Strategies for the change in shifts in a dialysis unit.

[moley89]

Hello.

I am a second year medical student at the minute and I have been asked to produce a project on improving the change in patient shifts in a dialysis unit.

Since I'm only a second year I don't have a lot of knowledge and experience in this, so basically I'm trying to get a better idea of what sort of problems the shift change presents and how they are or could be overcome.

From speaking with the nurses in the dialysis clinic in our hospitals the main issue I've gotten is being shortstaffed, and that to help with this they stagger the time each patient is due to come off the machines.

If anyone on here has any other views on this then it would be really helpful to hear them.

Thanks.

[traumaRUs, MSN, APRN]

Hi I'm an APN in several oupt HDUs. Several different ways to do it:

1. Everyone goes on within 15 minutes od each other and both techs and RNs work to put people on. (6-10 chair units)

2. Everyone has staggered on times and then there is approx 30 mins where everyone cleans up and strings machines. Only works in 5 to 10 chair units with two shifts.

3. Everyone has staggered on times and staff keep working thru 3 shifts. RNs only help in emergencies. This keeps them free to do assessments and the endless paperwork and calls. This is what they do in my larger units, 21 to 32 chairs.

[mgdrn]

Some things you need to consider during shift change in HD.

Staff available, type of access, pt stability, policy/state law, equipment.

Staff available: I work in a 12 station unit, we try to keep off times limited to # of PCTs available with RN available if necessary.

Type of access: catheters don't require clotting time, chairs can usually be turned over a little faster.

Pt stability: Prolonged bleeding, hypotension, etc. can delay the next pt. Many of these problems can be corrected by identifying them and changing the tx plan (raising EDW, decreasing heparin, vascular assessment/intervation)

Policy/law: stations here need to be cleaned with disinfectant (including the chair after the pt leaves), we use a bleach solution which requires a 10 min "dry time".

Equipment: Machines need to be set up and tested between pts.

The real trick is to get this done and have the staff free to start another while they may have 2-3 other nearly done. As the CN I do end up helping quite a bit, whether this is rinsing pts, cleaning stations, walking pts in or out, or trying to trouble shoot problems.

You have quite a challenge, good luck!

[madwife2002, BSN, RN]

In my facility we have 20 chairs we plan for the following

15 mins between on's

20 mins between off's

45 mins between pts on the same chair

We staff 2 techs to come in at 4am-1300

2 techs come in at 7;30-18:00

2 techs come in at 12:00 till close

we run 4 shifts but the 4th shift is quiet

[ldyjstce]

I work in a 30 unit center with most chairs filled at each shift (we run 2 shifts per day/6 days per week). There is a definite "power struggle". The techs think the nurses do nothing but sit and chat; I, being an RN, can never get all the work done that we HAVE to get done. Assessments, med checks, foot checks, progress notes, etc. on 90 pts. along with putting pts. on, taking them off and turning stations over -- it is tremendously frustrating. Nurses and techs each have 4 stations and the nurses are responsible, of course, for putting on all the catheters (even if they are not our assigned pts) and pushing all the systemic heparin boluses. We are always behind the 8-ball. Needless to say, this being my first RN job out of school, and being 5 months into the job, I constantly wonder -- "what have I done?!?!"

[DeLana_RN, BSN, RN]

I work in a 30 unit center with most chairs filled at each shift (we run 2 shifts per day/6 days per week). There is a definite "power struggle". The techs think the nurses do nothing but sit and chat; I, being an RN, can never get all the work done that we HAVE to get done. Assessments, med checks, foot checks, progress notes, etc. on 90 pts. along with putting pts. on, taking them off and turning stations over -- it is tremendously frustrating. Nurses and techs each have 4 stations and the nurses are responsible, of course, for putting on all the catheters (even if they are not our assigned pts) and pushing all the systemic heparin boluses. We are always behind the 8-ball. Needless to say, this being my first RN job out of school, and being 5 months into the job, I constantly wonder -- "what have I done?!?!"

Oh, my, I'm amazed you're still there. You mean you alone have to turn over four stations, in addition to putting on/off the permcath pts of th PCTs?! That sounds excessive (and yes, all the other stuff too - meds, assessments, etc). And don't get me started on PCT attitudes.... (they just don't understand that the nurses have to do their job plus so much more).

Best of luck to you - hang in there, you've managed for 5 months; it should get much easier with time. And if it doesn't improve, well after a year you may as well move on (maybe to acute dialysis.)

DeLana

[madwife2002, BSN, RN]

I work in a 30 unit center with most chairs filled at each shift (we run 2 shifts per day/6 days per week). There is a definite "power struggle". The techs think the nurses do nothing but sit and chat; I, being an RN, can never get all the work done that we HAVE to get done. Assessments, med checks, foot checks, progress notes, etc. on 90 pts. along with putting pts. on, taking them off and turning stations over -- it is tremendously frustrating. Nurses and techs each have 4 stations and the nurses are responsible, of course, for putting on all the catheters (even if they are not our assigned pts) and pushing all the systemic heparin boluses. We are always behind the 8-ball. Needless to say, this being my first RN job out of school, and being 5 months into the job, I constantly wonder -- "what have I done?!?!"

Come work for me, the RN's do not unless absolutly no choice put pt's on or rinse back. But they have a mountain of paperwork which grows daily!