errosmith

We have a spot in the chart for psych/soc aspects of the patient with dropdown boxes such as "demanding", "combative", "hostile", "withdrawn". As a patient and a health care worker, such documentation covers everyones bottom. However, this documentation punishes the patient and labels them as a "problem patient". Patients can be difficult for many reasons and that often is not taken into account. The last time I was in the hospital (renal) I was very sick and not demanding...hence I was vunerable, Never in my life have I been treated and spoken to in such a hostile manner by nursing staff than this time. When I started to feel better, I spoke up to protect myself. I was in the hospital for 6 days and was moved three times, once at midnight! I was yelled at by the dialysis nurse because I was not ready to go to dialysis at 7am. I was still asleep at that time and had not brushed my teeth, gone to the bathroom, washed up etc. I had requested the night before to be informed of the time dialysis would be taking me and no one had an answer. My dignity and comfort were never taken into account. I had the lab draw blood without using gloves, techs and nurses not washing hands before patient contact or rubbing their noses with gloves on and then starting an IV, laying in a sweaty bed for two days (high fever) and no one changing linens, being kept awake though out the night by laughing nurses in the halls, no towels available to wash with, being woken up at 4 am to be weighed, even though a weight is taken prior to dialysis on the renal floor. Being woken up thoughout the night to take a bp and then 15 minutes later being woken up to take a temp and pulse ox. Waking up with leads off (tele floor) and no one bothered to check on this. None of this was critical and I was not in ICU, BUT it all adds up and wears you down so you do become hostile and withdrawn. and you hope that you are strong enough to fight back and live. I have had to go the the hospital (ER) three times in the past few months and I will say that I dread it. I feel that nursing staff can't wait to tell me how much they are being put out by my being there. I hate that with the economy or staff stress they are taking it out on the patient. We have no choice

Yes, I am. I have done most of the required meetings and doctor visits but am now trying to get my thyroid in order. They will not accept you with a thyroid problem. I just started synthroid , lab work done again and have an appointment next week for follow-up. One hurdle at a time...but there sure are a lot of them.

I researched PD and is just is not a good idea. It takes so much room for supplies plus I have animals at home. Also it has such a high Insident for infection. Home HD would not work for the same reasons above. Plus my family all work and I just would not feel comfortable, house not in order for company, phone ringing, dogs barking etc. I have a living donor available but do not fit the weight requirements for a transplant at this time. My job right now seems to be to advocate for better treatment of dialysis pts and to call attention to changes that need to be made in dialysis care.

quote: However, as in society in general, there is a subset of folks or pts that feel life owes them. In life they can't live by the rules of society and in dialysis that feeling carries over You are so right! People by nature are egotistic. Me first attitude. Being in the health care field (transfusion medicine) I do see a lot of this from donors who donate. Some do it out of the pure goodness of heart and expect nothing in return, others donate to make themselfs feel better and expect to be honored and patronized every minute they are at the blood bank. Some donate to have control over you with threats, ie, if you don't take me first I will not donate. Some donors are just unhappy and mean people regardless of the gift they are giving. Dialysis is like this is many ways with both staff and pts. Unhappy people, before renal failure, are going to be unhappy dialysis pts regardless. Staff who normally are/have an in charge attitude will carry this trait over to dialysis. You will constantly have conflict. Pts who once were in charge of their lives are now adapting to words like, compliance, protocols, restrictions etc. Its a big life changing situation and many pts have fear and anger that tranposes to others. But under no circumstances should anyone tolerate abuse. Its not right and can be considered criminal. Quote: As you well know, most dialysis pts are there due to hypertension and/or diabetes. Many are noncompliant with their care BEFORE renal failure sets in. I do see a lot of pts who are diabetic at dialysis , hypertentive and with heart disease. I have none of these, and for that I am very lucky. Still I would not judge them for past mistakes for their lack of care to not be sick. We all have done things that are not good for us, eating too much, drinking, smoking...but not everyone is on dialysis. I do see these pts passively punished by staff for not taking better care of themselfs. Its as if they deserve to be punished by spending their lives at dialysis. Its a conflict...you screwed up, you should be punished. And I believe thats where the anger comes in, on both sides. Quote: As to payment. You are right that Medicare bundles payments. However, after several months on dialysis, you qualify for Medicare which picks up 80% of the billable amount and then your secondary private insurance should pick up the 20%. I have been on Medicare for about 6 months now. If all I had was Medicare, the unit would accept that as payment in full. Since I have other insurance, those are also billed to get the most out of my insurance to a higher rate than by just having Medicare. As far as poor care that I have received in the past, I have always gone to the unit manager first followed by the network, risk management and CMS and the State Health department. Mental abuse is subjective. And with that being said, nothing is ever done to fix a problem. No corrective action is ever taken. The only results of this was that staff treated me with abuse to the point of me in tears most of the day, being put on paxil, unable to sleep nights and transferring to another unit. Transferring to another unit did not stop the problems at the other unit, those things still continue and I am not there to help the less than cognitive patients deal with it. For that I feel really bad.

