Pamilina

Please don't think that I diminish your importance, that is not at all my intention. I appreciate this forum like the rest of the people that come here. It just struck such a cord with me, when I heard your initial vent. I realize the frustration that nurses feel when we try to do all that we can to improve the quality of our patients lives. The thing that frustrates me so much, is the "belittling" that goes on behind the scenes, and sometimes not far from the patient/patients. I have heard one too many tales of the unkindly behavior that the patient's tolerate in order to receive their life saving Dialysis. I personally wish that we as professsionals could improve this situation. You may feel frustrated and bad for your patient(s), and we can be insulted by the lies that they tell us, but they have every right to do what they do, as they all have free will. They owe no one anything, and as long as they know the consequences of their actions, even if you repeat it ad nausea, or till you turn blue, the most we as professional nurses can do is document, document, document. Clearly, if this particular patient drinks excessively time and time again, and is able to understand the consequences of her actions, and continues this behavior, it is her choice and part of her illness. Her outcome will eventually be death, but you can't wear that on your sleeve. None of us can. We will go crazy if we continued to beat our heads against a brick wall. It isn't our place to insist that a patient do anything...if they choose to do nothing, we document and teach, and make sure that all parties are aware of the noncompliance. Though you state so elloquently your position, you still have in your thoughts "they lied" and therefore, what I am saying is this thinking, inside of your head can lead to negative behaviors. I've seen it, and see it daily. I'm not saying you specifically, but because you brought up your feelings it was concerning. I'm not any more special, or knowledgeable, or superior than anyone here. It just struck a serious cord with me when I read your first post. I'm sorry if I came off sounding all worldly, but my concern is that nurses burnout based on this type of frustration. We can't do it all, and we can't change the world, and when we have a non-compliant diabetic with severe heart disease and a double BKA, no amount of venting will change there eventual demise, and this is very sad. However, it is a part of the life of a dialysis patient. They probably feel so hopeless, worthless, and deminished as a human, and then with all their underlying medical issues, an uphill battle all the way. I really appreciate the clarification in your last post. I am sorry you felt you had to provide that. I'm no queen of dialysis that is foresure. My heart goes out to these patients, and especially because we all know that they have a shortened lifespan because of it. Their quality of life is so poor, and how unfortunate it is. It was especially nice to see how you shared the endearment that you have with your patients. As for being brutally honest, I am too. Of course, I say it matter of factly, if they want to get off dialysis early, or they drank too much fluid, or they skipped a week or two of dialysis. I educate letting them know that they death can result from noncompliance, and not getting their full sessions or no sessions, or eathing too much of this, or too much of that, you know. We can only educate. They should try to be responsible about their behaviors, but as I've seen in dialysis patients, some are very anxious and require medications of all kinds, and some are serious diabetics, and with all their underlying heart disease, I am sure that they are losing valuable brain cells. Neurological impairments, poor blood flow, consistent toxin levels, all amount to some serious distorted thinking, and non-compliance is a big part of it I am certain. It is wonderful that there is this modality to keep patients alive that lose kidney function. However, it doesn't mean that they want to be alive like this, or have the right thinking because they are so sick and for so long. Thank you for bringing this topic to light, again I am sorry if I offended. I learn a lot from everyone's input as well. Thank you..

you can throw mud, dirt, whatever. "your thoughts motivate your actions." think about that. sure this is a place you can vent, but it sounded like a statement of fact was being spewed out! we are not gods, we are nurses, we can only note that we discussed a situation or behavior with the patient, and their repsonse, and how we educated and notified the doctor, nutritionist, ect...re-educated patient and family member. we have no right to make judgements! as nurses, we are to care for the mind, body, and spirit. i hear all the horror stories from patients, and how badly they are treated with such contempt in the clinics! that my friends speaks volumes to me!!! it should to you too. nursing in any area, should always be professional. i don't care that you think that they should know better and take responsibility for their actions, you have no professional right, and no right to treat any patient with such indignant behavior!!! if you are thinking it, i can certainly assure you, you are acting out those thoughts in some form that would get you yanked out of nursing so fast it would make your head spin! however, as long as professional nurses continue to allow bad behavior to continue by unprofessional nurses, we may revert back to the days we were shoveling coal, and washing the linens, because we aren't fit for anything more compassionate. nursing isn't made for everyone, and if you are having these feelings, it could be a red flag to let you know that you aren't cut out for this field. i realize the times are hard, people out of jobs and all, but if you aren't doing what you enjoy, and find yourself thinking dismal thoughts, and feeling frustration and anger, it could be worth the effort to remove yourself from the field. if you recall "thoughts create actions" even unseen at times. if you harbor these bad feelings and exhibiting or thinking about contemptuous behaviors, remember that at the cellular level changes occur within your own body. to be healthy you have to change your thoughts.

