rn,lmt

RAI is a company that has been around a few years. They were established when DaVita bought Gambro (and some clinics needed to be divested). Anyway, RAI has grown a lot over those years and is (I think) the third largest provider of dialysis services in the U.S. It is a good place to work. The pay is decent, the people are respected, and a top-notch group of people manage the company. Hope this helps.

I worked in a unit where many of the patients had bedbugs. These little critters love to make their homes in pillows, mattresses, and a million other places. In fact, some of the patients were so infested, they would "flick" them off of their clothes, shoes, coats, and blankets throughout their treatments. I don't think there is a good answer about the pillow question.

It stands for Renal Advantage, Inc.

I worked with RAI in the past and they are a very good company. The president of the company, Mike Cline, is a person who empowers the people that work with him. You will find working with RAI a very rewarding experience.

I am a nurse manager for a non profit dialysis center. It is by far the best job in nursing I have ever had. I have worked in both for and non profit centers and I hope to retire from the company I am with now. So, my advice, look for a dialysis job at a non profit!

CONGRATS! Hope your career is everything you want it to be!

Steven, I completely agree! There SHOULD be NO Renalin left in the dialyzer but since we are dealing with human beings - any opportunity we have to protect the patient should be done. I personally do not like using REUSE. I know one of the large companies are completely REUSE free (however, they also make the dialyzers) and wish they all were!

The prime would also be dumped if the center utilizes "reuse" of dialyzers. This provides another, albeit small, way of protecting people from sterilant that may have not been completely rinsed out of the kidney.

I think it is so stressful for new grads to start in the critical care units (even if there is a great orientation!). I think you should look at other areas before deciding to get out of the nursing field. Believe me, after 19 years of nursing, there have been many times I have felt the same way! I am in a position now that I love - even though I went through many types of jobs to find my niche, I have finally done so. Try other things (and think of each thing as a learning experience). Remember, everything is temporary, and do what makes you happy!

Silverfoxxy, Did DaVita purchase a FMC clinic in your area? I know that DaVita bought Gambro....

Dear Susan, What does your facility policy for rinseback of blood? That is where you need to start because in a court of law, the policy is the Bible. If you are not following the policy, and, God forbid, something happens, you will be held responsible for the problem. Now, back to the question, (sorry about the rant, but I am an educator in the dialysis world).... I have worked in clinics where the policy was disconnection of the arterial line, but have also worked in facilities where the policy was to rinseback the other way you have mentioned. Personally, I can find positive and negative things in both. With the disconnection method, there is much less risk of air being pushed into the person because the air bubble detector is at the venous chamber and it would be bypassed if the other way is used. On the other hand, there is a lot less chance of contamination for the patient with the "closed" system. Either way, start with your policy and continue to search any recent published studies that recommends one way over the other. Sorry this is so long, but I am quite wordy sometimes.

I was a LPN (graduated in 88), got my RN in 91, and my BSN in 06. I am really glad I was an LPN first because I had a great deal of clinical experience in LPN school and felt that I had an advantage for my RN program. Also, since so many RN grads go from being a student to being a charge nurse in some settings, being an LPN first gave me the confidence in clinical settings that I was able to learn from rather being the one who needs to give the direction. Third, I was able to earn a decent living as a LPN while going to school for my RN. Oh yeah, my employer paid for my RN program.

It is truly unfortunate that these things do occasionally occur, however, there are precautions that can be used to cut down on these risks. One, is to make sure your clinic is using "dialysis safety needles". The second is when the needle is being removed from the graft or fistula make sure you (as the decannulator) teach the patient how to apply pressure to the area while the needle is being removed. Third, encourage and educate your patients how to self cannulate (I know this is a stretch, but the longest fistulas I have ever seen have been cannulated by the dialysis patient). Last, work with INTENTION. Every move you make in the field needs to be with thought and meaning. If you are removing a needle, pay attention to the procedure. If you are initiating a treatment, pay attention. As a nurse I know I have to juggle fifty things at once, but it is only good patient care to make sure at that moment of their and your life, the action that you are performing is the most important thing in the world. Sorry this is so long, I'm often wordy.

Hi, It's been a little while since I was in chronic HD setting (I work in a hospital based dialysis clinic now), but regarding your question, when a patient arrives to the unit, it is really next to impossible to do an assessment prior to all your patients starting treatment. Often the assessment (listening to lungs, heart, checking for edema, questioning if patient has shortness of breath, chest pain, nausea, vomiting, or diarrhea, or any other problems) may be done within the first hour of treatment (it often depends on what your policy of your clinic says). If within the first hour is not acceptable, if you as the nurse, stand at the scale and have each of the patients get a brief assessment as they are getting weighed, this could suffice until a more complete assessment is able to be done. Hope this helps!

