Recommendations for a student nurse wanting to go into Dialysis?

[girlynurse]

Hello to all, I am a student nurse in my third year of college due to graduate next year in May 2008. I am thinking of going into a dialysis floor when I graduate but I would like to know if you guys would recommend going into a med surg the first year after graduating and then transferring to a dialysis unit? What kind of skills would I have to aquire before going to a dialysis floor? Thank you.

[nurseangel47]

Venipuncture skills are helpful as are sterile technique and accessing shunts, fistulas, double and triple lument subclavian catheters...maintaining b/p via meds., trendelenburg positioning, CPR, assessment of lung and cardiac sounds, heparin monitoring and becoming familiar with lab values such as potassium, bun, urea, creatinine, bun:creatinine ratios, dietary teaching/counseling of foods not allowed for ESRD pts., reinforcing teaching of fluid overload symptoms, reinforcing teaching of importance of limiting fluid intake, PICA information, accepting that a lot of ESRD pts. are very noncompliant and you just have to let them lead their lives the way they see fit. Also, lots of diabetic teaching/reinforcing these principles to those who are diabetic. Hope this helps.

[DeLana_RN, BSN, RN]

Hi, there!

I would recommend 6-12 months (12 are better) in a hospital unit - med/surg, stepdown or ICU - before specializing in dialysis. Although some outpatient dialysis providers do hire new grads, as do some inpatient units, you would be at a disadvantage dealing with this medically challenging (due to comorbidities, as pp described so well) pt population.

If you're interested in outpt/clinic dialysis, many companies do have an orientation program (6-8 wks in general), which often includes classroom as well as on the job training. However, they will only teach you how to do dialysis, but as an RN you will be expected to be able to handle anything that can happen in a unit (e.g., pts with symptoms not directly related to dialysis, such as MI, stroke, GI bleed; power outages; cardiac arrest). Also, you will have to supervise UAPs and sometimes LPNs; in dialysis, this can be challenging since the tasks they do are similar to your own tasks. What exactly these are varies from state to state (e.g., unlicensed personnel may or may not be able to push IV heparin - are you horrified?!), but it adds to the challenge of this environment. You will also need excellent assessment skills and knowledge of meds, both best learned on a general hospital unit.

If you do want to start out in dialysis, I would recommend a hospital inpatient unit. Usually, they have only RNs and may have an excellent orientation program. In the hospital, you will definitely learn more (charting, meds, some procedures in addition to dialysis), however keep in mind this is still a specialty area.

One final consideration: As I said before (sorry for repeating), dialysis is very specialized. It may limit the areas of nursing you may easily transfer to down the road. Although not impossible, it's harder for "seasoned nurses (what many consider nurses out of school for more than a year to be) to find a good basic orientation or internship program. But then again, like many of us, you may never want to leave this area!

Best of luck to you,

DeLana

[girlynurse]

I am going to be doing an externship at Thomas Jefferson University hospital this summer at the Liver and Renal Transplant unit. It is a med surg unit that has pre-op and post-op (stable) patients. If I like that unit, I hope that I can secure a position there after graduating. I maybe able to see patients that are on dialysis and I may feel more comfortable dealing with that population. After getting some experience in med surg, I do want to go into dialysis. Thanks for all your advice.