What does the RN do all day?

Specialties Urology

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I had an interview for a dialysis position today. I was told that I would be on my feet for the entire shift. However, coming from med/surg I can't understand why. What exactly does the RN do all day?

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I had an interview for a dialysis position today. I was told that I would be on my feet for the entire shift. However, coming from med/surg I can't understand why. What exactly does the RN do all day?

Yes, you will be on your feet all day.

If you find a tiny unit (less than ten chairs) with great staffing however... you will have time to go through all those labs and call the docs/write orders, assess treatment efficacy for fluid staus, evaluate patient meds, send one patient to the hospital with unstable angina while stabilizing another who is pulling his needles out and blood is spurting across the aisle, and answering the phone and counting gauze and bottles and bandaids so that corporate doesn't holler at you for using one too many and evaluating RO water readings three times a day and counting EPO and slinging another patient into trendellenburg who is looking a little gray, while so-and-so wants off the machine to go poop and oops one of your techs just stated they're going home early because they feel nauseated and feverish so get in there and take off three patients while doing all of the above.

Oh, and don't forget the five remaining twenty-page care plans that need to get done on your new admits.

Yes, you will be on your feet all day. :)

disclaimer: 50% of the actual workload has been unintentionally omitted from this post: pre and post treatment, patient assessments on each and every patient being one obvious, and glaring oversight...

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I can't say you will be on your feet all day, but it will be 95% of the time (unless you are lucky to get a pee break or a lunch). The RN does pre & post nursing assessments on all patients, administers all meds, sets up & tears down machines. Not to mention taking your own assignment of patients to start treatment on, monitor during tx & take them off. Most of the time you are the ONLY RN or licensed staff in the building. We have to do ALL the nursing paperwork, med reviews, diabetic foot checks, lab reviews, physician orders, order supplies & meds. UGH I'm tired just thinking about all I have to do.

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Most of the time you are the ONLY RN or licensed staff in the building. .

Ah the joys of Corporate McDialysis Chains.

Pretty soon, only fast-tracked immigrants will be willing to do it, for less pay.

Ooops did I just say that? Why yes, yes I did...

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Specializes in Nephrology.

It all depends on what size unit you work in and in what state you are going to work. I work in MN so our PCTs can administer heparin and access CVCs. I know that in some states the RN has to do this.

I work in a unit with 26 chairs. We run 24 patients, three shifts a day. Each RN is responsibe for half the unit.

Here's my typical day:

Patients start at 6am. I arrive a little before this to check on what I need to do for the day, notes from the RN who worked the day before, etc. I check to make sure water checks were done and all wnl, that log books have been filled out, meds counted, all that kind of stuff. When patients come in, I begin assessing them as they go on. PCT's take vitals and I make sure they are ok, any problems or procedures since last treatment, double check that rx is set right, right dialyzer etc. Once I have assessed the first 12 pts, I go to draw my meds for those 12, between 30-50 syringes each shift. Once I am done drawing those, it is time for the next 12 to come in (second nurse isn't there until 9am). I do all the same for those 12 pts except draw their medications, the next nurse does that when he gets there. In between assessing those patients, I work on giving meds to my 12. By the time the next nurse comes in to take over his side, my patients are starting to come off. I now start post treatment assessments and assess the new ones coming in.

During all that, I am answering any pt questions or concerns and dealing with any complications that may arise (low BP, needle probs, HTN, cramping, etc.). Oh, and I try to squeeze in a break. Second and third shift are not so bad because I only have my own 12 to deal with. Once I have second shift assessed and running I usually take that break I was trying to squeeze in during the morning. Now I have time to do med reviews, call Docs or NP's with concerns, follow up with stuff that came up in the morning, work on care plans, daily notes and monthly notes. Then the next turnover starts. Again with the post treatment assessments and the new shift coming on. Draw and give meds. Finish up paperwork and go home (between 6-8pm). And thats on a good day! God forbid patients have problems. I've had those days where I have sent multiple people out in ambulances. Now those make for crazy days.

I have picked up shifts at smaller units where I have had time to sit and read if I wanted to but I feel like if I'm at work, I should be working....

Maybe someone from a smaller unit could give you an idea of how it goes there.

I wouldn't say I am on my feet all day, but at least 80% of it I am. It takes a lot of good time management and efficiency to be able to get to that pesky paper work.

I think a lot of people have misconceptions about being a hemodialysis nurse. It is not an easy job and it is a lot of responsibility. Good luck! Let me know if you have more questions!

Disclaimer: The spell check will not work for me so sorry for errors in advance.