Thanks gauge14iv, When I go back to graduate school I will try that program. Thank goodness for my BSN I had an instructor who was a stickler for APA so I was pretty proficient by the end of the twenty month program, but I am not going to start my next program until March of 07, who knows what I'll forget by then.

The APA software doesn't work with MAC computers (just in case that is what you have).

I have worked in a few outpatient dialysis clinics doing everything from being a staff nurse to being the director of the clinic, and I feel that it is my duty to say, if the clinic is too short staffed to help a HUMAN BEING after they are incontinent, then maybe they should file a complaint against the company, contact the state licensening bureau, contact Medicare, or have the patient's family members do it. NO ONE SHOULD EVER BE MADE TO BE HUMILIATED SIMPLY BECAUSE THEY PERFORMED A BODILY FUNCTION! Also, if the clinic is that short staffed, then FIND ANOTHER JOB! That is why nurses are treated like second rate citizens at times, because we let THEM treat us that way. STAND UP, BE HEARD, MAKE A DIFFERENCE FOR YOUR PATIENTS!

I work in a hospital based dialysis unit. There is not a day that goes by that I don't clean up stool. I can appreciate how difficult it is for patients to be changed when they are sitting in a recliner, but our patients are usually in beds (making clean up much easier).

My thoughts exactly!

Hi, Glad you decided to specialize in dialysis. You will be forever in demand and will be able to provide a wonderful service. Each organization offers their own training program. This is usually a six to ten week program including a didactic portion that explains the physiological and clinical process of renal failure and the actual hands on portion that teaches the "how to do dialysis" aspect. It is a great idea to have a good general knowledge base regarding dialysis prior to starting. DaVita Dialysis has a great website that has a ton of information. There are also books that you can purchase (one is Review of Hemodialysis for Nurses and Dialysis Personnel by Gutch, Stone, and Corea). You can order this (even used) through Amazon.com. Don't fret about learning everything in a day! We nurses have a tendency toward needing to know everything TODAY. We also think we should be perfect from day one. This does not happen with dialysis. Take your time, understand that you will need to take one step at a time, and do not get frustrated. Ask lots of questions - ask them to your nurses, techs, dialysis aides, charge nurse, secretary, and biomedical tech. The more you ask, the quicker you will feel comfortable. Hope this helps. Keep us posted on how it is going for you! RN, LMT

NephroBSN did a great job explaining what life is like in a freestanding dialysis clinic. (I did this for years, too). I work in a hospital based dialysis clinic in Ohio. There are mostly all RNs who do the patient care. We have a couple of seasoned LPNs (who are great). Our techs help with setting up / breaking down machines, vital and weigh patients, stock the floor, transport, run labs, hold sites, and lots of other things. Being a hospital unit, we have both chronic outpatients (usually too unstable to be transferred to a free-standing clinic) and we also dialyze people who are inpatient. If the patient is not in one of the ICUs we have, they come down to the dialysis unit for their treatment. If they are in the ICU, we go to them for their treatment. This is one on one in the ICU. However, on the floor, our ratio is 1 nurse to 2 or 3 patients per shift. Some of our staff works 8 hours, some 10 and some 12. The acquity of our patients is very high and the job can be very stressful at times. However, I like dialysis (especially training new employees and new patients). Hope this adds a little different perspective in a different setting for dialysis. RN,LMT

Frann, Start by calling the police. They will take your statement and then do an investigation of this jerk. His degree may be from some bogus place that issues degrees for $15.00. Anyway, even if he does have a degree he can still be a pervert. Call the authorities today and inform them of what happened. Don't wait and DON'T BE A VICTIM of this person. He is not a healer, he is a cancer.

Frann, Absolutely, positively, this is wrong! This guy not only needs reported to the massage board but you need to report him to the police. He molested you! Call today before this happens to other people. This kind of jerk gives professional massage therapists a bad name! leeleigh

Hi, I am a RN and work at The Christ Hospital in Cincinnati. I am going to school at Indiana Wesleyan University for the BSN program. Hope to get my masters there eventually. Great program! Leeleigh

Thanks for the ideas, if you have anymore, please let me know! Thanks, leeleigh