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kdunurse

kdunurse

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kdunurse's Latest Activity

  1. kdunurse

    Concerns about WGU

    What the others have said. Often ADN or diploma nurses aren't eligible for non-acute nursing roles. The BSN is designed to prepare you for those. I'm surprised your counselor wasn't able to explain this to you clearly.
  2. kdunurse

    What is the standard orientation time for HD?

    I'm not with Davita or Fresenius; our dialysis clinic is hospital basis (our hospital is part of CHI). I think the orientation is 6 weeks because that's the standard orientation time in our hospital. And most of the first week is taken up by general nursing orientation stuff, not dialysis related orientation. So it's only a 5.4 week orientation. Our unit is in a world of hurt right now. We've had a number of staff resign, so we will be orienting 4 staff members at once. This, while being extremely short staffed. I have no idea how to make the orientation experience remotely good for these new staff members. Anyone have an ideas?
  3. kdunurse

    What is the standard orientation time for HD?

    So I talked to my clinical coordinator about this, and she's not bending on the idea that new staff (we have 3 new hires with no dialysis experience) need to be practicing independently (no preceptor) after 6 weeks. Are there any regulations or standards of practice to back up the need for a longer orientation?
  4. I've been a dialysis nurse for 3 years and am starting the educator role for my HD unit (hospital-based, mostly chronics). We have just had a large turnover so I will be working on new staff orientation for several LPNs and RNs. Our unit does 6 week orientation for all roles (RN, LPN, PCT), which I don't believe is nearly adequate. What is the standard orientation length for HD? And are there any regulations regarding this? I'm looking for information to take to my clinical coordinator besides just "I don't think it's long enough"...
  5. I'm working on an evidence-based practice paper for my BSN, and the subject I've chosen is CLABSI prevention with IHI's central line insertion bundle. I'm trying to show that this is a nurse-driven topic, and I'm trying to find statistics on RN scope of practice, without much luck. Are RNs in all states allowed to insert PICCs? And how many states allow RNs to insert IJs/femoral lines?
  6. kdunurse

    HD catheters - dressing or no?

    Our facility uses the standard CDC policy for central line dressing changes (q48h for gauze, q7 days and prn for occlusive), but our clinical coordinator has said there is research indicating that infections are lower when no dressing is used. I can't find any information about this online. Has anyone heard of this?
  7. kdunurse

    6 weeks orientation then left alone? What to do..

    How many other RNs are there? If there are none, and you've only received 6 weeks of orientation, then it is very unsafe (I'm assuming you've never done HD before). You are well within your rights to refuse to do this. If something happens, you will be held responsible (along with the facility). If the director han't done HD before, she will be of no help to you at all. This is a potentially very dangerous situation.
  8. kdunurse

    In Texas and looking for scope of LVN in Colorado

    Try the Colorado board of nursing. There should be a scope of nursing for LVNs there, and it should describe any exceptions for dialysis nursing.
  9. In our unit, dialysis pts who want to end their tx early must sign a release of responsibility. They are basically agreeing to leave AMA.
  10. kdunurse

    A Word To The Wise.........

    Folks, Godwin's Law was invoked in the very first post. Any further discussion with the OP is pointless....
  11. kdunurse

    administering medication via fistula needle...

    I think I would rather be safe than look good with the patients. There is no good rationale for piercing tubing - it breaks sterility and invites leaking, as well as raising the potential for needle stick injury. Why on earth do your coworkers not use the injection port?
  12. kdunurse

    Is turning the utrafiltration off ok?

    Just an update - I had spoken to my clinical coordinator about this issue, and last week she showed me a letter from Fresenius (think it was dated 2005), the gist of which was that they say there is no harm in turning off the UF. I guess if the manufacturer says it's OK, then it should be OK.
  13. kdunurse

    administering medication via fistula needle...

    I'm also confused - are you a dialysis nurse? If you're not, you should not be doing anything with a patient's access. If you are, are you being asked to insert a needle into the access tubing? You should never puncture tubing anywhere other than an injection port. Normally dialysis tubing comes with injection ports for medications and blood draws.
  14. kdunurse

    Is turning the utrafiltration off ok?

    I thought that most of the waste products are removed through diffusion rather than ultrafiltration, and that ultrafiltration regulated the amount of fluid removed. Some solute will be removed with the fluid, but it can still diffuse across the dialyzer membrane when the UF is off. The only time there is no waste removal is during SCUF, when the dialysate flow is turned off. I've never heard of having to keep the UF on during dialysis - in fact, we have one patient on whom we do dialysis with the UF completely off throughout the treatment - she's not my primary patient, but I'm pretty sure her numbers are good.
  15. kdunurse

    Late patients

  16. kdunurse

    Late patients

    Our dialysis unit has been struggling to find a way to deal with a few of our patients who are chronically late. We run 2 shifts, so if they are late for first shift, the patient who follows them has to wait, and if they are late for second shift, the closing staff has to stay late. Sometimes these patients are half to an hour late. Our director doesn't want to cut their time, so that isn't an option (it would probably seem to be a reward to some of them!) Does anyone have any suggestions on dealing with this?