RN625

You are correct to request another MDS FTE. The position is so paramount to reimbursement, quality indicators & care planning that it should have the full support of administration. It will make or break you. MDS accuracy requires time & attention to detail, residents are sicker and more complex than in decades past so prior coverage does not meet current requirements for CMS guidelines.

Everybody's situation is different. Times are different. ADN nurses can certainly get work.

Perfect job for a mature nurse like yourself. I'm 59 and did the job about 15 yrs ago x 3 years; left and went back to acute care. Now I'm back at MDS and will stay FOREVER!!! Please ask how many residents you will be responsible for, don't agree to float out to the floor..you won't have time & keep reading the posts.

There is life after being a clinician. I too found myself making mistakes and was "let go" several weeks ago. After coming to terms with this I utilized the local employment office resources to "rebrand" myself and was recently offered a position as a manager. I don't want to say more in order to protect all, but look in different places. Rebrand yourself to use your knowledge in other areas. I started looking at the insurance industry and then clicking on everything non-clinical. There are unusual sources out their that we never knew existed. Good luck. I look forward to hearing your about your success. In the meantime I have homework to do, which is why I'm on this blog. Merry Christmas & a prosperous New 2015.

I would hire a new grad, however....Dialysis is a highly specialized field & will require many weeks & months of learning; be careful if you are still going to school. This will limit your availability & a company's consideration investing in you.

The only time we go to the homes is to screen for safety, help them get organized or if there is a problem. We Are on the phone a lot; case-managing these patients. They come to our clinic 2 x monthly, once for labs/assessment & later to see the MD. We do a lot of education, both ongoing education about their ESRD diet,infection control,medication, fluid balance, etc. &&& new patients who are just learning how to do their PD. It is regular hours, we do have a call phone for problem solving, etc. Your patients can be very stable or having difficulties, sometimes related to all the comorbidities that many of them have. I was a hemodialysis nurse for over 25yrs. I came to PD 2 years ago & love it. It is very good for nurses who like looking at the "big picture" and working independently but in close contact with your Nephrologists.

Have you considered re-locating within the state? I know there are serious openings.....expand your search.

Call the dialysis staff & ask them, they'll check with the nephrologist if necessary & will appreciate that you are "thinking". Patients are different, but many of them should wait until after treatment. When they return you should be aware they have had fluid removed, sometimes large volumes 2-3 liters which can cause hypotension. If their BP gets too low they can clot their access in the arm (which you should listen to & or feel for the pulse every shift). Diabetics should have their blood sugar checked. Most will need their meal, any IV antibiotics should be given post dialysis (or sometimes given by the dialysis nurse) They usually will give any blood transfusions required to avoid rapid fluid overload & K+ loading. Those pills ordered with their meals , Calcium acetate, Tums, phoslo, renvela, etc. are phosphorous binders & only work when given immediately before eating; so if their scheduled at off times please leave them for the patient to dose at the appropriate time. High phosphorus levels in dialysis patients is one of their most challenging problems since phosphates are in so many foods, so please help them c this while they are there. Chronically high levels leads to bone disease & vascular calcification. I know this is a lot of advice. It takes time to learn about these things. If your pt is well enough, they can tell you about some of their issues. And last perhaps most importantly, most dialysis patients have a fluid restriction of 1 liter per day unless they still make urine. Please check your orders & post the notice so they don't get "pitchers of water". Thank you for asking! Good luck:)

How's it going so far?

I hope you don't give up. I moved to home 2 yrs ago from acutes & I love it. And hopefully you have a mentor or someone with experience. If you're on your own, don't feel alone. Many of these problems are shared by other clinics. We spend a lot of time making calls, we educate & re-education about some of the same things all the time. Different pts have different areas of non-compliance and sometimes it takes a long time to get to the bottom of the real problem. Thus the importance of really getting to know your pts & their challenges. Yes, we get gigged on lots of things that sometimes we 'can't control', ie "how do we get their Albumins up". We do our best, this month we are cooking meatballs to have at "clinic" and providing a recipe. Each meatball provides about 10GM protein. The albumins are our biggest challenge....reminder calls about appts help with getting documentation etc. Keep up the good work & do your documentation to get credit for taking good care of them.

Do NOT let the techs talk you into calling somebody in early or switch pt put-on schedules. It will just screw up the turn around & as the nurse you will be the one to suffer every time! I don't know why they want to do it; you just work twice as hard to finish 15min early..it's not worth it and you'll be frazzled the rest of the day.

It's good for your career if you plan to stay in dialysis, for professional development & looks good on your credentials/resume'. If you have a local chapter it is good networking; the conferences are very good but expensive. Employers will send promising & productive employees "sometimes" depending on your company/manager,etc.

