Question regarding smaller unit...

:uhoh21: as an new nurse in a recently opened stand alone dialysis unit, the concept of divided patients is being abolished. the approach is now that all 8 patients are yours on your day of working only. i have one tech to assist with putting on and taking off as well as being responsible for assessments and meds, and critical thinking. changing the format of your facilities assignments will be a tough one as you somehow have to convince the people above you that this is in the best interest of the patients and not yourself. do you have any experience or knowlegde in the area of safe staffing per dialysis pt ratios? please help me

I work in a 12 chair unit. MWF. There are 2 nurses. We are both charge. So, we have split the patients in half. She has half, I have half. We each do our own care plans and other paperwork/teaching/etc. However, we trade "sides" the patients sit on. She takes one side one week, I take the other and we trade each week. My issue with this is that when she has one of "my" patients, she will change orders, tw, diet orders, etc., without discussing with me first. This past week, she took one of my patients down an extra kg, which resulted in the patient getting to 66/22, unresponsive until 500cc NS was given. Honestly, I was pissed off. This other RN doesn't like this particular patient...and I feel she did this on purpose. (However, she brown noses like the worst of the worst, and I cannot prove my case to the director). What I would like to do is have MY patients on one side of the room and hers on the other, so she doesn't take care of MY patients. Has anyone else had this issue? We are a small unit and get very close to our patients and their families! This is driving me crazy, advice needed! :)

I think switching once per week is a great idea. It gives you and the patients a whole new week to look forward too. However, with the politics that occur in clinics, it makes things a little tricky. The first thing is, it could have been the wish of the prescribing M.D. that requested the extra Kg to be removed. Sometimes, doctors like to challenge the patient for many reasons.

If this wasn't the case, then the nurse errored. In that case, you could ask to speak to her in private, and try to come to some arrangement to how you would like to work together. It never does any good to go above a co-workers head to a more superior person, if it is something you could both work out together.

If you follow the M.D. plan each time, when it's your week, then of course, realize that is what you do. If she doesn't then someone must be witnessing this action, and it will be something that management will have to deal with. How much to remove is a doctors order (Not a Nurse).

Things are better...the other RN and I have been working out our issues, and so far, so good.

As far as the staffing ratio's, some states have them, and I believe it is 1 tech for 4-6 patients, one nurse for 10-12.

Of course, in our unit, we don't have a secretary, reuse person or water person...we do it all on top of the floor work! Along with reports, ordering, inventory, etc....

As an old-school nurse I firmly believe in the concept of "continuity of care". I worked for several years in a smaller center (15 chairs, MWF) and we didn't switch up unless a schedule spot came open and someone else wanted to move to fill that spot. Each nurse and each PCT had her own patients - the same patients - every day (which you can do in a MWF center). I think it benefits the patients and the nurses to do that - to know each patient's individual quirks and what they can and cannot tolerate...and it builds trust and builds that relationship between patient and caregiver. There are just so many benefits to the nurse having her "own" patients to care for and do the paperwork for - for everyone involved that the ONLY downside I can see to it is the potential boredom factor - but then again...dialysis? BORING?. Assignments can be made for balance...one nurse need not have all the "difficult" patients....I just don't understand why you would WANT to switch up and have these issues at ALL....

Barbara

I work in a 12 chair unit. MWF. There are 2 nurses. We are both charge. So, we have split the patients in half. She has half, I have half. We each do our own care plans and other paperwork/teaching/etc. However, we trade "sides" the patients sit on. She takes one side one week, I take the other and we trade each week. My issue with this is that when she has one of "my" patients, she will change orders, tw, diet orders, etc., without discussing with me first. This past week, she took one of my patients down an extra kg, which resulted in the patient getting to 66/22, unresponsive until 500cc NS was given. Honestly, I was pissed off. This other RN doesn't like this particular patient...and I feel she did this on purpose. (However, she brown noses like the worst of the worst, and I cannot prove my case to the director). What I would like to do is have MY patients on one side of the room and hers on the other, so she doesn't take care of MY patients. Has anyone else had this issue? We are a small unit and get very close to our patients and their families! This is driving me crazy, advice needed! :)

My first question would be to you, do you both charge at the same time? We never have two charge nurses charging on the same day, it just doesn't work. Who is held accountable if something happens in the unit, you or her? In my experience, my charge nurses would take turns charging on a weekly basis. The "paperwork" would still be divided, but during treatment there should only be one person in charge at a time. Just an opinion.

Thanks