Starting late?

First, I would suggest that you put yourself in the patient's shoes. It is not easy for patients, no matter how long they are on dialysis. Even a few minutes outside their normal routine of getting to unit and being put on can have psychological effects. I am not sure I could do as well as many of our patients - dealing with dialysis. As far as the RN is it possible to ask her why she told a patient a certain thing? What specifically does she say to patients in lieu of policy?

Lacie,

Pt's complain because they got on only 5 min late? That's not bad at all considering all the responsibilities a nurse has in the chronic setting. In general, it's "supposed" to take about 15 min to put on a pt, but that's without constant interruptions (e.g., having to assess a PCT's pt, push heparin, and/or dealing with another pt's problem). And on top of that you are new, and will necessarily be somewhat "slow" (I hated that word when I worked in chronics... all the short-cut queens used it on me).

If you go in at 0530 and are supposed to put on a pt immediately, I assume someone else sets up your machines? And draws the heparin for all pts on your team? Tests the water, etc.? It always took me about 30-45 min to get ready to put on the first pt (nurses had to set up their own machines, draw heparin, etc). One way to manage if time is a problem: Come in early to get started. That is, if your clinic allows that.

As for complaining pts, keep in mind that what makes chronic dialysis great - developing a long-term relationship with your pts - is also its greatest drawback. Dialysis does not improve anybody's personality; if anything, it can bring out the worst. ESRD pts have the same mix of personalities (including disorders ) as anybody else; so you will have the chronic complainer. Many wouldn't care if they got on 30 mins late at times while others will "explode" it it's only 5 min. This doesn't make it any easier, I know.

Pts observe, often there's nothing else to do. They can see that you're not reading the newspaper while you're getting ready to put them on; they know you are busy with another pt, PCT, whatever. And they know that you're new and that speed will come with time. You shouldn't have any problem with most of them, and the rest will find something to complain about (if they dont' like you; and sadly, some may just not).

My advice would be to come in earlier if this would give you an edge. As for Miss Know-it-all, that's a tough one. You can always show P&P to them if they doubt what you're telling them. And some may just believe anything Miss K-i-a tells them, just because they know and (often misguidedly) trust her. Again, this will improve as they get to know you better.

HTH. I wish you the best of luck,

DeLana :)

Thanks very much for the responses. I must agree with you Delana and realize this is an area requiring a great deal of patience majority of the time. I pretty much tell them they are following someone who didnt get off just in time or I'd rather do the job correctly and ensure they are getting quality care. Going in early isnt the option for the moment due to facility scheduling not my own which I hope resolves soon. At the moment the only thing I'm not doing is water checks which will be added to my routine soon. I'm also one elected to do our computer conversions shortly which I know teaching and getting other staff used to the new programs is definitely going to cause further delay for a hopefully short period of time. (Crossing my fingers lol). I do enjoy the work though in light of some of the temperments.