Thoughts from a brand new dialysis nurse

[Nurse Magnolia, BSN, RN]

So I've been a dialysis nurse for two weeks. I am a second career nurse who spent the first year of licensure as a psych nurse and then decided to make the switch to dialysis for many reasons. I am training at a Davita clinic in the Pittsburgh region right now. My training is 9 weeks in orientation and then three more weeks of independent practice with oversight until I'm on my own completely with my own assignment.

I honestly had no idea what to expect. I couldn't even shadow for the job before accepting it because of Covid. I can say I am very pleasantly surprised at how much I am enjoying it so far. Here are my thoughts:

The Good:

I was worried to begin about being trained by a PCT. In the hospital, the PCT's have far fewer responsibilities and I just couldn't see the value. NOW, I do. The PCT training me is amazing. PCT's in dialysis do so much more and have so many more responsibilities than hospital PCT's and her knowledge is vast. I understand this may vary depending on who's training you - but my preceptor is awesome at her job and she's been there 10 years. The RN preceptor has been there 9 years as well. Everyone I've met has been with Davita for a very long time, giving me a positive image of the company.

I learned to set up the machines this week and I am up to doing 3 machines in an hour and helping at turnover getting machines set up. Apparently, this is pretty fast for a brand new person. So I feel like I'm making progress. The flow of the unit is starting to make sense to me as well and I like the pace. Super busy getting everyone on the machines, then time to get caught up and talk to patients, and then it's time to take patients off and put new people on and you are super busy again. The ebb and flow is something I like.

I was concerned about PCT's pulling meds for patients, but then I realized once on the unit that it's pretty limited and very little room for error. The nurse verifies that the PCT pulled the right about of heparin before it's given. All other meds are given by the nurse. This fact seemed missed in a lot of the posts I'd read prior to starting.

I really enjoy talking to the patients and I'm excited to learn about cannulation next. Right now I am independent up to the point of putting the patient on the machine, including charting.

The Bad:

There isn't much bad. Getting up at 3am is tougher than I thought. But I work 4am -2pm right now and I like getting home in the afternoon.

The class portion is interesting to me, but tough because PCT's and nurses are trained together for the first 12 weeks. The PCT's that I'm working with are amazing because they've been there a long time and succeeded within the company. My training class is another story. Not everyone makes it. And I can tell that some won't. Coming in late, one was sleeping during class, talking back, rudeness, unprofessional. It's tough because the entry-level for the PCT is nothing. No experience needed. All training on the job. So you have people coming straight from working retail or fast food and coming into a professional environment and some just don't know how to behave. There are 8 people in my class. Three nurses, the rest PCT's and of my PCT classmates I can see two making it as they are professional and eager to learn. Lack of previous education does not make one unsuccessful as a PCT, but some of the people literally have no desire to be there except that it makes more money than other entry-level jobs. I feel like the PCT turnover has to be extremely high.

I wish nurses were trained separately but I understand why they are not. We are all learning the same things from the ground up. It's just hard being in class with others who don't care, can't keep up with what page we are on, know literally NOTHING about medical terminology and talk back to the amazing instructor we have.

The only other bad is the chairside charting system. It is SO OUTDATED and not very user friendly. They are supposed to be getting a new system which will integrate all of their systems and I think that will help a lot. Right now there are several different systems and they don't talk to each other.

Other than the class frustration, I've found my first two weeks at Davita to be really good. I'm loving the company culture and the people I've met. I can see myself here for a long time. I hope. I am pleasantly surprised at dialysis nursing. I am still on task mode but am starting to piece together why certain things are done and how that affects the patients. The rationales will come. But for now, I'm happy!

[IMOKAY, BSN]

Thank you for this! I'd love to hear more from you after you've been there awhile.

[Ambitious Nurse P, BSN, RN]

I am so glad you are enjoying the village. You will like it if you do not pay attention to the drama in the clinic. You will learn to cannulate next then you initiate and terminate treatment and put all tasks together and in a no time, you will make significant progress.

By practicing machine set up, you will set each machine in like 5 minutes. I promise it will all come together. Please let me know if you have any questions and welcome to the village!

[slopez0313]

I would also love to hear more about your new position. Would you recommend this Position for a new grad? A clinic is actively hiring and I have been in touch with a recruiter who is currently in the process of getting my application to the clinic manager. I don’t have much exposure to dialysis besides the one occasion that I saw a patient get dialysis at the bedside in an ICU, however Prior to nursing school I worked in primary care clinics for about 7 years and I believe I prefer the clinic setting over a hospital unit.

Good luck with your journey in dialysis nursing !!

[Hoosier_RN, MSN]

The reason for not mentioning that techs draw and administer heparin: not all states allow it. Good luck in your future. I have found that nurses love or hate dialysis. No in between

[Nurse Magnolia, BSN, RN]

Update:

I have now finished 4 weeks at Davita. I still like it ? . I have learned so much and I'm really getting to know the patients - although that kind of stinks because I am going to switch clinics when my training is done. I can do everything from getting the patients on, to getting them off of the machines, with the exception of cannulation. I learn that this week. Then I can put it all together. So far, so good. I can see myself staying with this company and Dialysis. The 3am wake up's have me exhausted by the end of the week, but in a good way.