oh goodness, not a very caring or professional attitude toward your patient. this is an absolute "no, no." these patients are vulnerable and as nurses we are not their rulers! they require the dignity just as anyone else. if you ask a patient a question and you feel they are lying to you, consider that they must feel very guilt ridden about whatever it is that you feel they are lying about. not every patient has a phd, m.d., or nursing degree to know the details of all the consequences to their actions. to belittle anyone is harmful, but to belittle a patient who is vulnerable, and requiring dialysis treatments on a regular basis, is reckless, and negligent at best. you may want to reassess your career choice. you or i could be this very patient, and this is the treatment we could receive???? horrible, this is not professional nursing!!!! i'm utterly embarrassed to learn that anyone in the nursing field could reduce themselves to treating, or verbalizing such a reckless disregard for anybody. a patient that receives dialysis as part of a life saving protocol usually has diabetes or some other underlying condition that causes in addition to that, heart disease. retention of fluid is part of the signs and symptoms of heart disease in chf, and it is not entirely the patient's doing for fluid retention, but if they are non-compliant with their fluid and diet restrictions, and who isn't???? it's very likely they could have gained a significant amount, or calculations were off prior, or they missed a treatment as well. especially, diabetic patients having the voracious nature of needing to drink water, a major sign of diabetes can be such a difficult issue to live with, but an issue that can seem very urgent to the patient, and since they don't all carry a medical degree, and are trying to eradicate the urgency of thirst, means that they very well could be over stepping their fluid intake. however, this or anything else that a patient does that is non-compliant should not be a sign to treat with ill repute, belittling their person, reducing them to nothing more than imbecile, is a total disregard. they are human beings that have unfortunately lost the function of their kidney's and require a lifesaving procedure. not ridicule from the likes of the one providing professional care to them. all you can do is educate, and make a note of the weight increase, investigate it for knowledge sake and to correct any previous error in recordings. re-educate, find out what their problem could have been if they feel they have one. possibly see about an evaluation with the nutritionist, and be sure to let the doctor know the variation right away. please, do not ever diminish any human, and especially, a vulnerable patient that comes to your for aide. they are your mothers, fathers, brothers, sisters, aunts, and uncles. you wouldn't want anyone you cared for treated this way i am certain.

Good luck! I know that feeling, of old thumper!

LOL...I guess I feel like it's been a long time, that we haven't heard. LOL! Hope she gets it!!! :)

keeping my fingers crossed for you! did you get it?

Call Davita or Fresenius; they will train you and send you out to hospitals, or you can work in the clinics. Try calling them and speak with a Manager...good luck!

Nursing in general is a very demanding job, and I think because it carries so much stress...and there are so many personalities that we are forced to work with, we are challenged daily. However, I have gone through so many areas of nursing myself. I found my niche, for now. "Acute Dialysis Nursing"! Work in the hospitals. Go to Davita or Fresenius. They will train you on the job! Even for Hospital Dialysis. There you have autonomy, and one on one patient care. It's very rewarding. Although, being a new nurse, you could check around. I have seen in my career, those that I have run into from different areas of nursing, seems to be "Psych" nursing that is the favorite! Those nurses are always happy! LOL...Acute Dialysis is next, and then home health nurses, they have a lot of autonomy too. Being a nurse is a great thing! Don't let a bad situation destroy your joy of nursing. Just jump into something else. Take a vacation first before starting up with a training program. Take care of yourself first! It's emotionally draining when you work against such resistance, and never being validated or appreciated. It's a "Dog eat Dog world", and nothing says it better than nursing, when the nurses eat their young. Go ahead and give your two week notice, after you score the next position. If there is truly a shortage then programs are offerred up like crazy. Davita and Fresenius train you on the job, with in classroom, and then on the floor. If you train for the hospital even with 4 months of experience they will train you. Best of Luck!

Thanks for the clarification.

