Thoughts from a brand new dialysis nurse

[Nurse Magnolia]

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]

From what I've read, it's usually every other day (3 x week) for continuity of care. You have the same patients. I'm not a dialysis nurse, this is just what I've learned from looking into it.

[integrativenurse]

We're scheduled to work 4 ten-hour shifts then your typical every other weekend (Saturday); not necessarily 4 days straight though. I don't want to jinx it but we're are lucky to have more than enough staff and no one gets sent home when census goes down, so we can sometimes ask to work 4 days straight just so we can have a very long weekend (5 days straight).

[Nurse Magnolia, BSN, RN]

1 hour ago, aksti1018 said:

I’m doing home health right now and thinking of switching to dialysis. I have done time in ER, med/surg oncology, outpatient IR and now home health. I love HH but hate having to be on call and I’m always thinking about work- there’s no clocking out. I’ve been interested in dialysis for a while but scared to take that jump. Do you have to work 4 days in a row or is it every other day? I know different clinics have different schedules.

Your posts have been very informative so thank you for sharing!

I have worked 3 in a row, but not 4. But it can happen. The shifts really depend on the clinic so that part is true. There are only two 3 day a week clinics in my area so those nurses work 3 12's. But most clinics are 6 day a week clinics with patients coming in M, W, F and a different set of patients coming in T, TH, SAT. Dialysis patients get dialysis 3x week. But because of shift and assignment changes, you likely won't have the same patients every time. But given that the same patients come all week, every week, you end up getting to know your patients very well because eventually, you take care of all of them.

The job right now is hard. I'm learning tech work and also starting to throw in some of the nursing things like meds and assessments. At the training clinic, the nurses also have an assignment because it's a small clinic. At my final home clinic, the nurses generally don't take an assignment. It can be a physically exhausting job with ebbs and flows to the day. When it's busy, it's super busy. That's usually at shift change. But we also get a 30 minute on the clock break in the morning and a 45 minute off the clock lunch each day. And I'm out of there by 4 usually. Very early mornings some days. And some days stretch past 10 hours....but then again some days I'm done in 9. It's variable due to patient rides and patients showing up late.

I'm still really liking it. I am working a two patient assignment start to finish at this point plus adding in the nursing stuff. I'm looking forward to learning more of the nursing role at my clinic which is more of a care coordination role rather than a hands on patient care role. I will rarely have an assignment after I'm trained unless a tech calls off.

[kbrn2002, ADN, RN]

I am one of the experienced nurses that switched to dialysis. 25 years experience in nursing has definitely helped I think. Though I do have to admit I didn't know how much I didn't know about kidney care until I started this journey.

I did my PCT training in a small 8 chair clinic which I am feeling was beneficial. There was enough down time that I am the only person in my training class that managed to stay on track with getting all the computer education completed on time with no problem.

I was also the only nurse in my training class and thanks to fast tracking some of the training after COVID hit I had a lot more computer training than my PCT friends which took me off the floor more than I liked. I still don't feel I am as proficient as I should be putting people on and taking them off. Turnover can be shall we say a little hectic!

I moved to a 19 chair clinic for my nurse training. I had heard from a few recent hires that the nurse training was easier than the PCT training and I have to say I agree. As of yesterday I was on my own and while I still have a lot of questions thankfully the nurses I am working with have been extremely supportive. Not once have I been made to feel I am not progressing fast enough, quite the opposite. Every single staff has warned me that I won't really feel comfortable until about the one year mark and I certainly believe that.

Overall I'd say it's going so far so good. I am liking the pace of the clinic. It's a long day but it's busy enough time goes fast. Eventually I will be floating to other area clinics and I am nervous/excited about it. Hopefully by the time that happens I will feel more confident about what I am doing!

[slopez0313]

Hey all,

I decided to take the job for the dialysis clinic. This is week 4 for me and I can say it’s going about the same as @Nurse Magnolia has described during her journey. I began cannulating this week and initiating/terminating treatment as well. This is my first job as an RN. And So far I like how it’s going!

