mamabaer439

I was dialysis nurse for 3 years and loved it. I like having that kind of continuity of care and every day is pretty much the same. I am now in home health and love it too. Continuity, autonomy, independence, making my own schedule and every day is different. Both are great career paths for a nurse. Just depends on what you like. Before doing home health, ask lots of questions about compensation. Most pay per visit, but I was lucky enough to get a place that pays hourly, $37+/hr. My first home health agency had at most 10 pts for the whole agency and paid $45 per visit. Only 6 visits per week. Not enough. Found this new agency with plenty of work to keep me busy.

I was dialysis nurse for 3 years and loved it. I like having that kind of continuity of care and every day is pretty much the same. I am now in home health and love it too. Continuity, autonomy, independence, making my own schedule and every day is different. Both are great career paths for a nurse. Just depends on what you like. Before doing home health, ask lots of questions about compensation. Most pay per visit, but I was lucky enough to get a place that pays hourly, $37+/hr.

Yes, 5 patients for the whole agency, and two of those are therapy only. The agency is about two years old. They keep saying now that we got certified to take Medicaid we should be getting more patients. They have been saying that since May. It is pretty sad. I don't see how they can stay open. All of the staff see the writing on the wall, but the DOO and BOM keep saying don't worry. Well I am worried. I cannot support my family on five visits a week.

While I understand the reason behind the HIPAA laws, it frustrates me that they have taken parents out of their children's health care. I don't think that this was part of the original intent. On another note about HIPAA, I was recently released from a job for a "HIPAA" violation because I handed one patient a phone number from another patient, with the second patient's consent. Who would have thought? And is a phone number really part of a patient's protected health information? They were just looking for an excuse, I think.

Lucky724, I did not receive the message. You can email me at [email protected]

I started with Amedisys in May. At the time that I was hired, I was told that I would be paid a salary for 60 days and then would go to per visit pay. However, the DOO told me that they would probably extend the salary (as they have for the last 2 years to the other nurse) as long as the census was low. This happened for one month, but I am now being told that I will be going to per visit pay on my next paycheck, a cut of at least 75% to my pay. Our agency has 5 patients and two full time RN's. Do the math. This is not going to pay my mortgage, let alone the utility bills! I am upset that I was misled this way. I am new to Home Health, and needed lots of training. The CBT's available are wonderful, however, I found that the individual one on one mentoring that is supposed to be provided (based on the training plan I found somewhere in their online documents) was nowhere to be had. When I complained to the DOO about the lack of mentoring (I had one visit with another RN), she said that was the way it was for everyone in the office. That still doesn't make it right. So now I am being called into the office every other day about something I did wrong, because I was never trained the way to do it right. Her response is that I don't ask the right questions. How can I, when I don't know what I don't know. They don't do prehire drug screening, but I found out that they do perform random screening. I have had enough. I am looking elsewhere. I have an interview on Tuesday with another HHA (hospital based). I pray something comes along soon. I want out now!

I tried acutes for one month, after working chronic for 2 years. While I like doing acute dialysis, I could not tolerate the hours. Up to 16-18 hour days. Of course it all depends on the census. Some days there are way too many patients to finish the day at a decent hour, other days there are no patients at all so you get called off. Because of the variations, there is no guarantee of 40 hrs per week, or there are weeks you work 60+ hours. Then there is being on call. Needless to say, I said adios to full time Acute Dialysis. I do work per diem at Acutes to fill in hours that I can not get at the clinic (low census there too!) Now I have been called off of Acutes my last 4 scheduled shifts due to low census. Hit and miss. Some people flourish on all the craziness. You may be one of those. Good luck.

This happens at least once to everyone! Get into a routine. Always have the clamp in your hand, ready to use, when you grab the lines, grab the clamp. That sort of thing. Also, watch the arterial line. If blood doesn't start traveling up the line the way it should, check to see if the saline line is clamped. This is always the first clue that the line is not clamped. Don't beat yourself up. It happens.

My manager has a set of bright yellow and orange print top AND print pants. This outfit looks like something a clown would wear at the circus.

Trach care with long stringy sputum. I almost lost it. I also hate toenails that are so long they are curled and the smell of unwashed feet. I once had a dialysis pt that had extremely long nails and I called his care center to let them know that they needed to do something about his feet (he's a diabetic for cryin out loud.) The next week I check his feet again. There is this deep depression in the bottom of his foot. Upon further investigation a large curled toenail falls out of his sock. Looked like an old dried up piece of macaroni. He had been walking on it and didn't feel it due to neuropathy! How long he had been walking on it is anyone's guess. Why do old people have such gross feet?

