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!

[SmilingBluEyes]

On 6/16/2020 at 6:12 PM, vegasmomma said:

Thank you for each update!! I'm loving this thread. I'm still trying to convince myself to go for dialysis.

I do have worries because on other threads I read that techs can be vindictive and make it hard on nurses in training. I've read in some states it's illegal for techs to give heparin but they still do it and the nurse is liable. I've read that nurses find themselves being the only nurse in the facility at times.

Techs don't tend to be vindictive if you help them out and respect their knowledge. The techs I know who have given nurses a hard time, it tended to be the nurses being unwilling to lift a finger to help, especially during turn-around.  I find almost anywhere, if you treat people how you want to be treated, it goes well. I have had very few problems in my 25 year career with getting along with others, or having people behave "vindictively" toward me. 

And yes, if you have less than 17 patients, expect to be the only nurse in the building (except maybe, the Charge Nurse II). That is standard. Plan to bring your food, or use the heck out of uber eats.  In my clinic, we are located in a fairly rural area, so uber eats is out for me. Fortunately I stick to my mostly vegetarian diet. I make a lot of foods and bring the leftovers for lunch the next day. And since in my clinic, some days are as long as 14 hours, I bring protein drinks, too.

[Nurse Magnolia, BSN, RN]

1 hour ago, SmilingBluEyes said:

Techs don't tend to be vindictive if you help them out and respect their knowledge. The techs I know who have given nurses a hard time, it tended to be the nurses being unwilling to lift a finger to help, especially during turn-around.  I find almost anywhere, if you treat people how you want to be treated, it goes well. I have had very few problems in my 25 year career with getting along with others, or having people behave "vindictively" toward me. 

And yes, if you have less than 17 patients, expect to be the only nurse in the building (except maybe, the Charge Nurse II). That is standard. Plan to bring your food, or use the heck out of uber eats.  In my clinic, we are located in a fairly rural area, so uber eats is out for me. Fortunately I stick to my mostly vegetarian diet. I make a lot of foods and bring the leftovers for lunch the next day. And since in my clinic, some days are as long as 14 hours, I bring protein drinks, too.

This was not the case at the clinic I was at, and subsequently left.  Many of the techs were good to me - but a few were just horrid to everyone that was new.  They liked to watch us drown and set it up so that you would drown.  I came early, stayed late, took patients for the techs, jumped in, and completed tech and nursing duties, basically doing the job of two people - and they were still mean.  I was kind to each one at the start until they started the hazing and then I just ignored them.  Some people are just mean.  I was the third nurse to quit that clinic in a year over the same three techs and one nurse who were just not nice people.  I did quite a lot of soul searching after I left that job and decided after much self-reflection - that the situation had nothing to do with me.  I did everything I was supposed to, and more.  The nurse that replaced me has also already left - so the unit is toxic and I was glad to escape after only 6 months.  

I am in a hospital dialysis unit now and all of the nurses and techs who had been in OP clinics have similar horror stories from a tech or two along the way.  Maybe because of that - this unit has been extremely welcoming, helpful and nice.  I don't need to be best friends with the people I work with - but I do need to have mutual respect and kindness.  

It is not always the fault of the person on the receiving end of cattiness.  Sometimes, people are just catty.  

[IMOKAY, BSN]

Nurse Magnolia, I believe you 100%. It seems like it's a problem in many places. You are not the only one who has posted similar experiences.  

[TAKOO01, BSN]

I am not in dialysis, but I just want to say that I love this thread. I love the enthusiasm and the realism. Thank you for giving us a look into your specialty. I wish I could find such candid information on all specialties.

I am especially cheering on Nurse Magnolia. All the best to you!

[LO1619]

Nurse Magnolia, just a quick question. What are the hours for your current dialysis unit?  Im currently doing med surg and would like to start dialysis. The only options I know of is chronic schedule or crazy hours acute schedule.  I was just wondering if there is something that is strictly 3 days a week without call in the hospital setting or part time PRN?

[Hoosier_RN, MSN]

1 hour ago, LO1619 said:

Nurse Magnolia, just a quick question. What are the hours for your current dialysis unit?  Im currently doing med surg and would like to start dialysis. The only options I know of is chronic schedule or crazy hours acute schedule.  I was just wondering if there is something that is strictly 3 days a week without call in the hospital setting or part time PRN?

It is going to truly vary by the individual clinic. In acutes, there is always a call schedule situation-there has to be for those admits outside of normal hours that are so emergent that they absolutely cannot wait until regular hours of operation. Some acutes are more busy than others, call in during the night constantly, others hardly any. At most it varies, truly feast or famine. Scheduling is going to vary for the same reason, actual need and predicted need. You can ask those questions during an interview. Apply, and good luck!

[kbrn2002, ADN, RN]

11 hours ago, LO1619 said:

Nurse Magnolia, just a quick question. What are the hours for your current dialysis unit?  Im currently doing med surg and would like to start dialysis. The only options I know of is chronic schedule or crazy hours acute schedule.  I was just wondering if there is something that is strictly 3 days a week without call in the hospital setting or part time PRN?

