Hospital (Inpatient) v. Clinic (Outpatient) Dialysis

  1. Hi, everyone!

    I've been away from dialysis - and nursing - for almost 2 years and am now ready to get back into it on a PRN or part-time basis. Although I've done some med/surg and cardiac stepdown in my first year of nursing, I've spent most of the other 5+ years in chronic/outpatient hemodialysis at a clinic (large national for-profit chain; this was/is the only outpatient dialysis provider in this area). For various reasons (including horrible early morning hours) I would not consider returning to outpatient dialysis.

    I thought that was the end of it since the only local hospital not staffed by RNs from the chronic clinics (who have to do acutes in addition to their clinic workload - another reason I wouldn't want to work there!) never has any openings in its dialysis department. So I reluctantly looked at other possibilities (such as outpatient post-procedure observation, of interest since they get lots of dialysis patients ) - but nothing really interested me. Until - suddenly the hospital inpatient unit has an opening!

    Well, my reaction showed me that I have definitely not "forgotten about" dialysis, like I tried to convince myself (whom was I fooling)? Anyway, I called the manager, and the interview seemed to go really well. The job seems to be perfect: PRN, shifts that can be coordinated with my husband's (he's an ICU nurse in the same hospital), and the manager really impressed me. All is not wonderful, of course: some overnight call would be required, and the pay that HR quoted me is less (!) than what I made at the clinic two years ago; this is, of course, negotiable (and I've already told them that I will not work for less than I made in my last job!)

    I have to make a decision later on this week. I don't know why I'm hesitant at all, it seems to be all I ever wanted: a dream ratio (1:1! Imagine that ), new skills to learn (PD, new machines!), all-nurse staff, great hours (mid-shift). But I don't know much about inpatient/acute dialysis. My last employer had just started requiring all clinic nurses to do acutes right before I left, so I didn't get much experience (neither did I want it at the time!) But this won't be the case here, of course.

    For those of you who have done both, and especially inpatient after working in a clinic: How does it compare? Would you recommend it? I have another interview (my request) later this week, is there anything I should specifically ask about? Will I regret having to take call? I'm willing to do my share (they mentioned two nights/month), but don't want to get from the frying pan into the fire!

    I have been so excited since this job possibility literally fell into my lap; this - and the fact that I have had some dreams about dialysis - show me that I shouldn't let this chance get away. I have missed my patients so much... and although I wouldn't be happy that they're in the hospital, it would be so nice to see some of them again, as well as others (as we all know, the chronic patient population has its pros and a few cons ).

    All right, convince me. Or - give me some hints, questions to ask, or even warnings. I'd rather ask now than be surprised later.

    TIA!

    DeLana

    P.S. Would any of you ever consider working for less than you did in your last job, especially if it was a while ago? I really don't want to... but I also don't want to go back to clinic dialysis!!! And I know this hospital pays fairly low in general...
    Last edit by DeLana_RN on Oct 10, '06
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  2. 9 Comments

  3. by   ariesbaby
    Hi DeLana -

    I am a new nurse working on a nephrology/urology unit so I can't help you out with advice about inpatient versus outpatient dialysis. From reading your post though, it sound to me like you already know what you want to do - you're just scared to make the plunge for various reasons. The job sounds like it has a lot of pro's - PRN, shifts that you can coordinate with your husband's, great patient ratio, good shift time and a manager who made a good impression on you. Cons: you'll have to do a few overnight calls a month, the money isn't more than what you were making at your last job and as you stated "I don't know much about inpatient/acute dialysis.

    If overall you'll be happier because of the hours/flexibility/good management/low patient-nurse ratio - I'd say suck up doing a few calls a month. You said you already told them you won't take less than you were making at your last job. I'd reiterate that in your second interview. It sound from what you said though that they are willing to negotiate. So really the only thing that I see standing in your way is that you feel you don't know enough to work in an inpatient setting. I don't know how different the two settings are, but dialysis is dialysis to some extent right? It's got to be like riding a bike after 5+ years experience in an outpatient setting- maybe not the bike you're used to riding, but you know the general principles right?! And what you don't know you'll learn and you'll pick it up a heck of a lot easier than a new nurse (like me for instance) - so maybe you can use your prior experience to negotiate your salary? I'd try to find out what they pay the inpatient nurses who have 5+ years of experience and ask for that, personally. Shoot high - worst they could say is no, right? It would give you some bargaining room too.

    I think you should go for it - you sound way too excited in your email to let this one go by!

    Good Luck!
  4. by   DeLana_RN
    Thank you, ariesbaby, for the encouragement; you are very perceptive

    The things I really need to clarify are call (e.g., how soon?), the training period and method (the throw them to the wolves method has never worked for me - I know dialysis of course, but there are new machines, PD, hospital procedures, etc.), and of course the pay rate. I do know that this non-profit hospital pays their staff nurses (v. float or premium/weekend only staff) below average - a friend of mine, an ICU nurse with 10 years experience, makes less than I did in my last clinic job (my husband makes more because he's on a premium plan which wouldn't work for my friend due to the required shifts).

