"Why are you here?"

foxy1112 · Aug 23, 2015

Most people want to live. I don't know how conscious that is as opposed to self preservation.
As for patients in the 70s, most patients don't care, because they cannot see beyond their own pain/suffering.
If a nurse told me how lucky I was to be on dialysis I may not take that too well.

That's why a lot of patients are also depressed coz they see things as 'what should be' instead of 'what is'

foxy1112 · Aug 23, 2015

Most people want to live. I don't know how conscious that is as opposed to self preservation.
As for patients in the 70s, most patients don't care, because they cannot see beyond their own pain/suffering.
If a nurse told me how lucky I was to be on dialysis I may not take that too well.

You said you're not a dialysis nurse so you're probably not familiar much with the culture. In the unit, we try to be as positive as possible. We try to make the experience lighter for the patients. All interdisciplinary team work hard for it. We truly understand what they're going through from head to toe and we give them the best possible care that we can give. It seems like you think I don't know what I'm talking about but I do. Yet in this care, there's no room for any more negativity.

Farawyn · Aug 23, 2015

You said you're not a dialysis nurse so you're probably not familiar much with the culture. In the unit, we try to be as positive as possible. We try to make the experience lighter for the patients. All interdisciplinary team work hard for it. We truly understand what they're going through from head to toe and we give them the best possible care that we can give. It seems like you think I don't know what I'm talking about but I do. Yet in this care, there's no room for any more negativity.

I didn't say anything about what you thought. I don't do that. I was telling you how I thought.

I am not a dialysis nurse, but I am extremely familiar with the culture. I have cared for many in patient dialysis patients, with multiple diagnoses. My mother, in fact, has 1/3 of 1 kidney, and was on dialysis for a time.

You mentioned keeping positive "until their kidney transplants". That's great, positivity is a good thing, and so is the fact that your patients are candidates for transplants.

The super sick in patients on dialysis I took are of? No.

My mom? No.

Not that they didn't respond to positivity, I'm not saying that. There was no end goal of a transplant, though. We concentrated on little victories.

How long have you worked in dialysis?

Chisca, RN · Aug 23, 2015

Perhaps the low opinion dialysis patients have for the whole experience is, in the US, hemodialysis is delivered by low paid barely trained techs. You don't think you could tell the difference between a McDonalds happy meal and one from a chef? It's part of the reason we have such a high mortality rate is we accept such low quality. All dialysis treatments should be delivered by a registered nurse.

"Because of significant limitations in the reimbursement of dialysis procedures, staffing of dialysis facilities in the United States is predominately by technicians, who are often high school graduates with comparatively little training and who, until recently, were not required to undergo national technical competency examinations. Although there is a requirement that a nurse be present in each facility, the ratio of nurses to technicians (and patients) is highly variable and specified by only a few states. In contrast, staffing in European countries is predominantly by certified nurses and in Japan exclusively so."

Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World?

AcuteHD · Aug 23, 2015

Just need to be optimistic as much as possible until they get their kidney transplant

I'm not going to bash you for being a cheerleader, but you can acknowledge that dialysis and all the restrictions and pain that go with it are a burden without adding to the negativity. Instead of focusing on dialysis as a blessing, focus on some aspect of the pts life that brings them joy and accept that they are going to view dialysis as a necessary evil. Just because you are a dialysis nurse, don't take it personally that patients HATE dialysis.

Also, keep in mind that most patients are either not eligible or want a transplant, and most that are on the list will never get one.

The best dialysis NP I know describes herself as a cheerleader.

AcuteHD · Aug 23, 2015

Whether such differences in staffing expertise, ratio of staff to patients, or frequency of physicians' rounding affect patient outcomes has not, to our knowledge, been explored adequately as a risk for poor outcome.

- Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World?

AV vs. Catheter access and rate of missed treatments were the two big factors in our high mortality rate. This is a really depressing article, but thanks for posting it Chisca.

foxy1112 · Aug 23, 2015

I'm not going to bash you for being a cheerleader, but you can acknowledge that dialysis and all the restrictions and pain that go with it are a burden without adding to the negativity. Instead of focusing on dialysis as a blessing, focus on some aspect of the pts life that brings them joy and accept that they are going to view dialysis as a necessary evil. Just because you are a dialysis nurse, don't take it personally that patients HATE dialysis.
Also, keep in mind that most patients are either not eligible or want a transplant, and most that are on the list will never get one.
The best dialysis NP I know describes herself as a cheerleader.

I feel like you're putting words in my mouth. See, you don't get it. I didn't say dialysis is a blessing, I said the opportunity that patients get nowadays to be able to get dialysis treatments is something to be thankful /grateful for. Maybe I should just refrain using the word "blessing" coz it can be taken out of context easily? Geez.

I do acknowledge the things they have to go through as a dialysis patient. Believe me, I review their "do's and dont's" with them and provide patient education everyday. Nope, I don't describe myself as a cheerleader. That's not what I do.

foxy1112 · Aug 23, 2015

I didn't say anything about what you thought. I don't do that. I was telling you how I thought.
I am not a dialysis nurse, but I am extremely familiar with the culture. I have cared for many in patient dialysis patients, with multiple diagnoses. My mother, in fact, has 1/3 of 1 kidney, and was on dialysis for a time.
You mentioned keeping positive "until their kidney transplants". That's great, positivity is a good thing, and so is the fact that your patients are candidates for transplants.
The super sick in patients on dialysis I took are of? No.
My mom? No.
Not that they didn't respond to positivity, I'm not saying that. There was no end goal of a transplant, though. We concentrated on little victories.
How long have you worked in dialysis?

I'm sorry that you're mom had to go through dialysis. I know it must've been tough for you. My patients inspire me everyday. I don't know if I would be just as strong as they are if I were to face the same kind of situation.

I've only been in dialysis for less than a year. I've always wanted to work in this field since 3 years ago but companies always want to hire those who have experience. Fortunately for me, a company wanted to train me from scratch. I was truly grateful for that chance. In six months time, they assigned me to manage the home hemodialysis program due to my good work ethics and passion in dialysis. It was quite an achievement for me knowing that even the seasoned nurses were not offered this position. I had a lot of naysayers behind my back, they thought I couldn't make it coz I was the "new girl". But here I am..:)

AcuteHD · Aug 23, 2015

Yeah, I think the term blessing with dialysis set of some alarm bells. LOL

Patients HATE dialysis for lots of good reasons, but they keep coming back. Focus on what keeps bringing them back. Cheerleader is a good thing, was not meant to be degrading or insulting.

Good luck with your home HD program.

Farawyn · Aug 23, 2015

Yeah, I think the term blessing with dialysis set of some alarm bells.

It's almost an oxymoron. ALMOST.

Trauma Columnist · Aug 23, 2015

I've been a nephrology APN for 9+ years now and have cared for many dialysis patients. Like pts with different disease processes the outlook of these pts depends on multiple factors: how old they are, what are the realistic chances of a transplant, their ability to pay for their meds/transportation, their ability to work, and their general outlook on life.

As to the tech's pay, at least in my area they get paid quite well, starting pay in the $12/hr range. They receive three months of training too.

And...finally as to why dialysis pts do better in other countries: in Europe, and the Far East, they dialyze 4-6 times/week so they more closely mimic their native renal function.

AcuteHD · Aug 23, 2015

As to the tech's pay, at least in my area they get paid quite well, starting pay in the $12/hr range. They receive three months of training too.

That's about right for my area too, but that's still $3 less than the New York fast food worker. SMH

I would have a hard time believing that our poor rates are staffing related, all the techs I've worked with in my limited career have been awesome.