So How Long Does the Misery Last?

iriskkerry · Nov 22, 2006

I'm by no means an expert here, but, I can share what draws me to dialysis. Maybe it will help. I love the process. It has a daily beginning, middle and an end. It has short term goals (even tho at times that goal is just keeping your head until the end of the day). It has long term goals (improving clients numbers and quality of life). The pay is decent, benefits are good, there's always OT available. It is a daily challenge to use ALL of your nursing skills. You have the ability to get to know youyr patients and sometimes their families. I am curious, what brought you to dialysis in the first place?

DeLana_RN, BSN, RN · Nov 22, 2006

Hi,

to be able to give you some meaningful advice, I need some more info. How long have you been training so far? How much classroom, floor, or self-study? And especially, what aspects of the job do you dislike or find difficult(technical, other workers, patients, hours...)? I assume you work for a for-profit dialysis company in an outpatient setting.

Yes, the training can be very difficult and challenging; but I don't want to make any assumptions and give you advice that may not apply to your situation. You may have heard (by coworkers, perhaps) that you will either love or hate dialysis; in reality, it's never that simple. Some people don't find out that they really like it until they're much further along, say 6 months or so.

Good luck!

DeLana :)

HardworkinRN · Nov 23, 2006

Hi- Yes I'm working for a large for-profit company at a very busy clinic. I'm several weeks in to the 10-12 week training that includes both classroom and floor work throughout. To be honest I didn't know much about the field before I started but wanted something new after several years of working as a nurse in another field. Now I find that I'm hating the technical aspects of the job and feel very overwhelmed by all the details and the heavy patient loads. The clinic is in compliance with patient-staff ratios but it seems borderline unsafe to me. Workers not getting breaks, lots of shortcuts, stressed out nurses, etc. My co-workers are nice for the most part and the manager seems like a decent guy but is mostly focused on the numbers.

I'm thankful for any thoughts other dialysis nurses out there might have.

DeLana_RN, BSN, RN · Nov 23, 2006

Are you having trouble with the machines, cannulation, that kind of thing? It will take time, lots of time (don't expect to be as good and fast as someone who has done this for a long time!), and lots of practice. I thought I was never going to figure out recirculation (at least my evil preceptor :devil: told me so; she also threatened me with an egg timer 'cause I couldn't keep up with her - well, she only had about 8 years experience :angryfire ), but guess what, I did. Initially, what helped me a lot was flash cards with the steps written out (taken from the P&P) in my pocket.

Are you in a state where PCTs can push heparin? If so, this would make the job much easier (of course you have no control over the BON's rules). It's illegal in my state, and guess what, most of my fellow nurses let or made them do it anyway. This bothered me a great deal, along with the other short-cuts they took. However, I refused to sink to that level and always followed P&P; it wasn't easy - I'll admit - but I was able to look in the mirror. And I stayed there for 5 years! (I left for personal reasons).

The patients will be testing you and some play games ("You can't stick me!") However, once they get to know and trust you this will change (and some won't, but don't take it personally; they weren't very nice people before they went on dialysis and that sure didn't improve their personalities ).

Nice coworkers (and I assume your preceptor) and manager are a big plus; as for your boss being focused on the numbers, he has no choice in the matter; it comes from above. But from what I hear from other nurses, this isn't limited to dialysis...

You won't feel comfortable as a dialysis nurse for at least a year; I say, more like 2-3 years (to be able to deal with most situations that may come up). It's truly different and not for everyone; the training period is especially overwhelming, you may think I will never learn this. But you may want to give yourself more time, by 6 months or so in the field you should know if this is for you.

BTW, I won't lie to you; I'm getting ready to go back to work (PRN), but not in a clinic. The early morning hours (I'm so not a morning person!) alone were very, very difficult for me (can you believe it, although I worked these hours - having to get up at 4:00 a.m. - I didn't really get used to them in 5 years? So I figured I never would ). However, with the experience I have I had no difficulty finding a position in a hospital inpatient dialysis unit with the unbelievable ratio of 1:1. Once you have at least a year's experience, you will have no trouble finding such a position and most who work there say it's much, much easier than clinic dialysis (I'll let you know).

I wish you the best of luck, hopefully I was able to address some of your concerns and give you encouragement. Feel free to ask more questions or PM me if you like.

Happy Thanksgiving!

DeLana :)

Trauma Columnist · Nov 26, 2006

DeLana - I do hospital care too and yes, the acute RN's love it - they have only one patient and they have the support and back-up of an entire hospital including doctors and other RN's.

DeLana_RN, BSN, RN · Nov 27, 2006

DeLana - I do hospital care too and yes, the acute RN's love it - they have only one patient and they have the support and back-up of an entire hospital including doctors and other RN's.

Thanks, I needed that - I'm starting tomorrow!

