Aquamarine

I think jobs are difficult to get. Everyone wants someone with a connection, or with experience . so it is true, you might have to take what you didn't like but it will lead to better things. And every path of nursing is useful. It will give you a little more knowledge than someone else...or more for you to share with others. there is a shortage in my unit. We are mandated to stay until we are done with our patients. It is at least 3 nurse with an hour of two of OT nightly. We are so tired we just want to go home, but the money is nice also. good luck

I don't get it...really, the ppe. Okay we aren't supposed to put anything in our pockets? Well, where are we supposed to put out pens, etc? I have been wearing one around my neck....do you know how many times that thing has touched something disgusting? so a pocket is worse? I think it is one of those rules that if you want to wear it...fine, but the fabric is gross. I only wear it when the boss is on a kick, and I notice the few times she works the floor....guess what? no PPE. We don't work in a sterile environment. We run, not walk to get more saline, meds, water, etc...what ever the patient needs. So we are supposed to take it off and then hang it up to go into the med room, get out meds and how are we supposed to hold the meds and put the PPE back on...crazy! so if you do something for the days they watch, isn't that a bit ridiculous. We are nurses, not in kindergarten, we really do come to work clean, none of us wants to take germs home, or give them. We love our families and love our patients. Time to get real. Maybe they can hire little maids to remove them when we walk in a room and stand there and wait for us to come out or the room and help up with it back on. Think...that is all I would like people to do. thxs:no:

Oh, so now I understand and thought about that after I posted. If you have a tech license then go for that and demand more $$ per hour because with Davita there is 18 months from today for them to get thier license or certificate and you are ahead of the game. Only one of our techs has a certificate from the opposing coast of the US. So you are in a good position. I have similar feeling that you do. I quit the hospital because if passing meds and charting is "nursing" then I am not in the game. Of course caring is always appreciated. I feel in dialysis, those people at least "need" thier meds and so I have no problem with that. We also pass few meds. So actually our expertise is in sticking them, doing cath care and that is more acceptable to me. Read "our daily meds" a fairly new book. You will not like passing meds even more. I worked in telemetry hated it, and went to rehab. In Rehab you passed meds even before they felt pain. Handfulls. What are we doing???? I also work for a MD, do you know how many people all ages, all walks of life are addicted? or have terrible side effects from the meds we push in the hospital. Read the book. I am older, at the last 5-8 yrs of nursing, so I am in a different place. I can't pass those meds, just can't do it, it is against my morals and integrity. What I do for my $$$ matters. I feel in dialysis you can make a difference, it is more about care than meds and notes. I am sorry to counter my first statement. I do think that med surg still opens doors, for travel nursing you need two years, etc. But I was bothered by the med thing. So then, you obviously care, have a heart, have integrity...so whatever you decide you will be good at. take care...good luck. The answer will just come to you, you will know your decision is a good one based on your own beliefs.

Nephrology is great, the MDs usually exceptional. A lot of details that I personally love. A great education on many aspects of health. I couldnt' say enough. Go for it and become the best in your field. Nancy

I think two years in med surge never did anyone any harm and will get you in many many doors. Going straight to dialysis is limiting, although a good second experience. If you are totally sure you never want anything else, then working as a tech would be a way to get some insight. Most all companies now nationwide are requiring techs to get certified by the beginning of 2010. There are college courses for that so you can get ahead of the crowd and take such a curriculum. I work in dialysis as a second experience, I do like it but I am at the end of my career. If you are in the beginning I would highly recomment hospital experience as you never know where you want to go in the future, where you will move to, what the health trends will offer...that two years will open so many doors. Dialysis is limited in that way but a nice job I think.

We just had to do a on line class and little test on it.

What does RAI stand for. Mike Cline sounds great.

I think the PPE is an overkill. First of all ours don't have a place to put your pen, the material is paper and irritating. I don't wear it and will get written up but I like my own jacket and I take it home and launder it. I wear long sleeves because our patients are not clean, I have gotten bit by bugs on my wrists just to show you. I keep my body covered. Nurses in hospitals wear their own scrubs, right? When you work in the medical system you always have a threat of bringing germs home. YOu have to take precaution and do your best... that's all. Leave your shoes at work, change, take your jacket off before you put your jacket on, etc. Germs are everywhere, even in the supermarket.

We have much better RN coverage in our Davita unit which is security for our licenses. I am grateful for that.

You are fight about the cattiness. I think they have too much time on thier hands then. You work in a fish bowl and maybe that contributes, don't know...but your observation is true and shamefull. I think your advice is excellent. Observe, shadow, and ask questions before saying yes to a job. That is your interview of the place. Great advice.