Hopefully y’all can still say the same! Good luck ?

[Nurse Magnolia, BSN, RN]

I'm now in week 11. I passed my final exam with a 96% and now I'm just doing my 'soft landing' at my home clinic. I have usually two patients per shift, but then I am also pulling all of the meds and helping out with other pods once my two patients are on.

I like my home clinic a lot - but there are some growing pains with switching from a training clinic into a final placement because my training clinic does things somewhat differently than my home clinic - so I'm trying to learn the "new" ways and in some ways I feel that has put me back a bit. If possible, it's best to train at the clinic that you will be working in. For example, I missed drawing some labs because my training clinic tapes the post dialysis labs to the front of the machine. This clinic hangs them on the IV pole and I didn't even see them or think to look there. Little things like that can make you feel like you are in week 3 again.

The clinical coordinator at my clinic is also new to the unit. She's very nice and wants to make some very needed changes to the patient schedule, but the long time techs are in an uproar about this. Apparently they feel that the way the unit has been going for years is "fine" even though we are often working against policy by cleaning and setting up machines for the next patient while patients are still in the chair holding their cannulation sites. We have to do this because nobody really works with the patient schedule and they just take people as they get there - which leads to a cluster when you have three people in one pod getting done at the same time. They like working against the schedule because it helps everyone get out of there by 4pm. Everyone just pitches in in different pods to get everyone taken care of. It does work - in a chaotic kind of way - but the techs seem very used to it. As a new nurse, though, it's a tough way to learn. Trial by fire I suppose. I am becoming a master multi-tasker.

I am looking forward to learning more of the nursing duties at this point. I'm working mostly as a tech right now with a few nursing duties thrown in. I'm enjoying getting to know my patients and I actually enjoy cannulation, etc...

Still glad I made the decision to do dialysis. I do really enjoy it. It's very faced paced and can be hard on the back if you already have back problems as I do - so after a year or so, I may switch to the PD team or education. But I will stay with Davita whatever I do - I really like this company.

[integrativenurse]

Welcome to the world of dialysis staff. People don't like change especially if they're being told by someone who is new to their clinic. It is really frustrating if you're working with people who want to get out work early and /or don't care about teamwork. This is especially frustrating for the nurse to has an assignment and have to run to different patients to give their post treatment meds or flush the arterial line (if it's state policy).

Yes, PD nursing is another route. However, a lot of nurses do not get their hours.

[kbrn2002, ADN, RN]

The one thing that stuck out to me Nurse Magnolia is how you describe the techs cleaning/prepping the machine for the next patient while the current patient is still in the chair. Yep, seems that's the standard! I work for the other big dialysis company and it's done that way in both clinics I've been in. Plus I am now working with a travel PCT that's literally been all over the country and has 30 years experience, guess what? They clean and turn over the machine while the current pt is still sitting there everywhere! I wonder if that changes to doing it by policy when the corporate bigwigs or state is in the clinic?

[Hoosier_RN, MSN]

1 hour ago, kbrn2002 said:

The one thing that stuck out to me Nurse Magnolia is how you describe the techs cleaning/prepping the machine for the next patient while the current patient is still in the chair. Yep, seems that's the standard! I work for the other big dialysis company and it's done that way in both clinics I've been in. Plus I am now working with a travel PCT that's literally been all over the country and has 30 years experience, guess what? They clean and turn over the machine while the current pt is still sitting there everywhere! I wonder if that changes to doing it by policy when the corporate bigwigs or state is in the clinic?

