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Ashley_SF BSN

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Ashley_SF has 5 years experience as a BSN and specializes in Dialysis.

I'm a dialysis nurse with experience in the chronic outpatient setting, newly transitioning to acute care and pediatrics. 

Ashley_SF's Latest Activity

  1. Ashley_SF

    Too gutsy??

    Thank you 🙂
  2. Ashley_SF

    Too gutsy??

    Our youngest inpatients are newborns, the youngest outpatient I've had is 3 years old. We really try to initiate peritoneal dialysis, especially with the little ones. Right now most of my outpatient peds patients are teenagers.
  3. Ashley_SF

    Is working per diem worth it ?

    As others have stated, it depends on how busy the unit is. I work per diem, but can float to another hospital in our system to make up hours. The other unit I float to always needs help and I have more than enough hours per week. I do work in California for a union hospital so my per diem rate is high and I can afford to purchase my own health insurance. The per diem rate is 25% higher than the full time rate. I had a second per diem position because I was worried about hours, but realized that I have more than enough at one job, so I let the second job go. You can take multiple per diem positions to make sure you have enough work and then quit one site once you get a full time position. The great thing about a per diem position is the flexibility, and again, a per diem job is better than no job.
  4. Ashley_SF

    Your most bonehead moment in nursing. Or 2. Or 3.

    During my maternity rotation in nursing school I spent the day on the post-partum unit. My patient had a foley that needed to come out, so my clinical instructor walked me through the steps and we went into the room to do the removal. I deflated the balloon and grabbed the catheter several inches away from the patient and pulled it out in one fluid motion just as my instructor was reminding me how long the tube was... As the foley exited the patient it whipped the air spraying myself, the patient and my clinical instructor with urine. I was mortified!! The patient was a very kind woman who apologized to me!
  5. Ashley_SF

    Per Diem vs Full time in San Francisco

    I work per diem in San Francisco and get as many hours as I want, but I think it depends on the hospital and the specialty. I work in a specialty that allows me to float to another hospital in our system if the census is low on my home unit. I accepted the position in March and this is my first experience working per diem, so my data is limited. But, I have a friend who has been a per diem ICU nurse for years at the same hospital and he flies in from out of state every week. As far as I know he's never had issues getting his hours in. I work days and my friend works nights. I would ask the hiring manager how many hours you can expect to work. They should be open and honest about expectations. I hope this helps!
  6. Ashley_SF

    This is Where the Cowboy Rides Away

    I'm not a school nurse, but I love this group and I love reading your wisdom and input. Enjoy your retirement!
  7. Ashley_SF

    Help! I Can't Get Rid of My Dark Cloud

    I like to lift weights, ride my bike or go for a nice walk. On my mornings off I really enjoy and savor cooking breakfast and brewing a wonderful cup of coffee. I really need quiet and time alone on my days off to help refill my energy and empathy stores.
  8. Ashley_SF

    Those students that really get to you

    You're welcome @OldDude! Sometimes it's hard to see the difference we're making in people's lives and a little reminder is a nice boost 🙂
  9. Ashley_SF

    Those students that really get to you

    As someone who lost a parent very young and had a mother that struggled to carry on. I can't tell you how much it meant to me to have a safe place at school with supportive adults who really helped raise me and my sisters. Throughout the homelessness and my mother's drug abuse/arrests I successfully graduated high school near the top of my class. I am now a nurse of nearly 5 years. All of this was possible because of people like you. This little one will grow up and remember the kindness and support you showed him and he will be stronger because of it.
  10. Ashley_SF

    And The Reason Nurses Don't Get Fired

    Nurse gave patient hectorol instead of zemplar because "I couldn't find the zemplar" and "they're basically the same thing." She didn't consider that maybe said patient had an adverse reaction to hecterol which was why she was prescribed a different vitamin d analog.
  11. Ashley_SF

    Does hair color affect hiring decisions?

