Toni3

Dear Ms Dorsey Hello how are your thanks for asking about my week. How long did your patient train? Was it a easy one or not? I have completed my first week of training, my patient is really motivated he is cannulating but needs assistance. He wanted to do everything himself but it is hard to pull needles alone. His wife is pretty helpful. The Nxstage educator is a good resource. I think she is so into how wounderful the company/product is that I get a one sided training. I have lots of paper work WOW. How do you make time for clinic during a training? Do you see a few patients each day or all in one day for clinic? Well, my patient is on the machine for nearly 4 hours so it takes almost 6 hours of my day, I know it will decrease as he gets more confident in his skills. I have another questions that popped into my head on the way home today. When a patient gives themselves saline during a treatment and the saline bag empties what stops the air from going into the patient. The saline T is before the air detectors right? During priming air is being sent inside the saline bag so that is different than a regular IV bag that will collapse down on itself and not allow air to continue down the lines. Am I missing something? Well, I like teaching and spending time with the patients I pray this is the place for me to be. Have you had any complications with any of your home patients? I have a program just like yours I do everything, biomed only came by and RPM'd the centrifuge. I have long waiting list of patients to be trained some are really large and need to be trained on the BabyK they will be later I need to learn one machine at a time. Let me know how your week went. Have a restful weekend Toni

Dear Ms Dorsey, It's great to here from you, I'm glad you are doing well. You are on a second training that is wonderful I am very impressed I hope this patient does very well and no complications. How many patients do you have now total? Did you inherit a clinic or did you start one from the beginning? I was on a vacation my family came here to visit me lots of work but worth every second. The first patient to train will start on Tuesday. The NxStage educator will be with me for 8 days then on my own. My initial training and time has been in PD other than the week in Tennesee and Seattle I haven't had much time in HHD. Thank God for you and the perceptor who gave me some great information to take back I don't know how I would have started gettin things together. The NxStage machine had been sitting in the clinic for 2 years with out any attention. On Monday I tried uploading the 1.13 version on the Pureflow to find out I needed a new jewel box that didn't come directly to me but another patient in a different state. Next I needed a control unit the first one they sent leaked water at he UV light. I was grateful another nurse had one to give me until mine arrive on Tuesday. A batch started at 08:30 PM Friday night no cultures or AAIMS have been done on the machine. The patient will run on bags for the first week or more. What is your experience with NxStage and their technical staff and equipment. I'm actually looking forward to how this training will go. The patient says it won't take him 4 weeks but 3 weeks he is really motivated. Though he is 133kg I hope he will stick with the program. I'll let you know at the end of the week how my first week of training went. Thanks for emailing again I like keeping in touch with you. Toni

Dear Ms Dorsey: I sorry I didn't get a chance to respond before I left for preceptor class. I have returned from a one week perceptorship. I had the opportunity to see a patient from the beggining start training. I did get a chance to see the Nxstage in actual working mode. It isn't very complicated if the patients follow the instructions. However one must have a good working fistula or graft. I'm not to crazy about catheters though, I have seen too many patients become symptomatic in the chronic unit that appeared fine before their run began. The nurse was awesome she gave me alot of information to get started and her training notes which I thought were wonderful. I'm still quite nervous about doing a training alone. I meet the Nxstage nurse she will only be with me for the first 8 days and then its up to me to finish on my own. Tell how did that go for you? How is your patient you trained is he/she flying solo now? Did it take you 3 weeks to train completely. The couple that started were educated but they had long way to go in 2 weeks but I don't know how in depth the teaching can be. In PD we teach so much anatomy, dialysis(osmosis and diffusion), anemia, bone disease, epogen injection,heparin, adequacy, diet, complications, the actual manuel exchange and the cycler, fluid volume management, asepsis versus sterile man I'm getting my self tied up just thinking about how much more patients need to know cannulation, BLEEDING and how to handle it, multiple alarms, clotting lines, infiltrations. Do the patients leave training knowing all these things? I quess I'm getting worked up because class is over and its time to know enough to teach it. I sure you started off the same way you learned then turned right around and taught the patient. What was your background before HHD. My perceptor said it isn't a difficult job if you are not training a patient but the paper work can be overwhelming. I noticed she used that word overwhelming a couple of times. There are a few things easier than PD one you don't have to search for vein to give iron and take blood. You don't even draw the labs yourself. You only need to schedule the clinic visit once a month and not the MD visit as well. You have fewer patients, therefore you can get to know them better. But, there is that use if supplies I don't see why they can't order gauze, needles, pads, ExSept like they order their supplies from Nxstage the PD patients are responsible for ordering all their supplies. Well, I understand that HHD is in its infancy for this company so in the next couple of years we should see a lot of positive changes. This Friday I should be getting and ideal of the first patient I am to train we work with many MD so I have a list of about 19 patients that have shown interest I don't know how many are still interested or how many are good candidates so I imagine that number will be about half which is a large number to get trained. I just have the jitters I could go on here for awhile so I'm going to wish you a happy belated Easter and hope I hear from you soon. Toni