WOW. I am sorry you feel so picked on. I am sorry your kidneys don't work. That sucks, and it really is an awful way to live. I get that. But for every disease process there are things that people need to do to maximize their life expectancy. Heart patients, need to eat a healthy low fat diet, diabetics have to avoid carbs and take their insulin, everyone needs to take their prescribed medications in their prescribed way. It just so happens that you have a condition that means you need to adhere to a stricter diet and fluid restrictions. It is unfortunate, but it is your reality. Fluid restrictions are not some arbitrary way for us to hold you in our power. They are a necessary evil to protect you and your heart, so that you can live a longer life. When you drink too much fluid and are a dialysis patient there are repercussions. Excess fluid puts a strain on your heart and over time, can shorten your life. Large amounts of fluid are hard to pull and can cause you discomfort (cramping, low blood pressure) during your treatment. I don't want these things to happen to you, so I tell you not to drink. God knows, I would love to let you have all the fluid in the world, but it is not in your best interest. So do not complain if I tell you that you shouldn't have it. I am doing my job, trying to teach you the best way to care for yourself. You can choose to ignore me. Fine. That is your choice. Just know that by doing so you are shortening your life. The diet that has been recommended for you is also not some arbitrary way for us to exert our control. It is not in your best interest to eat high potassium or high phosphorous foods. Sorry about that, it sucks. Life dealt you an unfair deal, now you need to decide if you want to follow our recommendations, or throw it all out, and live your life the way you want to. Go ahead, but again, know that by doing so you are shortening your life. You seem to think that we like enforcing these "rules"; that we get some sort of maniacal kick out of making your life miserable. We don't. We know that what you are facing is difficult, and not fair; no one deserves to have to live like this. But the fact of the matter is that kidney disease is your life, you didn't choose it. But you do get to choose how you want to deal with it. Instead of tearing apart your caregivers, how about looking at it from their perspective. They have a job to do. That is to help you live a full and productive life with the diagnosis of End Stage Renal Disease. To do so we will work with you as long as you work with us. Problem solve with your nurses to find alternate strategies to slake your thirst. Rebel, fight, ignore if you please, but do so at your own peril. Follow their recommendations and extend your lifespan. Your choice. I am glad you have found a modality that works best for you. There are options out there for every dialysis patient. You are right that nocturnal is best. Most people that I have worked with, even when it is explained to them that it is the best option, choose not to take that option. They have choices, the choices are made available to them. They choose. They are not forced into a 3 day, 12 hour dialysis schedule. They can choose the better nocturnal schedule. But they don't. I hope that someday you will realize that we are not heartless creatures put on this earth to make you miserable, but rather, caregivers that care and only want what is in your best interest for you. God bless you and I hope you do live a long, full and productive life with this terrible disease. It can be done.

TraumaRUs, you have just spoken to my biggest fear. Everything about this screams bad outcome and I don't want to be caught in the crosshairs. Our SW is on vacation, but I am going to advocate for a meeting of staff, family and doctors about this, when she gets back. We can no longer allow her to jeopardize her life and our licenses in this manner. It scares me to death.

Thanks for the feedback. The amazing thing about this patient is that if she has a hypotensive crisis in the middle of her treatment, she does not want us to stop the treatment, turn off her UF or give her fluids because that would mean she would come off of treatment heavy. She would never want us to stop her treatment early. I have never had to deal with someone so vain that they would jeopardize their health to maintain their looks. I personally do not understand this. We are talking about a 1.5 kg gain, that is less than 4 lbs! When she was yelling at me about giving her fluids, I have her approximately 2.5 ounces. It just seems to be such a petty thing that she is putting her life in danger over.

I have a dilemma that I hope you all can help me with. I have a patient that believes that her EDW is no more than 49.5 kg. "I have always weighed 108 lbs. There is no way that I could have possibly gained any weight." Every treatment her BP bottoms out, she passes out or vomits. We have used the Critline and it shows that her actual EDW is closer to 51kg. She doesn't believe this, and wants us to remove more fluid than she has on, every single treatment day. I have tried to explain to her that her symptoms of hypotension, loss of consciousnes, vomiting, dizzyness, cramping are signs that we are trying to remove fluid that is not there. She doesn't want to listen. I have shown her the critline and explained it to her. I have gone over this repeatedly, explaining to her that every time her pressure bottoms out, she is going into shock. She doesn't care. "I'm fine" is her response. She refuses to allow us to give her any fluid to treat the hypotension. I keep telling her that this is not safe, it is not good for her, and that I won't ignore her body's need for fluid in this situation. Last week, despite a BP that was frighteningly low, she demanded that we remove her needles immediately after her treatment was over. We explained that they were there in case we had to give her fluid. Nearly 30 min after her treatment was over, her BP was 64/15, so I gave her some fluid. She was absolutely livid that I gave her any fluid. I told her that to fail to give fluid in this situation was close to malpractice and that I was not going to jeopardize my license like that and to please not ask me to. I tried to explain that if I called the Doctor, they would only tell me to give her fluid. She didn't want to listen to me. She was furious, because now she comes off of treatment over 50.5 kg. Today, after discussing this situation with the FNP, she gave me the order to increase this pt's EDW to 51kg based on the critline data, to not remove the needles until the BP is stable and to administer saline when her BP is less than 90 systolic. When told about these new orders, the pt became incensed. She believes that when she talks to her nephrologist he will reverse these orders, and I am afraid he might. So far all he has done is placate her. The medical director has basically thrown up his hands and is convinced the pt is a whack job and that there is not a lot we can do, pts have a right to self determination, yada , yada. But where does that right for self determination end, and not allowing a pt to cause harm to themselves begin. This is all very frustrating, and I am curious how you all would handle this situation.

Hahaha. Yes, there are difficult patients. But, I for one love my patients and my job. I like that I can develop a relationship with my patients and really get to know about their health problems. There is a lot of teaching involved and I love that. I love the challenge of getting pts lab values to fall into the desired ranges. I do the anemia management at our clinic and it is my personal challenge to get that hgb between 10 and 12! One of these days I will have them all there. I like that I have to use my brain to be able to provide a quality treatment. It isn't rote, repetitive tasks. Every day, every treatment is different. I find my job incredibly rewarding. I don't want to do anything else. I hope you find it as rewarding and challenging as I do. Good Luck.