MizChelleRN

You'll want to stress your abilities to lead others, to hold your team accountable for policy and procedure. You'll want to emphasize your ability to make smart clinical decisions quickly, how you are in an emergency, and extra attention to detail.

Sometimes "panel interview" just means the manager pulls in some of the other employees (so they can feel you our as a potential coworker!). Sometimes a couple managers get together because we're both hiring and we interview you at the same time and fight over who gets to hire you (!). Sometimes I pull education in to interview with me because the second interview for me is with them, so we cover your first and second interview at the same time. It's just like any job interview. Relax, breathe, take your time and be yourself. You got this!

I'm managing incenter. It's a huge challenge but I like it.

What a great memory, posting these a few years ago. I did end up in management and I love it! It's challenging but I found my niche. Love it.

I was blessed that my employer told me, apply for unemployment, we will not fight it. Just get better. And they were true to their word. Not bragging about it, but I didn't realize that isn't usually the case. Curious to see what others say.

Can someone explain this one to me? Maybe it's dialysis 101 but I honestly don't remember. The details probably don't matter but the patient had no reason to run yellow amp. (Good AVF, long run, 14g, etc) usually set to run even, no fluid gains between treatments. Always had us scratching out heads as to why he still ran yellow. Someone suggested flushing/bolusing to make the UFR >300. Lol and behold, green amp with UFR of 350. I can't figure out why this is? I thought with high flux dialyzers, you didn't need a min UFR. Or was it all just a coincidence?

First, let me say, I LOVE that our subforum is really active lately! I am so passionate about dialysis and networking ideas with fellow nephrology peeps. So.....recently I had a conversation with a colleague. We were trouble shooting ways to get fluid off of a hypotensive patient. We put the usual stuff out there, cold dialysate, uf profiling, na modeling, IUF treatment, etc. And he brought up that the patient was on the largest size membrane, possibly there is too much volume outside of his body, perhaps the dialyzer was contributing to the bp dropping. Doesn't add up to me, but would love to hear your thoughts? Is it significant enough to make a difference?

Oh and I wanted to mention watching what the kecn is doing with those dialyzer fibers clotting off.

This is a great conversation. Not sure either if it "prevents" clotting, but it gives me a chance to clear the drip chambers so I can see what's going on with them. If they are getting thicker, with blood sticking around the walls of the chambers, the saline will wash it out. I like your point with the low platelets, are they really going to clot anyway? And the saline sodium content was a good point.

I've used a continuous infusion to prevent clotting before too. I've seen it hooked to both arterial or venous lines. I prefer hooking to the venous line, bc I figure art line clotting is less likely bc it's so close to the patient. Hooking it to the venous line keeps that venous drip chamber watery, diluted. But it won't stop a clotted dialyzer. Actually I prefer a good hard manual flush so you can evaluate how thick the drip chambers and dialyzer headers are getting. But for time issues, I like the infusion flushes. Plus the patient will not overfiltrate if the manual flushes get missed. Oooooh so that raises this question: do you set your goal pretreatment to include the 1500 cc of saline you intend to give, or do you add 200 to the goal every time you give a 200 flush?

I never want to feel again, what you feel now. It may be the scariest, worst moment of your life but I promise it will produce love, happiness and success beyond what you can dream today. Stop being controlled by your disease. Join the fight and let's get on top of this. Much love.

You can always pop over to Nursing Specialties- dialysis and renal nursing :)

Agree 911 should have been called but honestly she was probably seen way faster the way it actually happened.

Especially as the charge nurse earlier that day rolled her eyes and sighed "ohhhh that patient"....and then went on to come at you like that. Plus you said you and your preceptor were floats to that unit that day. Seems they could have come to you, told you what the patient said, and said just don't bother with that patient the rest of the day. I would have removed the nurse from the case JUST so the patient didn't escalate. Then that's that. If you were a floater, you were probably never going to see that pt again anyways. No need to "add it to your file". Hopefully the note added to your file clearly indicates what a PIA and how non-credible this patient was.