The clinic that I started at, south of Indy, if the CM caught anyone doing that, it was TROUBLE. She's still there, and that doesn't go on. It's been a fight in my clinic, but I go out on the floor to help during changeover. It lends extra hands, plus I can keep my eyes on things. It doesn't go on while I'm there, but I cant be there every minute of the day

[Nurse Magnolia, BSN, RN]

I am now two weeks out of orientation. Things are going well. Not perfect, but good. The biggest frustration I have is that I have a pretty good idea what it's like to be a dialysis tech....much less so what it's like to be a dialysis nurse. I function pretty much as half tech, half nurse. I put patients on and take off and do turnovers, but I also do meds and assessments. But the rest of the nursing duties are not known to me and I don't have my "RN" training class until DECEMBER. So until then, I guess I'm half nurse, half tech. This is not only frustrating to me but to the other nurses who need me to be a full nurse. Today one of the nurses asked me chart a lab result and I didn't even have access to the program she was talking about, let alone know how to use it yet. I could tell she was annoyed, and unfortunately, that annoyance was with ME, even though I have no say in when I'm trained for what.

I can do a pod of three, usually. But I don't understand how people do four in a pod alone. Especially, with the come as they may scheduling going on. I had three patients today coming off within 6 minutes of each other. How can ANYONE do that successfully? It does make you feel a little like a failure for not keeping up. I am not the only new one at our clinic so I know I'm not alone in my feelings. We help each other. We trade patients so that their turnover times fit better, etc...

I love getting to know the patients and I do love the fast paced nature of dialysis. I like the structure. I like the ebb and flow. I enjoy the technical aspect of cannulation and machine and patient diagnosis. So I'm glad I'm there - I am just feeling like I don't know what I don't know yet in order to function as a nurse, which is what I was hired to do.

[kbrn2002, ADN, RN]

@Nurse Magnolia That is frustrating I'll bet to not even have access to the tools to do your job. I would be a little upset about not even having that part of the training scheduled until December myself. I don't know what charting software you use there but I know the software we use is pretty darn confusing and I am still learning how to find components that aren't used on a daily basis.

My training was kind of the opposite of yours which also wasn't the most effective. I was learning nursing specific parts of the job pretty close to the beginning of my PCT portion of the training so of course since I didn't use any of it right away the odds of remembering what I learned when I started the RN orientation were about zero. I did found out that was not the norm but since COVID hit right about when I started my training was shortened by a couple of weeks and nursing classes were rescheduled so the new hires could get up and running sooner.

Also having so many nursing specific portions of the training during that time was taking away from time on the floor learning to function as a PCT which I feel slowed me down somewhat in that role.

I am finding that I am putting on and taking off at least a few patients a day also which is OK. I am responsible for one chair a shift and we run two shifts in my clinic but I am usually working with a newer PCT that can't take care of CVC's yet so I also have that patient. The only time I feel stressed about it is turnover when I have two coming off pretty close together plus a couple of end of treatment meds to administer so that timing is pretty tight. Especially since one if not both of the end of treatment meds are for patients that are more often than not coming off a little earlier than scheduled so that throws a monkey wrench into the timing as well.

Turnover is pretty much all hands on deck so everybody is busy helping to keep from getting behind. It gets busy and can be a little hectic but it's been doable without me feeling too much like I'll never catch up. I do have to admit it's not always possible for me to get my PCT stuff done and then get all my nursing assessments done in the 30 minute window that is expected. Even in the morning I run into issues with that though. While I am putting on my patient three more are arriving so I have to play catch up with their assessments when I am done, again it's doable but it's a lot of running to get it done in the time frame that's expected.

My charge nurse has strongly hinted that hours are available if I want to pick up a shift or two as a PCT but she hasn't outright asked me to pick up a PCT shift yet. I am kind of leaning against doing that even though I could use the hours. It's not like I feel working as a PCT would be beneath me. I just don't want to work strictly as a PCT until I get a bit more comfortable in my nursing role. As it stands now I don't think I'd be fast or efficient enough to handle a pod of four myself as a tech. I'd like to be able to comfortably handle my role as a nurse before I try to tackle that.

[SebastianRN]

Hi guys! I just wanna ask how many days/week is the classroom training? Thank you