Hoosier is right that hours vary on what you position you are hired for and schedules vary by clinic.  I am working in outpatient dialysis and have a block schedule that I really like. I work a few days, off Sunday because we are closed and work a few more days then I am off a week. So it's basically one week on, one week off.  That schedule is pretty standard in my district. 

The PRN nurses are usually the ones that are hired as a float position which can require a little travel between clinics but they do pay for travel time plus mileage and at least in our area none of the clinics are so far apart that overnight stays are necessary, the farthest distance between the clinics our floats travel to is about an hour and half drive one way.  There are usually open spots that are posted for staff to pick up and occasionally I get a call asking me if I want to come in to cover an unexpected open shift but that's not common and there are no on-call requirements. 

The acute nurses that cover the hospitals do have an on call rotation as Hoosier said, it's necessary in the hospital setting as there is no telling when a patient might need dialysis though from the acute nurses I've talked to it's not a common thing to get called in after hours. Their hours vary a lot more as the acute caseload is dependent on the census of the hospital.   

[Nurse Magnolia, BSN, RN]

15 hours ago, LO1619 said:

Nurse Magnolia, just a quick question. What are the hours for your current dialysis unit?  Im currently doing med surg and would like to start dialysis. The only options I know of is chronic schedule or crazy hours acute schedule.  I was just wondering if there is something that is strictly 3 days a week without call in the hospital setting or part time PRN?

I work for a hospital system on a dialysis unit, which functions just like any other procedural unit in the hospital. Patients come to us from their hospital rooms for their treatment. If they are on a trauma unit or ICU, then we go to them. Our shifts are set. I work part time, two 10’s a week, but we have other nurses who work casual, three 12’s or four 10’s.  Basically the same shifts that are anywhere else in a hospital.

Because emergencies happen, there are on call hours but for full time nurses it’s only two call per six week schedule. 
 

It is not nearly as chaotic as in clinic chronics and doesn’t have the wild hours that clinic acute programs have either. It’s been a very good balance for me and I can’t see myself ever going back to chronics.  The staff roles are more defined in the hospital system with the techs functioning like techs  rather than nurses and the nurses functioning like nurses and not techs. 
 

It may have just been my clinic but the egos there were out of control....I am finding a much more inclusive team approach in the hospital. 

 

 

[disarrayofsunshine, BSN, RN]

On 1/23/2021 at 10:44 AM, Nurse Magnolia said:

I work for a hospital system on a dialysis unit, which functions just like any other procedural unit in the hospital. Patients come to us from their hospital rooms for their treatment. If they are on a trauma unit or ICU, then we go to them. Our shifts are set. I work part time, two 10’s a week, but we have other nurses who work casual, three 12’s or four 10’s.  Basically the same shifts that are anywhere else in a hospital.

Because emergencies happen, there are on call hours but for full time nurses it’s only two call per six week schedule. 
 

It is not nearly as chaotic as in clinic chronics and doesn’t have the wild hours that clinic acute programs have either. It’s been a very good balance for me and I can’t see myself ever going back to chronics.  The staff roles are more defined in the hospital system with the techs functioning like techs  rather than nurses and the nurses functioning like nurses and not techs. 
 

It may have just been my clinic but the egos there were out of control....I am finding a much more inclusive team approach in the hospital. 

 

 

I am also new do dialysis and not really loving the chronic setting. I am in a good clinic and the manager and 99% of the people are awesome. The early wake up calls of 4am, even with a mix of evening shifts are excruciatingly painful to me; this is what I hate the most,  I hate what it is doing to my body. I take on an assignment a few times a week. Turn over is crazy and is horrible to my back and feet, even with good shoes and compression socks. I keep waiting for my body to get used to it but its been months. IDK how long I can take the toll.  

I am looking into going to acutes. It seems less stressful and less chaotic than chronics? I am glad its going well for you there.

Thank you for all the updates.

[CN101, BSN, RN]

Hi, everyone! 

I have a phone interview scheduled with a recruiter from DaVita early next week. Any tips? I'm super nervous. This is my first interview as a new grad nurse. I'm not even sure how to prepare. Were the questions they asked difficult? I have zero prior healthcare experience so I'm hoping they won't ask me super hard healthcare questions. 

 

Thank you.

[Hoosier_RN, MSN]

21 minutes ago, CN101 said:

Hi, everyone! 

I have a phone interview scheduled with a recruiter from DaVita early next week. Any tips? I'm super nervous. This is my first interview as a new grad nurse. I'm not even sure how to prepare. Were the questions they asked difficult? I have zero prior healthcare experience so I'm hoping they won't ask me super hard healthcare questions. 

 

Thank you.

Good luck! Don't stress it. Just prepare as you would for any nursing interview. Read up on dialysis so you have an idea and express a desire to learn

[CN101, BSN, RN]

On 1/30/2021 at 12:28 PM, Hoosier_RN said:

Good luck! Don't stress it. Just prepare as you would for any nursing interview. Read up on dialysis so you have an idea and express a desire to learn

Thank you! I think my phone interview went decently. The video interview I had with a hiring manager wasn't what I expected. They didn't ask me any of the questions I had practiced except for "tell me about yourself". But I tried my best and that's all I can do. We'll see what happens in a week or two.