Becoming a Dialysis Nurse

Spring, 1989

Ever since returning from the mission trip to Honduras last fall, I have been asking the Lord if it is time to move on to a different type of nursing. After caring for patients in Honduras, it made me realize how much I miss direct patient interaction and bedside nursing. I have now worked in Staff Development for 6 years and have enjoyed teaching other nurses, but am ready for a change. One of my colleagues in Staff Development recently transferred to outpatient dialysis part time on evening shift and is enjoying it. She said there is another opening for a 4 evenings per week nurse. They are closed every Sunday and holidays, and each nurse works every other Saturday. The evening shift extra pay is very good, so my pay would stay the same even though I would be working one less day each week. Each RN is on call one Sunday 4 times per year to cover ICU emergency dialysis.

The Lord gave me peace about applying for the position, so I did. The head nurse called me, interviewed me, and gave me a tour of the unit which is a free standing building across the street from the hospital. The new unit is designed for dialysis with large windows and a nice open layout of 18 recliner dialysis chairs. They do 3 shifts of patients a day Monday through Saturday. There is one RN and one technician for 6 patients.  Day shift dialyzes the 6 a.m. group of patients and starts the next group at 11 a.m. Evening shift works 2-10:30 pm and takes the middle group of patients off dialysis, and then starts and finishes the evening group of patients. They end by cleaning all the machines internally with bleach and vinegar.

So the unit dialyzes 54 patients daily. Each patient comes to dialysis 2 or 3 times weekly to have their blood cleaned for 3 to 4 hours by the machine because their kidneys have gone stopped working. Some patients are waiting for kidney transplants. Some patients, especially on evening shift, work all day and then come for dialysis at night. The main causes for kidney failure are diabetes and hypertension (high blood pressure). Without dialysis, the people die within a matter of weeks from kidney failure. Sometimes the patients become weary of dialysis, and choose to take themselves off of it and go on hospice for their final days on earth.

The next day, the dialysis head nurse called me to offer me the evening position 4 days per week. I would keep my full-time benefits. She agreed to give me every Wednesday off. On the weeks that I worked Saturday, she said my day off would also be Thursday so on those weeks I would have 2 days off together in the middle of the week. The orientation is 10 weeks on day shift and the last 2 weeks on evening shift. I would also need to become ACLS (Advanced Cardiac Life Support) certified so I could run a code if a patient had a cardiac arrest while I was dialyzing him in ICU. I told her I would consider it and let her know by the end of the week.

I went home and prayed for a few days and called my friend, MJ, who was working in dialysis, to talk things over with her again. I could move my Bible Club to Wednesday afternoons and attend prayer meeting at church on Wednesday evenings. Since I had every Sunday off, I could continue to teach Sunday School at church. I always enjoyed evening shift when I was a new graduate because I have never been a morning person. By the end of the week, God gave me wonderful peace that this was His open door. I’m looking forward to this new chapter in my life!

Be anxious for nothing, but in everything, by prayer and supplication with thanksgiving, let your requests be made known unto God. And the PEACE of God, which passeth all understanding, shall keep your hearts and minds through Christ Jesus. Philippians 4:6-7

Dialysis Orientation

I gave 4 weeks notice in Staff Development and started on day shift in dialysis for my orientation. I have to be here at 6 a.m., so arise at 4:30 a.m. which is challenging for me. Every day I ask God to keep me awake and help me learn all this new information. (Remember, I’m the one who fell asleep in statistics class in college and during my nursing state boards!)  They have assigned a preceptor to me who is an experienced dialysis nurse. The first week I watched her set up the machine and cannulate (put the needle in) the special fistula that the surgeon created in the arm of each dialysis patient. They connect an artery and a vein together which creates high blood flow. We use large bore needles for dialysis. One goes in the vein to remove the dirty blood, and the other goes in the artery to return their cleaned blood after the dialysis machine removes the impurities. I watch videos to learn about kidney disease and how dialysis works. It is such a complex process. I feel like a new grad all over again and go home totally exhausted daily from information overload. I ask the Lord to help me learn quickly and so I give good dialysis to each patient and do them no harm. This is definitely the most complex and technical nursing I have ever done. I can see why they don’t hire new graduates into dialysis.

Cobe 3000 dialysis machine I learned how to use.

Cobe 3000 dialysis machine I learned how to use.

To make matters more complicated, the unit just bought 12 new computerized Cobe 3000 dialysis machines, but we still have 6 older Fresenius machines where we have to do more calculations. We have a third type of machine in ICU. Thankfully, I won’t have to learn that one for awhile. They don’t make me take call until I’ve worked here 6 months and am totally comfortable with dialyzing someone independently. There is no one around on Sundays to ask questions where the on call nurse is all alone in ICU. So you have to able to do your own troubleshooting when you run into problems. It’s a huge responsibility for these critically ill patients. It’s good to lean hard on the Lord!



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