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RN duties at your facility

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I am very new to dialysis only being in it for the last 3 months. I was just wondering what the RN's duties include at the different facilities. Where I work, when I get there at 630a, I am responsible for setting up machines with the tech in the pod we are in for the day. At 7a, the patient's arrive and I must assess them before the tech puts them on but I am also responsible for putting on patients. I also do all the charting and meds. One thing that I was really wondering about was the fact that the techs are allowed to put on catheter patients and do cath care. Granted, they are not allowed to do the heparin dwells at the end. Before I became an RN, I was an LPN for 20 years and was not allowed to touch a catheter! Just seems odd to me. Where I am at, basically, I do everything the tech does from cleaning machines to garbage. Just wondered if this is standard practice.

Thanks in advance for the responses.

Lacie, BSN, RN

Specializes in jack of all trades.

Depends on the state and company policy. When I was with Davita, pct's did cvc's but did not do cath care. Where I am now the pcts can do neither. They can rinse back but that's it. As an RN, I come in set up machines, do all the assessments, give all the heparins and other meds, do all the lab checks and reviews, call the doc, make rounds with docs and take patients dependant on staffing. I also do the initial assessment paperwork on new patients and the monthly care plans and med changes. Did I mention the only RN on the floor also lol. Yep that's dialysis!!

pricklypear

Specializes in Telemetry, ICU, Resource Pool, Dialysis. Has 11 years experience.

I think its just totally dependent on company policy. My company allows techs to do catheter care (everything including heparin packing) after 1 year on the floor and some training. I was surprised by that when I first started, coming from a hospital career where techs didn`t go near anything IV.

My fellow nurses and I also do everything else that is needed - putting on, taking off, cleaning machines. It`s really a team effort or everything would fall apart.

Tish88

Specializes in Dialysis (acute & chronic).

As per the pct's, it depends on what state you are in and what your company policy states. My pct's put cath patients on, do cath care and instill heparin post treatment.

As far as RN's, they assess patients in and do "some" put ons and take offs..I primarily have the pct's do "most" of all the put ons and take offs. The RN passes meds to 20 patients. (ratio 1:20), sign off orders, call in refill prescriptions, call MD's when needed, pt med reviews, quarterly care plans and medication protocols.

The pt acuity level in my facility is pretty high.

pricklypear

Specializes in Telemetry, ICU, Resource Pool, Dialysis. Has 11 years experience.

Tish88- geeze, with a ratio on 1 RN to 20 patients, I'm surprised you have time to do anything!! You're a braver girl than me!! We have 16 chairs, 2 RNs and 4 techs.

Tish88

Specializes in Dialysis (acute & chronic).

You just have to learn a routine! and try not to get distracted.

corky1272RN

Specializes in Med Surg, Home Health, Dialysis, Tele.

as far as rn's, they assess patients in and do "some" put ons and take offs..i primarily have the pct's do "most" of all the put ons and take offs. the rn passes meds to 20 patients. (ratio 1:20), sign off orders, call in refill prescriptions, call md's when needed, pt med reviews, quarterly care plans and medication protocols.

the pt acuity level in my facility is pretty high.

all of you are soooo lucky. i have 1:12 ratio. one rn (me), 2pcts, 1lvn. i have to do all of the above and the pcts can't do any cvc care at all. not even rinse back the blood. when i first started here, the pcts could at least rb the pt when the tx was completed but several months ago that was changed. the lvn is able to do everything, so that helps, but he has his own 4 pts to care for. right now it is just toooo much to do. plus we have a few new employees so i have to help alot in turnaround. very stressful and tiring! :cry:

Tish88

Specializes in Dialysis (acute & chronic).

It would be nice to have a ratio of 1:12. I have a ratio of 1:20 with 5 pct's.

It gets a little crazy when you are trying to hang all the IV irons and push all the other meds.

Niecystewka_RN

Has 2 years experience.

In my clinic we have 24 chairs 3 pods and 2 shifts on TTS. We have 2 nurses and we both have 12 pts each. Each pod will have 2 techs working together. Our techs are allowed to pull up pts heparin boluses and infusions up, they are able to changed CVC dressings, check glucometers for high/low levels, able to fill pts jugs depending on prescription, but not allowed to spike any of them without a RN doing it for them, techs set up all pts machines, they put on pts and rinse the pts back, they make packs or the MWF shifts if needed, check BPs q30min, and stock the carts at the end of the day.

RNs duties is to pass meds, recheck techs machines to make sure they are correct, assessments, spikes baths, notify MD if any issues, phone calls, round with MD when around, help techs with turn over if needed, teach patients w/ whatever they have need.

I can't imagine having to pull up heparin for pts for the entire clinic and change dressings all the time. Some pct's aren't allowed to rinse back pts?!?! How do you have the time to do it?!?! My clinic gets nuts and sometimes I have a hard time getting what my usual stuff I need to get done ... done.

Go you nurses!!

