Ashley_SF

If she's doing acute dialysis then she will have mannitol and albumin for BP maintenance. My docs do not use hypertonic solutions though..

I relocated for my first nursing position and was also really homesick. It was a new grad program and although not required, I did stay for 2 years before moving back home. It was challenging, but manageable. Those 2 years of experience gave me what I needed to find a more desirable job back home. I now have over 5 years nursing experience in my specialty and am working at a great hospital doing a job I love. Those 2 years taught me so much and I am so grateful I stuck it out, one day at a time.

Thank you ?

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.

I have worked as an adult outpatient dialysis nurse for 5 years and as a pediatric dialysis nurse for the last 8 months. I work for a large university hospital and my unit is NOT like a Davita clinic. Firstly, pay is largely going to depend on where you live. I will say that my current position pays me about 30% more than my previous positions in chronic dialysis, but that may be specific to my area. Dialysis can be a very rewarding profession if you enjoy building relationships with patients. Good things to know about the position: do you have technicians? what is your orientation like? will you be required to set up/take down machines? Are you also doing the inpatient pediatric dialysis treatments at the hospital? What is your nurse:patient ratio? As someone with experience in dialysis it wasn't a huge jump for me to go from chronic, adult dialysis to chronic/acute pediatric dialysis. I already knew the machines, how to set up and troubleshoot and how to react quickly to avoid certain issues that come up. I would be most interested in what the training is like and how much support you will have. Some patients may seem fairly stable, but it's very important to be observant and think critically to avoid complications. Best of luck! Feel free to message me if you have any questions!

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.

I'm surprised you were able to stay in the program. I failed a course in my nursing program and was dismissed. I had to petition for them to reinstate me and I had to retake the course before advancing in the program. When I graduated the failed class did not impact my gpa.

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!

This stood out to me. When I first started in dialysis I had this thought too. Once I knew how to set up machines, connect patients and manage ESRD labs, I craved something harder too. ICU or ED, an area with more bells and whistles. But, I stayed in dialysis and I realized that I thought many aspects of my job were too easy, but in reality I wasn't truly putting the pieces together and critically evaluating my patients. Once I started really focusing on my assessment skills and asking more nitty gritty questions my patient acuity wasn't quite what I thought it was. I second other's opinions to stick it out, acquire certifications, sit on committees and as FolksBtrippin said: You may still find that you're not passionate where you're at and that's ok, but at least give yourself an opportunity to make a more informed decision.

I'd take it as a big red flag if they were losing a lot of employees at once.

I would never again work salary in dialysis. Whenever we were short I would get called in to fill in as a tech, nurse or both.. even if I had already worked over 40 hours for the week. I didn't have time to myself and I dreaded the phone ringing. I second working in acutes. After working in the chronic setting for 5 years, I much prefer the schedule and flexibility of working in the hospital. In the outpatient setting I was sometimes the only nurse and could never relax on my "break". Yesterday I dialyzed a couple patients on our acute unit, sent them back to their floor nurses and had a glorious hour of uninterrupted lunch before heading out to the ICU to do a run.. Then I got to go home, without being pressured to work overtime. I love working in dialysis, but the chronic setting was too much for me and I didn't even have to worry about children at home.

I am off today after working yesterday and I can relate to your post. I feel so drained and foggy, my body aches and it was an effort to get out of bed. I started a new position a few months ago which requires me to work in many different areas; ICU, transplant, med surg, pediatrics, adult, etc.. sometimes in the same day. I'm hoping that after a few more months I'll adjust. In the past I've done what others have mentioned and made sure I exercised regularly. I definitely feel better.. but getting my butt to the gym has been very challenging lately. I still eat healthy, protect my sleep routine and drink plenty of water. I'm usually rested for work, but I'm a zombie on my off days. And yes, I definitely have a harder time after a more emotionally stressful day. Recently I've been in the habit of making up songs and doing silly dances at work when I have a private moment. This helps me to shake the stress off ?

I'm late to this post, but I wanted to say thank you for working in the area you do. My twin sister was diagnosed with stage 4 neuroblastoma back in the late 80's; she was given a 5% chance of survival. She endured total body radiation, a bmt, and chemo. I am happy to report that because of the work of people like you she is alive and thriving today, almost 30 years later. We can't save them all, but like others have mentioned, we can make the time they have left more comfortable. Sometimes our job is to ease the pain and suffering that our patients and their loved ones experience, no matter the prognosis.

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!

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

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.

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 ?

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.

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.

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 ?

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!

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.

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.

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!

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.