Thanks I needed to hear a lot of these things. I'm a newer manager still trying to find my style.

My favorite book in recovery was God on a Harley.

Actually a really high percentage of us were in that same situation. They walk hand in hand, and that's a good thing. The BON and the law each know you are being monitored by the other. Which is not to say either will be lenient. But it is to say that if you screw up, you're doubly screwed. And if you're successful you'll be doubly blessed. I walked both paths, the alternative program with the Ohio BON and the Chance program with the law. In fact to have my felonies expunged I spent a full year in an intense probation program and the alternative program lasted me three years. Both required completion of a treatment program. And I did it all. So can you. Good luck my friend.

We are going to expect that you understand the science behind the care that you will perform. We can train you to do the rest.

Davita is good for allowing a candidate to shadow for a few hours to see if they are a good fit. An independent chain in NE Ohio did the same for me. You really don't know what goes on in dialysis until you see/experience it. We say this all the time on this site: you either love it or hate it. I almost always discourage new grads from getting into dialysis. Number one I need you to get some good real world experience, assessment skills snd snap decision making abilities. In many cases you are your own only resource. A good experienced tech can make decent decisions in an emergency but ultimately it's your ass on the line. You better be confident in a decision you make in an instant. Plus a new grad almost pigeon holes himself in dialysis (a pretty extreme specialty) and if he decides to go find something else, the specialty experience might be a hindrance rather than an asset. Please don't flame me for those opinions. Of course there are exceptions, notably technicians who become nurses so they can be dialysis nurses. Veering back on topic..... Davita vs. Fresenius blah blah blah.....have you ever worked in an environment with a rival company? Or even think about your favorite football team rivalry. You can villainize one company or another but if you look closer, you see it's still just hardworking dedicated nurses and techs just trying to do their jobs and give good care. Some care more, some care less. Every single clinic has a unique culture a unique dynamic that makes it different. It also depends on the level of leadership in the clinic. A manager can be people driven, business driven or money driven. You can pick up on this dynamic almost immediately when coming into a clinic. If you're truly interested in nephrology, get into it. Immerse yourself into learning the specialty. Then you will become the driving force in what kind of culture you work in. Dialysis needs leaders. Needs strong, smart personalities. If you are the force that leads and drives your unit, you will work in a calming (? Lol calming?) Environment where you know what's going on with every person (patient and tech!) in your unit. If no one has a firm grasp on the reigns, the whole team feels like they are in chaos, an unqualified person is probably running the show, and the v linic is not providing safe care. Are you the nurse others can look up to, to lead and anchor their unit? Believe me, the staff nurse in tge unit is the driving force. The manager has a pretty hands off role, running the behind-the-scenes and we rely on the face of the clinic to be the leader. Did I veer off topic again? Where are you at in your career? Hungry for knowledge? Eager to learn? Seasoned and experienced? Oh and the money.....don't be fooled by the offer of a nice salary. Often the more attractive the offer (think huge sign on bonuses!) the more challenging the clinic. Go with your gut and don't let the flash of money drive you. After taxes, we all make the same give or take anyways. Oh and don't get me started on money. Nephrology is going broke quickly. We don't get reimbursed nearly what it costs to keep the clinic afloat (unless you have a high commercial mix, not likely in poorer communities) and Medicare reimbursement is about to get way tighter, read: do more with less. We are careful to count how many 2x2 gauze pads each patient gets, careful not to waste one blue chux pad. They constantly drill down on the clinic for staffing, cost per treatment, and yes you feel like all management cares about is the almighty dollar. But we have to be so cost effective just to keep our doors open. Good luck to all of you! I might work for one of the big 2 but injust want to see good people in place in my specialty, don't care what company ya work for. These renal patients deserve quality nursing care.

