A week in the working life of a Senior Charge Nurse, Renal Unit
Monday 14th July
Good morning, I’m Anne, Senior Charge Nurse in the Renal Unit at Raigmore
Hospital.
It’s the start of another busy week for me and the team
That’s some of our team in the photo, we caught them at a quiet moment. It didn’t
last long!
I’ve offered to be the “tweeter of the week” so hopefully you’ll get an insight into what
goes on in a renal unit
There is lots of variety in our work.
We look after patients on haemodialysis, peritoneal dialysis, kidney transplant
patients and patients in acute renal failure.
We’ve got a full house today with 17 patients coming for haemodialysis this morning.
14 patients this afternoon and 7 on the later twilight shift, the waiting area’s never
quiet!
All staff on duty today, no sickness, so that’s always a good start!
First order of the day is staff safety brief and handover, communication is key to
everything we do.
Machines are all up and running, no problems so far but our 2 technicians are on
hand if anything goes wrong.
Spoke too soon, water treatment plant is alarming, blocked filters. Swiftly changed
by technicians and business as usual resumes
I’m not in the clinical numbers today so I’m not directly caring for patients.
I’m on hand for support, advice and anything else that arises, which can be varied
It can be unpredictable - just heard a patient feeling poorly so need to move patients
around to free up a single room!
Off to Ft William tomorrow to interview for Belford renal unit Senior Charge Nurse
post. Need to book a car or I’ll be walking there & back!
Reading the application forms for tomorrow and preparing questions, really important
we appoint the right person.
Datix incident report just arrived by e mail as well as pecos orders needing
authorised
Two staff heading off to tissue viability training.
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I’m taking over their patient care till they come back, time to take patients off dialysis
and prepare for next shift of patients
Lots of phone calls as usual, our new receptionist makes a big difference with that,
the nursing staff don’t need to answer all the calls.
Patient arrives for dialysis with a clotted fistula, needs sorted immediately.
Emergency radiology slot booked and patient goes for procedure, great team
working.
Patient returns, successful procedure so we can get dialysis started, what a relief for
the patient!
A new patient started dialysis today; it’s a very daunting prospect for them.
Staff spend a lot of time explaining and supporting as it takes time to get used to it all
Tuesday
Off to Fort William today to interview for the Senior Charge Nurse post at Belford
Hospital.
Need to leave about 0900 so checking in with the unit before heading off
Flat battery on our Computer on Wheels this morning, COWS as we affectionately
call them! Asked estates to replace them ASAP
Full house of HD patients again today. A lot of patients travel in and out by
ambulance so we keep them very busy
My deputy Susan is off on annual leave this week but lots of other very capable staff
to hold the fort
It’s a perk of the job getting to travel through such beautiful scenery whilst getting
paid.
It beats the view from my office any day, a portacabin wall!
It’s also nice getting to test drive different types of cars through work, always mindful
of the speed limit of course! A Vauxhall Astra today
Off to interviews after a catch up with Marie Law, Belford Hospital Manager (11.30)
The Fort William renal unit has made such a difference for dialysis patients who
previously had to travel to Inverness for treatment
We got 15 new dialysis machines a month ago so lots of training still ongoing with
them.
Dialysis machines are very complex pieces of machinery
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Staff have done really well getting to grips with them; they’re making our working
lives easier, & more importantly patient treatment better
The PD team have a busy day today with 2 kidney biopsies & a new patient starting
on peritoneal dialysis as well as home visits planned
Back home in Inverness renal unit now, can’t tell you the interview results yet, maybe
by the end of the week I can confirm!
The Inverness Courier want a statement about the impact of second hand smoke on
our patients.
It’s been a big problem as people smoke at main entrance next to our department
With the help of security & new posters the problem with smoke coming into the dept
seems to have improved, hopefully this will continue
Meeting with a new member of staff today to see how she is progressing, all going
well & she’s enjoying her new post in the renal unit
Outpatient staff arrived for a look at our videoconferencing equipment; they’re keen
to make more use of VC.
We would be lost without it now, saves on so much time and travel
Off home but on call tonight, hopefully things will stay quiet overnight!
Wednesday
Successful interviews in Fort William yesterday.
We appointed Heather Andrews to the post of Senior Charge Nurse, & she accepted!
She gave me permission to tweet the news!
Another busy day in the renal unit commences!
Thankfully not called in last night, call-outs are quite unpredictable but obviously a
very necessary service
When our nursing staff are called in overnight it leaves us one staff down in the
morning so that’s another variable for the staffing
We are dialysing all the patients in the unit today.
And we have a patient with “acute kidney injury” in ITU who needs dialysis, another
unpredictable part of the job
Hand hygiene results from our audit this month are 100%. Well done #teamrenal!
Weekly video conference with Ft William renal nursing staff, really important to
support the remote satellite units & share information
We also do a weekly VC link with the renal unit in Wick...