Edited by Niecystewka_RN

corky1272RN

Specializes in Med Surg, Home Health, Dialysis, Tele.

yeah, it is really hard to get everything done in a timely manner. in fact most of the time my main charting on pts has to be done when all the pts leave and everything is calm :tbsk:. ok not that calm but distractions are minimized. it also seems like every week more is added on to the rn. sometimes i would like to say, "what the techs were good enough last week to do that, now all of a sudden it is an rn duty only, what happened? " i just wish at least the pcts were able to rb the blood, you just don't know how much that one little thing would help.

Lacie, BSN, RN

Specializes in jack of all trades.

Forgot to mention I am also the clinical manager and doing the floor!! But in light of it all today was my very last day in dialysis!!! :woot: Someone else can beat their heads in the wall I'm cooked lol.

corky1272RN

Specializes in Med Surg, Home Health, Dialysis, Tele.

Wow Lacie, where are you going? doing? I am looking for another job. I interviewed today for med-surg at a main hospital in my area. :plsebeg: I need outta here too!!!! I am even going to take it if it means a pay cut (hopefully not toooo drastic).

WOW...compared to all of you, I have it easy! We have 5 pods, 4 of the 5 have only 6 pts, the other pod has 9pts. The pods with 6 have a nurse and a tech. The big pod has 1 nurse and 2 techs. So, like today, I was in the big pod. The techs and I each brought in pts and I assessed while they put on. I just kept bringing them in and assessing. Then I go around and give all the heparins, make rounds, put in all the assessments, give meds, draw up heparin for next shift. By then, it's time for take off. I do take off more than I put on since there are no assessments. M-W-F, I only work until 1 or 2pm so I help put on the next shift until the next nurse gets there. Then chart and I'm out of there...haha. So, I guess I don't have it so bad. I will be sure to pass this on to all my fellow nurses when they start complaining!

Lacie, BSN, RN

Specializes in jack of all trades.

I went to careerbuilder yesterday and checked out somethings. ResCare already called me regarding needing an RN to oversee 2 intermediate group homes for clients with developmental disabilities. Patience is a strong point with me in relation to clients just not with bully administrators :) It's a buck more per hour then what I was making as a manager in dialysis!!! Mon-Fri 8-5 and 3 miles from my home. Not the 50+/hrs aweek with the 45min drive to work that's for sure. Be a whole new world for me but I think I'm going to check it out and go through with an interview at least. I'm big on pt advocacy and that is the main issue I found in dialysis as it seemed profit first and patients last. This company is the largest in the nation providing the type services so may be something to consider. This entire issue may have turned out to be a blessing in disquise for me who knows but I am going to take my time. Well as long as the bank account can hold out that is lol. I was considering home care anyway just to keep from beating my body up anymore than it is lol. At least I would get to set down now and then.

Tish88

Specializes in Dialysis (acute & chronic).

Let us know how the interview goes.

Also, you could consider it more than a buck an hour more since you will only be traveling 3 miles instead of 45 minutes.

I always consider the amount of travel to and from work in my salary (hours at work + travel time to and from divided by hourly wage). also consider the amount you will save in gas money.

Good Luck to you!

Lacie, BSN, RN

Specializes in jack of all trades.

I noticed your in transplant? That would be my first choice but limited opportunities in this area as it seems. We have one hospital starting to do kidney transplant but they want people with other experience. Guess chronics doesnt fit the bill which I have yet to understand. My husband was 34 when he passed suddenly from a brainstem aneurysm and we did full donation. I was shocked to see how many people were helped by one person donating. Initially what got me into dialysis.

Tish88

Specializes in Dialysis (acute & chronic).

I did transplant coordinator/case management for all organs and bone marrow transplants.

I did not work the surgical unit post transplant.

I did that for about 1 year, but missed dialysis too much so I came back. I think I would have stuck it out if it was just renal patients - they have a personality of their own!!!!

Valerie Salva, BSN, RN

Has 19 years experience.

I went to careerbuilder yesterday and checked out somethings. ResCare already called me regarding needing an RN to oversee 2 intermediate group homes for clients with developmental disabilities. Patience is a strong point with me in relation to clients just not with bully administrators :) It's a buck more per hour then what I was making as a manager in dialysis!!! Mon-Fri 8-5 and 3 miles from my home. Not the 50+/hrs aweek with the 45min drive to work that's for sure. Be a whole new world for me but I think I'm going to check it out and go through with an interview at least. I'm big on pt advocacy and that is the main issue I found in dialysis as it seemed profit first and patients last. This company is the largest in the nation providing the type services so may be something to consider. This entire issue may have turned out to be a blessing in disquise for me who knows but I am going to take my time. Well as long as the bank account can hold out that is lol. I was considering home care anyway just to keep from beating my body up anymore than it is lol. At least I would get to set down now and then.

Good luck! I'm glad you got out and hope things get better from here. Keep us updated!

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