idodialysis

Sounds like you are a tech working a 4 patient pod? I am an RN but worked as a tech first. You need a system. Here is mine. 1) Check your 4 patient's orders. If you need a special bath or dialyzer place it at that machine now. 2) Get the needed supplies and string all 4 machines and get them started priming, starting with your earliest patient and moving to your latest. 3) get your heparin, put on supplies ready at each chair, again going from earliest to latest. 4) get your pre- documentation i.e., machine checks, chlorine/chloramine in the EMR. 5) check with your team leader for any special instructions re labs, special meds like antibiotics being given or schedule changes.

I hired a nurse on restrictions when I managed a dialysis clinic. No problems, we don't keep any narcotics on site.

I just heard a discussion re: this on NPR. The jist was that research has found that note taking is far and away the most effective way of learning class material .

I agree with your preceptor. I try to "manage by walking around". Talk to patients, physicians, family the housekeeping staff, everyone. Get their points of view, see what changes, they are interested in, observe what is working and what is not. This should take up a month or two to come up with a 6 month , 12 month, 18 month and 2 year plan to present to your boss. Good luck.

I agree with Nutella. From what you have said, you do not have the right personality for dialysis. It is busy, busy, busy and you are NOT a manager but will be supervising techs who push back at you especially when you are new to the job . And the patient behavior you described in your post that bugs you will happen every day! I have worked in dialysis in the Cleveland area for 25 years so I know of what I speak.

Consider Acute Dialysis . Once you are trained and competent, you work independently. The nurses caring for the patient are responsible for all other care, so except for helping to reposition or get a patient on or off bedpan your hands on care is limited to that needed to accomplish the dialysis treatment. Plus the technology is pretty cool. And the best part is you go from unit to unit or hospital to hospital so no unit politics to get involved in.

Change your shoes upon entering and exiting your facility.

FYI it's not your company (Fresenius?) mandating pain assessments , it is CMS=government beaurocrats. They are also rolling out mandatory depression screenings. But , yes, the staffing ratios are not satisfactory for good patient care.

Well IV iron generally has to be given over 2-5 minutes so I would not give it during rinse back; it would be permissible to give epogen or zemplar. If given per procedure you wouldn't have any air present in your syringe.

In my area of expertise (dialysis) it is an infection control violation to use anything carried in your pocket for patient care ie., tape, bandages, gauze, alcohol preps. Cross contamination and all!

I saw this frequently when I did acute dialysis...get that line in the patient, hook up to crrt only to die 12 hours later. No sense on a 90 something year old.

I would consider the dialysis tech route. Dialysis patients have many Comorbid conditions and you would get exposure to many disease processes. You will likely get better pay and benefits as well as tuition assistance. Fresenius is a good company. I think you would benefit greatly!

I just read about this on Ohio Board of Nursing site. It said that if the nurse is not able to function safely they should not be working. So I guess when you reach that point you must start moving up the chain of command at your place of employment to be relieved of patient care.

In the clinics I've worked in few patients have albumins 4 or over.

Dialysis patients actually need protein to keep their immune systems intact and aid in wound healing. In fact most chronic dialysis clinics give out protein supplements to patients to consume during their treatment.