Apheresis VS Dialysis job offer....need help deciding!

  1. Hi!

    After being laid-off twice since graduating last year, I finally got a job offer from Fresenius as an Acute Care Traveling Apheresis RN (I'll cover 74 hosp in a 75 mi radius). This job sounds awesome---lots of autonomy, not being stuck in one place for 8+ hours, 1:1 patient contact, cutting-edge technology in a highly specialized field (which will soon boom b/c of the Stem Cell stuff Obama passed, thus now is a good time to get into this field b4 it get flooded!), learning lots of procedures dealing with apheresis, seeing a myriad of health issues, and being exposed to many different pt populations. However, the traveling could get old, and I HATE hospitals and having to deal with docs. Plus, it involves a lot of follow up calls, both the night before and morning of. I'll be the "visitor"... on foreign turf. My manager warned me to not let the RNs on the unit boss me around and have me do things other than what my purpose for my visit is: apheresis, not the unit RN's duties. Oh, did I mention that this manager rocks?

    However, I just got an offer for an interview for a Home Healthcare Therapeutic Dialysis RN for the same company! Home Health is my passion and I've been dying to get a job in home health. Same positives apply for this job, except that dialysis isn't as cutting-edge, and I won't get that "acute care exposure" that a newer grad so "desperately" needs. Plus, if something goes wrong, I'll be all alone... at least with apheresis, i'd have the help of the unit staff. Would i get bored with dialysis? But, I guess the same could go with apheresis.

    Can anyone give me any insight on what each position encompasses, and which would provide me with the most clinical skills, knowledge base, experience, and challenges (but not too challenging, lol)? I want to make the right decision---I HAVE to. This has been a horrible year, job-wise, and I need to pick the wise career.

    Thanks SO much!
  2. 17 Comments

  3. by   DeLana_RN

    having worked in hospitals and in dialysis, here is my advice (for what it's worth, and you may not agree).

    I think either job is too challenging for a fairly new grad (you don't say how much experience you have, and in what area of nursing). Why? Either way, as an acute apheresis nurse covering 74 (!) hospitals (my goodness, you would probably have to do a brief orientation at all 74 of them! I had to do this at the hospital where I did acutes for a short time while working in a chronic dialysis clinic...) or as a home dialysis nurse, you will be on your own much of the time. Yes, there will be other RNs in the hospitals, of course, and if the pt crashes you can call a code. However, they will most likely not be able to help you with anything related to the apheresis procedure, machine, pt response, interventions, etc. Your orientation could not possibly be long enough - unless they have you train with an experienced nurse for an extended period of time (unlikely) - to cover all possibilities. And as a recent grad, your clinical experience in general is still very limited.

    As for the home dialysis position, much of the same applies. Again, you will be on your own, and there won't even be other nurses around if something happens to the pt. It depends on the training, but in my experience it takes at least 1-2 years in a dialysis clinic setting to learn all you need to know to be able to function independently (and most advise new grads not to go into such a specialty right out of school).

    I encourage you to pursue dialysis or apheresis (both are equally technical and cutting-edge, IMHO), but start out in a setting where you will be with more experienced nurses for at least a year before you strike out on your own (e.g., dialysis clinic, blood bank).

    Just my . Good luck to you, whatever you decide to do!

  4. by   xEdgexRNx
    Thanks for ur reply!

    Jobs are very scarce here, and these have been the only offers I have managed to obtain, despite applying EVERYWHERE. Hospitals are at an hiring freeze, and IF they ARE hiring, they only want people from with-in, whom possess at least 3-5+ yrs experience with a specialty, and a BSN. I know of a 5-yr ER nurse who got laid-off and still can't find a job after 4 months. It's BAD here. I even applied out-of-state, but they won't bother hiring someone without the above criteria whom also doesn't possess their state's license.

    I feel I am qualified for these jobs... I graduated valedictorian of my class and am a fast learner. Most importantly, I have the drive and desire. Sure, being "new" may cause for a steeper learning curve, but they have an excellent training program for the Apheresis position: 2-3 wks classroom + 2-3 months (or longer, if needed) full-time preceptorship (which was more than I got at the hospital). They make certain that u are competent in what u are doing before letting u go on ur own.

