Dialysis with a difference

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If you’re looking for a nursing career that’s rewarding and challenging, with opportunities for advancement in a warm and welcoming work environment, look no further than Credit Valley’s regional renal dialysis program. The program is one of the largest in Canada which includes a nephropathy clinic, pre-renal program, in-hospital dialysis, home peritoneal dialysis, home haemodialysis and a post transplant clinic.

It’s the variety and challenges that attracted acting nurse managers Tracey Graper and Carmela Nelson to Credit Valley 14 years ago. Carmela recalls, “I arrived and liked it so much, I called Tracey and told her she needed to come and work here too. Tracey arrived three weeks later!”

Just as the community has grown significantly since then, so have the number of renal patients. There are now three renal dialysis care centres at Credit Valley: the new 56 station outpatient clinic in the hospital’s beautiful and bright new ambulatory care centre; a 6-bed inpatient unit as well as the 24-station Watline Centre located about ten kilometers away from the hospital. 382 patients are currently receiving hemodialysis at both Credit Valley and the Renal Care Centre at Watline, excluding the home haemodialysis patients. Watline has a pre-renal clinic for patients which provides ongoing assessment of health care needs up until the need for dialysis or transplant. Treatment options education ensures patients are aware of all treatment modalities offered at Credit Valley such as home peritoneal dialysis, home hemodialysis, conventional hemodialysis, or transplantation if a suitable donor is available. Transplant patients are then referred downtown to St.Michael’s Hospital or the University Health Network for the surgery. Follow up clinic appointments can be arranged in the transplant clinic at Credit Valley.

The renal unit differs from many other nursing units because the 382 patients seen in the centres receive dialysis several times each week. “You really get to know the patients,” Tracey says. “We feel comfortable with one another and that’s important to both the patients and the staff, since you are a patient indefinitely or until you have transplant surgery.”

As well as the special bond that between caregiver and patient, there’s a sense of belonging that develops. “The patients spend so much time here,” says Tracey, “that we strive to create an atmosphere that is safe as well as comfortable. We listened to the patients when we were designing our new outpatient clinics in the hospital and at Watline.”

The 24-station off-site dialysis centre at Watline opened in 2001. Because construction of the new ambulatory care centre had not begun, and because the demand for dialysis could no longer be accommodated at the hospital, it was necessary to develop the offsite centre. Initially patients and staff were leery about moving away. Carmela recalls “It was like cutting the umbilical cord.” The off-site centre was fully equipped, in a beautiful open-concept design with large dialysis stations and large overhead skylights that bathed the centre in natural light. “Even so,” she said, “both the staff and patients were reluctant to leave the hospital’s ‘womb'” Both patients and staff were cajoled to “try it for a few months.” That was all it took. The new Watline Centre was a huge success – so successful, that now staff rotate through both centres willingly.When the new Vijay Jeet and Neena Kanwar Ambulatory Care Centre was designed, the same attention was paid to light, patient privacy and comfort. There are three separate care centres in the 56 station outpatient unit. This enhances the centre’s already strict infection control procedures, and includes three isolation rooms to accommodate the already immune-compromised patients, when they are unwell. The rooms have just recently been outfitted with cameras to allow nurses to monitor the patients and adjust their machines from outside the room.

This state of the art approach to renal care is also evident at the Watline site. Carmela says “We have a program that enables us to track each and every treatment the patient is having and has had in the past at the Renal Care Centre at Watline. This gives us the opportunity to individualize each patient’s prescription for their dialysis, and provide a treatment with minimal symptoms.

Innovation is more than just a buzz-word at Credit Valley. “The renal unit embraces technology and utilizes computers and software programs to enhance patient safety and care” Tracey says.

Carmela acknowledges that it’s not just the technology that entices our all-RN staff to join the Credit Valley team. “We’re self-scheduling. Rotation is ongoing. Every month two full-time staff rotate between sites. The part-time staff are shared by both so they will, or can, work at both sites consistently.

We even participate in a summer camp program offered to dialysis patients across the Greater Toronto Area (GTA),” Tracey says. Each year two of our nurses go to Camp Dorset. It’s a wonderful opportunity for our patients and our nurses to get away!”