Liaison Nurse - Hemodialysis

Hospital RN caring for the patient is responsible for overall supervision and management of the patient. While the patient is in the dialysis suite the hospital HD suite liaison RN is responsible for primary care of the patient while the patient is in the dialysis suite.

EDUCATION AND EXPERIENCE REQUIREMENT(S):

Graduate of accredited RN program. Current licensure in NYS or eligibility for limited permit to practice. Bachelors' degree preferred.

PRIMARY RESPONSIBILITIES OF THE POSITION:

Duties include:

• Assessment, documentation, medication administration, management of the unstable patient, initiation of emergency responses and access of central lines if necessary, including
• Obtain Dialysis Orders from providers and clarify orders as needed.
• Medical management of the dialysis patient (Medications, diabetes management, etc.)
  • Collaborate with Nephrology physician/provider or Pharmacist if there is a question or concern about any medications.

• CVA dressing changes.
  • CVAD flushing pre and post hemodialysis must be performed by Hospital RN or HD RN and not the hemodialysis LPN or CCHT.

• Management of HD patient census.
• Obtain consent if not on general consent.
• Coordinate and assist with transportation as necessary.
• And other duties as assigned.

Orders - All orders for hemodialysis shall be entered in the Electronic Health Record (EHR) by the Nephrology physician/provider.

* Prior to first use of temporary catheter access, RN must obtain order for approval to use catheter.

Hand-off Communication from floor nurse will occur and should include:

Patient's daily weight, medication status and medications due during treatment, pertinent assessment findings, status of dressing change and end cap changes, isolation status, and other reportable conditions or safety concerns.

Prior to hemodialysis hospital RN will:

• Obtain baseline vital signs (temperature, pulse, respirations, blood pressure and oxygen saturation)
• Do NOT use arm with AV fistula/graft for BP monitoring, venipuncture, and blood sampling. This Limb should have a bracelet to indicate LIMB ALERT.
• Hospital RN or Hemodialysis RN to change CVAD dressing per hospital policy prior to each dialysis treatment and prn.
• Hospital RN or Hemodialysis RN to document CVAD dressing site assessment and dead-end cap change in EHR.
• Perform and document assessment the patient for signs of fluid volume excess including edema, hypertension, crackles (rales), tachycardia, distended neck veins, shortness of breath and symptoms of hypoglycemia.

During hemodialysis:

• Dialysis catheter: To be accessed by HD or Hospital RN. CVAD flushing pre and post hemodialysis must be performed by Hospital or HD RN and not the hemodialysis LPN or CCHT.
• AV Fistula/Graft: Only HD Staff to access, after RN assessment.
• Blood specimens may be drawn directly from the dialysis circuit by the HD Staff as ordered.
• The HD Staff responsible for implementation and monitoring of extracorporeal circuit during procedure.
• The HD Staff will maintain line of sight of patient throughout duration of treatment.
• The HD Staff will monitor injection sites, dialysis needles and tubing for blood leaks, hematoma, disconnection, or kinking.
• The HD Staff will obtain blood pressure, pulse, and respirations prior to and at after initiation of treatment, then every 30 minutes thereafter and prn. The Hospital or HD RN will report any abnormal findings to the provider.
• Hospital or HD RN is responsible for assessing the patient for any complications that may occur during dialysis treatment.
• The HD Staff will communicate with Hospital RN to address patient needs during dialysis.
• Hospital RN will administer all medications and/or blood/blood products.
  • Two Hospital RNs must verify blood product orders and is responsible for the administration of these infusions as outlined in their respective policies.

Post hemodialysis:

• The Hospital RN will obtain post-treatment vital signs after patient is removed from the dialysis machine.
• The Hospital RN will perform focused assessment:
• Level of consciousness, cardiac/respiratory status, signs of hypovolemia and/or hypoglycemia.
• Neurovascular assessment of affected leg if femoral catheter is used.
• If dialysis catheter used, Hospital RN to administer catheter lock anticoagulant per order.
• If AV fistula/graft was used for dialysis, pressure will be maintained on injection site until hemostasis is achieved, then a dry sterile dressing will be applied by the HD Staff.
• Hospital RN or HD RN will assess dressings over puncture sites of AV fistula/graft for bleeding.
• All staff will monitor for post-treatment complications.
  • Any medications held during hemodialysis, to be administered by Hospital RN on the patient's unit.

Documentation:

• The Hospital RN caring for the patient is responsible to ensure the following documentation is completed in EHR:

• Document pre-assessment and weight, patient's response to dialysis, any complications during dialysis, post assessment and weight including net gain and/or loss on appropriate form.
  • Document medications, transfusion and/or albumin, flushes, instillation of medications into catheter lumens, catheter dressing and end cap changes
• Any changes in patient's condition during dialysis
• Evaluation of effectiveness of care i.e., presence of complications and stability of fluid balance
• Provide and document patient education related to dialysis therapy
• Documentation on EHR by HD Staff includes pre/post treatment notes, fluid removed, and the Hemodialysis Flowsheet copied into a progress note in the patients' EHR at completion of treatment.

PHYSICAL REQUIREMENTS:

• Should be able to push/pull, lift/move 35 lb., be able to perform moderately difficult manual manipulations such as using a keyboard, writing, and filing for extended periods of time, must be able to perform tasks which require hand-eye coordination such as data entry, typing and using photo copiers. Mobility requirements may include the ability to be stationary at a workstation for a prolonged period time in addition to being able to squat or be mobile for a reasonable length of time and distance. Communication requirements include the ability to comprehend the spoken English language in addition to being able to communicate and read the English language.

Ellis Medicine is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex/gender, age, national origin, disability, genetic information, predisposition or carrier status, military or veteran status, prior arrest, or conviction record, marital or familial status, sexual orientation, transgender status, gender identity, gender expression, reproductive health decisions, or domestic violence victim status.

Salary Range: $39.23-$55.58 /hour Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.