Started in chronics, then did home dialysis and now acutes and PRN to some chronic clinics. I will list it for readability.
Pros- designated breaks and lunches. Ability to use restroom, (not during changeover). No call.
Cons- Since techs can make our breaks your bay/pod you're day may be hell b/c others don't work as hard as you. I hate pt care to be compromised b/c a tech has an attitude or bad work ethic. Don't mess with my patients care. Lol
Pros- Build very close relationships with your patients and physicians. Train patients daily or 1-2 weeks so personality is key as well as good teaching ability. Great retirement job
Cons- Cannot ever escape your patients. Same patients for life as long as they chose home dialysis. Hard to take off due to the training schedule of patients. You can't really be sick or be off during the 1-2 weeks of training a patient. You have to follow a strict daily regime so the patient can learn best. Can get boring and can lose some acute nursing skills.
ACUTES-My favorite. Why? I love the autonomy, I work so hard and b/c I get to work alone with my patients their treatment success is based on my ability and knowledge and that's all in my control. I control learning more and working hard. I have seen some lazy nurses in chronics that let their patients tank every shift but not in acutes...you'll rarely ever see that. Every acute dialysis nurse I have come in contact with was the best of the best. Work ethic of those around you is amazing.
Pros-Money is the best, never boring, every hour/day can be different, you do every type of dialysis inpatient (HD, PD, Apheresis, CRRT, SEQ, etc.) Work alone a lot, if your patient is awful-you'll be done with them in about 4 hours no worries. Close relationships with MD's and their NP's. You feel like superwoman sometimes, ICU like, learn so much everyday. Awesome autonomy and is advanced dialysis. The best of the best dialysis nurses are in acutes. No room for a lazy nurse or tech. The docs would find a way to get you out b/c you are one-on-one with their patient. Less personalization than home units. You get to clock it, work your butt off and clock out. Your patient may or may not be there when you return the next day. I see my old patients from all the units I've worked in again as inpatients.
Cons-Call, long unanticipated hours/you don't leave until everyone is dialyzed. Don't make personal plans on working days or if on call. The minute you thought you were about to clock out, the phone rings and the ER just got a patient for you. Sometimes there are a lot of folks to be dialyzed and you don't have enough machines or staff. While chronics may only triple shift, you are there an illegal amount of hours. Pt's are critical and you may have too many. Stand up for yourself with your limits and protect your license. Pt deaths are more. You can't get attached like in home or chronics. It's acutes for a reason. Codes. No known history of patient accesses and most of the time they can't tell you (intubated, etc.) You gotta go with your knowledge. You are alone at 2am on call and can't get an AVF stuck, clots, blown, collapsed, etc. The MD's don't stick and can't help you. They get peeved when they have to drop a line in someone at 2am. Just part of working alone.
A lot of info....apologize if it is a bombardment. Hope it will help
My heart and passion is dialysis.