unit Rules

[imperial]

I am interested in knowing rules of various units. i.e. DaVita, Gambro, FMC, RCG, independent, etc.

1. Are family members allowed with patient during put on and take off?

2. Do your units do access flow testing, and, if so, what type?

3. Do staff adhere to infection control practices, in reality, i.e. washing hands between patients, or between touching machines if gloves are not worn, washing hands before and after gloving?

thanks, trying to get a complete understanding of this dialysis culture as I see it. Trying to sort out alot about healthcare. Thanks.

[imperial]

I agree COMPLETELY>

I only ask of you all because you are the ones who can give 'truthful' answers related to care, in order to understand the system and how it works. Yes, I have spoken, actually, to two corporate people regarding issues and, of course, as you all can well imagine, it is quite different that what reality is. I sincerely appreciate your input and , hopefully, continued input as I am concerned and want best care for patients. Yes, you all do work very hard and truthfully, I could not do it. There is a c ertain skill needed in this area and kudos to you all. I am sorry that I made it seem as if I am not pointing out the positives, for, I, better than most, understand what it is like on both sides,,, only to well...

[nosonew, BSN, RN]

Yes, it is getting to be a bit much... I agree. We, too, are getting an unbelievable increase in patients as well as patient acuity.. many of our patients now are very limited in transfer ability, etc., all of which requires far more time and effort. These things are never considered when they question any overtime which staff aquires during the day.. and our poor Clinical Mgr. has to try to "push" us out the door in the evening just to keep her SELF out of trouble with the "suits".

Our nephrologist is fabulous.. he has full confidence in our judgement and abilities.. re dry weights and other issues.. and has gone to bat for us many a time.

Yes, I, too, have nursing notes still to be done for this month, as well as careplans... and no time during the day to do these.. so I guess I'll be staying over my usual 12-13 hours one day to tackle these.. and of course that means overtime..tsk, tsk, tsk.

Dialysis COULD be wonderful.. it USED to be when I started there eight years ago.. but the patient load has doubled, (and therefor also the paper work, etc.)...but the staff numbers have stayed the same.

Someone is always demanding more for less. :stone

Actually, DaVita does ask for our input...however, our administrators get huge bonuses for no OT, decreased hours of staffing time, etc. Our FA used to be great, but now I think she is all about HER $$$/pocketbook. She is seldom in the unit, and it sickens me to think her focus is more on her checkbook than our patients. I personally would gladly give up my bonuses just to have more time to spend on teaching with my patients. However, that isn't an option. If we all gave up our bonuses, we could have additional staff, which benefits the current staff and patients.

Perhaps I should write our CEO.... Hmmmm....

[jnette, ASN, EMT-I]

I agree COMPLETELY>

I only ask of you all because you are the ones who can give 'truthful' answers related to care, in order to understand the system and how it works. Yes, I have spoken, actually, to two corporate people regarding issues and, of course, as you all can well imagine, it is quite different that what reality is. I sincerely appreciate your input and , hopefully, continued input as I am concerned and want best care for patients. Yes, you all do work very hard and truthfully, I could not do it. There is a c ertain skill needed in this area and kudos to you all. I am sorry that I made it seem as if I am not pointing out the positives, for, I, better than most, understand what it is like on both sides,,, only to well...

OK.. then we are making progress here. :)

There was an apparant misunderstanding of your inquiries initially, as it appeared that they were directed at staff incompetence and attitude (and yes, I'm sure there IS some of that SOMEWHERE).. but I personally felt that you were generalizing and was somewhat put off by that. As we both know, there is attitude and incompetence to a degree in ANY field, and ANY profession or career.

We (as are nurses everywhere today.. not just in dialysis) are so very frustrated in not being able to BE and DO all that we as professionals would like to do for our patients. In dilaysis particularly, it has gotten very "mecahnical"... it wasn't this way when I started and our census was half of what it is now.