    I'll let you know what happens. Thanks again.

    DeLana
    Last edit by DeLana_RN on Oct 10, '06
  5. by   diabo
    I assume you will clock in as a normal hospital employee? I worked in our hospital owned clinic for 6 years before becoming charge nurse of the acute unit 3 years ago. Although our clinic is a good place to work, I love it where I am. The role of an acute nurse has many aspects: independent thinker, team player with the other care givers, ambassador to the families, right hand of the doctor who won't be there most of the time, ability to prioritize and coordinate the day by acuity and workload, ability to read the doctors henscratch and interpret the information in the chart, eagerness to learn and learn, sense of humor, optimistic, good communicator, self assurance coupled with a generous dose of humility, ability to cheerfully come in and run a noncompliant patient with a potassium of 8 at 2:00 in the morning, and much more. Are you convinced? Sounds to me like you should accept the position. It's never really about he money, stress is the real killer. Hey, I'm 58 with at least ten more years to go. Who would've thought I would be a cute dialysis nurse.
    Steve
    Last edit by diabo on Oct 10, '06
  6. by   DeLana_RN
    Quote from diabo
    I assume you will clock in as a normal hospital employee? I worked in our hospital owned clinic for 6 years before becoming charge nurse of the acute unit 3 years ago. Although our clinic is a good place to work, I love it where I am. The role of an acute nurse has many aspects: independent thinker, team player with the other care givers, ambassador to the families, right hand of the doctor who won't be there most of the time, ability to prioritize and coordinate the day by acuity and workload, ability to read the doctors henscratch and interpret the information in the chart, eagerness to learn and learn, sense of humor, optimistic, good communicator, self assurance coupled with a generous dose of humility, ability to cheerfully come in and run a noncompliant patient with a potassium of 8 at 2:00 in the morning, and much more. Are you convinced? Sounds to me like you should accept the position. It's never really about he money, stress is the real killer. Hey, I'm 58 with at least ten more years to go. Who would've thought I would be a cute dialysis nurse.
    Steve
    You sound like you love your job (wanting to do this for at 10+ more years), that's pretty convincing

    Yes, I would be a hospital employee (and although this PRN position has few benefits, at least I won't have any trouble getting my CEUs anymore); the local clinics cover the other (for profit) hospitals in this area which are too small to have their own dialysis departments.

    So far, I haven't had a nursing position that wasn't stressful (neither has my husband, who works in CICU) - but no, I'm not ready for the doctor's office (no offense to nurses working in offices; it's just not for me.)

    I found working in chronics extremely stressful, for various reasons (e.g., too many patients/too little time; some PCTs and nurses with poor attitudes and work habits; ineffective management; horrible early morning hours, which did not agree with this night owl at all; and TURNOVER, TURNOVER, TURNOVER ). And I do realize that the patients aren't in the hospital because they're doing well - although the manager indicated that very few are truly acute patients).

    But it will be so refreshing to work with other nurses, and only nurses (no more PCTs who think they are nurses ) - and some of these RNs are apparently very experienced (they stay forever, i.e., retirement!) I know the nephrologists and their quirks . I also love to learn new things, and in outpatient you do reach a point where you begin to stagnate - and the most important aspect of your job becomes getting the patient to the hospital before s/he codes! In other words, the more challenging patients will (should!) be in the hospital.

    Thanks for your response, it helps to hear from someone who feels so positive about his job.

    DeLana
  7. by   DeLana_RN
    I got the job!

    Looks like a great opportunity. I'll start next month.

    Wow... time to brush up on drug math and all that other hospital stuff

    DeLana
  8. by   diabo
    More opportunities will likely open up in the future. Learn a lot and keep a good track record. Glad you got it.
    Steve
  9. by   DeLana_RN
    Quote from diabo
    More opportunities will likely open up in the future. Learn a lot and keep a good track record. Glad you got it.
    Steve
    Thanks! Any suggestions on how to make a good impression on experienced hospital nurses when you've been away from dialysis (and nursing) for a while?

    A former coworker (LPN) who used to work in this unit told me that "the RNs there all think that outpatient RNs don't know anything." Great :uhoh21: I don't want to live up (down?!) to that rumor, but also have to be careful not to come across as a know it all (not my nature at all, but I do like to study the P&P and such things; maybe I'll just do that discreetly). Is it better to ask questions, or get the answers on your own? Some nurses get annoyed with newbies either way...

    I guess I'll just use common sense - nobody tends to hate you when you set up their equipment to get more practice

    DeLana
  10. by   diabo
    There's a song we sing in our church that goes like this: "In quietness and confidence shall be thy strength". People will find out that your'e the real thing without hearing it from you. Unless someone asks, that's different. Let your motive be to help not to impress. Simple things can really help lighten someone's load.
    Steve
    Last edit by diabo on Oct 15, '06
  11. by   DeLana_RN
    Steve,

    thanks for the words of wisdom. Now if I could only get over the new job jitters - well, I haven't started one in 7 years! But I have 3 weeks to get ready

    DeLana

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