Whats the deal? Home therapies is great. I spent my entire career in acutes until last year. Now I help patients take care of themselves, well most of them... some need more help than others of course. Call is giving advise, no going out at night; closed every weekend. Why are there so few PD RNs available? I live in one of the nicest vacation areas in the southwest and finding a FT RN for home therapies seems impossible...... So if you're considering a change, think home....the rest of the world does! I can't say where this opening is, but if you need a new view, check out the major company websites next week, a new position just came open. :)

Hi Jennifer We've been using ecube since Feb. If I understand your practice, printing the med sheets for review by the patients is just the first step. When the nurse interacts with the patient in revewing the meds that nurse should document a home med review by charting in the "intervention" section. Our sheets are created from ecube reports, user defined parameters, then orders summary. I select the pt, etc. , de-select all orders, choose home meds, then the report will run. We don't have shifts in home therapies, so I'm not sure if you have that options. The nurse reviewing c the patient should be charting the intervention. Please discuss c your supervisor that you cannot chart something that others have/have not completed. Making you responsible for printing & handing out the reports is not the same as having them complete a "home med review". I can only suggest you divide the lists & list the nurse assigned to which patients/shifts/pods ? Then it should be that nurse responsibility. Is 1 person responsible for all the foot checks? Its almsot the same thing, impossible for 1 person to do. Sorry, not sure if this helps you.

Guttercat has it right. Your thinking is right on & I applaud you for recognizing the skills that acute RNs have and use. We are most often criticized for "sitting around" at the bedside. I too moved from ICU and was prepared when the patient went south. I also hate working OP hemo clinics which are repetitious, etc. Acutes is very physically demanding and after many years I had to leave it behind. I now do Home therapies, teaching & managing Peritoneal & Home hemo patients. This too is very rewarding, more phone managing & clinic work with seeing patients 2 x month, etc. I think you should give the acute team manager a call! Good luck! Let us hear from you. As we say, you'll either love it or hate it!

Don't forget about Home Therapies. It is not hectic like Acutes or the clinic and has more regular hours. All companies are trying to build their home programs & anticipate it will grow in future years.

Glad to be of help; no I had to give up the good life.....got too old for those kind of hours, etc. I enjoyed many years in acutes, but every time but once I worked for private companies, ya know the ones that have now been gobbled up. I did work for FMC for a few months and found it satisfactory and much the same as other experiences. Now I'm doing home PD/HD and enjoying it very much, there is life after acutes.

Those certificates are sponsored by ANNA, an American organization. The BONET is international, so is better known worldwide. I took it instead, ANNA requires a bunch of "their" CEUs even to sit for the exam.

Sounds normal to me. You didn't say what if other nursing experience you have; but even ICU nurses get frustrated when they "can't get it" as fast as they expected. Will look forward to hearing your updates.

To answer akosiba, it depends on what's going on. You can sit at a bedside 3-4 hours only getting up to check your pt q 15min...or you can be up x hours managing 1 or more patients c a lot going on. You do move machines around, bend & stretch...can drop a few pounds if needed. Also going out at night for emergency run must certainly count as physically demanding. Sometimes you worked that day, or will have to stay & start a new day after coming in, etc.

It would be a very good change for you. You will use your assessment skills and knowledge every day & should make an excellent acute dialysis nurse. It will be challenging enough to refresh your nursing brain cells & many times you will find yourself back in the ICU, where you will be very comfortable managing those folks. I started my dialysis career the very same way, many years ago. Go for it, but be patient; the learning curve is about 6 months even c your knowledge, so don't kick yourself. Talk to the RNs on the team to see what the situation is, take a tour of their areas, etc. Be prepared for all the disruption the others have described; acutes is its own animal...what a ride!

nlovell is right about the $, I made my most profitable year in Acutes. Call pay, callback, OT adds up! Go for it!

Acutes is physically demanding but can be very rewarding. Start your day not knowing when you'll get home, take your lunch & dinner just in case. Average days 12hrs? hard to say, it depends where you are, how many hospitals your team covers and how many RNs you have. Houston should be pretty busy. You'll learn a lot! If you like autonomy its great; ICU experience helps but you can learn. It will give you greater experiences for your future & marketability. Not for the lazy or scaredy cats!

I recently made the switch. There is life after Hemo. I like it very much, lots of teaching, clinic environment with regular hours, our call is mostly phone management as is much of the patient care. They come in once a month for labs which you review & manage, then to see the doctor. Otherwise after initial training they call when they have a problem, ie peritonitis, etc to manage. It seems to be a great choice for aging HD nurses that need to give up the physically demanding hemo life. Good luck!