Seeking advice for a new dialysis nurse

SnipRN · Mar 11, 2020

Hey there! I'm assuming that you've probably already started your new position by now, but if you'd still like to talk, I'm up for it! I'm totally a newbie nurse compared to you (just graduated last June), but have been working in chronic dialysis for the last 8 months. It is a very demanding job, and I am often physically exhausted at the end of the day...but I totally love it!

If you haven't started yet, you can expect that training will begin with you learning the role of the patient care technician first. In fact, you might even train UNDER a tech, to start. It seems weird, but you can't direct what you don't know, and the PCTs have a lot of responsibility in dialysis. You'll learn how to build the machines, how to troubleshoot, what the different alarms mean, and how to intervene. You'll get lots of practice cannulating fistulas and accessing catheters. There is a lot to learn, just on the tech side. I'm not sure about other facilities, but my company requires skills testing and several written exams throughout the training period. Once your fully comfortable with safely running a pod (usually 4 patients) from start to finish, you'll begin training as a nurse. It is quite the process.

Ideally, the techs are responsible for initiating treatment, but you should expect to be right out there with them, in the thick of it. If a patient has a difficult (or new) access, you will be responsible for cannulation. *Most* days (because we are chronically understaffed ?), I am running a pod (as a PCT) in addition to being the primary nurse for another 10 patients. It is almost like having two full time jobs, but only being paid for one. That is a definite con. But there a lot of pros also! The biggest for me is the relationships I get to build with my patients. You also can't beat the schedule, and the pay (even as a new grad) is pretty good.

My current nurse/patient ratio is 1:12. With you coming from LTC, I would bet that you are already used to having a large patient assignment--but the pace is going to be a lot different. It is go-go-go all day long. Personally, I love this aspect of the job--but some people have a hard time keeping up. I think this is where a lot of new employees get overwhelmed and quit before they are even fully trained. I'm not trying to scare you off, its just the reality of the situation. Some people love dialysis, others hate it. It's not for everyone.

Anyway, let me know if I can answer any questions for you! I think dialysis is a great field, and the patients are *truly* wonderful. You can't imagine the level of dedication they have, and it is really rewarding to be part of their journey.

kbrn2002, ADN, RN · Mar 11, 2020

Thanks for the response! Yes I started orientation, just! Two days in only and that's been all classroom teaching and new hire paperwork, so far so good. And yes, there's a lot of computer learning and testing as well as skills tests. I wonder if we work for the same company? It's likely as there's really only two big ones that I am aware of.

I am impressed with the compensation package. Pay is good, they matched my requested salary without too much argument. I am starting above where I was at my previous job by a few dollars which I was asking for to offset the loss of accrued benefits I had based on my seniority . Plus I was beyond pleased when we went over benefits yesterday. PTO accrual is better than where I was with my previous employer right out of the gate which I knew when I accepted the position. I wasn't going to even look at 401K enrollment since I have an IRA but the company match is great so I will definitely reconsider! I haven't done the health care enrollment yet but from what I see based on the rates it looks way better than what I had with my previous employer. Policies regarding attendance seem more than fair. Not that I am interested in tons of overtime but it sure looks like there is ample opportunity for it.

I will be training with a tech which I actually prefer, I'd like to know the job from the ground up and that seems the way to go. I'll start that soon. It was actually supposed to in a couple of days but the PCT they placed me with already had a trainee scheduled with her my first day on the floor so I am going to be tweaking my training schedule some. I"ll certainly have a ton of new stuff to learn which excites me. After 25 years of long term care I can't wait to learn something new.

I am not too worried about the time management aspect of the job because I am used to juggling a huge patient assignment so transitioning those skills to a different setting should be doable.

What's maybe a challenge is the manager at my home facility just went on an extended medical leave so none of my actual training will be there. I will get to know the staff and the workflow at a facility I won't even work at unless I pick up a shift there now and then. A tech in my training group is in the same boat and her training is in yet another facility. Plus is sounds like my "home" is getting a brand new building so I'll also be looking at moving to a different place when that's completed, probably this fall. No big deal there as the commute won't be much different and I'll be still learning at that point so familiarity with a new building will be just one more thing to learn.

Thanks again for responding! It was really helpful. Don't be surprised if I take you up on your offer to answer more questions, LOL!

SnipRN · Mar 12, 2020

Awesome! Good luck with your first day on the floor, I think you'll have fun with it! Definitely sounds like you've got the right attitude going in, and you are clearly no stranger to hard work! ?

Hoosier_RN, MSN · Mar 15, 2020

I've been an RN 22 years, with varied experiences. I've been in dialysis 2 1/2 years now and love it. I progressed pretty quick to clinic manager, but still tech and floor nurse often to keep skills. I love it! I'm with the F company. Are you with F or D? Theh are the big 2, but there is also US Renal, a couple of small private owned and some hospital owned. Just don't let the tech part frustrate you, as that job can be overwhelming, especially at turnover. You will get the hang of it. Good luck on your new adventure!

kbrn2002, ADN, RN · Mar 16, 2020

10 hours ago, Hoosier_RN said:
I've been an RN 22 years, with varied experiences. I've been in dialysis 2 1/2 years now and love it. I progressed pretty quick to clinic manager, but still tech and floor nurse often to keep skills. I love it! I'm with the F company. Are you with F or D? Theh are the big 2, but there is also US Renal, a couple of small private owned and some hospital owned. Just don't let the tech part frustrate you, as that job can be overwhelming, especially at turnover. You will get the hang of it. Good luck on your new adventure!

Thanks! So far I am really enjoying the challenge of actually learning something new. I work for the F, so we are with the same company. They are the only dialysis provider in my area. Nine facilities in the district. At some point the plan is for me to float, the longest commute would be about an hour and half one way. Knowing I'll eventually working everywhere makes my weird training schedule a little easier. Classroom training is one facility, my training with a PCT is in another and I have no clue yet where I'll be when I train with an RN. The only thing I am pretty sure of is it won't be in my "home" unit since the manage is out for at least 3 months and I understand none of the nurses based there have been there more than a year.

Hoosier_RN, MSN · Mar 16, 2020

9 hours ago, kbrn2002 said:
Thanks! So far I am really enjoying the challenge of actually learning something new. I work for the F, so we are with the same company. They are the only dialysis provider in my area. Nine facilities in the district. At some point the plan is for me to float, the longest commute would be about an hour and half one way. Knowing I'll eventually working everywhere makes my weird training schedule a little easier. Classroom training is one facility, my training with a PCT is in another and I have no clue yet where I'll be when I train with an RN. The only thing I am pretty sure of is it won't be in my "home" unit since the manage is out for at least 3 months and I understand none of the nurses based there have been there more than a year.

Welcome to the company!

Zarry · Apr 22, 2020

You're awesome! Thank you for enlightening those who are seeking information re dialysis RN. This is certainly helpful.