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.

I was told that I will be on the next schedule as a PCT, working evenings. What happened to the job I loved?

Thanks Joni's mom for the reply. I was hired as an RN and I am trying really hard to look at this as a learning experience, but it's hard when I can't even look forward to going to work. I'm definitely not leaving because I love the RN position, it's just such a huge let down to be hired as an RN on days then be switched to a PCT on nights.

I guess I just need to vent. I'm thankful to have a job in dialysis because that is what I wanted when I graduated nursing school. I was hired at FMC a few months back working days and now I'm working evenings as a PCT. The thought of going in this afternoon is so depressing to me! This is a complete turnaround because I loved my job, enjoyed taking on new duties and enjoyed being there. I know that in this economy I should be thankful that I have a job, and I am, but I'm having a hard time being positive right now.

Hi Natanis! I also started out my new nursing career as a dialysis nurse back in October. What I really like is getting a chance to get to know the patients and seeing them every other day. I'm a people person and enjoy talking with them and hopefully being a bright spot during the time that they are in the clinic. I went thru 7-8 weeks of training and still have so much to learn. It seems like I learn something new every day I'm there and I love it. We are short staffed right now and I'm having to work as a PCT for the next couple of weeks, I'm trying to keep it positive and consider it another learning experience.

I have to work as a tech for now and dont feel comfortable about it at all. I am a new employee and new to dialysis. I was hired in Oct. as an RN on days and now I'm a PCT working nights. Very disheartened and hoping it will not last.

Thank you all so much! So many good ideas and I appreciate it. If anyone else has any please keep them coming. I don't know yet the date for presentation but will find out soon. I am really liking the texting while driving thing to because I know my kids do that. I'll keep you posted. Thanks again!

I have to do a presentation to a group of high school students and it will probably be in a health class. What would you want your teenage daughter or son to hear about that would be beneficial to their health and well being? I'm a mom also and I was thinking along the line of STD's or teenage pregnancy but, as high school students, they have probably heard all about this already. All suggestions are appreciated! Thanks!

my thought exactly! i will be graduating as an rn at the age of 50. go for it!

I am in nursing school (ADN program) and just finished my first semester. I do not have children at home but one of my friends has 6 children and is doing very well; her husband and mother are wonderful and take care of the kids so she can study. I wouldn't recommend getting pregnant during nursing school (it's hard enough without having a newborn) although I think as long as you have a good support system at home you may do fine mixing school with kids. School is difficult but as long as you are dedicated and study hard you can succeed. The most stressful part for me (and most all the other students) was doing skills check-offs in front of an instructor. This involved about a 1-2 hour lecture/demonstration from the instructor on one day, 4 hours of practice the next day then coming back a day later and demonstrating the skill in front of the instructor. I'm so thankful that we are finished with all that. We did have a couple of days that we were in the hospital and actually used some of the skills that we learned. There were assignments to complete, which were pretty long and drawn out, along with testing we did online. We also had the regular tests for the skills part and tests for the lecture part along with finals for both classes. Next semester we are in lecture one day a week and in the hospital two days a week. Can't believe I'll actually be dealing with patients the first week I go back to school. I'm excited about it and a little scared but I have heard that this is when you really learn a lot so I'm looking forward to it. Good luck whatever you decide.

You should check out Addison, TX which is in the DFW area. I read that it is one of the safest places to live and there are hospitals aplenty in the DFW area. Good luck!