Hello Ms. Dorsey: How is your training going? You should be in the 3rd week now. Were you on the HHD conference call for March on Friday plus there was a LMS on weekly billing this week? Do you think weekly billing is a better idea since patients don't always get their flowsheets in on time. I thought a fax machine was provided for the patients. I will be going to Washington to train with a perceptor in April I heard that will be a good learning experience. For me the sooner I get started the better I'll feel. Did you get the HHD workbooks from the store? I wonder if they are a good resource. I've believe they will be of help because the PD workbooks are quite good. Have you rolled out with the new lab process yet. It does sounds OK and you can add labs for individual patients as needed. I don't know if I mentioned I am splitting my time with PD and HHD. I'm training PD patients currently yet the cycler is still a area I can still use some training myself. For me I think it would have been so much easier to just do one thing. I understand that my time has to use effeciently until the HHD program get off its feet. I know you are busy with Epogen, labs, heparin, flowsheets, water cultures, clinic visits. When you are train 6 hours a day that leaves you with 2 hours to get all that done. Do you train 5 days a week on the same patient or 3 days a week. I really like to teach so I hope that will also be the same for HHD. You are really doing a good job getting out without overtime during a training. Thank you so much I look forward to hearing for you. By the way there is one HHD nurse no 2 but they are out of my general area I have meet them at different events. They seemed to be reasonably happy with their positions. Unlike PD I almost had to go in on Saturday to give an IV antibiotic it turned out that is wasn't my week to be oncall. Again thank you it means a lot to hear from you. I pray your training goes well. Toni

Dear Ms Dorsey: Congratulations on your 2nd training. I hope you don't run into overtime on this one. I can understand on your first one because it is so much to process yourself and then adequately teach someone without a medical background. How many hours does each training session takes beginning to end? I've heard about 4.5 hours. Your input has been invaluable to me. I really was apprehensive out of the gate. I think it is because my last job was acute dialyis. These patients were the most noncompliant out there and so many were also very ill. I believe 7 patients is quite busy for one nurse, 15:1 can that be done? I've heard nurse trying to quit when they get to 12:1. I don't mind working or paper work. I just want to be done in eight hours and know exactly what I and doing. The HHD class has not changed much apparently. I just wasn't really given time with the Nxstage machine to learn it at all. We all helped but the lines on the machine and the pureflow was not mentioned. I wanted more hands on and how to handle complications. But it was learning styles, surveys, It solutions, townhall discussions ect. I'd would have kept most of that to minimum and stayed with the machine and complications. I do like teaching, not having a staff to moniter like on the chronic floor, and regular hours. Oh by the way it was not my supervisor who trained the one patient in the program, it was another nurse who left that did it. But the supervisor has been handling all the issues that have been coming up related to this patient. I hope this patients does very well with treatment, picks up fast and has a good care partner. Toni

Dear Ms Dorsey I hope all is well with you. I returned yesterday from a three day HHD class in Brentwood, Tenn. Have you had a chance to take that one? I do feel better about HHD now. Though I did tell my supervisor that I would not be training any patients dialyzing alone at home, not too safe in my opinion. I did take a look at the consent the patients have to sign and it pretty much covers everything. How many patients do you have? Nxstage and/or BabyK. Have you had a chance to train any patients? Sorry I came back with lots of questions. I hope you had a good week. Toni

Thanks Ms. Dorsey It's good to know you enjoy the program and you have learned all the computer programs. I will be starting up the program for the most part because we only have one pt thus far. My supervisor trained the first and only one so she will be a great help. How many patients do you have and how often do you do overtime like staying after 16:30. I'm glad you have never had to go out on a late night visit. I was nervous because everyone keeps talking about it's a big job and lots of paper work. Have you done PD and is it more or less the same amount of work and time. I really appreciate you reponses and insight. I'm be going to a retreat for my church this weekend so I won't be able to get back to you until Sunday. Thank You so much. Toni

Thanks for replying. Yes, you are correct it is DaVita. I'll be the only home hemo nurse. This program is part of an in-center unit that also does nocturnals. I'll be sharing call with the supervisor which will mean every other week call. Honestly, I can't see working 8:00 to 16:30 and no saturdays if I am to accomodate the schedules of training and monitering patients. Right now we only have one nocturnal. How often do you need to go out to the patients home to help cannulate, especially after an infiltration. I hope I'm worried about nothing but that's not what my gut tells me. I really won't have a sitter for child care at all times, which is really my concern. I really appreciate your time and attention to my concerns. Thank You Ms. Dorsey

Hello, I'm Toni I've been hired to start home hemo. I'm curious about the hours and oncall. I need to only work 8 hours Monday to Friday. I'm afraid there is more to it than I'm being told. If there is anyone working in this area that can tell me what the oncall is like. How often do you visit the patients home after hours to assist with cannulation? Also extending treatments to weekends or working after five in the evening. This is very important to me for child care. I'd appreciate any input. Thank You