If you’re a new nursing graduate who’s still exploring your career options, then you don’t want to miss this episode!
This week, you and I will be diving deep into the world of hemodialysis nursing; what it is, how it works, and everything in between.
With almost ten years of experience in dialysis, I am here to guide you through the realities and rewards of this specialized field. This episode is set to become your all-access pass to the secrets no one tells you about hemodialysis nursing.
I hope you’re prepared to be both informed and inspired about your potential future in this dynamic and fulfilling profession.
Are you ready?
Let’s dive in.
What Is Hemodialysis?
Hemodialysis, also known as dialysis, is a specialized and rewarding field that gears towards patients with kidney disease. As hemodialysis nurses, we provide treatments to these patients, which plays a crucial role in extending their lives.
Patients with kidney diseases have kidneys that can no longer perform their essential functions. Dialysis treatments play the role of the kidneys, and it’s our job as dialysis nurses to understand how to provide the essential treatments by setting up the machines, giving patient education, proper assessment, and more.
In this blog, we will explore the role and responsibilities of dialysis nurses and what a day of being an outpatient hemodialysis nurse is like.
The Roles and Responsibilities of a Hemodialysis Nurse
As a hemodialysis nurse, you’re not providing patient care all by yourself. You’ll be working closely with nephrologists, patient-care technicians, social workers, dietitians, clinical managers, biomedical engineers, and more. Everyone’s primary goal is to ensure that the patient is receiving the best dialysis treatment possible.
Preparation:
A dialysis nurse’s responsibility starts with dialysis preparation. You have to check the schedule to see where you are assigned, which patients, and the technician that you’re responsible for.
For example, in the state of New Jersey, the ratio was one staff member to three patients. But overall, a nurse could be responsible for up to nine patients. So sometimes I could be responsible for two technicians as well as my own patients (up to nine). Sometimes, I would be assigned one or no patients, but I still had to be responsible for the care of my technicians’ patients, which would leave me at six patients total.
All equipment must be sterile. You have to set up the dialysis machines with the proper equipment, punch in your patients’ orders, and get the chair ready with the needles, gauze, medical tape, and medications. Preparation also includes drawing up pre-treatment medications for each patient as ordered, such as Heparin.
Assessment
Patients arrive in the unit and take their assigned chairs. They can’t just switch chairs as desired because their specialized orders have been set on the machines for them. Each of them has a scheduled time so you have to start each treatment based on the chair time.
Before starting each treatment, you have to assess the patient for any changes in their condition as well as their vital signs. For example, if their blood pressure is too low, you can’t start treatment right away. Pre-treatment assessment is essential to ensuring the patient does not go unconscious or experience symptoms during treatment.
You also have to evaluate the patient’s vascular access site for potential signs of complications or infection. The vascular access site could be a fistula, graft, or catheter. If the fistula or graft does not have any bruits or thrills noted during assessment, the patient unfortunately cannot receive dialysis treatment and must be sent to Intervention Radiology to get a procedure done to remove clots and then get rescheduled for dialysis treatment at a later time.
After putting in the vital signs and necessary information into the machine, you have to get a second signature from another nurse or technician confirming that the correct dialysis orders have been placed. This step helps ensure that patients receive the correct dialysis orders.
Administering the Hemodialysis Treatment
During dialysis, blood is removed from the patient’s body and gets filtered through the artificial kidney on the machine, which is known as the dialyzer. Filtered blood is then returned to the patient.
Treatment time can average between three to six hours, but the most common time is three to four hours. Based on patient responses to the treatment, you may have to adjust the parameters.
Medication Administration
Some patients might have to receive medications that are prescribed by the nephrologist. The majority of medications are injected into the machines and do not need to be directly injected into the patient. These medications can include antibiotics, iron supplements, Hectorol, and Epogen.
Of course, if this is the patient’s first time receiving the medication, you must assess the patient’s response within the first half hour of receiving the medication for potential allergic reactions.
Patient Education
Educating patients and their families is essential. Patients must be educated on their dietary restrictions, such as limiting high sodium and high potassium. Fluid intake must also be restricted.
The point of dialysis is to remove waste and fluids. If there are too many fluids to remove at once, the patient can become symptomatic or even go unresponsive.
