Registered Nurse

Position Summary

The In Center Hemodialysis Registered Nurse provides safe individualized nursing care to patients receiving maintenance hemodialysis. The RN assesses patients before during and after treatment implements prescribed care administers medications responds to changes in condition and emergencies documents care educates patients and caregivers and collaborates with the interdisciplinary team. This is a direct care staff RN position. The RN provides required clinical oversight of assigned patient care activities but does not have routine personnel management authority.

Essential Duties and Responsibilities

Assessment Care Planning and Education

• Establish and maintain professional therapeutic relationships with patients and communicate respectfully with families caregivers practitioners and interdisciplinary team members.
• Complete the RN components of the initial comprehensive assessment within the later of 30 calendar days or 13 outpatient hemodialysis sessions and complete reassessments within required timeframes.
• Continually assess patient needs and contribute to the development implementation evaluation and revision of the individualized plan of care.
• Participate with the patient and interdisciplinary team in comprehensive assessments care planning conferences follow up reassessments and annual or monthly reassessments as applicable.
• Include patients and when appropriate families or caregivers in care planning and education regarding dialysis medications vascular access care infection prevention treatment adherence emergency preparedness modality options and transplantation.
• Establish measurable patient goals with the interdisciplinary team and evaluate progress toward expected outcomes.

Hemodialysis Treatment and Patient Safety

• Provide direct nursing care to assigned patients in accordance with the dialysis prescription practitioner orders the California Nursing Practice Act facility policies and demonstrated competencies.
• Initiate monitor and terminate hemodialysis treatments safely within the RN's training and demonstrated competency.
• Perform and document pre treatment intradialytic post treatment and discharge nursing assessments.
• Verify patient identity allergies dialysis prescription practitioner orders machine settings dialyzer dialysate anticoagulation vascular access ordered medications and applicable precautions before and during treatment.
• Assess vascular access before during and after treatment and promptly address or report signs of infection infiltration bleeding stenosis thrombosis or access dysfunction.
• Monitor vital signs fluid removal treatment tolerance machine parameters and patient response throughout treatment. Evaluate abnormal findings and intervene within scope and policy.
• Recognize and respond to dialysis complications and medical emergencies. Initiate emergency procedures notify the appropriate practitioner and arrange a higher level of care when indicated.
• Provide immediate clinical supervision of assigned Certified Hemodialysis Technician functions as required by California law and facility policy. This responsibility does not include hiring discipline performance evaluations scheduling or other personnel management authority.

Medication Orders and Clinical Follow Up

• Administer and document medications and treatments according to valid orders the California Nursing Practice Act facility policy and demonstrated competency.
• Review clarify when necessary implement and document medical orders accurately and within required timeframes.
• Complete medication reconciliation at admission at least monthly after hospitalization or a transition of care and whenever medication changes are identified.
• Review relevant laboratory results and trends implement authorized interventions and notify the practitioner of significant or critical findings according to policy.
• Participate in practitioner rounds and patient care conferences as assigned and promptly communicate significant findings changes in condition and unresolved clinical concerns.
• Complete or support follow up related to missed or shortened treatments hospitalizations emergency department visits and transitions of care according to facility workflow.
• Coordinate referrals appointments and continuity of care needs related to the dialysis plan as assigned.

Infection Prevention Equipment and Environment

• Follow infection prevention requirements including hand hygiene personal protective equipment aseptic technique medication preparation injection safety vascular access care station disinfection bloodborne pathogen precautions and hepatitis B isolation practices.
• Confirm that required machine water dialysate and environmental safety checks are completed and within acceptable limits before treatment proceeds. Immediately report and respond to abnormal results according to policy.
• Review required clinical treatment medication safety water and equipment logs and address or escalate incomplete documentation and abnormal findings.
• Report equipment concerns unsafe conditions occupational exposures and other safety events promptly and according to policy.

Documentation Quality and Compliance

• Review the patient record for diagnoses allergies dialysis prescription current orders vascular access information precautions and pertinent clinical history.
• Complete nursing notes treatment records assessments summaries care plan documentation and other required records accurately and within established timeframes.
• Maintain current nursing documentation and contribute to timely updates of the interdisciplinary plan of care.
• Report and document adverse events medication errors suspected abuse or neglect and other reportable incidents according to law and facility policy.
• Participate as assigned in the facility Quality Assessment and Performance Improvement program including review of clinical outcomes infections hospitalizations missed or shortened treatments vascular access medication events incidents and corrective actions.
• Protect patient rights privacy and confidentiality and comply with DCD policies professional standards and applicable federal and state requirements.

Professional Responsibilities

• Attend required staff meetings in services emergency drills continuing education and competency activities.
• Follow the established reporting and escalation process. If management is not present in the building, use the DCD Escalation Flow Map to identify and contact the appropriate leader.
• Participate in orientation training and competency support for new or current staff when assigned and when within the RN's scope training and demonstrated competency.
• Provide coverage at other DCD facilities when assigned based on operational needs and after required site orientation training and competency validation.
• Maintain required licenses certifications health clearances competencies and continuing education.
• Perform other duties within the RN's lawful scope of practice training and demonstrated competency as assigned.

Qualifications

• Current active and unrestricted California Registered Nurse license in good standing.
• Graduate of an accredited or state approved registered nursing education program.
• Current Basic Life Support certification maintained as required by facility policy and before independent patient care assignment.
• Successful completion of DCD orientation dialysis training and initial and ongoing competency validation before independent assignment.
• Previous dialysis experience is preferred but is not required when the RN successfully completes the facility approved dialysis orientation training and competency validation program.
• Ability to maintain all required licenses certifications health screenings and documentation required by law and facility policy.

Knowledge Skills and Abilities

• Knowledge of dialysis principles vascular access infection prevention medication safety emergency response patient education and clinical documentation.
• Knowledge of the California Nursing Practice Act and ability to practice within applicable federal and state requirements professional standards facility policies and individual competency.
• Ability to apply clinical judgment recognize changes in patient condition prioritize care communicate clearly and escalate concerns promptly.
• Ability to provide required clinical direction to Certified Hemodialysis Technicians and assigned care team members without assuming personnel management authority.
• Ability to use electronic health records dialysis equipment emergency equipment and required clinical systems after training.
• Ability to work effectively in routine and emergency situations and communicate respectfully with patients families caregivers practitioners and interdisciplinary team members.
• Commitment to patient rights confidentiality professional conduct dependable attendance teamwork and a safe care environment.

Physical and Work Environment Requirements

With or without reasonable accommodation the employee must be able to perform the essential functions of the position including standing sitting and walking for extended periods bending stooping kneeling crouching reaching pushing pulling and lifting up to 30 pounds communicating effectively and observing patients vascular access sites equipment displays alarms and color based safety indicators. The employee works in a clinical environment and may be exposed to blood body fluids infectious diseases chemicals sharps and moderate equipment noise. Required personal protective equipment and safety precautions must be used. Travel between DCD locations may be required based on operational need.