What do you think about dialysis nurses?

NurseRies, BSN, RN · Sep 2, 2013

Our yearly in service from the dialysis/renal/diabetic team helps so much to avoid conflicts, and misunderstandings.
Our dialysis RN's do give transfusions, meds, change patients, etc. A dialysis patient is off the unit for 4 hours, that is a HUGE amount of time. They are their primary RN for the time, until the pt is transferred back to the unit. They get report, and give it.
I learned that a RN that takes over for a pt procedure, test, is then the responsible RN for the whole pt. So in different facilities what is the difference?
Our response team is called to transport pt's that are to travel on tele, or go to CT, MRI, etc. when there is a change in condition requiring RN transport.
They take report from the unit RN, and are then responsible until they give report back to the unit RN.
During that time frame. They do all 5 steps of the nursing process. They will call us when needed to update us, or if pt is going to be transferred to a critical care unit.
I do not understand the difference of a response RN taking over, vs. a dialysis RN in the other facilities I am not familiar with.
So much can happen in 4 hours. As a floor RN I would not be comfortable not seeing a pt for hours.
Who does their assessment on the q 4 hours? Checks/flushes their NG or peg tube? Documents IV and PCA site/lines/pumps?

The difference in some facilities, obviously not yours, is that dialysis units are run by nurses that are not employees of the hospital. They are Davita and fresenius nurses and are legally not allowed to even touch an IV, let alone a peg tube, PAC pump, heparin drip. Doing so I have found out is a HUGE deal. CT and MRI usually have hospital employed nurses, they don't outsource their services. So they are trained and covered by Liability Insurance to do all levels of care. We are not covered. I wish it was different because I feel bad calling the floor nurse to come to the unit to refill an IV drip or give insulin. That is why we only bring fairly stable patients to the unit and their meds just get put on hold. I get very frustrated as an outside nurse with little control over what I can do for the patient.

And yes, we cover 8-10 hospitals in big cities, so we may come work a 12 hour day at your hospital and then have to float to another hospital at 7pm to do another treatment and not get home until 1am, still on call. Even the hospital run dialysis programs are slowly getting bought out by these outsourced companies. The hospital run dialysis programs usually lose money and the big dialysis companies can offer their services for cheap, and efficiently. They have their own benefits, etc and can reassign nurses to different hospitals as census fluctuates. I don't like the idea at all! I think hospitals should run a fluid unit, are there any other specialties that get outsourced or contracted like us?

all4neuro · Sep 3, 2013

Our facility got rid of homecare and hospice coordinators. The social workers took over doing some of the tasks the RN's once did.

There is no one better than a hospice RN to coordinate hospice care. The home care coordinator position's, although I miss a lot of the RN's that went elsewhere, their job tasks have easily been distributed among the multidisciplinary teams. Hospice RN's are just so valuable. and when there was a consult they came immediately. Which, hello?? that was a big deal. Now, it is hours or a day later before we get a consult completed.

FineAgain · Sep 3, 2013

The only problem I have had with dialysis nurses is..in my hospital they often call to give me report just after I have settled my patient back in their room. A little heads up that they are on their way back would be nice. Other than that, I think they are wonderful!

Do-over, ASN, RN · Sep 3, 2013

I work with some great dialysis nurses.

SN - shouldn't blood products always be infused with dialysis when at all possible? Its not like they need the fluid volume...

NurseRies, BSN, RN · Sep 4, 2013

I work with some great dialysis nurses.
SN - shouldn't blood products always be infused with dialysis when at all possible? Its not like they need the fluid volume...

For sure! It's just easier on the nurse and the patient. We can't keep the patient past their treatment Time to infuse blood though bc we have a very turn and burn schedule, we need to get the next patient in ASAP. But they can't expect us to do type and cross, wait for results, and still have time to give blood, it usually doesn't work.

Erikadawn RN · Sep 4, 2013

I really don't think the floor nurses understand what the scope of dialysis nurses are. I also work for anoutside company. I do not have access to the pixes system or the lab system. Even at the few hospitals I have worked at, when dialysis nurses can access the pixes, it is for dialysis medications only, epogen, heparin, venofer, benadryl. No I can't give your morning meds because I simply do not have access to them. Most bp meds are also held pre dialysis or the Pt may bottom out and die. I can't feed your Pt, because it is contraindicated during dialysis. I had one nurse say after I explained that to her, that she felt that we were just being mean and that's why we don't feed the patients. The ICU nurses that I work with, generally have a good understanding of dialysis and what it entails. They know I will get blood for labs, give antibiotics, and transfixed the pts. Plus at my hospitals I can only take orders from a Nephrologist, No one Else. Unless the physician in charge asks me to stop a treatment. So when the docs write an order for Percocet, I can't give it. Sometimes just inquiring may be better than assuming. After all we are all there for the Pt.

wildboo · Sep 6, 2013

You are absolutely right! I'm a Fresenius nurse, and, technically, we are not allowed to touch a pt, even to roll them. We do, but per company policy, if it isn't dialysis related, we are not allowed to do it, period. I'm an acute nurse as well, and work primarily in a rehab hospital. He hang antibiotics for the nurses because we can run some of them during treatment, and often the only access pts have is their dialysis shunt. We also run blood during treatment when we can, because I can run it in 30 minutes, and they have to run it over 4 hours. I take pts to the bathroom, clean them, put them on bed bans, clean and change linens, pull blood for them for glucose checks. And yes, I've been a "real" nurse for a long time, doing ER and PICU, so I know what it's like to run my tail off. But when you work the floor, you have many people who know your job. When I'm working bedside, I only have ONE other person who knows my job, and when my pts goes to hell, and I'm pouring in albumin and blood and my machine is screaming and the lines are clotting, you can't help me. So trust me, my job is about "pushing buttons" as a floor nurses is about emptying bedpans! At least when you have a crummy pt you can leave the room! I'm stuck there for 4-5 hours with them with no relief. And we actually aren't allowed to read books or magazines, and we DEFINITELY aren't allowed to hook them to a machine and say, "call me on my cell if the machine beeps." That's a pretty good way to kill someone.

We don't let them eat because at best, they get nauseated and throw up during treatment. Worst, their BPs tank and we fight And if you think listening to 4 hours of Gunsmoke is every day for weeks on end is MY idea of a great way to spend the day, it isn't. I'd rather be running from room-to-room, but it's pts choice. We would rather be able to do all of our nursing duties than have our hands tied. Believe me. Makes the day go faster

And, for those of you who think we just sit on our butts, perhaps if you asked us about our jobs or our equipment or about treatments, you might find we're pretty good resources for a great many things, from mediations that are or aren't dialyzed off (so you know what you shouldn't give prior to dialysis) to renal diets (how to keep those K+ levels down) to just random weird things (many of us have had prolific careers). We'd be glad to share!

wildboo · Sep 6, 2013

In our unit, we only have two dialysis nurses, and just the one shift, so, we're done when we're done. Eight hours or 18. There is no shift change. We're it. Not ever place has such a small acute staff, but most acutes have just the one shift, and they can be l o n g. We also do call seven days on, seven off. In case anyone thinks we slack.

wildboo · Sep 6, 2013

Dialysis is the only specialty I have seen (so far) run like this, and it has been nation wide. Not sure why that is. I don't see ER nurses or IV therapy nurses outsourced this way (I do those s well). Could be there aren't companies that are in the same vein as dialysis? Since contracting Davita isn't the same as having travelers, since your employee base is more consistent.