What is like working on Hemodialysis?

[aldrich21]

I'm currently working on Med/Surg Floor for 6 months right now, i'm really really really stressed out. On our floor were having 7 patients, lot of meds, charting, too much work! Planning to move Hemodialysis Clinic. Any advice?

[dishes, BSN, RN]

There are several interesting articles on dialysis by nurses who work in the specialty, to find them, look at the yellow banner at the top of the page- click on specialties-click on dialysis/renal/urology nursing articles.

[CrunchRN, ADN, RN]

Are you going to be the only nurse? Grass isn't always greener....

[nutella, MSN, RN]

I'm currently working on Med/Surg Floor for 6 months right now, i'm really really really stressed out. On our floor were having 7 patients, lot of meds, charting, too much work! Planning to move Hemodialysis Clinic. Any advice?

If you are already stressed out in med/surg chances are that you will be also really really stressed out in a chronic dialysis clinic

The technicians are the ones who have the best job in a HD clinic - the nurses usually have the short straw.

[SmilingBluEyes]

Dialysis has its own stressors. You, as a nurse, will be responsible for overseeing the treatments of anywhere from 12-18 or more patients every 4 hours. The average workday is 10-12 hours. You will have working under you, 3-5 technicians responsible for initiating and monitoring the conditions of the patients during their treatments. They will be reporting to you any changes in patient condition and issues with treatment and may rely on you to back them up when they have difficulties with cannulating their fistulas or grafts. You are responsible for everything they do; they work under your license. In some units, an RN both puts on and takes care of patients (meaning in the role of both technician and RN). You will have to ask about that at the units at which you apply/interview. This can be challenging, especially for the RN new to dialysis.

Meantime, while the patients are on treatment, you will be attending to your primary patients, a list of 25 patients or more, whom you will follow closely, their monthly labs, do their diabetic foot checks, home medication reconciliations, anemia management and also, doing monthly care plans and comprehensive RN assessments. Numbers are everything in dialysis and you will be responsible for monitoring how clean their blood is getting, if they are meeting their dry weight goals, and many other things. You will be very, very busy, all the time.

Like I said, it's stress, just different stress, than the floor. The learning curve is VERY steep. The "Big Two" (Fresenius and Davita) do provide comprehensive classroom and floor training and you will be required to spend time learning on the floor, under a technician the ins and outs of how the floor works, before you are then assigned a preceptor RN to learn how to be a dialysis nurse. I found it took me well over a year to become comfortable with any competency I gained.

I have been doing dialysis just over 5 years now, and I have to say I do like it. I do like that I know my patients well. Many are like family and I have come to really know intimately, their families, their ups/downs and struggles. I celebrate their victories, especially when they get kidneys, and mourn their losses when they die. You do have a more predictable routine and there really is no such thing as "low census" as you have the same patients, unlike the floor. That I like. And no mandated overtime, as again, you have a predictable census.

I could go on and on, but you get the drift. If you want more info, just ask me. I will answer any questions you have. You should check out the dialysis forum here and get a look at what they talk about there. It's far from easy, but may be very rewarding. Good luck, whatever you decide to do.

[TheCommuter, BSN, RN]

Moved to our Dialysis / Renal Nursing forum.

[StarBrownRN]

Also, because you will be new to dialysis, you will most likely be required to perform the work of the techs and the nurse for the first six months before you are eligible to be trained for charge nurse duties. More than likely, you will not have an RN preceptor at any point. But rather, the RN will give you a brief over view of a few things and sign off on it. You may get a few days of "training" before you become charge; but you have to have a minimum of 6 months of dialysis experience before you are even eligible to be charge--according to NKF regs.

So, you will be running a pod of 3-4 patients, setting up machines, initiating and terminating treatments, doing nursing assessments, passing meds, checking vitals every 30 minutes and doing change over at break neck speed. Add in the occasional code, seizure or prolonged bleeding episode--chronic HD is VERY stressful.

[Rn.bsn.]

Hi! I'm an acute dialysis nurse. I've gotta tell you all nursing jobs have its own stressor, and dialysis nursing is not a walk in the park either. I work in different hospitals and schedule is always a mess. You work on your own and most of the time you are the only dialysis nurse in the whole building, although this may be a better fit for you because you are on your own. You still have to deal with primary nurse and other departments and they treat you like an outsider. I know your asking about dialysis nurse in the clinic,and I know a little bit about it. They say it's less stress but when I was training there before, you have to deal with the politics everyday and even on your break time you still have to deal with it. Too much patient and too much responsibility and it seems like you have to please everyone, esp your technician or else they will give you a hard time.