mxems

We have been seeing more and more Qwave Fistula's in the unit. Is this the new thing? Having to have a rep come in to train us on these so we can officially put our hands on them and cannulate the patient. Are you guys seeing more and more of these. Any problems that you have seen. How different are they from standard fistulas in the cannulation process? Things to look out for?

The Roots - Good Day (in the morning a the beginning of the day) DMX - Lose my Mind (end of day)

I have seen 3 or 4 different patients that I have that are fluid overloaded that I am unable to take a decent amount of fluid off of. Blood Pressures are great and sometimes hypertensive. 4-8kg fluid overload Common theme is diabetes and neuropathy. I've tried various fluid profiles for removing and nothing seems to work. The most I can get off of this type patient is about 3-3.5kg without them cramping like crazy. Anybody have this problem? Yes I've done fluid education and yes they come in for extra treatments now to help get that fluid off. Since most of the fluid is lower extremity has anyone asked patients to use compression stockings before coming into treatment to help push the fluid back into the blood vessels? Thanks Everyone

Do any nurses out there use an elevated diastolic pressure as a sign of fluid overload? I know that's not your only tool to assess but I was wondering who else might use that as a sign. I had a NP mention that to me when I was notifying her of an elevated b/p and it didn't really dawn on me to use that as an indicator. Maybe I'm a bit slower than the rest. :) So don't rip me too bad here.

I have yet to meet someone in dialysis that actually has their CDN or CNN. Do employers or managers even look at that when considering pay raises or hiring? I mean honestly, who here has one of these titles relating to dialysis or nephrology?

So I have in the back of my mind that I want to start working toward my CDN. Does anyone have any recomendations for study guides? Is the test pretty intense?

I was a new grad nurse hired at an out-patient dialysis clinic and did 8months on the clinic floor as a PCT. The normal training time was 4months but because we were so short staffed I continued to work as a PCT. At the time I just wanted to get into the nursing side of things but looking back, the time on the floor was invaluable in learning the machine, the patients, and managing the emergancies and complications that come throughout the day. I personally find it hard to believe that nurses should verify everything the PCT has set up on the machine and patient if they haven't done it and mastered it themselves. Nurses should be trained by qualified PCT's in my opinion to learn what they go through on the floor each and every day so that they understand what they need to do as nurses to help the PCT's and to gain the PCT's trust as their nurse. It is hard as a new nurse to gain the trust of a 5, 10, or 15 year veteral PCT on the floor. You do that by going through their training and being humble and not letting the title of nurse go to your head and thinking that your better than them. If you have a bad trainer then you have a bad trainer. Learning from anyone bad is not going to get you anywhere. I had great trainers and I have great PCT's who may be a little burnt out on their job but they still perform above and beyond what I believe is required. I don't have that long in the dialysis field but I do know that if you don't respect what your PCT's bring to the table in the form of care, and if they don't respect you, then it's bad for the patient and bad for the reputation of your entire clinic. It's not an individual that gets the bad wrap, it's the entire facility, that's why teamwork is a must from the PCT, to the nurse, to the dietician, to the social worker. If it's broken, then find a way to fix it. "Whether you think you can, or think you can't......you're right" Henry Ford

I work at an out patient clinic in Mesa, AZ and we are constantly short-staffed on PCT's. When I was fortunate enough to be hired as a new grad nurse I worked the floor for 8 months as a PCT because we were so short staffed. At the time I loathed it but the techs I worked with all have about 10 years of experience each and they all had exceptional team work skills so I learned a whole lot in a very short time. I learned so much working on the floor about the machines and getting to know the patients that when I transitioned over to the nursing side it really wasn't that much of an issue. So my question is to the charge nurses, clinical managers, and HR reps is where are you getting your new hires from? Do you use jobbing websites, staffing agencies, do you advirtise? I've never seen an advirtisement for any dialysis clinic in any nursing magazine or had a rep come to my college where I was graduating from to let me know of dialysis opportunities. I have this perception that dialysis as a whole is missing out some great new grad nurses and techs coming out of reputable nursing and CNA programs. If outpatient clinics as a whole are short staffed in techs or nurses, where is the recruiting effort?

So why would someone accept an offer to take over a dialysis clinic? Tons of responsibility, but what are the advantages that make it worth while? Are there decent bonuses? Stock options? What? Or is it a desire to succeed? Why would you do it?

As a new grad, if you get to talk to the clinical manager or the charge nurse about a position there I recommend showing a lot energy and a lot of enthusiasm. You move all day long, you get to sit down at the end of the day. The majority of the days you don't get lunches. The one thing I always tell people who ask about dialysis is that "if you all your work done or you have some free time,,,,you're doing something wrong". That being said, I absolutly love it. I wake up at 4am every morning and get home around 5 or 6 at night. Some nights during the month I make it a late night to really get all the little things done and I get home around 8pm or 9pm. But I love it. Every work place really depends on your staff and your manager and your charge nurse. Working for a corporation you deal with the bottom line of money, but the right staff can make it so great. I'm fortunate enough to have that. I work in a place that where staff are recognized for their hard work so I'm one of the lucky ones. I've only been doing it about a year and half (new grad) but I love it. It is a small specialty though so most of the nursing skills you may have learned you won't be using at the clinic. But I can see myself existing in this specialty. Oh, and don't lollygag while your there. move with a purpose and get things done. Earn the trust and the respect of the techs, regardless of what kind of degree or liscense your just earned. They can make or break you. Good luck

We do 3 hour runs on an extra tx. Never have inverted the dialyzer so the venous end is up though.

Nurse Nessa Awesome ideas. I've been hit up by the clinical manager and Regional manager on ways to make our clinic a place our patients would not think twice about staying. I think out clinic excels greatly in our nursing and tech staff, but we lack a great deal on creativity and games and things of that nature. Our patient population if around 65-75 years old so we interact with a different generation to say the least. Very much set in their ways. We did bingo over thanksgiving. Were gonna do the lobby up for Christmas. Great ideas though. Keep the ideas coming. I think these are things everyone and every clinic can benefit from. Thanks Nessa

I'm curious what different clinics do to try and keep their patients at their unit? I'm a firm believer that the first part is the people. The techs and nurses. But I'm talking about the little things that are unique that maybe not everyone has done. Decorations in the clinic? Games with the patient? Do you have coffee in the lobby? Do you give Christmas gifts? Do you have art on the walls as opposed to the pictures that you get from corporate? Do you have couches in the lobby as opposed to hard chairs? Do you have magazines in the lobby? Do you have pictures of the staff up in the lobby? Do you have the special heated chairs that massage? What unique thing does your clinic do that seems to bring a smile to the patients, or make them laugh, or make them feel at home, or that make them feel like family?

And knowing is half the battle.

I got a job at dialysis clinic as a new grad rn with no dialysisis or hospital experience. I was an EMT-B on a 911 ambulance for 5 years though. Maybe they thought that was enough. And I was trained and worked as a tech for about 7 months befire I moved into the nursing side of thing. But to be honest if your a new grad, you need that tech experience under your belt. You learn a ton of things. There is a ton to learn but it is worth it I think. I got lucky and I think I found my niche right out of school.