A Day in the Life of a Dialysis Nurse | Doing both PCT and RN roles

Exactly 9 months ago, July 25th, I started working as a dialysis nurse in my training facility 5 minutes away from my apartment. Two months later, September 12th, I was transferred to a different facility 35 minutes away to fill in since the regular nurse resigned. Today, April 24th, 2023, I’m back to my training facility.

To make the story short, I arrived in the US with a job offer in a dialysis clinic that is closed. So ever since I’d started working here, everything has been temporary. Neither the training facility is not my permanent clinic nor the second clinic I got transferred which is now filled in that is why I’m back to where I started.

The clinic where I swore not to go back because of experiencing self doubt and developing impostor syndrome yet now, I’m here.

Monday 5am, First day high!

One of the advantages working here is it’s a big clinic so, it’s always 2 nurses for 24 chairs. Plus, I’m with my co-pinoy nurse so it’s not bad for a first day. We share one pod so, we are assigned 2 patients each.

So, as soon as I came in, I go straight to the machines to set up and prime compared to the other clinic where I go straight to the nurse’s tasks. Machines take a long process of conductivity, testing, recirculation and connecting to CWOW (or computer), so I want to make sure to do this first and get on to the rest.

Mondays have 3 shifts so the closer nurse is expected to arrive 30 minutes later. As soon as she arrived, I tried asking the different roles. She explained that the 5am nurse do the nurse roles while the 5:30am nurse set up the machine but it was too overwhelming so I just wanted to focus what I have started and we switched roles, instead. She logged the nursing binders, fridge temp, medication count, glucometer testing then, withdrew heparin doses.

6am, First shift Patients arrive

First day is first day, at exactly 6am, doors open and patients started coming in yet I was not even completely done. We divided the patients and I chose the last two with chairtime of 6:30am and 6:45am to not feel too pressured. But since all patients arrive at the same time, my heartbeat started racing as they settle in their respective chairs.

The first patient I put on has an AVG, the access that I always find challenging. If the access is problematic, I have not reached a point yet of being able to troubleshoot it smoothly. Unluckily, I got my very first challenge, although patient calmly oriented me about it, the pressure, fear of failure, anxiety were all piling up affecting me to focus and do it properly and I didn’t. Thankfully, the patient was not all that toxic and even reassured me that everyone is also having the same difficulty so I have nothing to worry. But I stuck at a way farther area and I knew I couldn’t do it. I asked my co-nurse for help and the patient told me that the ones who could do it are the PCTs. I moved forward to my co-nurse’ second patient to make use of the time wisely instead of watching her troubleshooting it and she ended up asking help with the nearby PCT.

Then, I am faced with the very reason I dreaded to come back to this clinic. The toxic teammates who never run out of words belittling someone who cannot do what they can in a suave manner. And I was right beside her, bulls-eye listening. So, I thought it’s Monday, morning, everyone can be expectedly cold.

7am, Assessment and Medications

After sticking patients, I proceed to assessing first and verifying prescribed HD orders set on machine to all 10 patients while the rest were for the second nurse and the LPN then, prepare whatever medications left which is Mircera, a prefilled erythropeitin syringe. I go back to my 10 patients and give their due medications and document in CWOW accordingly.

8am, First Break

While I was busy finishing my tasks, the second nurse started preparing the packs for our second shift patients. And since her patients will be done first, she went to break first and I followed right after.

10am, Turnover

Turnover came. I reclaimed my diginity to my failed AVG attempt when he commended me of pulling out needles without feeling anything, mood started to lighten up. My two patients have not arrived yet, thereby late and one of them is a bit problematic who chooses PCT over a nurse to stick him and I am in for another challenge again. In a few minutes, I’ll be asking help from the same person who stick my first patient. While waiting, I started assessing patients.

As soon as my patients arrived, my co-nurse oriented me to just prepare everything because they’ll only stick the needles. So, I did and I kinda mentally prepared my lines when I finally approached her,
“I’m so sorry but the patient requested you to stick him.”

If there’s a perfect definition of a dual personality, this got to be it when she surprisingly transformed to a different person,
“Are you ok if I’m just going to stick the needles?”
“Ohe sure! It’s all ready!”

11am, Second shift

I continued assessing patients, verifying HD orders, preparing medications, giving out medications, documenting in CWOW then, closing the first shift patients. We had to input our post assessment before patient’s treatment can be closed.

Compared to my first few days here when I was still training, I can now remember patients easier. They don’t print flowsheets anymore so in order to distinguish patients, I go find their machine numbers in CWOW and verifing by asking the patient themselves. And when I go back to the station to prepare the medications, my memory is now better to remember all 10. I am more of a visual learner so I remember them as to where they are and not entirely their names.

1pm, Lunch Break

This time, I took the break first. I went outside to eat my lunch but just inside my car to get away from the work ambience.

2pm, Turnover

When I got back, my co-nurse’ first second shift patient was all done and her second was down to 2 minutes. I told her to go to break and I’ll take off her second patient. She oriented me that patient is, “Mej Bleeder” which I literally understood as mild bleeder but a totally opposite. Ohe well, I managed. I used to get anxious with bleeders too during my first few days and had a taste of messy blood all over the arm chair.

For this day, there is a new PCT who came off from training but is yet to take the final exam too so all her patients were left to us. Aside from taking off my co-nurse’ patient, I also helped take off the LPN’s who joyously said, “I appreciate you!”

4pm, Third shift

My shift is only until 4pm but I stayed longer to get familiar of the daily tasks in preparation for my next duty because by then, I’ll be with another regular nurse (not pinoy) and full 4 patients for both first and second shift. I made sure to close all second shift patients first before I listed down all the daily tasks of both 5am opener and 5:30am closer and ask anything I could think of–process of bleaching, routine laboratories including the difficulty of putting on patients and their attitude.

This clinic is more on the technical skills of a PCT while where I came from was more focused on the RN skills so I also had a fair share of giving her how-tos of the different outliers of target weight adjustment and reporting. The last thing I did was prepare packs for my next duty patients just in case.

It was almost 6pm when I went home!