What does the RN do all day?

Specialties Urology

Published

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?

Wow! I'm doing my final clinical rotation in dialysis and it is nothing like this...all LPNs and RNs, mixture of acute and chronic, no more than 4 patients/nurse...in a hospital, I always get a lunch break...Plenty of time to assess and talk to the patients and chart...8 or 12 hour shifts...

I guess this is not the norm? I love dialysis, based on the experiences I've had..

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Wow! I'm doing my final clinical rotation in dialysis and it is nothing like this...all LPNs and RNs, mixture of acute and chronic, no more than 4 patients/nurse...in a hospital, I always get a lunch break...Plenty of time to assess and talk to the patients and chart...8 or 12 hour shifts...

I guess this is not the norm? I love dialysis, based on the experiences I've had..

I love dialysis too.

It's also refreshing to hear that you're learning in such a terrific, supportive atmosphere.

Enjoy!

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Specializes in Hemodialysis.

There's a huge difference between a dialysis unit in a hospital and an outpatient dialysis clinic. HUGE. When I was in nursing school and spent time in the dialysis unit it was very different than what I experienced when I was hired in a clinic. I may have enjoyed it had I been working in an acute unit in the hospital.

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"What does the RN do all day?"

Everything but sit, rest, eat or relax.

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"What does the RN do all day?"

Everything but sit, rest, eat or relax.

I've long trumpeted a belief that there is a very delicate, tight-wire act between hard work (good), and worked to death (bad).

Too easy, and there's a propensity for people to become lazy, slack-ish, wasteful of company time and money, and generally non productive. The patients and company both suffer and the employees never realize rising to the next level of excellence.

Too difficult, and the results are parallel to the above while ending the same.

I'm currently reading John C Bogle's "Enough." It is a thought provoking traipse through the radical, yet long brewing changes of corporate and personal business modalities and ethos.

Bogle is one of the best minds in the biz.

In Ch.1, entitled "Too Much Cost, Not Enough Value" (sound familiar?), he opens with this (not his) nineteenth century quote:

Some men wrest a living from nature and with their hands; this is called work.

Some men wrest a living from those who wrest a living from nature and with their hands; this is called trade.

Some men wrest a living from those who wrest a living from those who wrest a living from nature and with their hands; this is called finance.

Dialysis and the health care industry at large today, obviously, hinges (precariously) on finance.

And finance, is the driving force behind why we as the "workers" are (in fact latently) experiencing this current round of work overload and decreased productivity in dialysis.

For profit dialysis corporations are not an Apple or a Microsoft with a relative glass ceiling on profit margins. The for-profit dialysis chains are scrambling to access as much market share as possible as cheaply as possible, in order to remain solvent and profitable...state and federal cutbacks in reimbursement do serious damage to profit margins... Edit to add: how many of you are counting gauze and bandaids?

Of course we are are also seeing the "reverse outsourcing" of RN's via fast-tracking, especially over the last ten years or so taking hold in some markets. Legislation has been introduced by certain individuals and entities at the national level to expedite this phenomenon... let's just call it, "Health Care: The New Agriculture."

Grunts in the front lines of dialysis and the health care industry that choose to let the chips fall where they may and deal with the fallout as it comes, are, imho in for a wild ride.

Dialysis is in itself an interesting, relative micro-economic view into what is happening in the medical field at large.

Here are a couple of links I pulled off my favorites list for anyone interested in why we are experiencing what we are experiencing. It pays to keep oneself at least minimally informed. It's better to be ahead of the game rather than merely sucking the fumes of those making the rules.

Will Renal Care Get on Board With ACOs

Healthcare Economist

Health Care Reform Economics and Forecasts

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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?

I worked in an inpatient dialysis unit at a university medical center with an all RN staff and each nurse was responsible for his/her patients that they put on, usually 2 patients per nurse but sometimes a 1:1 ration if the patient required a lot of time or was unstable. We set up the machines and tore them down when finished. We took care of all inpatient meds and treatments that they may need while on dialysis, charted and called report to their floor nurse when they were finished. We also dialyzed in the various intensive care units around the hospital and occasionally in the ER. We also did inpatient and outpatient plasma pheresis in our unit. When the unit was closed there was a RN on call for dialysis and one for pheresis. We also had an outpatient unit in a separate building staffed with RN's and dialysis techs. Inpatient and outpatient dialysis are very different but I enjoyed the challange of more acute patients.

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I've been in dialysis for about 7 years now, and have worked in hospital acutes, and in chronics.

Both will keep you hopping, but Acutes less so.

In acutes you will get your assignment. And if you have the "out of Unit" runs, Your day will go something like this:

If you are smart you will start with the patient that is in the Critical care unit furthest from the main inpatient dialysis unit. And work your way to the closest unit.

I worked in a hospital with two Cardiac/Cardio-vascular units on one side of the hospital, Medical ICU on the other side of the hospital, and Neuro-Surgical ICU in the middle. (600+ bed hospital)

If you are lucky, there will be a DI (Portable water system) and Dialysis machine in EACH ICU. If not you will have a cart, that contains lines, bicarb, baths, vinegar, bleach, syringes, gauze, liter bags of NS etc on it...All the stuff you need to do a treatment or two. A DI system, and a Machine to roll across the hospital to do a treatment. You may or may not have assistance to move all this stuff. (Think multiple trips--This is why you start furthest away from your supplies in the morning when you're still fresh). If the machine and DI are already where you're going, You only have to deal with your supply cart. (woot!)

