A Real Rant

[meadowlandsnj]

I go to dialysis Tuesday, Thursday, Saturday.  When I went Saturday I left at a certain weight--I always know the weight I leave at because I have caught the nurses in mistakes before regarding my weight.
During shift changes there is sometimes chaos with them trying to get people on and off the machines.
Weights are shouted across the room and sometimes weights are mixed up between patients.  Okay........when I got to dialysis Tuesday my nurse took my weight coming in and she whistled and said to me my God you gained a lot!  I said to her what are you talking about???  I gained only 3.2 K from my calculations from what weight I left at.  She told me I supposedly gained 7.7!!  I told her no way did I do that and I told her what I left at.  She proceeded to get all huffy and told me "well I wrote it down in the chart what you left at so it has to be right".  I asked her what it was and immediatly told her she was wrong.  I told her in all the times I ever came to dialysis I have NEVER gained that much.  I told her to look back at every run sheet to see what weight is my dry weight and to prove she wrote the wrong number.  Of course she didn't bother to do this and told me AGAIN that she didn't write anything wrong
and I was wrong because I'm just the patient and she's the all knowing, all omniscient nurse.  GOD I WAS PISSED!!!  And then one of the doctors was doing his rounds and he came over and looked at my run sheet and commented why did I gain so much weight?  I told him SHE wrote down the wrong weight.  He said to me "she wrote it in the chart though".  AAAAGGGHHHHH!!!! 
From now on I will write my weights down in a notebook and make them REPEAT it to me and MAKE them write it in the chart IN FRONT OF ME before I leave. 
BTW when I left I was way below my dry weight.......so that again proves I was right!  And she nurse kept saying to me during treatment "oh I'll never get this weight off of you, you can't drink anything from now until THursday".  HUH?  What the FLUCK???!!!   

[Sara]

What an ass!  And you're the one who has to suffer for her "fluck"-ups.   

[susie q]

Sorry you had to go thru shit like that... in our unit the scale is digital and has a print out
function... no screw ups.. 

[geoffcamp]

screw that you should know your dry weight and what the weight you came in at so it is a simple calculation to prove her WRONG!  Don't let them run all over you!!  My dry weight is 89 Kilos I usually come in at around 90 Kilos after a weekend so if they told me I had 7 Kilos on I would look at my weight and subtract the dry weight and come up with my goal minus the rinse back of course and show that BIOTCH what the REAL deal was!  They put you at risk of soooooo many complications by trying to take off sooo much more then they should have and I would go right to the doctor and the administrator and prove you were right (by these calculations) and tell them the WILL listen to you from now on and that is that!!!  That really sucks!!  But stick up for yourself and SHOW them they are WRONG!!!
Geoff

[Rerun]

BTW when I left I was way below my dry weight.......so that again proves I was right!  And she nurse kept saying to me during treatment "oh I'll never get this weight off of you, you can't drink anything from now until THursday".  HUH?  What the FLUCK???!!!   

If you were way below your dry weight when you left.... then you shouldn't have been able to even walk out.  If you calculated 3.2 and she calculated 7.7 and she tried to take off 7.7 you would have cramped into a permanent pretzel.  She should have looked at your last flow chart and if you came in that time at 85 and left and 89 then dah.........she wrote it down wrong.

[meadowlandsnj]

BTW when I left I was way below my dry weight.......so that again proves I was right!  And she nurse kept saying to me during treatment "oh I'll never get this weight off of you, you can't drink anything from now until THursday".  HUH?  What the FLUCK???!!!   

If you were way below your dry weight when you left.... then you shouldn't have been able to even walk out.  If you calculated 3.2 and she calculated 7.7 and she tried to take off 7.7 you would have cramped into a permanent pretzel.  She should have looked at your last flow chart and if you came in that time at 85 and left and 89 then dah.........she wrote it down wrong.

When she set the machine up I told her don't take off that much weight. Plus my BP was kinda low so she kept turning me off.  I felt kinda loopy and dull today.  I really thought she was going to tell me to come in for an extra treatment today!  Then the sheet would have hit the fan!! 
 As it turns out I think I may have lost about 3 pounds since last week also, I wasn't feeling too good so I didn't really eat the last few days.  By my calculations I am about 4-5 pounds below my dry weight.  I ate today so I am feeling better. 
How do you deal with a person who will not admit they're wrong??  Document EVERYTHING!!  Numbers. weights, now I'm going to ask for copies of my flow sheet every time.  This incident has really bothered me.  Usually I'm the type to let it slide but this just irked me.  I'm having a hard time letting it go and I know I'm being stupid by letting it get to me but...........

[Sara]

I don't think you're being stupid, this is your health she's dealing with.  It may not seem like a big deal to her, but she's not the one who has to deal with cramps and feeling bad after they take too much off.  You have every right to feel pissed off, and I think it's a good idea to keep your own records of your weights. 

