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- Dec 4, '11 by just keep swimmingQuote from GuttercatYou are right that their control is limited. I was speaking more toward the culture of the unit than staffing ratios etc. How great would it be to have half the patients!Always good to hear an alternative perspective. And I'm glad to hear of a success!
I have to disagree that it's "all about the individual unit's management." I agree they can make a unit miserable both for patients and staff, or make it run at optimum. But, their control is limited like it has never been before.
As an anecdote, remember there was a day when the only patient care staff in a unit, were RN's. When I started 18 years ago, there was one RN and one tech to every 4-6 patients. And that was a very large, very well-run unit.
We've come along way medically, in understanding and treating ESRD and in that regard, the patients have advantages over their counterparts of 20 years ago.
However, they were also receiving very, very personalized care each and every time they walked into the unit. We knew them inside and out.
Economically those ratios of days gone by are unsustainable, and we have what we have now.
Very interesting evolution to watch.
I think that one major problem in DaVita (can't speak to FMC as I have never worked for them) is that almost anyone can be an FA.
I'm all for promoting from within but when you put a PCT in a management position with no management or supervisory experience, besides possibly having been a preceptor, you're asking for trouble. That's beside the fact that they do not have a license and I have a real hard time with nurses being supervised by non-nurses.
- Dec 6, '11 by madwife2002Since bundling came in to control dialysis companies, it has become more about the dollars than ever before.
Payment from the government is controlled by outcomes which are fixed and each dialysis unit has to meet this outcomes or be penalized by a percentage drop in payment.
Do you honestly think that the for profit companies are going to take this loss of money sitting down.
NO they are no longer bothered if they lose staff, they don't care if the patient ratio is higher than ever before because it means less wages and less benefits-therefore profit margins increase.
Pressure on the managers has increased for them to make sure their units perform-and if they dont well there is the door!
Managers have to work and earn money too.
I am not sticking up for your manager but believe me a lot of pressure goes on behind closed doors
- Dec 6, '11 by Joni's MomI understand that Managers have constant pressure, but what about the safety of the pt? Short staffing gives no time for the RN or tech to react in the event of emergencies, and as we all know there are alot of emergencies that crop up in dialysis. When is enough enough! How much can they expect? How much voluntolding, where your told to do this work in the ruse of volunteering, do they want from staff? When is upper management going to bat for the underdog? What about advocating for pt's and staff? How can some facilities, working for the same company, have for instants, separate Clinical Supervisors and others appoint staff as an Assessment Manager doing the same job?
- Dec 6, '11 by madwife2002Trust me whilst I understand everything you are saying I have been an RN for over 22 years and I have never ever felt the stress or pressure that I feel at the moment in my job.
I have always been the pts advocate and I stand tall representing my staff, but recently it doesnt seem to matter how I try to make myself understood or how I have represented the pts and the staff-nobody is listening.
We have had our senior management team taken over by ex members of a large dialysis company and things have changed beyond our control.
We are a small company being managed by people who pretend to care but dont