I personally think the job atmospehre is up to the FA RN. They control the job in many ways. The pay? it is relative to the area, and not that much variance. If you are good, have excellent skills you can ask for more money and guess what...they will pay it. They can ask the company The benefits, I think they also are just about the same. I know in some cities the pay rate for dialysis is so very high and others it is moderate. I know of two units in my area, the FA in the Davita unit isn't so good, the one in the Fresenius is unstable...the pay is supposed to be better in the FS unit, but the benefits slightly cheaper in the Davita unit. The Fa in the Davita unit will work around school scheduling, the FA in the FS unit won't, the location of the davita unit is easier access from the expressway. The parking is good in both, the neighborhood better in the FS unit. So those are the things you have to weigh out. It would be nice if they allowed you a day to observe but don't know if they would, I think they might. See how the unit flows. I like my unit better and it is a Davita unit but that is personal. We just had a bunch go over to FS, and more power to them. Frankly they were not that good of workers and so it is a blessing. But if they found what they needed there, then good for them. You can't tell what a Facility adminstrator is like on an interview, just like they can't tell what you are like. They get to see your resume and call your ex supervisors, etc. You don't have that advantage. There is always something they ask that is a key question to what they are looking for that might be the decision. I have one boss that smokes like a chimmney and so the smoking question doesn't come up. I had one boss that told me she tells the person where they can go to smoke and then asks if they do. If they do...she doesn't hire them. Tricks like that. So watch your answers and try to really get a feel for the unit. Arrive 15-20 min ealry and listen when you are waiting....what is the general flavor of the place. Good luck, if you don't like it ....you can go anywhere.

Nausea can be for man reasons. One if they are gaining too much weight the treatment will be so much harsher on thier bodies.I encourage them to limit fluids to one cup with meals and one 8oz cut between, giving a general limit of 1500 ml. Of course that is general, check the diet order and speak to the MD or the RD. Also limit Na+ in intake will help with holding fluid. If they gain too much they will have to take more off and there is the issue of the side effects being more with larger weight gains. Blood pressure? where is it at. Can you give Na+ so they don't drop at the end. The profile, can you take more off in the beginning? Ask your charge nurse or the FA and if all else fails, approach the MD, even if he yells you will get some useful information. K+ has normal ranges but did you know there are "acceptable" ranges that are generally used for dialysis patients? Acceptable is under and up to 6.0. I know you feel so bad for the patients, and the dry weight often needs adjusting. I look at the dialysis proceedure as a real team effort and the patient is part of the team. They have to follow the diet, the fluid restriction, the medications taken as Rx'd. If they still have an issue they need to communicate with thier MD, and the staff also. The machine is part of the team, they have to stay for full treatments, and come to all the treatments. Everything involved has a play in that patients health. If the patient is unable to take care of themselves I tell the social worker thier might be a problem and they can take it to the monthly meeting also. Just document, who you told, and what you do, even your education to the patient. It can save you in more ways than you might know. Good luck.

I understand the frustration. I have seen the same. But the stage of renal failure also has a play in it. Patients that say they urinate a lot all the time may be losing K+. Also, doc's generally meet once a month in our unit to review the labs with the FA nurse. If I know the doc isn't good about his monthly review I will hold the K+ and call them. I am not going to give anything that is dangerous and I use my head first, follow orders second. But you just can't ignore orders without taking action and documenting. Have the patient chart in front of you when you call. If you notice pre and post dialysis K+, that lower number after will rebound, come up, in a few hours after treatment also. Some of our patients that understand the K+ refuse it and say they would rather "eat" thier potassium than get it in the jug on the HD machine. and I support that, they have a right to refuse and you document that. Our RD support that and goes to bat for the patient at the meetings. Also, if a patient ever tells you they just stopped urinating all together LET the MD know. This is critical. We had a young girl who alway had fair K+ values but cheated on her diet all the time. Stopped urination, still cheated, we drew labs...the K+ was 8.6, we thought it must be a bad lab, gave her a Rx for Kayexalate. Redrew the lab to double check. She couldn't get the Kayexalate at her pharmacy filled until monday, the new lab came back at 12.0, she died over the weekend, the doctor came after the RDand the RN to make sure that the patient was educated. So it is something to pay attention to, to understand, to know about, to educate the patients about while you are working. Great question.

Why would they die if thier access clots? they go get a new access or get femoral in an emergency. No one is going to ignore a clotted access. Not everyone that skips dialysis treatments die anyhow....yes, the risk factor is there....but they don't die automatically. I have patients that refuse to come in regularly...they live to do it again. It increases mortality but they don't automatically die. And we hold heparin with a fall, or pending surgery, etc. yes, but heparin has a half life...did you know?

Although part of what you said is correct, it is thier lifeline, I agree. And remember, knowlege and practice...is what it takes. The nurses need to be given the knowlege then the practice, if not who is responsible for the lack of that education. I know the patient is the priority but should be to the facility also. Cath's do clot off, and they are replaced, and it happens all the time, and you try to follow policy and proceedures to prevent that but even still it happens. It isn't anything to fear, it is something to learn the details of so you can be a better more educated nurse. It is easy to learn and to know with experience, practice and attention to detail. That's all.