MSLNT1.1

Frankly it does not matter which one you work for it will all depend on your CM/FA and the region you work for. I worked for Frensenius(FS) for 4 years and now work for Davita and they both still have some of the same challenges. But a lot of that has to with the how our healthcare system is in the US. I train pt's to dialysis in the home and I am experiencing some of the same things I experienced in the chronic setting at FS. It is all about getting the private pay pt's regardless to whether they are good candidates or not, just like getting a horrible pt in the chronic setting. Just make sure when you go on the interview that you get a true tour of the facility. Also make sure to ask about the nurse to patient ratio and look to see how many nurses are there that day as well as technicians. That will give you a hint as to what you will have to look forward to. To sum it up for me, FS trained me well, but the pay was lower, benefits are better than Davita, but you don't get any bonuses unless you are in management. At Davita pay is better, benefits not the best, they have 401k but they don't match and their insurance in Illinois sucks(CIGNA PPO), FS(BCBSPPO). However they do give bonuses, but that does not mean that you will get the bonus, depends on how well your area does. I love training pt's but it was suppose to be 1:1 training, but now I am training 2 patients at a time(that's very difficult because I have to train them to setup their own machines, cannulates themselves, care for their CVC, administer their epogen, troubleshoot their machines, and draw their own labs). Just a few of their duties. It is nice not being in a chronic setting, but being the only nurse training in a clinic can get overwhelming, very hard to get days off, training can last 3-5 weeks average or longer and you are the everything as the RN in responsible for the entire training. So just make sure you get a true picture of what your day to day can be like. GOOD LUCK:nurse:

I worked for Fresenius until May of this year and I have done Management so I understand a little of the pay. If you are inexperienced, you will have to go to training for 4 weeks and then be with a preceptor(also former education coordinator, in Illinois). Unlike acutes where you are paid per treatment if you work in the sub-acutes you will be paid hourly, and they will take into account your yrs. of experience as an RN but will also look at the fact that you don't have any experience is dialysis. But you can definitely try to bargain your salary so to say what your salary range will be is hard to pinpoint. But last I remember the chronic nurses made a little more money than the sub-acutes, and the acutes nurses made more than both. Hope this helps. Good luck.

Lacie, My sentiments too. Epogen can be administered through the med port on the dialysis lines or SC as indicated on the package insert. The bottom line is that we were taught in school what are acceptable sites for administration of medication. And as far I know SC is either given in the arm or abdomen. It should not matter about the Epogen protocol. I agree with TRAUMA RN there is not enough fat in the lower forearm for the absorption. Stick to the fatty area of the arm or abdomen. I train pt's to do dialysis in the home and they administer their Epogen themselves and they usually do it the abdomen unless their training partner is trained in which I train them to give it in the fatty part of the arm. Hope this helps. Also take a look at your companies policy. :nuke:

Actually most CVC are compatible with betadine and not the other products such as exsept(which should only be used to clean the exit site and not the actual lumens) or peroxide. I would look into the how old the catheter is and if the end caps are placed on too tight and staff have tried to pry them off they have sometimes caused cracks over a period of time. :wink2:

You should be angry. While there are many nurses that have this I am better than that syndrome, there are those of us who do believe in wholistic care. I have been a charge nurse and have never felt like I could not answer and alarm or put patients on unless I am truly swamped. Now I will sat that there is a ton of paper work in the dialysis setting that the nurse is responsible for. But I never want to wait for my patient to code, but at the same time I will not let PCT's take advantage of a situation There are times when I observed PCT's not watching there patients, not charting in a timely manner, and disappering off the floor for extended periods of time. In saying that you get bad apples in every position. Have you tried talking with the nurses or clincal manager? By the way welcome to the Wonderful world of nursing. There are going to be more times that you are upset because you will have other nurses you work with that does not share your philiospy. So it is perfectly normal to vent. Good luck in ICU.:welcome:

