die from bleeding out, unrepairalbe damage to accesses, and sepsis People do not die from diaper rash.

I'm with TraumasRUS. Why do people asume it's sad because we think we are too good? That is not the issue at all it's a huge safety issue. Just because some one is not a regular crasher doesn't mean that today isn't going to be the day that their pressure drops so quickly and so low that they die? Or that today is not the day that they are going to aspirate and die? It is sad if these patient never get a good meal but this is not Walmart or The Soup Kitchen. It's Dialysis Our Job is to run Dialysis treatment and keep them alive so they can go about the rest of their lives as normally as possible. Some of the people here commenting are not looking at this the right way what so ever. You need to look at what is best for the patienst over all well being and quite simply that is the safest most effective Dialysis treatment you can give them. So no Techs should never be off the floor pertaining to someone wants something from the vending machine they should be on the floor monitoring the patients. No one should be passing food or treats between patients hooked up to machines. That spreads infection. Why do you think that anything that enters a station needs to be disnfected or is trash. Dialysis patients have weakened immune systems and they are at high risk for deadly infection. You're priority is to keep them safe. Any if the dialysis way of life is to much for them you need to help the patient explore other options PD, withdrawl of HD, or get them talking to the SW so they can resolve it. Compromising safety and care is not the answer ever!

WOW, if O2 concentrators are a luxury why do we bother to have AED's?

TravelerRN...WOW you have a lot of requirements for a good day...LOL....I guesss I've only had a handful of good days.

It had come up from some of the techs @ our unit before and we also had a few people who'd been around for a while who gave the same warnings. No one has approached me and I'm not all that gung-hoe to be organizing. I'm a very hard worker and there are many people around who are not.

I have done both Acutes and Chronic and really the big thing is it depends on the kind of person you are. If you like a fast pace go chronic if you like things to move MUCH slower go Acute. Do you like to pretty much work by yourself go acute, you like to be around the same people a lot go chronic. People will tell you that the acutes you should have more expreience before starting I think this is only really true for the technical aspects such as machine trouble shooting. When in acutes if someone codes, before you have the patients blood returned the code team is there. In a chronic setting however more often than not there is no MD and you work collaboratively with the other nurses. Generally acutes will pay more (not sure of the pay difference betweeen the 2 companies as Davita generally pays better than FMC anyway) than chronic. Acutes have much more VARIED schedules if you have a strict time you need to leave work it will probably never happen and you'll be late to day care or where ever you need to be. Acutes nurses take call carry a pager, work Sundays and sometimes have to show up @ 2 AM for emergency tx's. If you are looking for OT go to acutes OT is very few and far between in chronics. Not sure what else would help.

So all of your O2 concentrators are being used @ the same time. That alone is risky what if someone else needs it. I know you have emergency O2 on the code cart. Still risky though. Do you have multiple shifts where management could space out these O2 dependant patients? I know where I work we have pateints that are PRN O2 users and their needs often pop up out of no where. We actually have I believe 7 concentrators for a 24 chair facility. And sometimes that isn't really enough. O2 concetrators and cannula add up expense wise. Part of the problem managemet has is Dialysis units are usually for profit and many of us as nurses are not focused on this at all. We forget to bill @ EVERY tx for the cannula and O2. I think it's crazy the way this works but it's a big part of the problem.

I recieved the letter about Unions too, hmm no one has approached me or anyone I know yet however

Even if the supplies and staff were there. It is dangerous! A HD patient's access is their life line! For many of these patients, if their aceess becomes infilltrated they will die. because they have exausted all of their orther usable points in thir vascular system. For the vast majority Patients are cannulated with 2 x 14g or 15g needles every tx directly into their venous system. Theses are no IV cannula they are Stainless Steel 1in or 1.5 inch large bore needles! The comunity based dialysis centers are out-patient facilities. If the patient can not function as an out patients they either need to go back to the Hosp/rehab or have their own personal assistants who come to HD and stay during HD with them to take care of their needs that go beyond why they are there. Diaper rash is a lot less deadly than sepsis, hemorrhage, or infiltration!

Did you guys know that DSI now actually does completely follow the no food or drink policy that DPH has outlined for Dialysis clinics. They actually had a patient who coded r/t eating on the machine. The pateint didn't make it. It was really sad, it did however make some patients actually understand that the no food thing isn't just some form of us trying to micromanage them. I'm on the acutes side more than in the clicinc these days and I do not allow any food in the room or visitiors during trreatment. It's written in our policy that way and I follow it to the letter. If a pateints wants to eat they can either wait or sign an AMA, and finish treatment then eat. I do however try to contact the pateints floor ahead of time to let them know when I should be there to try and schedule their food around it. Also if I show up in the morning and a pateint has their breakfast try and is eating I won't put them on. I'll either see if any other patienst I have for the day are not eating and they can get Treatment first or I'll wait and I bill the hospital for the wait time.

NDXUFan you sound like the ideal patient until I read you latest post. I'm sorry you had such a bad experience, and a nurse saying she didn't have time for you when you had cramps was out right wrong of her, that's her job. However,Dialysis is a medical procedure. And the staff that works there wants you happy but our priority is your health. We are part of the medical field not the consumer field. When you go to dialysis you are going for a medical treatment not to hotel/hospitality joint. And if the focus shifted form what is going to keep you alive to what is going to cause the least amout of Rucus I'd quit. Honestly I'm not willing to lose my Nursing license when someone dies or go to court the family of said patient also decides to sue. You are an adult and so are the other patients, the restrictions that are advised of you by the MD, Nurse, and Dietitan are not some warped way of us trying to micromanage your life it's a way for making the dialysis treaments work the best for you and keep your clearance high and treatment times short. If you decide not to follow them that is totally up to you.

there are no strechers in dialysis units. There is no room for them either. If a patient required a strecher or bed they are not fit to be in the chronic setting and should be in an acute dialysis setting which is inpatient. Also we are accessing the patints blood stream and moving them around is completely unsafe if the are attached to the machine, and still relatively unsafe if they are detached form the machine temporarily (like needles flushed still in arm or saline locks on catheters). There is the risk of bleeding , infiltration, and the risk of exposing a patient to sepsis (which when they have a central line in is a HUGE risk). Every time you rinse a patient back mid treatment you are also drastically reducing the adequacy of their dialysis treatment. I know where we worked we had many of the NH patients NPO before tx for the day (we tried to have them in 1st shift) . Also some patients recieved Imodium pre tx as well. Along with as others had mentioned. Bowel/and Bladder traing regime's in place. I Know personally it was something in the begining that I felt so Horrible and Cruel for but the more I learned about HD the more I realized that it wasn't mean cruel or because people thougth they were too good for it. the simple fact is Changing an Incontinent patient while on dialysis puts the patient at risk for more harm than it does good.

Halo425 sounds like you had an excellent interview and I wish you all the best.

Does any one know if passing the on-line course does constitute "Certification" in FHM?

OK So I called and the person in charge of Hiring at the hospital is out until Thursday. Any helpful suggestions would be much appreciated. This is pretty much a dream job!

Thanks Mugwump I'm going to call today and follow up on my application. I sent it in on-line on Wednesday. Long enough not to be a complete P.I.T.A. but still soon enough to prove I'm serious...I hope!