Registered Nurse - RN - Dialysis

Purpose and Scope

Functions as part of the hemodialysis health care team as a Staff Registered Nurse to ensure provision of quality patient care on a daily basis in accordance with FMS policies, procedures, and training. Supports the FMCNA mission, vision, values, and customer service philosophy and participates in process improvement activities related to the Quality Enhancement Program (QEP) and CQI.

Principal Duties and Responsibilities

• Directs Patient Care Technicians' provision of safe and effective delivery of chronic hemodialysis therapy in compliance with facility policy and state and federal regulations.
• Delegates tasks to direct patient care staff including LVN/LPNs, Patient Care Technicians, and Dialysis Assistants.
• Assesses daily patient care needs and develops appropriate patient care assignments.
• Monitors patient care staff for appropriate techniques and adherence to facility policy and procedures.
• Participates in staff training and orientation of new staff as assigned.
• Ensures educational needs of patients and family are met regarding End Stage Renal Disease (ESRD).
• Provides ongoing education to patients regarding renal disease, vascular access, dialysis therapy, and related health conditions.
• Provides patient-specific education regarding adequacy measures including OLC, AMP, and Urea Kinetic Modeling (UKM).
• Ensures transplant awareness, modality awareness, and drive catheter reduction.
• Educates patients regarding laboratory values and the relationship to adequate dialysis therapy, compliance with treatment schedule, medications, and fluid.
• Provides safe and effective delivery of care to patients with ESRD.
• Accurately implements treatment prescriptions including Sodium modeling and Ultrafiltration modeling.
• Assesses patients' response to hemodialysis treatment therapy and makes appropriate adjustments and modifications to the treatment plan as indicated by the prescribing physician.
• Communicates problems or concerns to the Team Leader or physician.
• Initiates Initial and Annual Nursing Assessment and ongoing evaluation and documentation of patient care needs.
• Actively participates in pre-evaluation, initiation, monitoring, termination, access homeostasis, and post evaluation of patients receiving hemodialysis treatment therapy.
• Takes appropriate intervention for changes in patient adequacy status and troubleshoots access flow issues as identified by OLC/AMP yellow lights.
• Provides, supervises, and monitors hemodialysis access care according to established procedures.
• Implements, administers, monitors, and documents patient's response to prescribed interdialytic transfusions.
• Ensures accurate and complete documentation by Patient Care Technician on the Hemodialysis Treatment Sheet.
• Reviews, transcribes, and enters physician lab orders accurately into the Medical Information System.
• Ensures appropriate preparation of lab requisitions and correct lab tubes for prescribed lab specimens.
• Identifies and ensures appropriate follow-through regarding missed labs and insufficient specimens.
• Ensures all specimens are appropriately packaged according to DOT policies and procedures.
• Reports alert/panic and abnormal lab results to appropriate physician.
• Enforces all company approved policies and procedures and regulations set forth by state and federal agencies.
• Maintains overall shift operation in a safe, efficient, and effective manner.
• Acts as a resource for other staff members.
• Routinely meets with the Clinical Manager to discuss personnel and patient care status, issues, and information.
• Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust, and coordinate care.
• Provides assistance to patients regarding prescription refills according to FMCNA Policies.
• Ensures all physician orders are transcribed and entered into the Medical Information System in a timely manner.
• Oversees all documentation of patient information.
• Maintains facility drug list for all required stock medications.
• Maintains competency with all emergency operational procedures and initiates CPR and emergency measures in the event of cardiac and/or respiratory arrest.
• Ensures verification and availability of adequate emergency equipment.
• Ensures provision of appropriate vaccinations, immunizations, and annual Tuberculosis (TB) testing.
• Administers medications as prescribed or in accordance with approved algorithms and documents appropriate medical justification if indicated.
• Administers PRN medications as prescribed and completes appropriate documentation of assessment of effectiveness.
• Maintains appropriate recording of controlled substances as required by law.
• Assists with the coordination of patient transportation if necessary.
• Ensures a clean, safe, and sanitary environment in the dialysis facility treatment area.
• Ensures competency in the operation of all dialysis-related equipment safely and effectively.
• Ensures all patient stations, including machines and chairs, are clean and free of blood and placed appropriately.
• Ensures that all blood spills are immediately addressed according to FMCNA Bloodborne Pathogen Control Policies.
• Ensures all relevant data including physician orders, lab results, vital signs, treatment parameters, and patient status are documented and entered into the Medical Information System.
• Ensures all FMCNA policies regarding patient admission, transfer, and discharge are appropriately implemented.
• Verifies accuracy of Patient Care Technician documentation.
• Reviews and ensures appropriate daily completion of Hemodialysis Treatment Sheets by all patient care staff.
• Ensures appropriate procedures are followed regarding opening and closing procedures.
• Initiates, documents, and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports.
• Completes monthly nurses' progress note.
• Ensures patient medical records are complete with appropriate information, documentation, and identification.
• Reviews transplant status and follows established procedure regarding appropriate action.
• Completes patient care plans for new patients within the initial 30 days or any patients deemed unstable requiring monthly patient care plans.
• Completes initial and annual Nursing History and Assessment physical.
• Ensures completion of Annual Standing Order Review with each physician as required.
• Performs additional duties as assigned.

Physical Demands and Working Conditions

The position provides direct patient care that regularly involves heavy lifting and moving of patients and assisting with ambulation. Requires frequent, prolonged periods of standing and the ability to bend over. May occasionally be required to move, with assistance, machines and equipment of up to 200 lbs., and may lift chemical and water solutions of up to 30 lbs. up as high as 5 feet. The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials. Employees are required to take the Ishihara's Color Blindness test as a condition of employment.

Education and Required Credentials

• Graduate of an accredited School of Nursing.
• Current appropriate state licensure.
• Must meet the practice requirements in the state in which he or she is employed.

Experience and Skills

• Minimum of one-year medical-surgical nursing experience preferred.
• Hemodialysis experience preferred.
• ICU experience preferred.
• Successfully complete a training course in the theory and practice of hemodialysis.
• Successfully complete CPR Certification.
• Meet the necessary requirements of Ishihara's Color Blindness test as a condition of employment.
• Provide coverage at any or all area facilities as required by management.
• ICD-9 coding training.
• Nurses Technical Training.
• Must meet appropriate state requirements (if any).