But there is no longer time to pull up a stool and spend time with a patient.. touching base, asking questions, educating.. and educating happens to be one of my favorite things .. breaking things down in simple and understandable terms.. motivating the patient, getting them excited about their potential for improved health and how they can contribute to that, and know that they have a truly important role in their health staus. I just LOVE motivating people and allowing THEM to take credit for better outcomes.

But the time for that is no longer there. Unless quickly in passing, or while taking the patient off, or putting him/her on. Seems like that is the longest period of "one on one" time we have with the patient anymore. Very sad indeed. Our patients themselves have noticed it, and they really "miss" our attentions and the time we used to have for them. That hurts me, too.

And yet, they do not blame us.. they know it is not negligence on our part.. but rather the "powers that be". We have yet to receive ONE patient grievance in all my years at this facility.. our patients dearly love us and we truly are like family. They sit there for hours on end and see firsthand how much we do, and all the many little crises interventions, and shake their heads in awe.. actually feeling sorry for US, when it is THEY who are sick.

They are the ones who motivate US and encourage us.. they bring us goodies and treats, homemade baked goods, fresh veggies from their gardens, carry candy in their pockets for us.. ... just to lift our spirits when things are crazy on the floor.

Truly, if it were not for our love for our patients, and our concern for their well being, I highly doubt that ANY of us would still be there, including our clinincal Mgr.

[imperial]

You all seem like devoted wonderful nurses and I am sure that your patients value each and every one of you. This problem is bigger than both of us and it is at a corporate level of greed. Yes, having worked in healthcare for many years, doing a variety of positions, I know the frustrations, etc. Again, I value your input with my questions as I want the best for patients and with your input of how the real world is..............well, then maybe there is a way to improve the situation.

Of course, as you might know, I read recently in California, where the governor vetoed the bill, that would have started 1/05 to increase staffing ratios, but now it will not happen. I also read, to my recall, that the nursing association is sueing him for same.. He was bought, imho, by the corporations. However, after reading the new ESRD proposed language, I am finding that only a few states actually have ratios for dialysis units. Again, thank you all for input,,,, it is appreciated. Presently, I am not affiliated iwth any group or organiztation, but am thinking seriously of it in order to attempt to approve deliveyr of care. Input from those directly working with patients tells the real story..............thanks............

[nosonew, BSN, RN]

You all seem like devoted wonderful nurses and I am sure that your patients value each and every one of you. This problem is bigger than both of us and it is at a corporate level of greed. Yes, having worked in healthcare for many years, doing a variety of positions, I know the frustrations, etc. Again, I value your input with my questions as I want the best for patients and with your input of how the real world is..............well, then maybe there is a way to improve the situation.

Of course, as you might know, I read recently in California, where the governor vetoed the bill, that would have started 1/05 to increase staffing ratios, but now it will not happen. I also read, to my recall, that the nursing association is sueing him for same.. He was bought, imho, by the corporations. However, after reading the new ESRD proposed language, I am finding that only a few states actually have ratios for dialysis units. Again, thank you all for input,,,, it is appreciated. Presently, I am not affiliated iwth any group or organiztation, but am thinking seriously of it in order to attempt to approve deliveyr of care. Input from those directly working with patients tells the real story..............thanks............

I was recently told by a co-worker at another unit that Davita is implementing a new staffing ratio that is supposed to be better. I will see what I can find out...he was supposed to email me the info. Haven't seen it yet.

[MedicalZebra]

I could care less about the lint on the BP cuff... but I WON'T sit there wearing a cuff that is so full of the previous patient's sweat that it stinks! Yesterday at dialysis I asked for (and got) a different cuff. The cuffs are washed nightly, but in this case the morning patient had sweated all over it. That's a body fluid, and I sure don't want it all over my shirt and/or skin. My nurse had no problem at all getting me a new cuff, and agreed with me that it was gross-- I think it's all in the way you ask for things. I'm sure if I had yelled at her, I might not have gotten a different cuff. Yes, we patients have rights... but we also have the responsibility to act like adults and ask for things in a civil tone of voice.

