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 worked in Staff Development for six years and enjoyed teaching other nurses, but I am ready for a change. One of my colleagues in Staff Development recently transferred to outpatient dialysis part-time on the evening shift and likes the patients and staff. She said there is another opening for a nurse to work four evenings per week. They are closed every Sunday and holidays, and each nurse works every other Saturday. The evening shift extra pay is good so my pay would stay the same even though I would be working one less day each week. Each RN takes call one Sunday four times per year to cover any emergency dialysis in the Intensive Care Unit.

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 eighteen recliner dialysis chairs. They do three shifts of patients a day Monday through Saturday. One nurse and one technician care for six 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.

The unit dialyzes 54 patients daily. Each patient comes to dialysis two or three times weekly to have their blood cleaned for several hours by the machine because their kidneys have stopped working. A number of the patients are waiting for kidney transplants. Some patients, especially on the evening shift, work all day and then come for dialysis at night. The main causes of 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 four 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 two days off together in the middle of the week. The orientation is ten weeks on day shift and the final two weeks on the 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 who works in dialysis to talk things over with her again. I could move my Bible Club to Wednesday afternoons and attend the prayer meeting at the church on Wednesday evenings. Since I would have every Sunday off, I could continue to teach Sunday School at church. I always enjoyed the 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 KJV).

Dialysis Orientation

I gave four weeks notice in Staff Development and started on day shift in dialysis for my orientation. I have to be there at 6 a.m., so I arise at the challenging hour of 4:30 a.m. Every day I ask God to keep me awake and help me learn all the 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 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 to create high blood flow. We use large-bore needles and put one in the vein to remove their dirty blood and the other in the artery to return their cleaned blood after the machine removes the impurities.

I watched videos to learn about kidney disease and how dialysis works, a complex process. I feel like a new grad all over again and go home totally exhausted daily from information overload. I asked the Lord to help me learn quickly. This is definitely the most complex and technical nursing I have ever done. I can see why they don’t hire new graduates.

To make matters more complicated, the unit just bought twelve new computerized Cobe 3000 dialysis machines, but we still have six older Fresenius machines which require more nurse calculations. We have a third type of machine in ICU. Thankfully, I won’t have to learn that one for a while. They don’t make me take call until I’ve worked here for six months and am totally comfortable with dialyzing someone independently. There is no one around on Sundays to ask questions while the dialysis nurse works alone in ICU. One has to troubleshoot independently when problems arise. I am learning to lean hard on the Lord.