DeLana

Trauma Columnist · Nov 28, 2006

Good luck...I'm sure with your knowledge and enthusiam, you'll do just great. They will be lucky to have you!

healthbuffnurse · Dec 2, 2006

hi well to be in the dialysis field takes a lot of gutts knowing that your patients conditon are mostly chronic and they might not live longer and you must have lots and lots of compassion for them and your work.

when i was new with hemodialysis, i cried for the first time when my patient didnt show up and later knew he past away, how can i not forget this patient, he calls me superman because he said i look like him, imagine he was in a very excruciating pain that time to still joke like that..i guess he was delirius from pain. i felt guilty for not doing enough maybe when he died. but soon i got used to it but my compassion for them is still there.

then about the machine, oh yeah, i had a headache so bad just looking at the machine and how it looks so complicated. but then im really into knowing things more and maybe challenged, in 2 weeks im doing it already with assistance, in a month im a little bit good, in 2 months im performing solo.

if a patient doesnt like me to stick them with needles, only their preferred nurse, ill tell them that nurse will be resigning soon so how can you get your treatment if you wont try me sticking it up for you, then they let me. just need some tricks. but then again patients are mostly irritable for they are sick, its understandable.

most importantly your cammaraderie and friendship with your co-workers in your center. these will make you at ease and enjoy while working in such condition.

well, hope that ill experience working in the us as hd nurse soon. maybe then ill see whats the difference.

scrabbler77 · Dec 3, 2006

I also have felt overwhelmed, --one day I started crying on the floor -- something I've never done before in my nursing career. But I'm working with a supportive supervisor and great staff and they're willing to wait for me to "get it" and in the meantime put up with a million questions. I've been at this clinic for about 4 months and I'm thinking it will take a year to be passable and maybe after two years to be somewhat confident. But I know that I love dialysis -- actually can't wait to get to work! I love the time you spend with the patients, the teamwork at my clinic, the whole pace of the day and most of all (I know this sounds strange), sticking someone cleanly, without causing them much pain (thank God for emla cream) and watching them run at a good blood flow with good pressures.

I would like to hear from experienced nurses about sticking -- is flipping arterial needles bad or good? If good, do you flip them after they're already in all the way or after you're in the access? Does anyone stick bevel down (I saw this recommended in a brochure)? What are techniches for tough sticks, accesses very hard to feel, etc.? And does anyone "buttonhole" AVFs? Does it really improve blood flow to point art needles down? Any technique advice would be very welcome.

This forum has really been a help to me, thanks y'all.

flyingsolo · Dec 4, 2006

I am seriously considering dialysis nursing when I finish school a year from now--but after reading this thread, I am thinking it is very much technical things, whereas I had thought that it was more holistic. Is hooking the patient up each day that difficult? I have only read/classwork about it, but I thought the patients already had these AV grafts which enabled an easy hook up each day. It scares me to read that it take a year to feel competent. Do you apply as a graduate/soon to be graduate nurse and then do they put you through a course? Is it more/less difficult to get a job in a hospital rather than a for-profit clinic? Are the hours any different, as in always days or do they go 24/7 with the machines? Is there any path for progression to supervisory, or is it pretty much the same job year in, and year out. Do you counsel your patients on things about advance directives, nutrition, etc. or is it just technical skills done during the procedure? Do you sit with them, walk around to mulitiple patients, get time to do paperwork or computer stuff? Thanks for any help from you experience people.

scrabbler77 · Dec 4, 2006

I can address a couple of your questions even with my 4 months experience. Yes, there is a large technical part of the job. You have some pts. with AV fistulas, some with grafts and others with catheters. Some fistulas and grafts are a snap to cannulate but others are not. Problems like scar tissue, depth of access, straightness, etc. Of course the caths just get hooked up but often caths are problematic and won't run well. Then there are the machines -- ours have many screens to go through when hooking people up. The challenging part is getting people on very quickly so as not to make the next shift late, and at changeover, getting 4 off and 4 on, almost at the same time. All this is quite doable and I think it's taking me longer because of my age and being a slowish learner. Most of our techs are awesomely fast and capable at these things. Being an RN gives you that extra pressure not to just do the tech stuff but teaching to sign for, meds to check on, etc.

And you do have lot more time for teaching and talking to pts. than in the hospital. They are there 4 hours at a time, 3 days a week. You really bond with them. At our clinic we work 4 days a week, from about 5:45am to about 4:30 or 5pm, with 2 breaks -- one a half hour and one 45 minutes.

I think working at a hospital is much more difficult because you feel like you have to know everything about everything. Also I think the teamwork in the dialysis clinic makes it a better job. You're all in the same room!

I've worked in a hospital, a health dept and a rehab facility and I am enjoying my dialysis job more than any other.