[Rerun]

You are not 4-5 pounds below your dry weight.......that is your dry weight.  Dry weight changes all the time.  What ticks me off is only the doctor can officially change your dry weight.  Well......it should be up to me.  I'm not going to go around with fluid on me because she decides not to visit the clinic that week!

[angieskidney]

 
How do you deal with a person who will not admit they're wrong??  Document EVERYTHING!!  Numbers. weights, now I'm going to ask for copies of my flow sheet every time.  This incident has really bothered me.  Usually I'm the type to let it slide but this just irked me.  I'm having a hard time letting it go and I know I'm being stupid by letting it get to me but...........

You are DEFINATELY not being stupid! This is your life and to the nurse it is JUST a job!

A lot of nurses get defensive because they feel we are trash talking them but can you blame us? I used to not understand when I was on PD becuase I didn't really have to deal with them but now that I am on HD I finally understand what other HD patients were talking about. And I remember the looks and rolling eyes from staff when a HD patient would complain. They automatically think that we are just whining and complaining and because of that they shrug it off and don't take anything we as patients say seriously.

But when it comes to your weight you can't let them get it wrong! There are too many bad things that research has proven happen when your goal is grossly miscalculated!

[jbeany]

If you don't have enough "stubborn and difficult", I'll lend you some of mine!  (My doc thinks I have to much anyhow.) 

No one knows your body better than you do - do NOT let them run you around.

[jedimaster]

Don't let nurses push you around!!!!....mistakes can happen, but here we are talking about our lives...I keep a log on my own data on a spreadsheet, so I can make all decisions I need. I go, do and then apologize....

[geoffcamp]

rerun,

At my center I tell them if my dry weight is changing and the nurse makes the change immediately.  Is there some reason at your center only the doc's can make that change???  For instance I have been losing weight from working out lately and last week I told my nurse to take my dry weight down another kilo and she did.  Just curious
Geoff

[Rerun]

They will do what I ask, but they can't "officially" change my chart.  Only the doctor can.  So, everytime I go in and get a different tech it goes like this:

Rerun:  I weighed 49.4 and my dry weight has changed to 47.4 (instead of 47.0) so I need to take off 2.6.......

Tehc:  Are you sure your dry weight is 47.4 it says here 47.0?

Rerun:  Yes!  I'm sure.  I've gained some weight.........so let's announce it to everyone!

You get the picture!!   

[kitkatz]

I think they have just about given up trying to tell me what my treatment weight should be and what I should take off.  I tell them what I want and they know to set the machine that way and they know I will double check it all anyway when I am settled in the chair.
     I think we are down to two people who are still there besides office staff when I began dialysis in this unit: a nurse and a tech. All the others do not have my seniority in the unit anymore.  The nurse and I just about started in the unit the same week. I never knew he was new there, just thought he was one of the gang. I met a new nurse last night who just hired on. We lost two or three people techs/nurses recently.  I told him my bark was worse than my bite   The tech standing there said "Oh she just talks."  They love me, I think.

[meadowlandsnj]

You are not 4-5 pounds below your dry weight.......that is your dry weight.  Dry weight changes all the time.  What ticks me off is only the doctor can officially change your dry weight.  Well......it should be up to me.  I'm not going to go around with fluid on me because she decides not to visit the clinic that week!

That's right..............a big DUH for me!   
Yeah only the doctor can change the dry weight where I go but some of the better nurses always ask me if I think they should change it. I've been trying to lose body weight so it gets a little tricky sometimes.  I'm pretty good about fluids though and I know my own body.

Thanks Rerun

[angieskidney]

They will do what I ask, but they can't "officially" change my chart.  Only the doctor can.  So, everytime I go in and get a different tech it goes like this:

Rerun:  I weighed 49.4 and my dry weight has changed to 47.4 (instead of 47.0) so I need to take off 2.6.......

Tehc:  Are you sure your dry weight is 47.4 it says here 47.0?

Rerun:  Yes!  I'm sure.  I've gained some weight.........so let's announce it to everyone!

You get the picture!!   

That was my exact experience just 2 weeks ago! I knew my target should be 63.5kg but they kept telling me it said 63.0kg on the sheet. I knew it should be 63.5 and told the nurse. She didn't change it or even put a note in the computer so I had to go through the same BS the very next time. And as it was that nurse ended up taking off too much off me and I felt like crap and my BP started dropping. The next time when I had to tell them again that it was wrong the nruse put it into the computer so now it is right.

