Outpatient dialysis managers are often forced to think of time as money and push their staff to do the same. I work in the inpatient setting for that very reason. I hate to say it but I think of outpatient dialysis as an assembly line... the pressure is really on to move them (the patients) in, get them on, get them off rapidly, and then move them out. Where's the human factor in that?? Do we think that our patients feel cared for and secure in this environment? I can tell you firsthand that they don't. I think that we, as nurses, can advocate for our patients in this area. Yes, we want to get patients assessed on begin their treatments in a timely fashion, afterall, the "clock" doesn't start ticking until you get them on, but certainly not at their, or our own, expense. Have you considered trying the inpatient, acute dialysis arena?