June 26th, 2012
By Jennifer Olin, BSN, RN
Jonathan Bush, RN, is someone I have known for years. A mutual friend refers to him as the “energizer bunny,” always ready to go do anything active: run, swim, lift weights, and take a bike ride. He is an inspiration for good health and healthy living. JB (as we call him) is also a hard working nurse. He is always up to take an extra shift, takes his call time very seriously, and seems to really enjoy his job. JB is a dialysis nurse in a large county hospital. As I got ready to interview him it dawned on me, I don’t really know how he ended up this specialty area of nursing.
So, JB, what’s the story behind your choosing a nursing career?
“I was in the Air Force for four-and-a-half years. I had medic training. I had just been out for a few months when I was called back from the inactive reserves for Desert Storm. Being a medic is what really gave me the taste for healthcare. I’d spent a lot of time in the ICU and got a real interest in critical care. I decided I wanted to be a perfusionist and the University of Texas offered a perfusion technology program. However, by the time I was free to go the program had been cancelled.”
And you didn’t consider nursing right away?
”Nursing looked like so much, lots of super-multitasking, lots of writing—not my strengths. I became an EMT and was working in a halfway house providing basic medical care, but I knew I wanted to go to college and finish my degree while I had the GI bill.
”I knew nursing was a huge profession and there were so many things I could do with a nursing degree. I started thinking maybe nursing was the route. I thought about medical school but knew that would just take me too long.“
So you got through nursing school, writing, and all. Would I be right that you initially went into intensive care nursing?
”I knew I wanted to be in the ICU. It’s that military medic influence. As a medic or tech in the military you do a lot more than in the civilian world. You draw blood, get blood gasses, a lot of nursing duties out here. I spent a couple of years in the trauma surgery ICU.”
How did you end up transitioning to being a dialysis nurse?
"I was always seeing the dialysis nurses when they would come into the ICU. They would come in with all their equipment and they had this insight into the patients. It was a combination of ICU skills, but out of the hustle and bustle, and basically, being a perfusionist. After all dialysis is the transfer of fluid, you know, osmosis.”
You say it is out of the hustle and bustle of the ICU but isn’t it still a pretty busy, patient oriented job?
”It can be very busy. It’s not just the dialysis itself, it's education (for both the patient and the family), it’s life style changes, it’s helping them believe that their life isn’t over.
”Dialysis affects their whole body: it affects their respiratory system; it affects their heart rate, their blood pressure, it affects their muscles. A lot of things can happen during dialysis.
”I look at the complete aspect of the human body. As a dialysis nurse I have to consider effects of dialysis like uremia, blood clotting, electrical activity of the heart, how their different medications will work. Many of my patients have diabetes and hypertension and that gives you a whole other aspect of things to consider.”
There are two kinds of dialysis nursing, acute and chronic. What area do you work in?
”I work in acute care. For my patients dialysis may be only temporary, maybe due to an infection caused by a trauma. They could be on dialysis for as long as year then their kidneys kick back into functioning. Or, they may be newly diagnosed patients who still have a Quinton catheter instead of a permanent one. “
I know a lot of people think being a dialysis nurse is an easy job, you can sit back and read a book while the patient is being treated. Is that true?
”Well, the machine does do all the work. But, we have to sit and monitor what the machine is doing and how the patient is reacting. Now, being a man we come back to that multitasking issue and what I like is that I only have one or two patients at a time. However, they get my total focus and I can really get really in-depth addressing their care needs.
”And, I have gotten better at the multi-tasking. You have to. You make adjustments—you’re a nurse.”
Can you come straight out of nursing school and become a dialysis nurse?
”I guess some places you could as a chronic care dialysis nurse where you have more time to learn and it’s a more stable patient base. I think you need some ICU experience before being an acute dialysis nurse. You need to be familiar with critical patients and with working on an intensive care unit with intensive care nurses.”
How do you see dialysis nursing, as a career?
”So much of it is building a relationship with patients. You are front line and it’s new to them and it’s important to give them that first will to want to do this. To get them to understand they can live with this.
”It’s always challenging getting someone new, a new patient. It’s about educating them, about educating their family as well. Telling the patient what the procedure is like, explaining it to the family. You have to talk about lifestyle changes, like you have to talk to the person who does all the cooking. We are the starting point for these patients.”