The Closing shift literally just means the last shift in a dialysis clinic. If it’s a big clinic that consists of two dialysis nurses, one is assigned as the opener while the other one as the closer. The small clinics may also have a different arrangement where the opener dialysis nurse works alone in the morning, joined by the closer dialysis nurse noon time who will then close the shift until the last patient.

As a float dialysis nurse, I get to experience both. I had my first closing shift in my big training facility last Monday then float to a different clinic yesterday, Wednesday for another closing shift. Is there any difference?

Time Shift Difference

Time is the huge difference between the two. One clinic is a 24-chair facility while the other is just 18-chair facility. The bigger clinic is always manned by two dialysis nurses so both come in at almost the same time with a 12-hour shift for the opener while 16-hour shift for the closer. The smaller one, on the other hand, can be manned by just one nurse with both having 10-hour shift only; 5am-3:30pm for the opener while 12nn-10pm for the closer.

15-hour Closing shift

Monday, 5am to 8pm. Starting my week at the bigger clinic, as the closer dialysis nurse, I extend hours until the last treatment. This covers all three shifts for the day.

From my previous post about a day in a life of a dialysis nurse, I handled only two patients since I shared the POD with another nurse. This time around, I did full POD so 4 patients for first and another 4 for second shift while 1 patient for the 3rd shift. We had 4 patients for the third shift so I was only paired with one closer PCT.

Turnover: Fast-paced!

It was a fast-paced shift doing both PCT and nurse roles. I hardly had any chance glancing the time. I’m lucky if I could take the first break on time but wait till turnover comes where most of the tasks are expected to happen: taking off first shift patients, setting up machines, putting on second shift patients, assessing second shift patients, preparing and administering medications. And when I thought I was done and can finally take a lunch break, my first patient of my second shift was already coming off. So it has been 4 hours already?

I checked the remaining time of my other patients to check if I have time to squeeze the quickest lunch I could make but seems it was too late already. After taking off my first 2nd shift patient, I had to prepare the chair and set up the machine again for my last third patient and in a few minutes, the rest of the machines will alarm for treatment completion.

Missed Breaks!

Exactly 4pm, all second shift patients have gone home and my third shift patient was finally hooked. As soon as I increased the blood pump to the prescribed BFR accompanied by words, “Anything else you need?,” I immediately eye signaled my other nurse that I’ll take a break. No words needed. It was understandable! We both forgot to take lunch but since she was going home soon, she just finished her remaining tasks, instead and let me take mine.

Once back, I was faced with the remaining tasks: close all treatments in CWOW, prepare the next day first shift packs, print the routine lab and medication labs. And Ohe, it was Monday, physician do rounds so, I had to carry out all orders. It was my first closer shift too, so I restocked all lacking supplies in our nurse’s station.

Leg Pain!

I went home around 8pm with the sun still up! I can remember how painful my legs and calves were. Walking back and forth in a big clinic is not a joke. Putting on and taking off 4 patients in every shift is manageable since I’m only at one place but doing the assessment and medication around the clinic is what I haven’t expected to be that tiring.

10-hour Closing shift

Wednesday 12nn to 10:30pm. The second day of my 4-day workweek was in a small clinic, 18 chairs. I join the opener nurse during turnover and only cover half of second shift and do third shift alone.

Turnover: Slow-paced!

I don’t have assigned patients here. I only do nurse’ tasks so, the shift here is slow-paced. Too slow, I was able to finish one whole module in starlearning. The AA gave me a new patient documents to be carried out in CWOW as soon as I arrived, but still, too slow, I finished it in 10 minutes.

On the other hand, the clinic is full staffed so nurses do need to help during turnover except for third shift when I am assigned with one patient while 8 for 1 PCT. Patients here do not arrive at the same time, the earlierst arrive at 3pm with gaps of 15 minutes in between and the last one can arrive as late as 6:45pm for a 3-hour and 30-minute treatment that will be done just before 10:30pm.

So, as soon as the first patient arrives, I prepare the medications of all 9 patients. Afterward, I get to log the nursing binder ahead–temperature check and medication count. And it was still 4pm, 6 hours ahead till end of shift. My patient’s chairtime on the other hand is 4:45pm then, I’ll be waiting for all patients to arrive and do assessment and medications.

Full Breaks!

By 7pm, I am completely done, do the last chlorine check and go to my dinner break. By then, I wait till each patient finishes, close each treatment in CWOW and back with starlearning. My last task is pour deoderizer in every drain at my side and I am done.

Dragging Shift!

No matter how relaxed this clinic can be and just perform pure nurse tasks, the cons is late end shift. The gaps between patients were too huge and it was too impractical. So, I’d prefer the fast paced clinic and not notice that it’s already time to go home than staring at the clock ticking and waiting to go home.