New to this field...... need advice

  1. Anyone has experience in Urgent care or Dialysis center. Can you guys please give me an insight? I'm very scared of starting a new field. Thanks in advance--

    carenurse85
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  2. 14 Comments

  3. by   jnette
    Hey there !
    I've worked in hemodialysis for the past 5 yrs. I was brand new to it also when I started. However, the company Iwork for put me thru intensive training before putting me out on the floor. It is a wonderful and interesting field. I'm not sure what all you need answered. Give me some specifics, and I'll try to help you out as much as I can. I'm still a "tech" there, but by the end of the year, I'll have my RN. Hope I can be of help.
  4. by   carenurse85
    Thanks a lot ... Jnette, can you please tell me how many techs and patients will be under one Rn. I'm a new Rn, and I'm scared to be in charge and be responsible for so many patients. Have you heard about Gambro H/D ctr? What are your thoughts about it? anyone is welcome to comment....
    thanks a bunch!
    carenurse85
  5. by   jnette
    Carenurse...
    The ratio of Techs to RNs varies from company to company. I happen to work for Fresenius, and our staffing is somewaht like this: (we are a small clinic; 30 pts.)...One RN on duty, with ususally one LPN (or two) and one or two techs. Somedays it's 1 RN with 2 LPNs and one tech, other days it's one RN with 2 techs (on the "short" days..8 pts.) Just depends on who is having their day off. Some days our DON is the one RN there on the floor as well as her office duties, other days, she'll just finish her office matters and we'll have another RN on the floor in her place (although she always helps us out first thing in the a.m. and during "turnover" when the next shift of pts. go on), regardless. So basically we have 2 RNs right now (one is DON) 2 LPNs and 2 techs. But obviously we're not all there all the time. It will depend on the size of your clinic, the # of pts., etc. I believe most of them like to have at least 1 LPN and one tech per RN, or 2 techs. All depends. There is a Dialysis web site you can go to and get ALL KINDS of info (but I must add, they're not nearly as nice as this site!), but they ARE dialysis specific, and there is much info on the various companies, etc. (ie. Gambro vs. Baxter, vs. Fresenius, etc.) They have a BB for nurses, one for techs, and all other info as well. It might be worth a look! Here it is: www.brumley.com/renal... should give you lots to look at.. it can be very helpful if you ignore the "tech board" with all their fussing and fighting ! I'll be glad to help any other way I can... once you learn the ropes, it's pretty interesting stuff ! Best of luck to you, and don't hesitate to drop me a line if you feel overwhelmed!
  6. by   carenurse85
    Thanks Jnette,
    How stable are your patients at H/D center. Have you coded a patient during treatment? I heard acutes are of higher risk of coding.
    I tried to get into the website you posted but was not successful. I can't seem to find the renal BB part.

    I really appreciate your insights. thanks for providing me info. about your job.

    carenurse85
  7. by   renerian
    I have tried to get into dialysis for several years and no one will give me the chance. I have been an RN for 16 years. Does not make sense in light of such shortages.

    renerian
  8. by   jnette
    Geesh, Renerian....That's hard to believe !!! There's a huge turnover in dialysis clinics ( mostly the large ones) due to lack of enough staff and/or staffing ratios. I don't know of a clinic anywhere that isn't begging for more nurses! The only thing I can assume is that the COMPANY isn't willing to hire more staff..they're known for attempting to get by with the least. If you do manage to get into dialysis, go with the SMALL clinics... much more personal, and you really get to know and enjoy your patients. Not near as hectic; far more rewarding. Accutes is also a good area (and more profitable) but there you don't get the satisfaction of seeing your patients over a long period of time. At our (small; 30 pts.) clinic, we are like family. Staff and pts. alike. Turnover is low. Hope you can find one you can get into and enjoy. There's a HD website I can refer you to, maybe you can find more info there re employment opp's., etc. :
    www.brumley.com/renal
    Good Luck !
    Last edit by jnette on Sep 8, '02
  9. by   jnette
    Hey Carenurse!
    Most of the patients will be stable.. but it really just depends on what else is going on with them. In my 5 yrs. at our clinic, we've only had to code one pt., and she (IMHO) should never have been put on dialysis in the first place... had NUMEROUS other lifethreatening issues going on with her, and she was a very new pt. to boot. We all agreed that she never stood a chance to begin with. But..........what do WE know, right? :chuckle I must say, though, that our nephrologist is pretty good about sending our pts. to the hospital when they take a turn for the worse and keeping them there 'til he feels it safe for them to return to dialysis...or having them placed in a nursing home which does dialysis if things don't look favorable for recovery.
    Again, so much depends on the "company", the clinic itself, your docs, etc. They all operate differently. As for the website..(sorry, Renerian, I just noticed I had already posted it to Carenurse, so my sending it on to you was redundant...:imbar )...try clicking on the "nurses" section. I've used the bb (they call it "message board") before to snoop around when our company was really showing their butt on some important issues. But there is some valuable info at the site, so keep trying!
  10. by   TELEpathicRN
    Working acutes is far better than working in a chronic clinic, our staffing is WAY better than in the chronics. But, it isn't any place for a new grad to be. I started out in the clinic (with 5 yrs nursing experience) and then transferred to acutes and I love it! We do get to see some of the pts over and over, but we really don't get the enjoyment of seeing the compliant and the "well" patients!
  11. by   renerian
    Jnette I have sent my resume in several times to both large and small clinics as I thought that would be a good traveling job. NOt even one bite despite ads being in the paper over and over. They wanted someone who was already trained I guess. I am starting back at a long term care skilled unit to refresh my skills then I am going to go into rehab traveling after six months. I am also working with cross country on an internship for dialysis. You need to committ to one year though. It is in Sandusky so it is only several hours from here in the summer so I could get home if I had to.

    I personally feel new nurses need to try something like med surg to develop their instinct if that makes sense. I think you only learn that over time and exposure to new things. Just my thoughts.

    renerian
  12. by   jnette
    So where are you, exactly? Here in my corner of Va. even as far up as Roanoke, we're BEGGING for Dialysis nurses ! THEY train YOU in a 2-6 wk. daytime classroom- structured course, depending on your skills/experience in dialysis. Same as most places in N.C. That's too bad, but I LIKE the internship thing you mentioned. Sounds good.. love to hear more from you about it when you get rolling, ok?
    Also.. agree wholeheartedly with starting out with med/surge. Once I get my licence, I'll have to stay with dialysis for 2 yrs., as mentioned earlier, but I fully intend to also work prn at a hospital in N.C. on at least ONE of my days off each week.. in med/surge. I've been shadowing a friend RN there the past 2 weeks and I LOVE it. Dialysis is WONDERFUL and fascinating, but I would miss not using all the other skills and bedside- nursing opportunities, which I so dearly love. We need to be "well-rounded", no matter what your preferences! In any tragedy, (and I fully expect we'll see more in the years ahead) we need to be PREPARED..and READY...for ANYTHING!
  13. by   renerian
    Jnette I am in Columbus Ohio. The internship cross country is trying to get ironed out is in Sandusky which is right on the lake so it is nice in the summer. Winter can be bad due to snow and the lake effect. They get dumped on. Here in Columbus we get more ice than snow. Could you find out if they take travelers and do any internships in your department? Maybe I could look at something like that. I liked Virgina. Went to Vbeach last summer. Was nice.

    Let me know,

    renerian
  14. by   renerian
    Oh yes Jnette most of the internship programs I have checked into are one year comittments. Cross Country would pay my housing and utilities. I would need that. Let me know if your department would consider something like that. Could be fun....

    renerian

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