aandrae

Hi Everyone, I am an acute dialysis RN here at my local hospital. I have my BSN and I'm now looking to become a nurse practitioner that specializes in nephrology. I've only worked with MD's so basically my question is if there are any nephrology NP's out there can you tell me a little about what your part is in the team? What's your typical day like? Are you working at a hospital, clinic, practice...all of the above? Also, my days as a dialysis RN are very unpredictable and I'm constantly on call for 24 hours due to the nature of the job. Basically, I'm burnt out so I'm wondering what are the typical work hours of a nephro NP? Last but not least, what is the best degree to get. FNP, Adult NP, Acute Adult NP? Not sure which one would provide the best basis of education.

Glad I found this topic and no longer feel alone. I've had 3 jobs as a nurse all completely different settings and specialities.....I despised my first two and the 3rd, which I still have, makes me really unhappy and stressed out 90% the days I work. I had ONE interest and that was to be a plastic surgery nurse, in a small office and be the surgeons first hand and main nurse...once I got out of school I realized I have zero chance in hell of that ever happening. I've been told a 1000 times *as they chuckle at me for being so naive* that I'll need to pay my dues in the hospital and work years at jobs that I'll hate and then maybe, just maybe I'll stumble across an opening at a surgeons office. Sorry for the rant. Basically, zero passion but it pays very well which is why I won't leave.

Yes. Perfectly said. If we had just the knowledge of dialysis and were completely task oriented then I would look at the dialysis orders and if the doctor said to remove 3 liters, then I would try to remove 3 liters regardless if I walked into the room and saw that the BP was 80/40 and the patient was on 50 mcg of norepinephrine.....yea right! I don't even turn on the machine. I'm calling the nephrologist immediately and he'll tell me not to do dialysis in most cases. I use this real life example because in situations like this I've had the ICU nurse then come to me confused/worried saying "But the patient NEEDS dialysis, because he has +4 pitting edema, crackles in his lungs and a K of 5" Me "Yes, but he either has no fluid in the vascular system for me to remove because it's all third spacing or he is so septic that he is unable to maintain an adequate blood pressure. Perhaps get an order for Albumin 25G IV to help with the fluid shift or we'll need to see if the antibiotics can get the sepsis under control. This patient is so unstable he will proabaly crash the moment I start to pull his blood out of him at 250 ml per minute..." and that's running him slow but what do I know I'm just here to run the machine. I am also thinking of the total care of the patient before I walk into the room. First I'm finding the ICU nurse and asking questions like "Can I start dialysis now or do they have another treatment/procedure coming up that takes priority (i.e. bronchoscopy, intubation/extubation), does the patient need to be re-positioned soon? This treatment will be 3.5 hours and it's easier/safer to move and clean them now while they are not hooked up to yet another machine. What medications will be due while they are on the machine? Some of them maybe dialyzed out and should be held until after treatment. His output is 2,000 ml in the last 24 hrs? Thank you for telling me I may not be able to get 2 L off if he's putting out that much." I understand that it may seem like we don't do much, but when I'm sitting there for 4 hours just monitoring thats a GOOD thing. That means the treatment is running smoothly and the patient is tolerating dialysis. Just because I am not constantly running doesn't mean my mind isn't. There's a reason why we are not allowed to leave the room while the patient is on the machine. As you ICU nurses know things can change within seconds for those patients and when you're not in the room the dialysis nurse needs to know how to recognize those small changes in order to react before things go completely bad. However, as I stand up for my specialty I will say this I still think ICU nurses are the cream of the crop of nursing, have the highest respect for them and love working with them. I searched this topic because I wanted to know if I could apply for my CCRN, which I found out I can from the AACN themselves. Since I'm working with ICU patient's all the time I think going for this certifiation specialty would be a benefit for myself, the patients, the ICU nurses and hospital. Patient's are getting sicker and all health profressions are getting more complex as time goes on.

I seriously appreciate this. As an acute dialysis nurse who is in the icu every day I do way more than just run the machine and hook the patient up to it.