I have not done a whole lot of "nursing" things, but this is to be expected right now as I need to learn dialysis first. Walk before I run. But I have dipped my toe into the nursing charting systems, policies for contacting the doctors, etc...My manager told me this week he would expect me to be a clinical coordinator at some point (way down the road) which made me feel like I must be doing well.

I do not miss the hospital AT ALL. I miss 3 12's, but honestly with how busy dialysis is I'm not sure I could handle a 12 hour shift. The 10's are enough.

I'm really glad I tried this - I wasn't sure what to expect. I work with great people and the clinic I am going to after training has an excellent reputation in our area - so I'm hopefully I will like it there also. The biggest difference in clinics is the size. I'm training at a 13 chair clinic and I'll be working at at 24 chair clinic. What I've heard is that the nurses there do less "tech" work because there are so many patients. They are more coordinators of care - which I like as well. I'm glad to be learning things from the ground up. It's a good training program for sure.

[Nurse Magnolia, BSN, RN]

On 6/3/2020 at 7:46 PM, slopez0313 said:

I would also love to hear more about your new position. Would you recommend this Position for a new grad? A clinic is actively hiring and I have been in touch with a recruiter who is currently in the process of getting my application to the clinic manager. I don’t have much exposure to dialysis besides the one occasion that I saw a patient get dialysis at the bedside in an ICU, however Prior to nursing school I worked in primary care clinics for about 7 years and I believe I prefer the clinic setting over a hospital unit.

Good luck with your journey in dialysis nursing !!

Both nurses at the clinic I am working for started in dialysis straight out of nursing school and have been with Davita for 10 years. I think it would be a pretty good job for a new grad. You won't learn the hospital stuff, but that's not everyone's goal after nursing school. I've only been a nurse for a year, so I'm still a "new grad" and I think that's helped me in dialysis. I'm eager to learn and willing to start at the bottom. Nurses who've been in the hospital for years and built up seniority may struggle with that. Even experienced nurses who are new to dialysis have to learn dialysis and it's a very specialized niche. So in that way, I think new nurses have an advantage. We already know we don't know much so we are willing to listen and learn!

[IMOKAY, BSN]

Yay!! Thank you for the update! So glad it's been a positive experience so far. There are so many things about dialysis I believe I'd love. It's just some comments on here about toxic culture and lack of training that make me hesitate to make the jump. I realize not all clinics are that way though.

[Hoosier_RN, MSN]

8 hours ago, Nurse Magnolia said:

So in that way, I think new nurses have an advantage. We already know we don't know much so we are willing to listen and learn!

Sometimes yes, sometimes no. New nurses have to learn how to be nurses. Experienced nurses have assessment skills and intuition down pat.

Newer nurses also tend to let the technology do assessments for them-this monitor says this, so blahblahblah-experienced generally see the big picture. So there is advantages to being experienced coming in, as well

[DeLana_RN, BSN, RN]

Like pp said, not all states allow PCTs to give heparin; mine doesn't, however most of the nursing staff at the clinics I used to work in let them do it anyway (I didn't, but that made my job harder). That's the main reason why I won't consider going back to clinic dialysis... it was a constant headache for me.
If that's not the case in your state, OP, it will make your job much easier.

I think you have the right mindset to become a great dialysis nurse. Like many others have said, you will either love or hate it - and you will know this very early. It's obvious you love it already, and your colleagues and manager undoubtedly have noticed (I loved it, too - which is why I'm considering going back into acute dialysis).

Best of luck to you, keep us posted! Your positive attitude is inspiring.

[Nurse Magnolia, BSN, RN]

Now in the middle of 6 weeks. I am still really liking it. I don't hate it so I must be one of those people who love it. I'm enjoying getting to know my patients a lot and I started cannulating at the start of this week and had no trouble. Of course, they gave me pretty easy fistula's and grafts at this point. My biggest challenge right now is turn over. I guess because some people come late and others show up early, sometimes we have two take offs and a put on within 10 minutes of each other. There is no way I can do that alone - even off of orientation. They say it's not typical to be scheduled like that and when it is, people jump in to help - which is accurate. I can handle a two pod assignment currently from start to finish. But I haven't figured out how to add that third in quite yet - but that's OK....I'm not supposed to know how to do that yet.

I haven't learned much "nursing" stuff, but I am doing assessments and meds. PCT's pull heparin for the second and third shifts. RN's pull for the first shift. I've learned a little about the nursing charting in their systems, but not a ton yet.

I've explored many of the opportunities for advancement and I am excited to know that in a year or two I can progress in my career.

So far, so good! I'm not sure why people think dialysis isn't 'real' nursing or that you'd be bored....It most certainly is, and I don't have time to be bored. I'm very, very busy all day!

[amoLucia]

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