shannon8282

I have just returned to work in a dialysis clinic that I left 3 years ago. (I left to go to RN school and spent a year in the hospital) I had been there 5 years prior and I love dialysis and the close relationship you form with your patients. It is a small clinic with a patient census of 40. There are a total of 3 nurses (counting me) and 5 PCTs. I have really enjoyed returning to this clinic, with the exception of one pt., and because of him I am thinking about quitting. He is ~45yo, and mad at the world. I think he has been on dialysis about 6 months. He is completely noncompliant. He misses tx., he ends his tx. early, he has a beautiful fistula that he won't let us even touch so we continue to use his infected catheter that he refuses to have removed. He cusses me and the other staff, he has called me a liar (I am his primary nurse)...it is GD this and GD that. He is offensive to the other patients and I feel like there is nothing I can do about him. He is young, and he does have a sick wife at home he is taking care of...and I understand his anger...but I am sick of the harassment. I have talked to my NM and she has tried to have the MD send him to another clinic, but the MD refuses. I love my job, but I dread dealling with him so much...Please help!

Thanks for the suggestions, guys. This is a great website for advice.

I recieved my nursing license one year ago, and since then I have worked on a step-down telemetry unit. I have taken a Critical Care course, and have floated to ICU on occaision. I enjoy the work, but I feel like I am ready to move on to something more hands on. I really want to try the ED, but am having some reservations about it. I feel like I handle stressful situations well, and I love performing skills, and that I would enjoy the ED, with two exceptions. I am having some major reservations about having to work with kids, and I am still intimidated by doctors. I like kids, but I don't know if I could handle their crying and being unsure of myself talking to them on their level. And the doctors...I work nights and mainly deal with them on the phone. I am able to convey to them what is needed, but I am not comfortable enough with them to make small talk when they are on the floor. I know small talk is not in my job description, but I think it helps when you can have the level of ease with them. So...I guess I am looking for some advice, insight, anything. I wish I could just try it out for a few days to see if I like it, but the small hospital I work in is very selective about who they let in to the ED. Thanks!

Before I start, please dont take this as criticism...I dont mean it that way. I only want you to see what I saw. I am finishing my first year in an ADN program. The school that I attend is very stressful (we started with 80 in my class and we are now down to 45 students), and I just had an extra stress added onto my life. My only brother died one month ago from today. He was 22. I loved him dearly, and this was very unexpected. I was the first one to the hospital, and my mother arrived soon after me. When she got there, the nurse came in to talk to us. She entered the room smiling, and she appeared bubbly. She told us that my brother was there, and that we needed to tell her what funeral home to send him to. The news of my brother's death was only an hour old, and we were unable to make any decisions at that moment, but she told us we had to decide quickly because the funeral home had to make arrangements. I know that she was only doing her job. And I know that my brother's death meant nothing more to her than a dead patient. But it meant a lot to everyone else in that room. I have learned over the past month that sympathy is not easy, and it is not comfortable, but it is greatly appreciated.

How close do you get to your patients? I became too close to a patient at the dialysis center that I worked at. She became a very dear friend to me, and her death was VERY unexpected. That broke my heart, and now I am reserved because I dont want to get that close again to someone else. How do you deal with this? Is it something you just get used to? I hope not...

These letters are awesome and inspiring. I have just PASSED my first semester of nursing school, and you are the people that I want to work with. You care, and that means more than anything. I have heard so many horror stories from nurses, and there seems to be more horror circulating than good stories. I want to make a change...I hope that sometime in my career as a nurse, I will only have the amount of patients that I can comfortably handle. I want to have time to sit and talk with them, and to be their good nurse. I have been taught so many ways to therapeutically communicate, and I want to use this. Maybe this just sounds idealistic and I am just being niave, but I want to make a difference, and I am glad that I am not the only one. Your letters are great!

I cant go into detail about it because of my lack of knowledge, but when I worked in a dialysis unit we used trendelenburg all of the time. If you know a dialysis nurse, they may be able to help you.

I am a first semester, first year student nurse. I have just recently started clinicals, and my instructor wants me to use a nursing diagnosis that I can't find any info on. She wants me to use "Impaired glucose metabolism". What would by my related to and my as evidence by ? I have read several books looking for help, and I guess I am coming to you guys as a last resort. Any information or suggestions are appreciated. Thank You!