Your best bet would be to talk with your clinical manager. Considering that you are in a small clinic may present a challenge. Here is Illinois, I mostly see LPN's in larger units because it is more than one nurse that needs to be there because of the number of chairs and it does have to be an RN. But in smaller clinics it is not possible because of the state laws here in Illinois, that an RN can only be in charge in a dialysis setting. Check your state laws, and if they are the same then maybe finidng a clinic with more chairs will be your answer if you want to stay in the field. Hope this helps.:)

My intention was not to say just clearly turn up the BFR between 400-500 that why I stated it is best to get the order from the nephrologist. Also not every clinic or region uses tables and guidelines. My reference to the BFR of 400-500 was in reference to a AVG and not a AVF which takes a lot longer to mature. Yes typically with a 15G needle and depending on length of needle will determine wheter you can achive a higher BFR. But please do not make assumptions before getting an understanding of what I stated and it I took your statment out of context then for that I do apologize. But to the orginial member who posted the thread find out if in your particular clinic or region that you work if they do have established guidelines or policies regarding BFR for AVF/AVG.

I tend to agree with the other posts. The majority of ESRD patients don't start out with cardiac complications, but if they continue to miss treatments and become fluid overloaded then for a while will exhibit symptons of hypertension but as the muscle around the heart tries to pump faster to compensate for the extra fluid the muscle becomes stretched and weakened and it affects the hearts pumping ability. Does the patient have CHF? They tend to function with a lower BP, but always seems to be SOB and is edematous because the fluid is still there but can be a challege to remove because the BP is so low. Hope this helps.

With a graft there tends to more give room because it is not the use of the patients native artery and vein. Yoru best bet it to get the order from the nephrologist. And sometimes to them that may seem tedious, but just imagine having a BFR that is to high and the access infiltrates. In many clinics that I have been in the BFR is usually between 400-500 as long as the arterial pressure does not exceed an -250. Aim low maybe 400 and if the patients labs shows that the URR/BUN is good then there may not be a need to increase, but if URR and bun are high then a higher BFR may allow for more waste to be cleared per/minute resulting in a more sufficient treatment. I hope this helps.:)

The bottom line is their is no longer RCG and unfortunatetly it is only FMC or Davita. Don't get me wrong as I stated in my earlier post their are a lot of things that FMC definetly needs to change, but what company doesn't. If FMC does not meet up to your standards then definetly don't work for them. But I do know of FMC clinics where the nurses have been able to educate and focus on the patients. But yes you have to very creative. But I don't know of any place where in regards to paperwork that there is not a tons of it:o. I know that they are finally putting out the chairside which in electronic charting. Hopefully it will help. But I do agree that a lot of uncessary duties are put on then nurses that need to be supervised by other departments. Hopefully one day they will get it right. I just wanted to put out that every organization has it flaws and that not one is perfect. So assess the situation and location and decide if it best for you or move on. Also FMC is making improvements in services that are provided to their patients. They do provide their own TV's, their is VCR to play movies, their are brand new facilites as well as those that have been renovated. So some facilites or states may need to catch up and hopefully some of the RCG philosophy will rub off on them.

I has this very situation happen to me yesterday. I had a pt. post dialysis who bled for well over an hour. The patient was in a hypertensive crisis. She had nausea, vomiting, headache, and BP with systolic >200 and diastolic>120 I paged the MD to make him aware of the pt's condition and by the time he arrived the patient BP dcreased to 159/78 and the bleeding had stopped but there is no official policy for how long you should wait. I would take a look at what your clinic policy and procedure is. But cover yourself and it it better to be safe than sorry send the pt. to the ER if you can't get the bleeding to stop.

