StarBrownRN

I wonder if we work in the same facility... I almost died of laughter when I saw a sign saying "Do Not Defecate" Like how do you even enforce something like that?? Poo-police??

The FA told you to push back, but didn't say they would address it?? That sounds suspicious. Have you spoken with the clinical coordinator? And I'm curious as to why the LPN and Charge RN are cutting patient times when the patient is in your pod?? Are you causing them to stay late?? If I were you, I would not cut anyone's time unless I was specifically and directly instructed to and I would have the person instructing to prepare the AMA.

Many times you won't even know the patient's HIV status. Like TwinMom said the biggest concern is HepB. It's more virulent than HIV. As for internal disinfection, biomed usually handles that. You may want to consult with them.

I think everyone should experience both, but I find that nurses who are really nurses and into Evidence-Based practice and critical thinking like acutes.

You can make all the money you are willing to work for, but how long can you work 60+ hour weeks?

I'm not sure how things turned out for you, but please RUN AWAY from any FA position that requires you to work the floor. That's a red flag. That clinic likely has staffing, management and retention issues; and probably a lot of productivity and fiscal issues as well. Additionally, it's unfair; there are plenty of FAs and RODs that aren't RNs. So, working the floor isn't a necessary requirement of that position. For some reason, there is very high turnover among FAs...just something to think about.

May I ask why you are doing this research? Might I suggest you conduct a thorough literature review...because all of your questions have been answered and are almost common knowledge

I hated chronics with a passion and couldn't wait to get to acutes. Then the unpredictable long hours of acutes started to wear on me. So, I went back to chronics on a PRN basis and I find doing both helps me. It makes acutes less grinding and chronics less irritating.

We were out of urinals, so the patient peed in his reusable coffee mug--while on a hemodialysis machine. (He could have asked to pause the Tx and go to the restroom.) And that mug of cloudy pee sat chair side for the remaining 3 hours of tx. After Tx, patient rinsed mug in sink and continues to use it. Perhaps not the grossest thing ever, but the patient gets coffee refills at Dunkin Donuts with that same mug.

The effects of Epo on blood pressure is in the medication's prescribing info. Hypertension is one of the side effects in patients with CKD/ESRD. You can visit the manufacturer's website for a copy of the prescribing info. Epogen has many contraindications and serious side effects.

I feel your family's anguish. My family faced a similar decision when my grandfather was diagnosed with cancer at 81 and already had CHF with frequent episodes of pulmonary edema. We had to ask ourselves was it worth putting him through radiation, chemo and surgery at 81 so that he could live in misery for another year, maybe two. At 85, with his many co-morbidities, dialysis will most likely not extend or improve your Grandfather's life. Rigors of it may take away from his quality of life in a way that isn't worth it. When I was in chronic dialysis, we referred to it as dialyzing the dead. I know it sounds harsh, but for some patients the treatment was futile and they were miserable--but their families made them do it.

You may want to consider joining ANNA, if you have a local chapter that is active. They have some great educational and professional development resources. It's also a good networking tool. (And what's a medication nurse? I had to leave ICHD altogether to get out of pods. I got so sick and tired of doing everything the techs do and everything the nurses do.)

Where I am, sodium modeling has been discontinued and exact dialysate temperatures are not prescribed. There is a temperature range, but we can use nursing judgement to adjust within the allowable range. Truth be told, using temperature to manage BP is not actually addressing the issue. It's like a cheat code. The underlying cause needs to be addressed--fluid volume, slow vascular refill, LVH or whatever the case. As for sodium modeling, all it really does is make patients thirsty. When I was in chronics, there was a patient who insisted on going back to sodium modeling--because he believed it helped with his cramping. However, the cramping was caused by trying to remove too much fluid during a treatment and the excess fluid gains (usually over 5L between treatments) were caused by the patient being very thirsty after treatment and never being able to meet target weight. There was one instance that I've seen sodium modeling benefit a patient--a 93 year old who had stopped eating or drinking, missed several treatments and was uremic. Given fluid bolus before treatment with sodium modeling, the patient started drinking and gradually eating; they received daily treatment for about eight days straight. I really thought the patient was going to die and that the treatment prescription was futile...I was wrong. There are ways to calculate the sodium and program a model that won't cause excess thirst--but it's not practical to do a custom model for every patient. My two cents...sodium modeling is only appropriate in specific circumstances, not for the management of hypotension.

I have had the same experience with scrubs and other clothing. In my dry clean only items, I use dress shields. In scrubs and other things, I spray the pit area with white vinegar right after I take them off. If you can, you may want to consider a looser sleeve style or size where the arm hole seam is further from the pit. I also add borax to the wash and rotate between Persil and Tide laundry detergent. Also, stop ironing the scrubs--the direct heat drives the odor into the fabric. Just remove them promptly from the dryer, shake and hang (or just put them on).

