noelraquel

well... I don't currently work for Fresenius, but I imagine the training is pretty similar. i was lucky enough to receive my training from a private dialysis clinic and they held my hand the entire training, im not ashamed to say.. i was assigned to one RN and had her an entire 3months until they deemed me 'ready' to cover the floor on my own. for the first couple of weeks i followed an experienced pct and learned about setting up the machine, pre and post tx, operating the EMR, cannulating. with the RN i learned head to toe assessment, med pass, protocols, scheduling and cvc care. i would advise to pay close attention to your preceptors. IF you have a good one, they are a great source of knowledge for you. don't be afraid to pick their brain. FOLLOW the protocols to the letter! especially focusing on what to do with allergic/pyrogenic reactions, cardiac arrest, cramping/hypotension...they are there to protect YOU and the pt and are invaluable! IF you have down time, read up on some of the pt's h&p. take advantage of the training! soak as much as you can up! do not rush.. it only can potentially endanger you and the patient. PRIORITIZE! get to know the patients when you can. most of them really appreciate what we do for their survival and some know how to really make you smile.

ive been a hd outpt RN for 7yrs. straight out of graduating and into dialysis. over the years ive learned so much and STILL feel that so much more can be learned. but, the most memorable aspects of dialysis is being a witness to the misery that some pt's have to go through. seeing the same faces 3x a week, no matter how hard you try to maintain a professional boundary, these little guys somehow burrow themselves into your heart but.. the big but... inevitably, as time passes and they get older, their minds and bodies begin to display the stress that comes not just from aging, but from dialysis too. the usual pattern ive experienced is that the patients who have dementia or are otherwise unable to make their own medical decisions are too often forced into coming to dialysis when they clearly DO NOT want to be there. yes, the dementia ones say 'im ok, im ok', but then when no one is looking, try to pull their needles out. or the ones who do have some visual recognition of where and who they are, are still wheeled in and placed in the tx chair when they are so obviously tired of it all and have said so to staff repeatedly, yet still agree to continue with dialysis for the day. when im working with such pt's as mentioned above, I know that we-the clinic, cant force them to stay on dialysis, but why does the family allow it to happen? I know being a caregiver to a loved one is difficult, but don't they see what a toll it takes on them? it is hard to let them go... but how selfish can one be to see that they aren't happy? would you want to be living like that, day in, day out during your last miserable years of life? there are families that just want the ssi check every month so they continue to bring them in, and there are families that are just SO co-dependant that, THEY don't know what would happen to THEM if the pt died! and then, this takes the cake, the family members that are given the POA and are too scared to make the decision for themselves to take them off of dialysis. ive documented and spoken to the appropriate avenues allowed to the RN but I just feel this repeating too much. what do you think?

graduated in 07 and was 23. in my class the students that had the hardest time with instructor criticism were 35+. yes the younger generation feels 'entitled' but so do a lot of people living in the land of the free. people probably wont agree with me, but, if these students are passing clinical and theory, by what tangible basis can you NOT pass them? working as a RN for as long as we have, don't we ALWAYS come across someone like that at least once a week? im not criticizing anyone's opinion; just trying to find out IF you cant pass them based on their attitude... in a perfect world everyone would work well with everyone. but, that's not what we live in... unfortunately..

in cali, working for big D. official ratio on THIS clinic is 12 to 1 RN and 2 pcts. I love it at this clinic. the experienced pcts and at times annoying old school RN make up a good mix of personalities that we've learned to work together well. yes, it is the huge wave put on and take off but as long as we're fully staffed for the day, it's not so bad. I always like jumping in and helping too because im not stuck looking at the stupid computer all day, charting..

elmo263 is right ive been a hd RN for over 7yrs and TRUST ME, ive wanted out too! remember that your clinic isn't THE ONLY outpt clinic around. work at different outpt clinics! NOT ALL co-workers are that way. yes it does help to at least attempt to work with them because they DO have the advantage of experience over you, but if you dread coming in to work that much; you have soooo much value elsewhere. it has never annoyed me so much as when I help out at another clinic and what they do there, is sooo different! yes, some are run better, like have a better cc, fa or more experienced pcts and rns and there are some where the staff is so clicky (spelling?) that they will never have full staff for long. I never would have known how rewarding hd can be if I didn't help out at other clinics and meet the caring, compassionate and humorous people there. patients included! like elmo263 said: being in our specialty nursing, you can go soo many places don't let that one clinic deter you from the other possibilities! as for not fully utilizing the nursing skills you've attained: this field is such a specialty, NO ONE outside of hd can ever do what WE do! I've found some solace in that, hope you do too.