    IDK what the HH dialysis training is like... haven't had the interview. And IDK about the brief hosp orientations u mentioned.... that would suck, lol, and seem like a waste of time and money for both companies.

    I think that Apheresis would be my "safer" bet, in case of complications.

    Can u elaborate on how u liked doing HH dialysis and what your days were like? Pros, cons, and anything else u can think of?

    Thanks for helping!
  5. by   DeLana_RN
    Hi, again,

    you're probably right, apheresis might not be such a bad choice (especially considering the job market where you live!) I would think it's less likely for complications to occur (as opposed to dialysis) and it sounds like you will get a decent, long enough orientation. Even in an acute, hospital contract position you can always stop your apheresis treatment early if necessary and call someone from DaVita for assistance. (Regarding the hospitals, if many of them are owned by the same company - such as HCA - you probably wouldn't have to deal with too many orientations).

    I never did home health dialysis, just chronic (outpatient clinic) for 5 1/2 years and then acute (hospital) for over a year (I liked that much better as opposed to clinic dialysis, but the drawbacks are call and - what happened to me - pt census can fluctuate so much that you won't get any hours). I think home dialysis would be fine, but you would probably want at least a year of a more supervised environment (clinic or hospital).

    It sounds like you're leaning toward the apheresis position (although, I would recommend that you do interview for the other one!). Before you accept, have a list of questions for them (e.g., training, back-up, night/weekend call requirements) and if you like the answers, go for it!

    All the best,

  6. by   xEdgexRNx
    Thanks again for ur input!

    After a lot of thought and making myself nearly nutso, I decided to go with the first choice: Apheresis. For all the reasons listed above and more, it just seems like the better fit.... I hope I made the right choice! I guess we'll find out, lol... but I feel good about it. I'll learn a lot and be right on the cutting edge of this field's boom. Can't complain about that!

    One problem... I'd need to trade my car in ASAP! I can't imagine driving all those miles with my crazy stick shift!
  7. by   Valerie Salva
    I would make sure you like the job and will stick with it before buying a new car.
    Last edit by Valerie Salva on May 28, '09
  8. by   xEdgexRNx
    obviously, lol
  9. by   Tish88
    I have done both hemo and pheresis treatments, and you experience the same complications in both treatments, that is why many dialysis companies contract out to perform the pheresis services too.
    As I mentioned in another post, when I was hired 20+ years ago, we all needed to have 1+ years ICU experience before we could be considered for hemo/pheresis position.
    You will be functioning independently and you need to know what to do in an emergency, because believe me - the hospital staff won't be able to help you out!
    To feel comfortable with these procedures, it takes every bit of a year of experience.

    Good Luck on your venture and keep us updated.
  10. by   xEdgexRNx
    I had my first day at the apheresis job and I hate it. I was totally misled... the hours are SO long, on call hours are insane, the company is understaffed (thus the long, erratic hours, lots of traveling, and lots of oncall)... basically, I wont have a life outside of work

    IDK what to do... this is NOT what I thought this job would be.

    Any suggestions? I need advice fast......
  11. by   Tish88
    Acute hemodialysis has the same working conditions with the long hours per day, a lot of call & call outs and traveling between facilities.
    My longest acute day was 23 hours straight, went home and slept 2 hours and returned for another 12 hours!!
  12. by   xEdgexRNx
    OMG.... that's what im afraid of. My body cant handle that

    What is chronic dialysis like?
  13. by   EricJRN
    That's rough. I was concerned when I read the part about Obama. Approving embryonic stem cell research and seeing an increase in peripheral blood stem cell collections are not closely connected, so it did sound like you had been misled.

    I'm hoping that you are able to resolve this situation very soon.
  14. by   xEdgexRNx
    What do I do? Should I talk to my manager so soon? Give it more time?

    I need the money and jobs are few and far between. however, i dont want them to spend all this time and money training me in such a specialized field (nor do I want to waste my time learning this) if it's not the right fit.

    how do I find my fit in nursing? I really want to do ICU, but no hospitals are hiring.