Be diligent, but don't be scared. A patient prescribed a 3k and ends up on a 2k will most likely not go into cardiac arrest after one 3.5hr treatment. When I was in chronic, we switched to using only the most common concentration among our patients from the wall. All else was made in individual jugs. There were times when patients would be prescribed a concentration we didn't have; we'd call the doctor and he'd change it to something we did have. (Which makes you wonder...) It's still very easy to miss the dialysate bath on the flowsheet when you are rushing to set-up. As Chisca mentioned, the only time it is very dangerous is if the patient has a very high K. We wouldn't even treat those patients because we had no cardiac monitoring capabilities; so, we sent them to acutes. I guess one way to be sure that everyone is on the right bath is to do very thorough Nurse TX verifications.

Also, because you will be new to dialysis, you will most likely be required to perform the work of the techs and the nurse for the first six months before you are eligible to be trained for charge nurse duties. More than likely, you will not have an RN preceptor at any point. But rather, the RN will give you a brief over view of a few things and sign off on it. You may get a few days of "training" before you become charge; but you have to have a minimum of 6 months of dialysis experience before you are even eligible to be charge--according to NKF regs. So, you will be running a pod of 3-4 patients, setting up machines, initiating and terminating treatments, doing nursing assessments, passing meds, checking vitals every 30 minutes and doing change over at break neck speed. Add in the occasional code, seizure or prolonged bleeding episode--chronic HD is VERY stressful.

In my area, Dialysis Nursing's hourly rate is higher than most Hospitals--but there are no paid holidays (unless you actually work on the holiday), no shift differential and often you do not get 40hrs per week. If you are in a clinic that is short-staffed, you might get overtime--but you will work for it. Most folks I know started at $30-$35 hourly. So, it sounds good on the surface, but it ends up being a pay cut. Also, previous experience has little application; chronic dialysis is through the looking glass, so to speak.

SmilingBlueEyes makes some good points about the unpredictable schedule of acute care. I was fortunate to work with great techs that I trust; but at the end of the day, a tech--no matter how experienced--is not a nurse. Yet, they do a lot of nursing functions for which they are not legally entitled to do, but are not entirely responsible for the consequences of their actions. Techs giving wrong amounts of heparin or an unnecessary saline bolus happens all the time and the nurse is responsible for the adverse effects. I was tired of that aspect of chronic. Techs act first then tell you what they did. I had to set-up my own machines and run a pod and be charge for 3-4 other pods in Chronics. And if a patient had excess bleeding or any other complication during/after treatment, there was no telling when you would leave. So, at least in acutes, I don't have the added liability of supervising techs who precepted me.

I'm sorry to hear of your difficult experiences. To be a profession of caring, nurses can sometimes be very cruel to their colleagues. And chronic dialysis can be especially grueling. As long as you are doing your job according to policy and the nurse practice act, what your colleagues think is secondary. If you feel that you can't work with them, you could try transferring to a new unit--but you may find a similar situation. If you like what you are doing and are effective, perhaps you can overlook/ignore the negativity. If you are feeling overwhelmed in general, you may need to make some adjustments to your schedule. Can you take a brief vacation? You didn't mention having a personal life or family. Perhaps you could find/develop some fulfilling activities outside of work. That might provide you some personal satisfaction and make the discomforts of work a little less painful. I'd hate to see you leave the profession altogether. I wish you all the best. **sending happy thoughts**

Auto insurance, full tank of gas, groceries and a pair of Jimmy Choo pumps :)

It's a individual decision. However, just from a liability standpoint, I'd rather be an RN in acutes than chronic. In chronic you are responsible for too many patients and too many techs. It isn't possible to safely supervise that many people simultaneously and the company doesn't provide enough time between patients to adequately assess them and the tech's work; even when everything is going well. Personally, acutes is my preference.

The big 2 hire and train people with no experience all the time. Even people with prior dialysis experience still have to undergo training on the employer's specific policies. There's a lot of turnover in this specialty. So, there always seems to be openings for various levels of experience.

In Maryland, you will have to obtain a CNA first, then be trained in an approved DT program. The DT programs are basically the training CNA hires receive when they are hired by Dialysis clinics; after the training they can take the CCHT exam and apply for the DT with the Board of Nursing. However, you may want to look into getting a nursing license instead. Foreign-educated nurses can apply for licensure, but have to have their transcripts and credentials reviewed and take an English proficiency exam.

I went to nursing school with someone who was 70. So, to me, 58 isn't old. You have 10 years to retirement. And if you are in good shape, you should be ok. I say it's never too late...sort of. Once you get to a certain age, you have to ask yourself not "can I?" but "should I?" Honestly, my 70 year old classmate was really nice, and it didn't bother me; they knew a lot of the meds, because they were taking them too. But a few folks were pissed because they felt this was wasting a slot in a competitive program on someone who will never actually practice.

YES!!! ABSOLUTELY!! I find myself buying full price from the thrift store. Before nursing, I only bought when it was 50% off. I even freely indulge in goodwill online and eBay. (Actually, I bought all my first scrubs and lab coat from the thrift store. They were new with tags ) I only get a new car every 10 years, so I tend to buy durable ones. Truthfully, my only real luxury purchases are fragrances, shoes and accessories--but in moderation and after saving up specifically for them. I know quite a few young, single nurses making $70k plus and they get carried away sometimes with their spending. Having a family kinda keeps me in line. However, I do plan to treat myself to a Chanel jumbo flap when I get my DNP.