Diva

27 years in dialysis here. I agree totally. We also keep all of the above plus clean clothing and always did.

I have found, with the chains, that it is local management, (regional and/or FA's) that can push for the niceties. One thing, though, is that the unit has to be performing financially to afford them. Don't forget the chains have to please the shareholders. Oh, don't get me started:o

Tweety and the others that supported him: Kudos for advocating for your patient. While I do not condone cleaning up a patient in the treatment area of a chronic unit, I do believe that the patient can be taken to the br, or an empty exam room to be cleaned up. In a chronic unit, what happens to the patient that is going home, in an ambulette or family members car? Against policy? Well, policies are written and can be changed. Staffing issues? who covers for breaks? If staff can be off the floor for breaks they can be off the floor to clean up a patient. In Tweety's scenario there was no reason ...he offered to do the clean up! The nurse who refused needs an attitude adjustment. Yes, Medicare funds ESRD...not totally, but 80% of it. Everyone knows what the reimbursement is. If the management cannot run a profitable unit within those restraints, they need to decide if they should provide dialysis services at all. I'm sorry but this is a pet peeve of mine. It is bad enough for these patients that they have to depend on us 3 times a week to stay alive. We should not allow them to be humiliated on top of that. Those units that have "policy against" or "medical director won't allow" well, question if that were his/her family member sitting in the dialysis recliner, would the policy be changed or ignored? Again, this is my pet peeve....many years in dialysis, several units and I HAVE had policies changed.

We would never have one nurse w/two patients. 1940nurse mentioned that above. I assume it was acutes and not in a chronic unit. We are fortunate to have adequate staffing with a few bad days here and there. If there is only one nurse, nothing else can be done, but we are not allowed to run with only one licensed person in fact we usually have 4 and sometimes 5. I've been with a chain in the past, so I do know what goes on out there.

Whoa! Against state regs? What about state regs regarding the respect and dignity of the patient? What about the other patients comfort if there is an odor? We not only keep depends but also cheap drawstring cotton pants (and tops). An incontinent patient is rinsed back and taken to the patient bathroom for clean up. We consider than an emergency. There is no way we could send a patient back out other than in the way they came in. I can understand if there is one nurse with two patients, but what would he/she do if one patient crashed and the other's needle came out? There needs to be someone else nearby to help. It is my understanding that while the patient is in our unit we take total care of the patient during that time. Anyone who asked a family member to clean up a patient (unless the family member offers AND insists) would be subject to a write up.

Hi & Welcome. I don't believe that you are overstaffed. If you can still maintain a 3:1 ratio even when the on-call nurse is out of the unit doing an acute, I think you are fine. I believe it is your hospital affiliation that must mandate an RN providing care rather than technicians. With the nurses providing treatments, giving meds, charting, etc, they do have a full plate. I think you feel you are not normal due to the fact that many of the other posters work for one or another of the dialysis chains. The ratios that the chains run are much higher than a private or non-profit unit. I think 4:1 is the norm (what happens when there is a sick call??) After 4 yrs, I am sure you will stay in dialysis a while and love it.

What a horrible situation to be in!!!! First, I don't know the size of your facility, but here are a few suggestions: 1. Check your employee handbook and see what it says re: terminations. Is there a "progressive discipline" clause? If so, make your DON aware that there are procedures to follow re: terminations. 2. Do you have an HR department? If so, is there anyone who you can speak to about this? Do it in a "friendly" way. Kind of, "this is what is happening and I am having a problem being able to deal with it". 3. The last thing any administrator or HR person wants is to receive is a letter from EEOC or Dept of Labor concerning an unfair or illegal termination. It costs the facility tons of money in legal fees. Make sure your DON is aware of this. If nurses are terminated to make way for "friends" you will definitely have a turnover of staff. People will feel uneasy and find other employment rather than have a termination on their record. Morale will go down the toilet. Something like that can take years to overcome. If I were you I would interview the LPN. If you feel she is truly "wonderful" say that. Follow up with "we will keep your resume on file and definitely call you as soon as we have an opening for an LPN". "Our staff is pretty stable so I have no idea when that might be." I think you have an obligation to the facility to bring this to higher ups. I am sure your new administrator would want to know, but do go to him/her with the problem and possible solutions. Since this person is also new he will appreciate that. You certainly have a good amount of credibility after a tenure of 12 yrs. Keep us updated on the outcome.

Hmmm...my attempt at showing you the format kind of failed. The short lines (name of care person) is centered over the longer lines (for station, patient name) and there is a larger space in the middle. Hope this gives you the idea.

