RN (FLEX) - Hemodialysis - The Brookdale Hospital Medical Center

Under the supervision of the Director of Nursing Hemodialysis Nurses provide direct and individualized nursing care to End Stage Renal Disease (ESRD) patients who require hemodialysis based on the application of scientific nursing principles. In addition to general nursing care, responsibilities of Hemodialysis Nurses include (but are not limited to):

Assessment: Conducts ongoing focused physical, psychosocial, and pain assessments; including assessment of patient education needs. 

Planning: Utilizes the assessment, identifies problems, makes nursing diagnoses, and formulates goals, teaching plans and outcomes to create an individualized plan of care to ESRD patients on hemodialysis.

Implementation: Prioritizes and implements an efficient nursing plan of care relating to the care ESRD patient who receives hemodialysis treatment.

Evaluation/Reassessment: Consistently conducts timely evaluations, recognizes changes in patient conditions, determines when reassessments are needed, and adjusts the plan of care as necessary. Compares expected and achieved outcomes of nursing care utilizing the plan of care.  Evaluate patient’s response to interventions and communicates with other healthcare team members the need to revise or maintain plan of care.

• Prioritizes tasks and adjusts priorities when necessary. Maintains an orderly, efficient, and timely flow of patients.  Recognizes and reports errors, near misses or unusual occurrences, and initiates corrective action when appropriate.
• Develops short and long-term goals specifying expected outcomes. Communicates these goals at multi-disciplinary meetings.
• Makes accurate, complete, and timely entries into the patient medical record addressing all steps of the nursing process.
• Demonstrates competency in setting up and operating the dialysis machine.
• Assess the patient’s vital signs, weight and pain. Observe for signs of volume overload and complications of renal failure. Assessment includes patient education needs.
• Knowledge of critical lab values.
• Knows special procedures related to dialysis such as changing dialyzer and or blood lines, the interpretation and comprehension of the transmembrane pressure (TMP) and deduce fluid replacement.
• Initiates/Terminates hemodialysis treatments in patients with AV graft, AV fistulas and catheters.
• Monitor blood pressure every 30 minutes or more frequently as needed.
• Makes accurate, complete, and timely entries into the patient medical record addressing all steps of the nursing process.
• Observe access and ensure access site is visible at all times.
• Ensure lines and connections are securely taped to avoid separation of blood lines.
• Observe for complications such as air embolism, hemolysis, exsanguinations, fever, seizures, arrhythmias, hypotension and report immediately to the physician.
• Prepares and administers and records prescribed medications. Reports adverse reactions to medications or treatments in accordance with the policy regarding the administration of medications by a licensed registered nurse.
• Recognize the signs and symptoms of respiratory emergencies and knowing how to start standard interventions to stabilize the patient.
• Inform the physician and have EKG done whenever a patient complains of chest pain. Administer 2-3 liters of oxygen and place the patient on a cardiac monitor.
• Recognizes lethal arrhythmias and acts appropriately. Initiates corrective action whenever information from monitoring equipment shows adverse symptomatology.
• Draws blood samples for laboratory testing.
• Reviews monthly blood values with patients.
• Reviews medication with patients every month.
• Prepares special dialysate solution example potassium.
• Provides dressing care for patients with all types of accesses including necklines as prescribe.
• Monitors vascular access (graft, fistula, and catheter) for patency, infection etc. and educates the patient on access care.
• Evaluate patient/family and significant other’s knowledge of kidney disease, treatment modalities and treatment and educate them.
• Ongoing review and evaluation of patient’s compliance to treatment and implement interventions.
• Update plan of care based on continuing assessment of patient.
• Collaborates with the physician to manage anemia.
• Admits and cares for all patient needs.
• Participate in multidisciplinary care plan meeting and identifies individual patient goals, readiness to learn, and incorporates family into the plan of care and provide ongoing education and support.
• Utilize principles of Infection Control in the delivery of care.
• Demonstrates efforts in the prevention of hospital acquired conditions (HAC) and falls.
• Refer patient for health maintenance e.g. podiatrist, gynecologist, ophthalmologist.  
• Initiates referrals to outpatient clinic and community resources.
• Utilizes available resources in planning care consults as necessary, with Assistant Head Nurse and Physician.
• Documents patient/family teaching, nursing interventions, patient’s response to treatment and effectiveness of intervention.
• Applies policy of HIPPA Regulations/Patient confidentiality by safeguarding the Protected Health Information (PHI).
• Maintains the culture of safety by properly identifying patients using two identifiers, accurate and timely documentation, and prevention of medication errors.
• Implements discharge planning based on patient care needs & consistently participates in interdisciplinary team discharge rounds.
• Participates in assigned departmental or organizational committees, meetings and/or conferences.
• Participates in the department’s performance improvement initiatives to continuously improve the quality of patient care.
• Participates in the formulation, review and or revision of departmental policies.
• All other duties as assigned.

Education / Experience:

Internal & 1199 SEIU:

• Graduate of accredited nursing program(s).
• Bachelor's Degree in Nursing preferred.
• Minimum one (1) year clinical experience in medical-surgical, emergency room, or critical care.
• Minimum one (1) year related experience in hemodialysis as a dialysis nurse.

Non 1199 SEIU Candidates:

• Bachelor’s Degree in Nursing (BSN) required.
• Master's Degree in Nursing, preferred. 
• Minimum one (1) year clinical experience in medical-surgical, emergency room, or critical care.
• Minimum one (1) year related experience in hemodialysis as a dialysis nurse.
• Will Accept Associate’s Degree with minimum five (5) years’ experience in medical-surgical, emergency room, or critical care and minimum five (5) years’ experience in hemodialysis as a dialysis nurse.

New Graduates:

• Bachelor’s Degree in Nursing (BSN) required.
• All required certifications within six (6) months of hire.

Knowledge and Skills:

• Demonstrates a commitment to continuing professional growth and development.
• Critical thinking, math, and computer skills – Excel & Word.
• Works as a team player.
• Demonstrates respect and professionalism in all interactions.
• Excellent oral and communication skills.
• Decision making and problem solving.
• Able to see, hear, read and write English.
• Ability to fully utilize BHMC’s electronic record systems, equipment and healthcare and billing systems relevant to this position.

Licenses, Certifications:

• Current NY State RN License required.
• Basic Life Support (BLS) required.
• Advanced Cardiovascular Life Support (ACLS) required.
• Basic Arrhythmia Class with Certificate preferred.
• Nephrology Nursing Certification preferred.

Physical Requirements:

• Physically demanding, high-stress environment requiring prolonged periods of standing, reaching, walking throughout the working day. 
• Position will be required to stoop, bend, lift, and carry items weighing up to 35 pounds for routine performance of essential functions.
• An individual in this position may be exposed to: Adverse indoor environmental conditions, Blood borne pathogens, Blood and body fluids, Physical hazards (e.g., needle pricks, etc.), communicable diseases, chemical hazards, radiation, and repetitive motions.
• Full range of body motion, able to lift up to 100 pounds, if necessary, to assist lifting and moving patients.
• Manual and finger dexterity, as well as hand and eye coordination.
• Corrected vision and hearing to within normal range.
• Frequently sitting at desk working on computer.
• Ability to work flex hours.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of The Brookdale Hospital Medical Center.

BHMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.