There’s a maximum that can be removed from each patient and it is calculated based on their weight and their treatment orders. Patients are also educated on medication compliance as well as treatment compliance. Majority of patients must get dialysis treatment three times a week.
Emotional Support
Many patients see you more than their own family and friends. Dialysis clinics become their second homes and they really trust you with their lives. Nurses become their emotional support as they navigate through this new chapter of their lives.
Post-Dialysis Assessment
After treatment is complete, the technician or the nurse removes the needles from the patient and makes sure that the bleeding has stopped prior to leaving the unit by applying pressure.
Patients that are alert and oriented can apply pressure to their own needle sites. Vital signs are taken and then the nurse will assess each patient to ensure that they are in stable condition before leaving the unit.
Dialysis Turnover
In an earlier example, I stated that I had nine patients, which is the ratio in the state of New Jersey. I haven’t worked in dialysis in a while so this can always change.
This information was only for the first shift. Our team was responsible for getting these nine patients to come in and complete their treatments, get them out the door, clean the machines and chairs, prep the machines, and get the next nine patients in on their scheduled time. Following the schedule is crucial because patients can miss their rides or be late to work if you don’t.
Some units have three shifts so that means there are two turnovers. Other units have four shifts, which means there are three turnovers. The turnovers are the most challenging part of the job because you’re getting the patients in and out with very tight time constraints.
In an ideal world, it would be easy to follow the patients’ scheduled times. Unfortunately, you may have a code, a patient who won’t stop bleeding, symptomatic patients that cannot be discharged yet, or a patient who came to treatment really late. A lot of factors come into play that can make turnovers challenging.
Shift Handoff
My clinic had four shifts so the staff was split into the morning and evening shift with ten working hours. The morning shift would provide a shift handoff if one of their patients was extremely late or if a patient had to be rescheduled to the evening shift.
Educational Requirements
To become a hemodialysis nurse, you first must become a nurse. You can have an Associate Degree in Nursing or a Bachelor of Science in Nursing. Of course, you must pass the NCLEX-RN exam and become a licensed registered nurse.
The majority of dialysis units prefer nurses to have experience in general nursing. However, this is where I started out as a new grad. This is where I trained a LOT of new graduates who came in with zero experience. What I loved about this job was that it provided several months of training and education before I could go out and confidently set up the machines and complete treatments for these patients. Companies, such as DaVita and Fresenius, have amazing programs for those who are starting out in the dialysis fields.
Working Conditions
This varies from unit to unit. The most common hours are fourteen-hour shifts three times a week.
I do love the flexibility of dialysis. You can choose your shifts and you almost always have Sundays off, unless it’s a holiday week. My favorite hours were when I worked on Monday and Wednesday from 4:45 AM until 12:00 AM. That would cover nearly forty hours for the week. Then I’d be off from Thursday until Tuesday without having to take paid time off. I loved the flexibility and being able to travel during my long weekends.
Inpatient Hemodialysis Nursing
Acute or inpatient hemodialysis nurses have unstable hours. It’s a very different workflow and there’s a lot more to it when it comes to dealing with unstable patients that are hospitalized. The focus is to provide immediate care and support during the patient’s stay.
Inpatient dialysis nurses do not have the stress of handling nine patients at a time back to back and dealing with turnovers. They provide care for four to five patients in their unit with one or two other nurses or patient care technicians.
Some nurses prefer this because they can provide care at their pace without the stress and challenges of outpatient dialysis turnovers.
Impact on Patients’ Lives
As a hemodialysis nurse, you play a vital role in keeping the patient’s quality of life as they navigate their lives with kidney disease. You make a huge difference that goes deeper than just providing them treatments. You are there to maintain their dignity and independence. For me, it was a very rewarding career choice. I absolutely loved seeing the same patients three times a week, getting to know them, and become a part of their lives.
I loved the stability of knowing what my schedule was going to be like and who I was providing care for. If you are considering a career in hemodialysis nursing and you are nervous about embarking towards a career you have little knowledge, don’t be.
Through specialized education, providing compassionate and quality patient care, you can make a difference in a patient’s life with kidney failure.
I discuss all of this in more depth in the episode above, so make sure to give it a listen when you can!