I have two insurance policies and also medicare. I am billed $34,000 a month for 12 tx and the insurance pays $30,000 as payment in full. I did not mean to say that I personally pay this but this is what is billed. Dialysis is a big business with the billing of medication often totals 40% of the units profits. Pts with Medicare only are billed as bunch payment (set amounts). This no where near what the private insurance sector is charged. Your tone of "C'mon" tells me that you think my figures were made up? It is what it is.

Quote We as nurses understand the hardship of going through temporary catheter while the AVF matures and working, the cost incurred for a new formation. That's why we are so very careful in doing so. I do believe that you have an idea of the hardship of having a temp cath placed but you do not have the knowledge of how it actually is. Only the pt has that knowledge. Personally, I have had 6 temp caths placed in a period of three years, three arm mappings, two fistula surgeries, one graft and two de-clots in the same arm. After all this, nothing was workable. I was advised that any future attempts at a fistula would be in vain. Not all fistula will mature and not all pts will have the choice to have a fistula vs a catheter. After three different doctors I did attempt another fistula in the right arm and it is now maturing. I will not let a new tech stick this access for the first time...period. New techs can stick someone else who has a larger more mature access. They have no business attempting to stick a new access. It is not my job to make sure they learn how to do theirs. And its the companies job to insure that pts lifelines are not damaged beyond repair in order to train their staff. Pts should be informed and asked permission for a new tech to stick a new access. Complications of a poor stick should be discussed with the pt and only then should the pt give permission for such a stick. Standing near the new tech and directing a cannulation is not going to make a bad stick any better. A life time of having a catheter stuck in your chest is not a consolation of being a good trooper and training the new staff.

Blue, it is unforunate that you are not paid overtime for your work. In the US it is the law to pay for overtime. It is also unforunate that there is no control over start times for pts at your unit. It would make your job easier if pts came when scheduled. That being said, No one is going to deny that a job as a dialysis nurse is less than a bed of roses. The hours are harsh, staffing is short and you are expected to multi task without error. You say that (quote) sometimes most patients don't realize the sacrifices that we made. As a dialysis pt, I understand how challenging your job is BUT I did not pick your career. Dialysis pts are consumers of care. It is not our job to praise you for the "sacrifices" you have made to do your job. After all, that IS your job. I personally appreciate the care I receive and let the nurses and or techs know this. Your sacrifices are compensated with pay. My sacrifices as a dialysis pt is compensated with living and I pay for this to the tune of 30,000 dollars a month. My life is totally changed as a dialysis pt. My family and I have sacrificed time, money, emotions, holidays, vacations, activities, and pt care etc everyday and they do this without monitary compensation. I can not work full time anymore and sacrifice not being able to do my job. We all lose something to gain something else. You can get another job if the one you have lacks the excitement it once had. I must go to dialysis wether I like it or not. As far a behavior problems of pts at dialysis??? I see more behavior problems with staff who are burnt out than pts. Some staff are just angry that they have to work the long hours and take it out on the pts. We are easy targets and are expected to put up with mean, nasty staff in order to feel better. Its a helpless feeling to be hooked up to a machine, unable to help yourself, at the mercy of an angry nurse or tech. That is the biggest problem with behaviors in dialysis.