New York is a very expensive place, and people pay a lot to live there. I'm not sure what part of New York you are talking about, but Manhattan area was outrageous in prices back in the 80's so. I would think they would pay a heck of a lot more. Here in California, the rates are very different from clinic to acutes. $26.00 RN's at clinics and $26 to $34 dollars for Acute RN's with little to so many years of experience, here in San Diego area. Kaiser Hospital pays the BEST...and UCSD pays the next best wage for Acute Dialysis RN's.

There is a form that specifies what size to use for how long, and each size has an allowable blood pump speed. You can't just put a pump speed up to 400 or 500. You have to remember what gauge needle allows for what speed. 17 gauge I believe is 200-250...but double check in the Policy and procedure handbook.

When a patient comes in with an infected dialysis catheter. That usually means the vas catheter (temporary or permanent). The catheter is like a central line only bigger and made for dialysis use only. Those usually have a higher rate of infection since, it's invasive, and the bacteria can congregate on this within the Internal jugular area where it rests inside of the patient or at the tip (superior vena cava). Bacteria enter via the entrance site, or the ports when they are opened to connect for dialysis if Sterile technique is broken. With a history of bacterimia, the patient probably has a staph infection in the blood...just guessing here. This will cause sepsis, and Staph in the blood is a terrible infection to fight. Sepsis, is the bodies response to a severe infection, WBC's can get as high as 50,000! The vessels vasodilate in septic shock (hence the extremely low BP); along with fever and chills. That's why more and more doctors in nephrology are trying to have all patients with renal disease requiring dialysis...to get fistula's, which is made from their own vessels that the vascular surgeon puts together. However, while it is a maturing vessel, they will have a temporary access, or a permanent access while the vessel matures. Sterile technique is of monumental importance, when accessing these ports on the catheter! For a 43 year old to have such a low BP chronically? I would read her history and physical. She has had previous bacterimia (bacteria in the blood), which through her course of treatment may have caused problems with her heart. Poor filling pressures ect...the vessles might not be as elastic. Or she may have some form of heart disease, and that could be the problem. They would have done an echo on this patient, and you can look to see what her EF(ejection fraction). Let us know how it turns out. Also, if you have anymore questions.

I know it all seems so bad, orientation didn't work out as it was planned, not one person assisted you in this situation. However, you are a nurse, and you went into nursing because we honor caring for the whole patient. How do you think the old people that have no choice, feel. You know you are a gift to them. Think of them first, do all the right things even if it takes you into overtime. Although, I think tomorrow is going to be a better day. It is really hard to make a judgement of a place with one day. I say give it one more chance. Remember why you went into the nursing home in the first place, and think of ways that once you get your job down, how much fun you will have knowing the new personalities that are living there and how you can improve their environment. I loved the nursing homes, even when we were really short staffed, and that was a multitude of times and half. You just go into teamwork mode, and do the best you can, it is amazing how it will all workout. I say stay...as time goes on you will be a HUGE BLESSING TO THAT PLACE! You'll be glad that you did. No bad mouthing the place, positive thinking, and positive intentions, will bring everything you need and want. Best Wishes! You can do this...

If you don't have the training yet as a Dialysis nurse. I recommend Davita...here in California, they pay you while you learn and then after some time, if you have hospital experience you can go into Acutes with this same center. The pay range for an RN who has no experience, is usually, $18.00 and you sign a contract I'm not sure if that changed. However, it's a great company with many excellent benefits. You could work part-time and then part-time in a hospital...so that when you have your dialysis experience/combined with hospital...then you can do acutes...that means that you travel to whatever hospital that Davita is contracted with. You usually get paid per treatment...and I do believe that is quite a lot of money...more than 30.00 an hour...plus, you are getting benefits and having a lot of autonomy. You should call them and find out more information. It's a great field to get into. Best of Luck!

Davita (Dialysis Company) will pay for your BSN as long as you commit to working for them for 2 years after you are all done. The pay for the two years might be around $18.00 or so dollars, but they have AWESOME benefits, and 401K and a 100% match for pension...health care ect... The reason I say this area of nursing, is one...they will pay you to get your RN degree...and two they will employ you and train you in dialysis. Three, Dialysis openings in the Acute area are on the high demand list...so, after two years, you can go to learn Acutes and make top cash...the clinics are busy...but acutes are something that isn't as demanding on your feet as the ratio in Acutes is one to one nursing care. The money is way more as well...and you really get to spend quality time with your patients. Good Luck.