Client.

Much to tell about dialysis and my new role, very excited. But with the little time I have today, I have to tell you about the first part of my morning.

I am no longer a "staff nurse." I work the bedside in a consultative role. I provide a service, namely dialysis, to patients who need it while they are staying in the hospital for whatever reason. And ESRD patients have a lot of reasons to be in the hospital. I have been on orientation (and still am) since early September mostly because we cover twelve area hospitals, and work alone. Each hospital is different; each system has its own rules and protocols. I don't use a timeclock. I get my to-dialyze list the night before and I go to whichever hospital needs me.

I have a LOT to tell you about why this is the coolest thing since cheese was invented.

A quick story:

This morning, I woke at 4 (which I hate, but will change). I drive 20 miles to a hospital across town to meet my preceptor. First on our to-do list is a young woman who is on periotoneal dialysis. We check our supply room and paperwork on the ICU first. We sneak quietly into her room a little before 6, and D is teaching me about the peritoneal dialysis machine. I know the physiology behind it, but I'm learning from him details about what concentrations of dialysate might be used for what conditions, what dietary restrictions PD patients have (and don't), and how the machine is set up. I'm learning about how the patient cares for herself at home, what she does, what she has to do to modify her life to do her own treatments.

The machine looks good, the treatment is complete. We take down the numbers we need and assess the output of the dialysate, talk about what it means, what I'm looking for.

The patient wakes. She's used to seeing dialysis RNs at this time of day. We introduce ourselves, ask about how her night was. We discuss her concerns about treatments, what she's discussed with the MDs, what her plan for her self-care is, how she's going to do this in conjunction with her ICU and floor nurses (who don't know how to use PD). We mask/glove/etc up, and disconnect her.

She has concerns about her dressing, and we do a sterile change for her. We discuss another of her comorbid conditions, ask how she's managing. After that, she has no other concerns, seems to be doing fine (telemetry and vitals all show stable). We bid her a good day.

We visit with the patient's ICU nurse, ask the nurse similar questions. We talk about what we did, and educate the nurse about the dressing, some basics on the machine, discuss the patient's plan of care today, her labs and meds. We're happy, the ICU nurse is happy, jots down some notes to pass on for the next shift. We borrow the chart and write a progress note, enter a charge into the computer then compile OUR paperwork.

Then we thank the nurse and head out the front door by 0730, on our way to a different hospital.

....

I. LOVE. That. Go in, assess the patient's needs, provide a helpful service or two and usually some teaching. We even help the nurses that are at the bedside of the patient, even sharing some new information to them when they're open to it. (And we nurses generally are curious about new things.) (Can I give this blood pressure med? Will this dialyze out? Does this dressing need to be done with sterile technique?) We didn't interact with the physicians until later today, but that's part of it, too. Chart, charge, bad-a-bing, out the door, on to the next consult visit.

I LOVE that.

Yup. Think I might love this job.