In regards to PTO, the business unit that I work for allowed RCG employees to take some of their vacation time so that they would not lose their time. But you do have a CAP so if you don't take the time it will either go into ESL bank or twice a year they offer you the opportunity to sell up to 80hrs of PTO to as long as you will still have 40hrs left. In regards to LPN being replaced , it depends on your state laws. In Illinois it will not work with and LPN in a small unit because state law states that an RN must be present in the facility at all times. In the bigger facilites they have more wiggle room because you have enough patients to support having 2 nurses on the shift. I started in a unit that had 39 chairs and it was me and LPN. But I have to agree that I can't see them letting go of a nurse over a tech. But you should check your state nurse practice act and talk with your manager about your concerns. When it comes to medications again it depends on your state. Here in IL PCT's can't pass meds at all they can give NS to treatment nausea and cramping and LPN cannot push IV meds, but I see in clinic all the time where LPN are pushing heparin(go figure). :balloons:

This is definetly an old thread, but we know the subject will never go away unless they somehow make it where you 1st degree has to be a BSN. In regards to which route and advancement opportunities are availalbe , there is definetly a difference. The field that I work in is not as strict, we have Area Managers who only have ADN, but because they possess strong leadership skills have been promoted. I would say this, if you are content being a floor nurse and know that you don't want to teach then just getting your ADN degree will be sufficent. In general whatever year you become a nurse then you can have an ADN and BSN graduate come out an make the same amount or maybe a $1.00 difference. In regards to being a Charge Nurse, I have seen any many settings, ambulatory and acutes where the CN has and ADN degree it just depends on where you work. There are several institutions that only allow nurse with BSN degrees to hold CN positions. I really don't look at title as much as the body of work a person has done in the field. But if you want teach I believe that having your BSN and then MSN is a must, the ADN program only goes so far in what is taught to you. But in the Universities they have classes that prepare you to teach and how to develop leadership skills, which is essential for those that it does not come naturally. Choose the route that is best for you. If you want to teach then a higher degree will be required. :monkeydance:

Hope you are getting use to it. When I first completed my degree and they introduced me as the nurse I thought it was so cute, but it tired soon. Then once I thought about it, nurses are held in very high regards in general as a profession, so it's your family's way of acknowledging your accomplishments and how proud they are. Welcome to the field. :welcome:

Yes, there is a code of business conduct that we all should follow. IWhen she was hired she should have been given the opportunity to read it. I know how hard it can be not to truly care for patients that you see on a day-to-day basis, but we need to tread lightly as healthcare porfessional on what is considered crossing the line. Maybe your wife could call and check on her patients at work, but him having her cell phone # is a no-no. When she comes home she may feel very comfortable talking with you about what goes on at work, just continue to listen. It is very hard to watch your patients' health decline. Maybe having a conversation with her about not crossing the lines would be a good idea. You never know who is watching and how they will twist a situation, it happens everyday.

I have read all the threads regarding Fresenius and it seems that just about everyone is being very harsh. I currently work for Fresenius and I don't always agree with their policies. I have come in contact with former RCG employees who have been very rude with current FMC employes. We must remember that it is a for profit company and patient care should be first and foremost, but this happens everywhere(FMC, DaVita, Midwest) . We face this issue no matter what setting we work in. The hospitals wants patient stay to be shorter. You can't run a successful company by making everything free, people cannot just do what they want to do, the company will go bankrupt. I do agree that they are many things that FMC need to work on (Patient care and salary) but they are no different than anyother business. And for those who have had horrible experiences need to thin. Maybe it's the facility that you work at or maybe you. Sometimes we have to learn when to be followers and not want to leaders all the time. I don't understand what made RCG so superior over FMC. When we go to work I am sure that we like or love what we do, but we expect to paid. So we are looking for our profit as well. If it does not suit you, then try another field. Also hooray for those states where you have unions, but we know it can also be a blessing and a curse at the same time. So for anyone considering working for FMC I neither enocurage or discourage, go with what your instinct tell you.