[scyankee]

"Meadow",
   If in the future that happens again, make sure that you are NOT hooked up and go back to the scale!!!!
I have been recording my pre/post weights to keep in check of what is going on and also as a memory
test for me before I go home.  I have the opposite problem.....they only take off .5 Kilos. What is the point
in that? Give me a break!!!  I have also had them not record my outgoing weight because they are
so lax. Raised in Essex Cty, NJ now in the south. No matter where you are having treatments you have to be
villigant when you go.  Hang in there, kiddo!    SCYankee

[kevno]

Old School Do the weight/BP/Temp myself and work out for them how much "I" want to be taken off! I am the weight I want to be, if I feel to be bit overloaded I sort it out for myself. Do not give a damn what the Nurses think it's my body and I know what is the best for the way I feel. Plus what the BP shows. For me if high overloaded if low too dry.

[stauffenberg]

As I once commented to a dialysis nurse, there is no government on Earth, whether Hitler's Germany, Stalin's Russia, or Pol Pot's Cambodia, that is so tyrannical it tells you how much water you can drink, and yet it is taken for granted in dialysis that a committee of generally quite stupid and careless people can make just such intimate decisions for your life.

For the first four years of dialysis I was still making so much urine that I never had any fluid to be taken off.  Each new nurse would refuse to believe that, and would insist that I had made some error in weighing myself or that at least some fluid should be taken off anyway, since I was no doubt gaining something.  The loss of personal autonomy, privacy, and dignity alone is reason enough to make dialysis unendurable.

[kitkatz]

Yet some of us do it and do it fairly well and for a long time.   Yes this can seem unendurable and yes it sucks.  I hate it, but eight years of life added on has been cool. I got to see my kids grow up and now are functioning adults.  One benefit.

[DeLana]

I'm an RN who worked in a dialysis clinic for 5 years and will soon work in a hospital inpatient dialysis unit. 

I'm sorry you had to go through this, it should not have happened.  Nurses should use their discretion when setting your ultrafiltration or fluid removal goal (that's what the assessment - BP, edema, etc. - is for).  In general, RNs can change estimated dry weight (EDW) under standing orders (i.e., the doctor will later sign them off); however, techs and LPNs cannot.  It can sometimes be difficult to tell who is who in a dialysis clinic since most staff members won't wear their name badges    Techs and LPNs should let the RN know that a patient's weight needs to be corrected.  In reality, this rarely gets done - on some days I would do nothing but change dry weights if I had a new assignment - they were often off by several kilos!

Please also remember your patient's rights; you can refuse any and all treatment and this includes having more fluid removed than you wish.  Staff should honor your wishes, however they may give you an AMA* form to sign (many won't bother, though - too much work  ).

Personally I would never doubt or question if a patient told me that his weight was recorded incorrectly, especially if there was such a large discrepancy and no clinical evidence of fluid overload.  If I thought, however, that more fluid should be removed I would explain this to the patient.  Still, he/she could certainly refuse; I would normally note this in the chart/record (AMA forms are only necessary if there's a serious discrepancy - for instance, the patient is short of breath, edematous, with high BP and insists on a low ultrafiltration goal).

HTH,

DeLana 

*AMA:  against medical advice

[JerseyGirl]

Agreed, DeLana.  I would never doubt it if the patient told me their weight was documented wrong.  I would assess the patient for proper UF goal and proceed after checking their lungs, edema, BP, etc.  As an RN I was the one to change target weights after looking at blood pressure trends, run sheets, etc.  the doc would simply co-sign my change.  Matter of fact, I still do it.  Sorry fellow jerseygirl - at least that's what I assume from "meadowlands" - this shouldn't have happened to you.

[stauffenberg]

Most patients, whether they are in a hospital, an out-patient clinic, or in the doctor's office, think they have lost all their civil rights and have no power to leave or to refuse treatment if they wish.  Hospitals should state clearly in signs in every room that the patient always retains a right to leave or to refuse treatment. 

That said, I have often witnessed in both hospitals and dialysis clinics that patients' openly and even vehemently expressed wishes are NOT respected by staff. I saw one man who was suffering horribly during his first needling for dialysis resist the nurse and exclaim, "Stop! This just isn't worth it," but instead of respecting his wishes, another nurse ILLEGALLY came and held the patient down so the first nurse could complete the conneciton.  I never saw him at the clinic again.  The law regards such an action as an assault, but neither the staff nor the patients seem to understand that, and the fact that they don't is itself a symptom of how much patients are held in UTTER CONTEMPT by the medical system.

[JerseyGirl]

"Utter Comtempt"?  Sorry you've had such bad experiences, but that's not my experience nor how I practice.  I welcome the patient's input - actually it makes me more happy to serve!

[kitkatz]

I sure used my patient's rights this last time in the hospital.  I made them turn the oxygen off  because it made a horrible noise in the room. Why can't someone invent something quiet in a hospital room?  I also refused to have my IV restarted. After all I did not need more fluid pushed into a system that can overload easily already.  I have also thrown a phlebotomist out of my hospital room when she could not get a vein and tried a place I told her would not work. Send in the professional, not the amateur blood takers!  I like to be told about things happening before they happen to me.  That way I can say yes you can do this or no you cannot and ask questions.