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And the Consultants do VC ward rounds for the satellite patients; they’ve been a real
success
Meeting with the Home Dialysis nurse specialist to review the home haemodialysis
service.
We’re keen to increase up take for home haemodialysis, we currently have 4 on
home HD
I need to organise retirement party for one of our staff nurses who retires at end of
Aug, she wants to go to Riva, should be a good night!
A night out with the team is always good for morale!
Meeting with our salaried GP Francesca today, we’re working on a quarterly
newsletter for patients.
We currently have a Christmas one but feedback from patients is that they want it
more regularly. It’s important to listen to patients!
Two holiday patients attending for dialysis in our unit this week.
It’s really important we make room for dialysis patients from elsewhere to have
holidays
Holiday patients come from all over the world to visit our unit,
I’m sure the scenery is a bit of an attraction too but our unit does get good press!
#teamrenal
I’ll sign off for the night on that positive note!
Thursday
We were so busy yesterday I don’t think any of us got a chance to sit down
While we plan our treatments and know who is coming in we always have something
that changes on the day
It’s never dull – wonder what today’s challenges will be?
Nurse on call last night was called in for an acute in ITU so the day starts with us one
trained staff down, it’s going to be hectic!
Off to the quality and safety huddle at 0830,
We don’t have “beds” as such but it’s good to get a feel for the hospital as a whole
and meet with senior management
Also gives us a platform to feedback about renal related issues, share the unique
challenges we have & get support from others
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Thursday is our weekly vascular access MDT, a meeting with the renal team,
vascular surgeons & radiology; it’s now a well oiled machine!
It’s vitally important that patients get their dialysis access planned well in advance of
when they need it to avoid the need for CVC’s.
Our patients get such a high quality service from Mr Wolf, Mr Siddiqui & the radiology
team, they are much appreciated!
We’ve taken on a new treatment recently, plasma exchange, we do it alternate
Thursdays so I’m doing it today.
There’s only 3 staff trained to do it and the other 2 are on holiday, no pressure on me
then!
This has been really positive for the patient undergoing the treatment.
Previously they had to travel to Edinburgh so it’s been a huge benefit to them and
their family
It’s also good for us to keep challenging ourselves and to be learning new skills
#teamrenal
We have our in house training today, a twice weekly one hour session on a variety of
topics.
Had to be cancelled due to clinical activity, patients always take priority!
Presentation was on work we’re doing around falls prevention for dialysis patients &
to update staff on the paperwork & referral process
This improvement plan has seen a reduction in the number of falls in our patients
which is fantastic & work has been presented nationally
The COW (computer on wheels!) battery now fixed and back in use, thanks to the
estates and IT teams for your help
Paperwork needing done.
Doing occupational health referrals for staff & preparing for HR meeting on Friday,
pecos orders, ordering new bin & bed table
Problem with patient fridge out of temperature, ongoing problem, away to phone
estates about it, again!
Just remembered need to complete COSHH assessments for cleaning products for
new machines, need to go on SYPOL database, I’m on the case
Everyone loves health and safety….don’t they?
Friday
Clinical caseload again today, it’s been a very busy week for everyone.
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We’ve had lots of dialysis access problems and patients going to theatre for urgent
procedures –lots of excellent teamwork to sort out
Working in a renal unit is a great combination of routine & unscheduled work making
it a fantastic speciality to work in, it’s rarely dull!
There must be some attraction in it; I’ve been in renal nursing for 25 years.
We don’t have a big turnover in staff which suggests it’s not just me that enjoys it
We’ve got 2 band 3 haemodialysis support workers on duty today.
These new posts have made a huge difference to way we work in the unit & created
a career structure for our band 2’s, a real success story
Just had my monthly meeting with human resources.
It’s essential to meet up with them to discuss complex or sensitive staffing issues,
they generally keep us right!
Spent time with a new dialysis patient today, http://www.nhsinform.co.uk/healthlibrary/articles/d/dialysis/introduction
They needed support and information about future dialysis options and what this
thing called a “fistula” is
We use some of the patient information leaflets from the British Journal of Renal
Medicine, they’re well written for patients to understand
They also have an ipad app- http://www.bjrm.co.uk/
We encourage our patients to register for “Renal Patient View” which is a confidential
website linked to our electronic patient record.
Patients can view their blood results, transplant list status & other information.
http://www.renalpatientview.org
www.renalpatientview.org
We have about 50% of patients using.
They really like being able to look up their own results without having to ask us & it
has lots of other useful links
Well things seem to be under control in the unit, very atypical for a Friday! It’s been a
busy week for #teamrenal
I’ve enjoyed sharing my working week with you all; hopefully you’ve gained a little bit
of insight into the workings of a renal unit
Have a good weekend and I look forward to learning about another tweeter’s role
next week
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