Before you get to your patient, you must look up their labs, get orders, hook your faucet adapter to the room sink, hook up the DI to the sink. hook Dialysis machine to DI, and run drain line to nearest drain. Turn on water and String machine. By this time the DI will have been hooked up and running for long enough that you can test the water for chloramines and chlorine. Also you double check that your DI has green lights indicating that both tanks are good.

Now you can assess the patient, and get report from the ICU nurse. Then you weigh the patient, determine how much fluid to take off, and hope and pray that the patient's blood pressure will cooperate with the goal you've set.

Next, you either cannulate the patient's access with needles or access the dialysis catheter. Then hook the patient up to the machine, and then you monitor the patient and chart every 15 minutes on b/p, pulse, fluid removed, pressures in the vessels.

Eventually, the treatment is done, and you return the patients blood, unhook the machine, and either flush the catheter, or remove the needles, holding the sites till the bleeding stops. If you can, you use clamps, then you can clean your machine (1:100 bleach solution). While continually assessing the access site to insure that it isn't bleeding.

If the Lord is smiling on you your next treatment is on the same side of the hospital or in the same unit. You can then take your freshly cleaned machine to the next room, set up your DI and machine again (as described above). And do it all again.

If you have to go to a different, and perhaps distant unit. You will be required to acid, and heat clean your machine before you go to the next treatment and a different machine and DI. About 40 minutes. If you've already given report post tx to the ICU nurse, you can run real quick and perhaps get lunch, or snack on the go.

Once your machine is in heat, you can usually leave it as it will turn off by itself. And you and your cart go to the next ICU and you set up all over again. If you have all your patient's on one unit, you can complete three 3-hour treatments in a 12 hour day.

If you are in the main unit, your patient's are brought to you, and it's much like a chronic unit, except your patients are sicker, and if you have to call a code, the entire world will be in your dialysis unit RIGHT QUICK!

It is a slightly more sedate pace than Chronics, but you will be up and down, all day.

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I've been in dialysis for about 7 years now, and have worked in hospital acutes, and in chronics.

Both will keep you hopping, but Acutes less so.

In acutes you will get your assignment. And if you have the "out of Unit" runs, Your day will go something like this:

If you are smart you will start with the patient that is in the Critical care unit furthest from the main inpatient dialysis unit. And work your way to the closest unit.

I worked in a hospital with two Cardiac/Cardio-vascular units on one side of the hospital, Medical ICU on the other side of the hospital, and Neuro-Surgical ICU in the middle. (600+ bed hospital)

If you are lucky, there will be a DI (Portable water system) and Dialysis machine in EACH ICU. If not you will have a cart, that contains lines, bicarb, baths, vinegar, bleach, syringes, gauze, liter bags of NS etc on it...All the stuff you need to do a treatment or two. A DI system, and a Machine to roll across the hospital to do a treatment. You may or may not have assistance to move all this stuff. (Think multiple trips--This is why you start furthest away from your supplies in the morning when you're still fresh). If the machine and DI are already where you're going, You only have to deal with your supply cart. (woot!)

Before you get to your patient, you must look up their labs, get orders, hook your faucet adapter to the room sink, hook up the DI to the sink. hook Dialysis machine to DI, and run drain line to nearest drain. Turn on water and String machine. By this time the DI will have been hooked up and running for long enough that you can test the water for chloramines and chlorine. Also you double check that your DI has green lights indicating that both tanks are good.

Now you can assess the patient, and get report from the ICU nurse. Then you weigh the patient, determine how much fluid to take off, and hope and pray that the patient's blood pressure will cooperate with the goal you've set.

Next, you either cannulate the patient's access with needles or access the dialysis catheter. Then hook the patient up to the machine, and then you monitor the patient and chart every 15 minutes on b/p, pulse, fluid removed, pressures in the vessels.

Eventually, the treatment is done, and you return the patients blood, unhook the machine, and either flush the catheter, or remove the needles, holding the sites till the bleeding stops. If you can, you use clamps, then you can clean your machine (1:100 bleach solution). While continually assessing the access site to insure that it isn't bleeding.

If the Lord is smiling on you your next treatment is on the same side of the hospital or in the same unit. You can then take your freshly cleaned machine to the next room, set up your DI and machine again (as described above). And do it all again.

If you have to go to a different, and perhaps distant unit. You will be required to acid, and heat clean your machine before you go to the next treatment and a different machine and DI. About 40 minutes. If you've already given report post tx to the ICU nurse, you can run real quick and perhaps get lunch, or snack on the go.

Once your machine is in heat, you can usually leave it as it will turn off by itself. And you and your cart go to the next ICU and you set up all over again. If you have all your patient's on one unit, you can complete three 3-hour treatments in a 12 hour day.

If you are in the main unit, your patient's are brought to you, and it's much like a chronic unit, except your patients are sicker, and if you have to call a code, the entire world will be in your dialysis unit RIGHT QUICK!

It is a slightly more sedate pace than Chronics, but you will be up and down, all day.

Way to make me think about work on my days off, oldguy.

:)

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