Behind the scenes: A day in the life of a nurse

headnurse and dialysis machine

Patients are well familiar with what happens during a haemodialysis session at a NephroCare centre – at least from their perspective. But what goes on behind the scenes, before the first patients arrive in the morning and after the last ones leave in the evening? Agnes Szekeres, head nurse at the NephroCare centre in Cegléd, Hungary, gave us an exclusive look into the daily routine of the centre’s nurses.

5.00 a.m. – Early start

Long before patients arrive, the daily routine for our clinic staff begins. At the crack of dawn, 5.00 a.m., the first staff members start trickling in. For most of us, a hot cup of coffee helps start the day on the right foot. It’s also a chance to briefly discuss yesterday’s events, and run through the daily schedule.

5.00 a.m. to 5.50 a.m. – Preparation time

The morning patient shift starts at 6:00 a.m. Our team has a short amount of time to prepare everything correctly so things will run smoothly once the patients arrive. On our daily to-do list:

  • Switch on the water and the Central Delivery System (CDS)
  • Check the water quality and hardness, conduct a chlorine test, and read the water meter
  • Turn on and check the dialysis systems, check residual disinfectant with a test strip
  • Set up and prime bloodlines, dialysers. Prepare all materials for treatment. Prepare personalised heparin for each patient.
  • Separately prepare connection materials for patients with a central venous catheter or an arteriovenous fistula
  • Prepare  disinfectant solutions for surfaces and for used instruments

5.40-5.50 a.m. – Doctors and patients arrive

From this point on, our work becomes visible to patients. We start each dialysis session by measuring a patient’s body weight and washing their fistula arm with soap and water. Then we show them to their reserved dialysis station.

6.00 a.m. to 10.30 p.m. – Performing dialysis

Our standard therapy is 250-270 minutes of post-dilution online haemodiafiltration treatment. During this time, our most important task is monitoring patients and providing the best problem-free treatment possible.  

Our nurses work hard to take care of each patient, giving them the attention and time as per their individual requirements. When time allows, nurses prepare tools and materials for the end of treatment sessions, and get ready to welcome the next group of patients.

Busy all day long

When not tending to patients, our staff have a variety of other daily tasks to fulfil, such as:

  • Recording data in the European Clinical Database (EuCliD)
  • Scheduling medical examinations for our patients and for those waiting to be added to the transplant waiting list
  • Planning laboratory tests, taking blood draws and preparing test tubes; entering test results in EuCliD 
  • Filling in daily quality control and environmental protection paperwork
  • Conducting diet consultations, conversing with patients, and providing psychological support, if needed
  • Organising treatments for patients in the intensive care unit 
  • Storing and dispensing of erythropoietin and monitoring its administration

11.30 a.m. – Morning session ends

The morning flies by. When we say goodbye to the first groups of patients, the chemical disinfection process inside the dialysis systems is already in progress. Soon we start carrying out surface disinfection. Next up: handling, transporting and storing hazardous waste. Finally, we hand over the treatment room to the cleaning staff.

11.30 a.m. -12.15 a.m. – Break time and scheduling

Before the whole process starts over with new patients, our nurses take another short break to enjoy a well-deserved cup of coffee. This window of time is likewise used for patient scheduling and arranging weekly patient transport, though all this can change from day to day. Because many dialysis patients still work, we often adjust the dialysis schedule to accommodate their work schedule. Doing so is challenging but we always find a solution. When requests for holiday dialysis come in we process them, and we maintain regular contact with other dialysis centres.

Ensuring highest quality

By regularly participating in training sessions and e-learning courses, we can carry out tasks with the highest possible skill level, and comply with the latest nursing standards. The quality of care we offer patients is regularly monitored through audits, inspections by the Fresenius Medical Care country head nurse and checks by regulatory agencies. Our target is to satisfy everyone at any given time.

Part of a bigger team

From a patient’s perspective, our staff on the floor may appear to single-handedly perform dialysis treatment. But this is far from the truth. Without our administrator, head of technical maintenance, technicians, and IT department, our centre could not open its doors. Tools, materials, and concentrates for treatment must be ordered and properly stored. Machines and the building must be maintained and repaired if necessary. And our IT system enables us to accurately and quickly enter data.  

Our work continues until 10 p.m., and at the end of one day, we start preparing for the next. Through it all, teamwork is the glue that binds us all together – allowing us to provide our patients with top quality care.