Well. I would say this. In Ohio some rules could be amended on the contract depending on the situation. You have to have a solid hold on the program: no missed calls, screens, put above average effort into your monthly reports, etc. Jump through the hoops and do so gratefully. My original contract said I was not allowed to be the only RN in the building. Tgen when I got a dialysis job, after a length of time and good behavior I was granted the ability to work afternoons and could be the only RN present. Of course YMMV and I'm in Ohio. A no overtime clause was overturned when I asked for it during a staffing crisis but I had to develop a plan on how I would keep my sobriety first. Or they assign you more meetings per month. What kinds of terms were you hoping would be overturned?

You know what I realized about pay? (This is probably veering off topic) but no matter how much I make hourly, my paychecks seem about the same! After taxes, benefits, 401k, your take home is nearly the same roundabout number. So I don't worry too much about the dollar amount.

I love hemodialysis but it really truly is a love it or hate it specialty. Your comment about a year in dialysis should land you a hospital job is probably untrue, sometimes I think we get backburnered like LTC nurses......Yes we all know it is "real" nursing, extremely skilled, multisystem involvement, quick assessments, thinking on your feet, but for some reason there is a stigma attatched that it's somehow not "real experience". Odd. Dialysis can be repetitive yes. I might not say monotonous but it can feel a bit like groundhog day. The schedule is and can be brutal, yes. Long days, early start times. But the pay is pretty good. Once you specialize and become proficient, you'll be invaluable and a hot commodity. But it doesn't sound like you want to commit your career to nephrology. If that's the case, you may be happier seeing a more diverse population in home health. And I just realized I just said what all the previous posters said. Good luck on your decision.

I'm unclear too....did you bring all this used stuff out into the hall or to the nurse's station? Or was this still in the exam room?

Be humble. Listen and learn. Your techs and what they know will make or break you. Treat them with respect. Ask lots of questions. Don't just push buttons on machines or silence alarms if you don't know what they mean or how to properly assess the situation. Never get too complacent or less alert, conditions in dialysis can change on a dime. Develop good habits per policy/procedure bc bad habits are hard to shake and will bite you in the ass every time. Stay current with the practice. Be easy on yourself, you will be lost confused and overwhelmed for awhile. Keep plugging away. I assume you'll be with one of "big 2" companies? Your first few weeks will be learning in a classroom. Study like you're back in school. Don't play the "I'm the nurse and you're the tech" card. Yes you'll have to override decisions but always question, ask what the thinking was and COLLABORATE. especially at first the regular staff knows these patients better than you do until you get your groove going. Know know know that water room inside and out. It's one of the hardest things to learn but you are absolutely responsible for every aspect of it. Know how to check the water logs bc chances are you won't be the one doing the checks but you have to be aware of what happens in there. Use your resources. Find out who and what they are and use them. Ask lots of questions. Don't let the patients see you sweat. Be calm don't scare the patient or give them any reason to doubt you. These are a unique people. Diverse. Scared. Sometimes spoiled and entitled, frustrating but always try to consider where they come from and how hard it would be to be in their place. Built up toxins in tge brain and body can affect their ability to learn, comprehend and understand. Give knowledge to them in small doses or how you assess they can accept it. If yougive them more than they can handle, you'll beat your own head against a wall. Don't be afraid to be aggressive where you need to be. Under-dialyzing patients is as much a disservice as running them too hard. Your spidey senses will eventually tell you what to do. Patients usually know what they can handle but their word is not the final word. Someone will tell you they can't take off X amount of fluid. Their needs change and sometimes you have to try for more to make them better. Conversely know when to say no. Dialysis ain't Jenny Craig. If you don't have 5 kg on, you can't take it off. Am I rambling? Welcome to dialysis. You'll love it or hate it but we need good people working here. Hope you stay.

I love that assessment. I don't know how accurate it truly is and I don't know if you're really allowed to view the results yourself (?) But I got to see mine and really agreed with the interpretation. It's quite extensive. When I prepared to move upward in the company, I got a chance to see mine and it offered my strengths, weaknesses and what to focus on for developing me. Be as honest as you can be and you'll benefit from it.