Few questions

Trauma Columnist · Apr 4, 2012

I'm an APN employed by a nephrology practice to see pts in 4 FMC HDUs:

1. 32 chairs, 128 pts, 3 shifts M-W-F, 2 shifts T-Th-S: 2 RNs, 5-6 techs on if full shift. Many no shows at this clinic so staffing levels vary.

2. 9 chairs, 53 pts, 3 shifts all six days, full clinic every shift: 1 RN and 3 techs.

3. 8 chairs, 47 pts, 3 shifts M-W-F, 2 shifts T-Th-S: 1 RN and 2 techs.

4. 5 chairs, 16 pts, 2 shifts daily: 1 RN and 1 tech.

Hope that helps.

MJB2010 · Apr 4, 2012

Thanks for the perspective. I really am against just having 1 RN there at a time. It is so unsafe.

Mine was 12 chairs, 3 full shifts x 6 days a week. 1 RN for the entire shift, 2 techs in the am, only 1 tech with me on 3rd shift.

I was "technically" not allowed to ever leave the floor, but I have to eat and use the restroom, on the rare occasion a meal break happened I usually got called to the floor every few minutes. I also think it is unsafe to have just me and 1 tech on 3 shift, the newest patients (or the most sick) always end up on 3rd shift and they are the ones that tend to code. God forbid the tech or I is in the restroom and something happened. I no longer work there, I was just thinking how lucky I am that nothing major ever happened while I worked there. Something will, eventually.

I miss the patients and fellow staff but well, the company made it impossible for me to stay working with those conditions.

Tish88 · Apr 4, 2012

CMS under the new conditions of coverage of 2008 only require to have 1 RN "in the facility".

"We have clarified the RN presence requirement by modifying 494.180(b)(2)(i), to require a registered nurse must be present in the facility at all times that ‘‘in-center dialysis patients’’ are being treated."

My situation is 20 chairs, 1 RN, 4 techs.

3 shifts 6 days a week.

You are allowed to leave the treatment area to go to the bathroom and eat, just as long as you are "in the facility".

Eleven011 · Apr 4, 2012

I just started with KD and am almost done with my orientation. My unit is open 6 days a week with 2 shifts each day, an occasional person is a third shifter, if needed. We have 10 chairs. We have 5 people on during the day, 1 Charge RN, and then a 1/3 or 2/2 mix of RN/Techs. Our manager is also ususally around and helps during busy times.

MJB2010 · Apr 4, 2012

CMS under the new conditions of coverage of 2008 only require to have 1 RN "in the facility".
"We have clarified the RN presence requirement by modifying 494.180(b)(2)(i), to require a registered nurse must be present in the facility at all times that ‘‘in-center dialysis patients’’ are being treated."
My situation is 20 chairs, 1 RN, 4 techs.
3 shifts 6 days a week.
You are allowed to leave the treatment area to go to the bathroom and eat, just as long as you are "in the facility".

That is frightening.

Guttercat, ASN, RN · Apr 5, 2012

I'm an APN employed by a nephrology practice to see pts in 4 FMC HDUs:
1. 32 chairs, 128 pts, 3 shifts M-W-F, 2 shifts T-Th-S: 2 RNs, 5-6 techs on if full shift. Many no shows at this clinic so staffing levels vary.
2. 9 chairs, 53 pts, 3 shifts all six days, full clinic every shift: 1 RN and 3 techs.
3. 8 chairs, 47 pts, 3 shifts M-W-F, 2 shifts T-Th-S: 1 RN and 2 techs.
4. 5 chairs, 16 pts, 2 shifts daily: 1 RN and 1 tech.
Hope that helps.

Somehow I missed this.

I have conversations with my nephrologists/PA's about the changes and demands in practice. RN's aren't the only group feeling the pinch of the "herding cattle" modum of health care delivery...

Here's a shout out to all providers given 15 minutes per patient...

Trauma Columnist · Apr 5, 2012

Amen - I have 230 pts on my list: I am required to see 216 pts/week and then the other 15 only once/month. Yep, even at 15 minutes/pt, I'm booking....ooops didn't figure in the drive time either. lol

Still I am very thankful for a job in these tough times.

Tish88 · Apr 5, 2012

Amen - I have 230 pts on my list: I am required to see 216 pts/week and then the other 15 only once/month. Yep, even at 15 minutes/pt, I'm booking....ooops didn't figure in the drive time either. lol
Still I am very thankful for a job in these tough times.

And just think, if it wasn't for the nurses in the clinics where you round in giving you the "heads up" and report on issues going on with the patients, it would take you longer than 15 minutes per patient.

And how about the nurses who use protocols for medication and treatment adjustments and standing orders, this also lightens your load.

I have doctors who just come in the clinic to sign all the verbal orders my nurses and myself have written for them!

I have over 120+ in center patients, 30+ home hemo patients, and 20+ PD patients.

I see these 120+ 3 times a week and my home and PD patients monthly.

Kudos to the nurses in your units who make your job easier.

Trauma Columnist · Apr 6, 2012

Oh yes, Tish I do so very much appreciate the nurses and techs that actually DO the dialysis.

Just curious - are you an APN?

Tish88 · Apr 6, 2012

No I am not an APN, but I have been in dialysis for 25+ years in acutes, chronic, transplant and access management. Prior to going into dialysis my background was in Trauma ICU.

I have been encouraged, for years, by many of my nephrologist to go back to school to become a nurse practitioner, but with having a family and working "many" hours a week I didn't have the time and now I feel I am too old to go back to college!

Trauma Columnist · Apr 6, 2012

Aw you're never too old. I went back for my MSN when I was 47, I completed my first post-MSN at 48 and my second post-MSN when I was 51.