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You will be on your feet all day, and it is a long day! Let's see this is how my day goes, I work in a 12 chair clinic I am the only RN there is 2 techs and the RN must do and chart all assessments, do and chart all meds, and techs cannot access catheters so I do all those too.

draw up heparins

start assessments

run around in circles pushing heparins and doing assessments and drawing labs

put on any and all catheters, change dressings

put my pod of patients on while doing assessments and pushing heparins

once patients on, chart assessments and heparins

monitor vitals

round to check all machines and baths set correctly

draw up all meds

give out meds, chart

give out prns

chart

care plans

repeat, repeat, repeat

run back and forth to answer phone

I know there is more I am forgetting

and this is on a day when there are no issues. You also have to call the DR for any orders, if pts out of scripts, for all abnormal labs and vitals (we get many each day of both) write orders in computer for med changes and protocols for abnormal labs. Patients show up whenever they want, appointment times are not enforced enough. Patients sign off early. Patients get cramps. Patients get nausea and vomiting. Any patients with a cather that have fever need blood cultures and antibiotics, and patients can code. I do send patients to the er a lot, for some reason our patients refuse to go to Dr appointments and the ER so they come in sometimes with major medical issues, chest pain, necrotic foot, all kinds of fun and excitement. They think we are the er sometimes.

My clinic runs 3 shifts of patients, so the days are 15-16 hours, then you fall into your car for the ride home.

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Specializes in Nephrology.

OMG MJB how could I forget anemia management! How much more am I forgetting. Seems like we sure do a lot in 14 hrs when you have to sit down and think it through. I'm off to bed now...it's tiring enough to think about it and I have to do it all again in 8 hrs! Good thing I love my job:D

Don't forget that you are not only the only RN in the building but you are oftentimes dealing with people who do not like that you are supervising them. You are also the end of the line for most things. No code team in hemo! Last few I had, I was doing compressions while running the code. Better hope no one around you freezes cuz when you're doing compressions and yelling orders over your shoulder, you can't stop what you're doing to fix what they are not.

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Wow guys THANKS for the info!! I understand now. However it still seems better than running up & down a med/surg floor, which I'm trying to run away from. I didn't know that codes are ran....I'm assuming that we have standing orders for code meds. What type of assessments are done?

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No code meds can be given unless the MD is in the building and he is there maybe once a month for only a few hours. So for a code you can do compressions and AED if necessary etc, but really you are just trying to keep them alive until the EMS arrives. And my clinic on 3rd shift has just me and one tech, so that means she calls 911 while I rinse back and try to code. Heaven forbid she is in the restroom or something. We do not have enough staff to properly code someone. Also the code cart cord is too short to reach a plug behind the machines, and even though this has been reported numerous times in writing, nothing has been done about it. We are not permitted to use extension cords. So really the AED is a decoration.

Assessments are pre and post treatment. Vitals, lung sounds, edema, etc.

I really enjoy dialysis much more than I did Med Surg, because dialysis although crazy busy does have some routine and regular schedules. It is predictable and you get to know the patients so you know their normals and when somthing is wrong. It is the same comorbidities ou deal with day after day unlike med surg where you are expected to remember something you have not seen for 8 months.

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You will be on your feet all day and you probably will not get a lunch or get a chace to go to the bathroom! On out unit (we do everything) you will wash up the NH patient who tells you they do not need to use the BR and as soon as you step out of the room they will put on their light and say they just wet their pants, go recover the SDS patient, run to check on the OB in labor, then go triage the CP at the clinic then have to take the pt to the ER and have then ambulance radio go off that another CP is coming in.. all whild your DON and ADON are at meetings!

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yes, you will be on your feet all day.

if you find a tiny unit (less than ten chairs) with great staffing however... you will have time to go through all those labs and call ... ... ... ..

hahahaha omg guttercat! cry or laugh! hahahah, i just graduated, yep that what it's like! it was my pleasure to be able to see most every dept and i was able to see hd for a bit, wow, learning the water r/o requirements and the machines alone, then taking care of those two thing was a job right there!!!

care plans?

jesus mary and joseph please help me.

is it at least point and click care plans? for goodness sake, you don't "write" them yourselves correct?

my last few weeks in clinicals i was able to do a few additions, omg... the computerwork was hellish! we did have to do careplans, we looked up each diagnosis-it had care plans associated with it-then we'd print them and pop it into the physical chart. is that what you do where you are?

of course after we did print those associated care plans- there was never any mention of them again, at least not to me. perhaps it was stuff which was evaluated later by the actual rn that i just never saw.

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Specializes in Hemodialysis.

Hahaha, all this brings back such horrible memories. I started in a dialysis clinic straight out of nursing school and it took me all of less than 3 months to figure out I better find another job quick before I became unemployable. Yes, you'll certainly be on your feet all day. I was dying to find a med surg job after dialysis, lol

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