I am a frequent visitor to the 'ethical dialysis' site, and have noticed that when I post something positive about my unit, it is trampled in favor of posters who are trashing their units. While I can understand that there are crummy dialysis units, there are also some good ones and it shouldn't be assumed that ALL dialysis units are in business to squeeze money out of patients' insurance companies and keep people clinging to life, barely able to function. It should be noted that some of those 'barely surviving' patients are people who refuse to follow the dietary/fluid restrictions and are chronic treatment skippers. If you do everything right and are still experiencing a poor quality of life, THEN yell about it... but try following the prescription first.

[imperial]

is definitely out there... as I said earlier,,, corporations halt those staff, often, who want to provide good care... They (staff) are hampered by corporate greed. imho.

There are many many good units with good staff.. however, we must be aware of those who do not get the care that they should. This is what we must change.

[jnette, ASN, EMT-I]

Thank you, Medical Zebra , for your input.

I do agree about the cuffs, although I'll be honest and say that this issue has never been raised at our facility. Perhaps we don't have "sweaty patients" :chuckle .. I don't know.. but it has never been brought up.. nor the "lint". I can certainly appreciate your point, however, for I, too, would not want such a cuff on me. And yes, if someone were to ask for a different cuff and explain why, I would be more that happy to find another one for the patient, absolutely ! (not that we have many extras.. jsut one or two..) but I DO think this is a valid and understandable request and I see no reason why we shouldn't have a whole drawer full of extras.. SHOULD htey get soiled, sweaty, not fit.. whatever.

I also agree about the compliance.. while we have only two patients who will skip a tx. here and there.. the rest are fabulous about coming regularly. Of course the fluid intake compliance and potassium/phosphorus issues still need work, but there is only so much WE as nurses can do.. the patient MUST take some responsibilty, as you say.

Imperial, Nosonew.. I agree wholeheartedly about the corporate greed. It is just so OBVIOUS, which makes it all the more difficult to swallow. We, too, were to get a new staffing module with the Ultra Care concept, but I can tell you right now that we will NEVER see that aspect of Ultra Care. It would be MARVELOUS, if they implemented what they are touting, but mark my words, it will never materialize. Heck, they continue to count our Clinical Mgr. in their staffing grid as part of the floor staff !!! While she steps up to the plate waaaaaaaaaaaaaay to often to help us out (thus neglecting the HUGE amount of work she has of her own.. and having the suits breathe down her neck about it when she is unable to get it all done.. ) as long as they count HER in with "floor staff", they feel like we have all the staff we need on the floor. While in truth, this is unfair to US... AND to HER ! We don't have her on the floor with us.. she's in the office doing her JOB ... so WE are cheated out of the help on the floor, and when she comes out to assist as she often does, SHE is cheated out of the opportunity to get her OWN work done !

When nurses can tend to NURSING rather than counting supplies, stocking, inventory, do technical dept. work... and all the other non nursing functions, and delegate these to our techs, pcts, etc.. things would be more tolerable.

But we have only two PCTs now, and they are not always on together.. so the nurses end up doing their work as well. But they will not hire more PCTs. either... :stone

Yes, there could be many improvements, indeed. But these cost $$, and just as in all the other healthcare industry areas, cost CUTTING is the rule. :stone aaarrrrrrrrrgh !!!

[imperial]

well said, J'nette.. you are oh so right.........................and the nurses are constantly in a conflicting situation. Oh I remember oh so well....

[N.IRISH DIALYSIS RN]

I work in acute dialysis and previously worked in chronic dialysis and recently there has been talk of introducing disposable BP cuffs. We have already benefitted from disposable slings for hoists used when lifting patients.

These are ofcourse are expensive but with the problems the NHS is presently having with hospital acquired infections such as MRSA, they are vital and probably cheaper in the long run.