Starting dialysis charge nursing, already feel like I'm drowning

Specialties Urology

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I started nursing in the ER as a new grad for 2 years ago, wasn't for me, and was looking for a change. I found dialysis interesting and was keen to leave the chaos of the ER in favor of a more predicrable and consistent day. I started with Davita 5 months ago and was told off the bat they need me to be charge nurse capable in 9 months. They assured me that it would not be sooner per policy. Before then, I would do 12 weeks of training (2 weeks class, 10 weeks on the floor being trained by pct). By month 4, as I'm getting the hang of med nursing, one of the 2 RNs that works here quit. He was a charge nurse and clinical coordinator so that was a huge blow to the clinic. In May my FA let us know were moving ahead of schedule and that I should be charge ready by July. I've been doing on the job training for charge for about 7 shifts total since the beginning of may with the only other RN, with one of those shifts being mostly by myself due to the RN training me having to leave early in the day for medical reasons.

Now I start next week and I'm not feeling totally confident in my ability to charge. Yes, I can do the basics like round with the doctor, start and end the day, and handle a code if need be, but I havent had that much training on alot of our charting programs (we have 3 charting programs), I don't know these patients very well since I've been switched between tts and mwf every other week simce I started, and to top ot all off, the last RN who was suppose to be my med nurse/backup charge is gonna be gone for the next month right when I start due to medical reasons. So now its gonna be me, an lvn or float RN as my med nurse, my fa who has no clinical skills, and an in-house pd nurse.

I left the ER to escape the chaos and I'm deeper than before: I've been doing online training this week before the week I charge and I'm learning all these policies and procedures that we haven't even covered on the floor.

This is mostly a rant, but I'm looking for feedback or insight on this situation cause as much as I hate to say it, I'm probably gonna look for another job at this rate. I feel like the amount of work put on the charge nurse, much less a new charge nurse who has no prior experience, is too much.

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Specializes in Dialysis.

Just do what you can. If you’re unable to do something, then just say you weren’t trained for it. I work for Davita and notice lot of experienced staff leaving due to poor management and budget cutting. I’ve been a clinical coordinator and having to cover TtHS and MWF on the floor for 2 weeks. Davita didn’t really handle COVID well with staffing as they did not hire extra staff. Also cause their new hire rate is not competitive at all.

if you feel you don’t want to be charge, then let your FA know.

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Specializes in Dialysis.

This is a recipe for disaster, for you and patients. Talk to FA immediately 

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Specializes in "Duncan6" Endocrinology and Dialysis.

I agree with Hoosier.  It takes a good year to be comfortable just doing all the regular RN work.  Your FA should know better.  Of course, you mention she has no clinical skills, so maybe she doesn't know...At any rate, I hope it works out for you.

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Specializes in Dialysis.

DaVita is a mess. It is completely chaotic; at least the one where I work is. I cannot wait to leave. I definitely would speak to your FA. 

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

3 charting systems? What a mess. FKC has two, Cerner and Chairside. And they talk to each other. I could not handle it any other way. I have heard a lot from techs and nurses that charting there is a nightmare.

I know I only addressed charting but that stood out to me. It sounds horrible.

It sounds like your clinic is in chaos. Another clinic might not be as bad. Have you checked around for openings in other clinics?

On 7/6/2021 at 7:22 AM, Hoosier_RN said:

This is a recipe for disaster, for you and patients. Talk to FA immediately 

Well stated as always.

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Specializes in Dialysis.
8 hours ago, SmilingBluEyes said:

3 charting systems? What a mess. FKC has two, Cerner and Chairside. And they talk to each other. 

Chairside and eCube (cerner) aren't perfect for sure, but the 3 charting systems sounds crazy to me!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
On 7/9/2021 at 4:19 AM, Hoosier_RN said:

Chairside and eCube (cerner) aren't perfect for sure, but the 3 charting systems sounds crazy to me!

Agreed far from perfect. But my friends at Davita describe nightmare charting there. I will take our imperfect system over that mess.

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On 7/5/2021 at 3:35 PM, maybaycao said:

Just do what you can. If you’re unable to do something, then just say you weren’t trained for it. I work for Davita and notice lot of experienced staff leaving due to poor management and budget cutting. I’ve been a clinical coordinator and having to cover TtHS and MWF on the floor for 2 weeks. Davita didn’t really handle COVID well with staffing as they did not hire extra staff. Also cause their new hire rate is not competitive at all.

if you feel you don’t want to be charge, then let your FA know.

Thank you for your input. It seems very unorganized here. When we get new admissions from other Davita facilities we have to enter everything in manually, despite using the same charting system. Which takes FOREVER. I took a look at our vaccinations, alot of people are overdo for tb tests and hep b shots by almost a year, and everyone has their own way of staying organized via makeshift binders and loose leaf paper and notes. Whenever I have a question regarding policy there is a 50/50 chance theres something in writing. Otherwise its just a spoken policy for this facility. This is for things like hanging certain meds or the hep b dose schedule. The RN who trained me said there is alot that I need to know but can't be trained on until it happens. Which would be fine if I had more time to train and experienced staff to support me. But with the accelerated training given to me and the only 2 experienced RNs for this facility gone it's been too stressful. I have this knot in my stomach every time I see the schedule with me as charge. When I first started, this feeling I had felt like lack of confidence in my own abilities due to a poor experience from my previous job; now I'm thinking I got myself into a mess of a job I'm not equipped to do. I will be speaking to my FA regarding my future here

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On 7/6/2021 at 5:34 PM, Eileen Meyers said:

I agree with Hoosier.  It takes a good year to be comfortable just doing all the regular RN work.  Your FA should know better.  Of course, you mention she has no clinical skills, so maybe she doesn't know...At any rate, I hope it works out for you.

I hope so too. I just replied to maybaycao regarding the situation. I'll be speaking to my FA regarding my future at this facility. I'm leaning towards more training, however, I'm keeping my options open.

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