I would suggest finding out from your patients did they eay prior to coming to treatment and if they checked their glucose before administering their insulin. I had a patient just the other day who became nauseated post tx and when I checked her glucose it was low. After I asked her, she said she had not eaten at all and I given herself the insulin and because her transportation was late she went well over 5 hours without any food. So although eating is not encouraged, diabetic's need to be looked at individually particularly those who come for the 1st shift because they either are not eating or they go too long during tx and it is lunch time and there is a delay in eating and they have no snacks with them. In regards to the water the opposite usually occurs, the patient tends to feel better if it is a water issue because they are no longer exposed. Also are the patients on the same RO loops or are they different? Dialysis Educator

For those of us that work for Fresenius we all know that last year they acquired RCG(Renal Care Group) which were still doing reuse. In the Central Business Unit of the company they were doing pilot studies because we started using the new Optiflux dialyzer that are being kept sterile using a Electron Beam Process and not Renalin. I know that they are working to rid the clinics of Reuse dialyzers and everyone will be using the one-time use dry packs. However you will still be required to "Fresh Fill" the system(100 from arterial and 400 from venous). From the most recent draft copy received 4/1/07. Dialysis Educator

After reading everyone's post I have to agree being a dialysis RN and educator that they all have valid and strong points when it comes to whether you should give antihypertensives. And as it has been said in general you advise the patient not take the BP meds prior to treatment. Also make sure if you know if any of your patients have uncontrolled hypertension. We need to be more assertive with the MD about guidelines as to when we should administer the patient their BP meds. I always educate my patients to bring their medication with them especially their BP meds and diabetic medications so that if an emergency situation occurs we can be as prepared as possible. Another thing to keep in my is that patient who have uncontrolled HTN may need to receive their epogen within the last hour of treatment or sometimes the MD may change the dose because it can cause exacerbate the patient's HTN. Look at http://www.ferrlecit.com. Also, I can't recall how many times I have seen a nurse push a patients iron fast and not as recommended. The possible side effect of that is also hypertension.

The dialysis company that I work for says that you must butterfly all AVFand AVG. To do this you should put a piece across the wings of the needle, place the butterfly cross and then finally another piece on top. If you have patients that sweat alot that can also play a role in why the tape loosens.

What company do you work for?

It is very commom to be precepted by a PCT to learn about about the machines, water system, cannulation and catheters. But eventually you should be trained by licensed personnel to learn the nursing aspects. Sometimes it is very hard when you are a nurse not to want to learn the nursing aspects but foucs on learning the technical aspects. Not only will it help make you a stronger nurse but the patients and PCT's will appreciate it. I use to be and Education Coordinator for FMC training new employees and ongoing training for staff in the clinic. But I have always said that each position need to be respected and nurses should not ever feel they are above putting patients on the machine or doing PCT duties. Nurses have to remember that although not every position in the clinic can be done, that as nurses sometimes we have to do a little bit of everything so be well-rounded. There are issues in dialysis just like in every field; you just have to figure out how to provide safe care.

I used to be a clinical manager and I know that the salary range varies, but as a new grad the usual in Illinois is anywhere between $21-23/hr as a fulltime employee.

From my understanding the FMC policy is the same. I use to teach education for the company, but I know that there are different business units and that can make a difference. If you have access to the computer and know how to look up policies on line I would suggest looking for a policy on termination of treatment. Also in regards to the nausea and sweating post tx , there can be several things happening, the patient can still be hypotensive and if they are a diabetic definetly check their glucose level. Hope that helps.

I would say coming out as a brand new nurse that acquiring some med-surg skills would be beneficial to you. I would say that dialysis is definetly not technical type of nursing. As healthcare continues to decline, you still have to deal with the patient holistically. Most patients have either diabetes or hypertension and eventually end up with cardiac complications. While it may not be the setting of and ER it can go from being a quiet environment to one of critical nature in a matter of minutes. Most people think that being in dialysis is easy but it is not. Although your primary goal is to attend to the issues of the kidney once again you end up dealing with all the patients issues. And we know that there are plenty on nurses no matter what area they are in can be risk. It can be very a enjoyable field but it will mainly have to do with your knowledge and skills and what you bring and want out of the position.