Ok, This may sound confusing, but it's not......Let me try to explain our staff assignment sheet. Been using this for many, many years and it works. First we have a patient schedule (excel spreadsheet) that it updated weekly, every Friday for the coming week. It consists of 4 main columns on each side (one for MWF patients, turn over for TTS. Each main column represents a patient shift. Within each main column (shift column) there are smaller columns representing Station number, patient name, on time, access type (AVG, AVF, PC) and presribed hours. Any changes that occur during the week are entered in pencil. For example, HOS in pencil next to the name indicated patient in hospital. When we know of their discharge, HOS is erased and "returns 11/1" is entered. If a patient requests a shift change for a particular day, "Not 11/3" is entered next to their name on their regular shift, and the name is placed in a blank line at the BOTTOM of the shift they will visit. Next to their name is "11/4 only". Each day the "Staff Assignment" is done manually. After a while it only takes 10 minutes. We run 4 shift per day, and have a larger unit than you do. So, our morning staff does two patient shifts, there is a 1/2 hour staff overlap and the evening staff does two shifts of patients. Our unit is staffed with one charge nurse and one medication nurse. Other licensed staff and techs have patient assignments. So, we have a form, on letter size paper. Top line: Charge______________ Meds_____________ 2nd line: Day ____________ Shift _______ Date______ ____________ _____________ ____________________ __________________ ____________________ ___________________ ____________________ ___________________ ____________________ ___________________ The Shorter lines above is where the staff persons name goes. the longer lines are for their patient assignment. We enter on that line, station number, patient name, #hrs. This format is repeated down the page for the number of assignments you have. This is done in pencil, so last minute changes are easy to make. Also you can see at a glance if an assignment is fair (someone has only two patients because of a no-show or unexpected hospitalization, and someone else has 4) The assignments are hole-punched and kept in a binder. Nice to look back on to check up on things sometimes. If you use pods, with techs and a licensed person, you can add another line (short one) for the licensed name. You really can modify this any way you want. If you want to see the shell documents you can pm me with an e-mail address and I will send it. It will be an attachment to the e-mail, one an excel file and the other a Word document. Another way I have seen it done, but don't like it, is to take the patient schedule and bracket sections of patients with staff names. Too messy and confusing. Any questions..please ask.

There are several different assignment sheets out there. Tell me some things about what you definitely require in an assignment sheet. For example, do you want flexibility? Do you frequently have last minute changes (sick calls, emergent patients, unexpected new admissions) How many hours per day does your staff work? Does the same staff work the entire day (12 or 13 hour shifts?) Or do you have some on 8 hrs and others longer? Do your patients ALWAYS sit in the same chair, or is there a lot of flexibility in where they sit. Last, what are you using now, what do you like about it, not like about it and is it manual (handwritten) or computerized. I have worked with several different styles....I do have my fave, but first need to know your needs.

My facility uses the same procedure as that of Hellllllo Nurse. The bucket is half filled with a bleach/water solution (I believe it is a 3% solution) each morning. It is also labeled with the contents of the solution, dated, and the time of mixing is also on the label as well as the name and signature of the person who prepared the solution. The solution must be discarded and new bleach solution mixed q 24 hours. (Ours is discarded at the end of the day just as Hellllllo Nurse states.) The label shows that the solution is within the time limit. State inspectors are impressed when they check the label

Per diem rates are generally the same for all of the same "class" of employees. Ex., all per diem RN's within a certain specialty, per diem LPN's. The higher rate comes with pros and cons. No benefits, but you can just decide to take a week off....not available. and you should not be scheduled. When per diem rates increase, it is a general increase for ALL per diems, it is not tied into an evaluation. Sorry, but that is just how it is.

You are very welcome! A 3x3 assignment is: Dialysis patients are done in shifts. In your case, the maximum number of patients per shift would be 20. There are generally either 3 or 4 shifts of patients per day. 3x3 is when the care person sets up machine, primes dialyzer, assesses patient, initiates, monitors, disconnects, 3 patients on one shift, then strips the machines and starts all over again for another 3 patients on the next shift. The usual course of events is that the trainee will start with one patient alone, then 1x1, 1x2, 2x2, etc, while you are getting up to speed. You are never alone, always other hands around to help. The "Dialysis Review" is an excellent choice. Dialysis is really very interesting. To get a head start on the terminolgy and the basics will certainly help you to understand things more quickly. You do have a strong nursing background and I am sure you will do well. The technology in dialysis changes rapidly so you will continually be learning. The nice part about dialysis is that the patients are chronic so you really get a chance to know them well. Keep posting, I will be interested to read your experiences.