I had a direct mucus membrane exposure at dialysis. Pt was not a known HIV+ but who knows?? I did not go on medication but was tested at exposure, 6 wks and at 3 months. All were neg. My exposure was from a dropped syringe filled with blood. Syringe hit the floor, plunger down and squirted me in my face and chest. I was very upset as you were and understandably so. Even though my exposer had a less than 1 % chance of HIV exposure, it was still a chance. Hope all is well.

Jorlus: I am a dialysis pt and I also am an apheresis technicain with transfusion medicine. I am well aware of the fact that "chronic dialysis is not all sunshine and flowers". I have seen first hand both sides of the coin and it is not pretty. I am well aware what the day in and day out is like in the dialysis setting. Pts are seldom treated with the same respect that one would give an animal. Let me inlighten you on how this is preceived by the dialysis pt...we are told what to do, when to do it, how to act, how not to act, threats of transfer, lied to, intimidated into submission and basicly kept in compliance (that changes to fit the staffs needs daily) to control the situation. It is very rare not to be treated as a child. We are told, "sit down and shut up", "Don't be such a baby"...We are scolded when we speak our minds or question prescription changes or lack of. And through all this, the proactive pt is looked upon as a trouble maker because we question the numerous mistakes and lack of direction of unit protocols. We question the lack of consistent prevention of a cross contamination, lack of universal precautions, false documentation and non compliance of pre or post assessements by staff. Those of us who are aware know that mistakes are made in our care but no corrective action is ever taken. I have had good care and horrid care. I have been called a "witch" and "adorable". The point is, horrible care should never go hand in hand with dialysis regardless of the situation or the pt. We should be treated with professional care and dignity without making fun of how much control you have over the dialysis pt who is hooked up to a machine. It might make you feel big but it makes up feel nonessential. We deserve more out of life than to constantly have to fight to live.

A pts access IS their lifeline. I would always let a newbee draw venipuncture but never, never let a newbee practice on my lifeline. Thats just not pudent. Some pts indure many surgeries to get an access to work in the first place. A wrong stick could end that in minutes. I would never call these pts "wusses" as they have been through much more in their dialysis life than most have in their life without dialysis. A pt can only forgive the screw ups for so long and then come to realize, enough is enough. Units have other ways to teach their staff without putting the pt in harms way as a lab rat. Staff should not have to "learn" how to do their jobs at the risk of ending someone elses life.

One has to wonder why a dialysis pt acts aggressive in the first place. It could be that they are aware that whatever tx they receive, good or bad, they must put up with poor attitudes from aggressive staff. More than likely they know that without dialysis they will die. How would anyone expect a person to react to this type of life changing situations? Jorlus stated: our doctors don't believe in "kicking them to the curb" although we all wish we could sometimesDoes this attitude give one power over life and death to determine who lives and dies? Seems more time could be spent determining why these pts are aggressive instead of pulling the plug because you don't care enough to care. Jorlus stated: they would've thrown down if it hadn't been for those handy needles in their arms : )Tell me what you find so amusing about this? Dialysis is so very hard to go through. Pts are not there for your amusement and welfare but are there to try and live another day. Put yourself in the pts chair for just one day and then tell me how you would feel to be constantly on edge wondering if you will make it through tx especially having to put up with all the stuff throw at you by staff who control your destiny and treat you like a child....knowing you have to put up with all the turmoil to live. Tell me how angry this would make you feel to know you are basicly a commodity, no longer a person who deserves respect and dignity. Step back and take note. Your behavior is not professional in the least.