ICAN!

Check the doctors order before you set up the machine. Very easy to do in our clinic with chairside computers.

It happens in our unit when a tech calls in. We are supposed to have one nurse for 12 pts and 1 tech for every four pts. When I have to take a bay I am usually responsible for 4 pts as a tech while also performing all nursing duties for those 4 pts and the other 4 in that same bay.

What do you do when your pt becomes hypotensive, asymptomatic, and says, "I feel fine?" I have a couple of pts with BP that goes into lower 70's/30's and feels perfectly normal. Protocol is trendelenberg, turn UF off, give NS, O2. These pts are acting perfectly normal and do not want any saline at all. I'm curious about what others do in this situation. Thanks!

I bought Mosby's Surefire Documentation - How, What, and When Nurses Need to Document.

the lvn at our unit works as a pct with 4 patients, she can also give their medications and if they are catheters she can start and end their tx and do catheter dressing care. we have a 24 chair unit and the lvn is usually on the side of the room where the charge nurse is so she can help the cn by taking 4, out of 12 of her patients, leaving the cn 8 pts. the other 12 patients are managed by another rn. all our rn's assess, pass meds and are responsible for 12 pts. each (this doesn't include the cia's and other paperwork that we do). this leaves the cn doing the same amount of work with 8 pts plus her charge duties. when the doctors are making rounds the day gets even longer with things to do for both rn's on duty. i don't know if i want to be cn anytime soon although i'm sure she makes a much larger hourly wage than i do.

Try Timberlawn in Dallas (they have a website), Trinity Mother Frances and East Texas Medical Center (Tyler, TX). I have had interview offers from all three as a new nurse and a job offer twice from one but decided to stay where I'm at.

I was offered a new job yesterday and my new schedule came out the same day. As soon as I saw my schedule I wanted to quit. Since I wasn't at work I threw a temper tantrum in the privacy of my own home, calmed down, and looked at the schedule again. He made me a closer and I thought you had to be checked off on the water treatment part to even do that. It's really true...... the job I was hired for (4/10s daytime job as an RN) is no longer part of the picture. The manager said there is an end in sight but I just don't trust him anymore. I told the other place that I would let them know on Monday so I can have time to really think this through.

I believe he missed a tx and wanted more taken off during the same time frame.

So a patient asked me, "If my BFR is at 450, wouldn't 500 do the work that much faster?" Another machine was alarming so I told him I would get back to him shortly (I really felt like I was saved by the alarm). I'm pretty new to dialysis but this made me realize that I need to read more and know my stuff! I went back over to him and he had turned his machine up to 500. I told him that the high BFR increases his AP and too high of an AP could cause hemolysis and also that he needs to speak to the MD about changing his prescription. This pt is very intelligent and imparts his knowledge on all of us, including the MD, so I'm thinking that he was just testing me. Regardless, I have never responded well to being "put on the spot" and I am going to try to be more prepared next time.

Nurses that have been there since early morning are closing out first and second shifts. Evening charge nurse is doing assessments for 8 pts and putting on any catheter pts in her bay. I and one other nurse are assessing, stringing up machines, putting on pt's, taking pt's off, charting and giving meds in our bay; we each have 4 chairs. The new nurse helped with some of the machines and put in a new admit on computer but other than that I don't know what he did at the computer the rest of the evening. He did come around and documented team leader rounds on my patients then left. I have been there 4 months and part of that was training and the other part hasbeen working as a registered nurse. Since orientation I have not cannulated a patient or set up a machine but have no problems putting on a catheter patient.

I would like to be that person that hangs in there but yesterday evening was complete chaos! They have not taken away my stethoscope at all. I bring in a patient, do their assessment, have them sit in the chair while I take off another patient, have a machine waiting to be cleaned and strung up and more patients waiting to be let in the door to be weighed. I'm going to do the best I can do and that's it. There was a complaint yesterday from a patient who had to wait longer than she should have, but when you put an RN in a PCT capacity who has no experience in that capacity your going to have unhappy patients. No nursing duties have been taken away from me. I still do my own assessments, meds and monthly paperwork that has to be done by deadline. I'm getting very stressed out and am in tears on my way to work. Just can't believe this is happening.

I'm the type person that needs eight hours how about you? This week I am on the schedule to work Friday night until 10:30 and then come back in by 6:00 on Saturday morning. It takes me an hour or more to wind down when I get home and I live 45 minutes from my place of employment. I'm figuring I will get about 4 hours of sleep and a little concerned about it.

It wouldnt be so bad if I had PCT experience and was faster. When I'm feeling positive I look at it as a learning experience, but when I'm behind and the PCT's have finished putting their pts on and offer no help at all, it is overwhelming. I want to tough this out but I'm starting to think I should cut my losses and move on. My RN duties are going to suffer. Maybe he wants me gone since he has hired too many RN's and the last one has more experience. Of course this is going through my mind too.

There are too many RN's and I am not the newest but the one with the least amount of nursing experience. We have had some PCTs quit and our census is growing. As far as paperwork, I still have all those RN duties. The fact remains that I was hired as an RN on day shift and am feeling totally let down and dissilusioned by my manager and the company. I could have been the most loyal employee he had because I want to be a dialysis nurse so bad and was very appreciative of the opportunity.