    I'm going to take another position and say it depends on where you live. I live in San Francisco and it's not unusual to see professionals with dyed hair. For example, my clinical nurse supervisor has light pink hair and one of the hospital nurse educators has light pink hair as well. I've also see tattoos and nose piercings on nurses at work. I have worked with plenty of Asian women with blond hair and no one batted an eye. I do realize that California is a bit different than the rest of the country. So, take a look around you. Did you notice nurses during your clinicals with different hair colors, etc? Personally, I enjoy working for a more inclusive employer who respects their employees' rights for self expression. But that's just me 🙂
  12. Ashley_SF

    A day in dialysis

    I have worked in chronic outpatient dialysis for almost 5 years and recently switched to working outpatient pediatrics/acutes and adult acutes. Because I'm per diem I'm not required to be on call, so I can't speak to that. But, I love being in the hospital! I still work per diem outpatient and the difference for me is mind blowing. Going from being responsible for 12 patients per shift with 3 patient care technicians working under your license, to now working 1:1 with patients, and support staff only setting up machines, is amazing. I can more closely monitor my patients and tailor their dialysis treatments. I have more access to tools to help facilitate fluid removal and assist with hemodynamic monitoring. In the outpatient unit I am constantly moving between people and trying to stay on top of medication administration, lab monitoring, notifying physicians, adjusting dry weights and getting people out the door in a stable condition. It feels good knowing I am knowledgeable about a specialized, life-saving treatment. I enjoy the time I have to sit down and get to know my patients and their families. I'm still busy, but in a more focused way which feels more manageable to me. I'd make sure to ask about how your coworkers function and how approachable your physicians are. The most challenging periods for me have been when I haven't felt part of a cohesive team. Best of luck!
  13. Ashley_SF

    Breaking into Dialysis

    I worked for both DaVita and Satellite and both hire new grad nurses and train them. I now work for a hospital-based unit which does not contract out its dialysis. It was much harder to get in to the hospital, even with experience. I agree with what many posters mentioned above. Many units are short and you may have a better chance of walking in and introducing yourself. Once they meet you and like you they may be more willing to hire and train you.
  14. Ashley_SF

    Heparin Practices

    She was saying that the acute patients are more fragile than in the outpatient units, especially in the ICU, because of low platelets, other anticoagulant therapy etc. But, that was my thought exactly about the short half life of heparin, that's why we use that particular drug. I'm going to talk to my manager on the pediatric side next week because we use heparin with both out adult and pediatric patients at our other campus. The other odd thing is that we have a general supervisor who oversees all of the dialysis units within our hospital system, so you would think we would all have the same policy. We use sodium citrate to keep the CVCs patent.
  15. Ashley_SF

    Heparin Practices

    I would like some input from my dialysis nurses, both acute and outpatient regarding the use of heparin where they work. I recently transitioned from outpatient, adult, dialysis to outpatient pediatric/inpatient pediatric/inpatient adult dialysis and am confused by heparin policies at my new place of employment. The adult acutes hospital (does not contract their dialysis out) I am working at does not use heparin period during dialysis to prevent clotting in the extra corporeal circuit. On the pediatric side, which is owned by the same hospital but at a different location, we do use heparin. The 40+ years nurse I worked with yesterday told me they don't find heparin or regular saline flushes necessary and it is a liability for the acute adult population we work with.. I've worked in outpatient dialysis for 5 years and have operated under the belief that heparin is needed for most patients during dialysis. I have many patients who develop clots in the arterial chambers/dialyzers if their heparin is missed.. I would appreciate any input, especially from the very experienced nurses. Thank you!
  16. Ashley_SF

    Does ANYONE like the hospital?

    I've only been working in the hospital for 2 months, but I love it! I've worked outpatient dialysis for almost 5 years and like Davey mentioned, I have so much more support and resources in the hospital. I enjoy working with a robust team and having other nurses and members of the IDT around to bounce ideas off of and ask questions, especially at a large teaching hospital. There are also more opportunities for growth and learning.