nurse/pt ratio? - page 2

What is the nurse/pt ratio at your centers??? How many pts do you take care of at one time on machines????... Read More

  1. by   jnette
    Hi Hellllllo !

    21 chairs, huh? And three shifts? Wow. I'd say it IS hectic !

    We have 12 chairs, 2 shifts.. on the LONG days. We do 12 pts. first, the 11 for the 2nd shift. On the short days we have 8 pts.

    Now don't you EVER think you should have this downpat in a few weeks.. no matter what ANYONE tells you ! Our DON (who is an angel) always tells new staff ( no matter WHAT they are.. nurses or techs).. that it will take them a good 6 months to begin to feel comfortable with the routine and feel like they know what they're doing.. and a YEAR 'til they really have it down !

    And it's true. You can't rush this.. there's just too much new info to process... just learning to set up the machines, etc. takes a good while to feel you know you're doing it correctly and efficiently... don't let anybody rush you ! All that.. plus "who comes in next, where do they go, I've got these two coming off at the same time.. heeellpp!!!" etc. Learning the meds, when and why to give them.. ALL of this takes time to learn and get into your system . I'm so glad I started as a tech, because I was able to spend those years familiarizing myself with everything and getting really good at it before going on to the next aspect.. the actual nursing end of it.

    While our techs (we only have one now) do pretty much everything the nurses do but meds and asessments, I don't think they fully appreciate how time consuming that is in itself !
    We have always been blessed with excelllent, knowledgable, and supportive techs.

    So do you have new staff come in after two shifts, or are you there for the full three? That would be rough ! Surely not?

    Im sooooooo glad our clinic is small. Don't think I'd be happy in a larger one. Too stressful, and not enough time to spend with the patients.. too hectic. Ours is hectic enough as it is !
    So hang in there, take your time and don't allow yourself to be pushed or pressured... you can't afford mistakes. Eventually you will work out your own little "system" as to what works best for you, and how to get things done in the least amount of time, and how to be more efficient. But it takes time, really it does. A year from now, you'll feel comfortable with your work.. and even then, still be learning !

    So hang in there ! Keep in touch here to vent or ask questions, and get emotional support,ok? Most techs don't realize that dialysis is not something that's covered extensively (if at all) in nursing school. so don't let them make you feel inadequate. Tell them you're learning something new at this, just like they had to.

    See ya !
  2. by   Hellllllo Nurse
    Thanks for your support, Jnette.

    Even though I know that dialysis is something I want to do for a long time, I've been feeling discouraged.

    Yes, most of the time, I have been there for all three pt shifts.

    It really is too hectic. I've been on the floor nine days and there have been three codes!

    The unit is really too small for so many pts and staff. We are tripping over each other and the pts are packed very close together.

    Funny how a couple techs complained to me about an RN who always leaves the take-downs for them to do- then they critisized me for being "too slow" when I was trying to learn it. Do they want me to leave the take-downs for them to do?


    Are there any openings at your unit?

    I have a friend back in my home state who graduated from nursing school w/ me. She works in a nine chair unit.
    Sounds like things are a lot less hectic in her smaller unit, just as in yours.

    In nursing school, we toured a dialysis unit. Mostly, they talked to us about the water treatment system.

    The ADON put me w/ a new grad LVN to orient.

    I think it's working out well-

    She just got her LVN license a couple weeks ago, but has been a tech for a couple of years.

    She has experience in dialysis whereas I do not, so she helps me there.

    I have ten years of experience as a nurse, which she doesn't have, so I help her there.

    It works out that we compliment each other in that way. Each of us is strong where the other is weak.


    I am looking forward to having more experience so I will not feel so stressed and unsure of everything!


    Thanks for letting me vent, Jnette.

    I'm glad I found this forum!



    Last edit by Hellllllo Nurse on Nov 13, '06
  3. by   jnette
    Geesh, Hellllllo !!!

    You mean to tell me you're there from 0345 until 1900 or later? And how many days a week ? WOW !

    The only time we ever do 3 back-to-back shifts (and remember, this is only with 12 chairs, and a total of 28-30 patients in all 3 shifts combined!) is at Christmas...so we can give everybody..patients and staff.. two consecutive days off for Christmas Eve and Christmas Day. And then, the doc lets us run them shorter, too.

    No, don't think I'd want to be in your shoes. I've always had a problem with the larger centers... too easy to screw up, not see what's going on with your patients, etc., because you're too busy... waaaaaaaay too busy with everything and every one else!

    Poor Baby.. I feel for ya ! But you sound like you're hanging tuff.. good for you ! :kiss

    Like I said.. the most important thing you can do for yourself is not allow yourself to be pressured by either the techs OR the other nurses.. just let their comments roll off your back. Do what you CAN, and patient safety FIRST !!! If possible, see if you can't just take a 2-3 patient load for the first month or two, then move up to 3 pts., then 4 when you're really comfortable in what you're doing. At our clinic, new staff ALWAYS gets only 2 patients for the first 4-6 weeks until they get to know the ropes, etc.

    Sounds like you have a good preceptor relationship going there.. that helps.
    Again.. don't LISTEN to what others say.. either TO you or behind your back ! Set your own pace.. you will improve dailey, but if you listen to BS remarks, it will only serve to discourage you. Don't allow that.

    Dialysis is really sooooooo neat, once you know the ins and outs, and learn all the aspects of it...just wish you didn't have to be at one of those BIG ones... that's why they have such constant turnover.. no one can take it long, and the poor patients don't get near the service they deserve. It's "put 'em on, take 'em off".. "get 'em in, get 'em out"... like an assembly line, and totally impersonal. Nope.. not for me. I'd get really cranky really fast ! I feel we owe our patients more than that.

    No openings at ours... like I said, the only person we've had to leave in the 6 years I've been there is one of our techs.. and that was so he could go to school for RN.. he now works in the ER. We had to replace him with another tech.. and I know the first one still wishes he were with us. We love our unit, love our patients, and work so well together... guess I'm REALLY fortunate , and I do appreciate where I work. The "company" totally sux at times, but not the staff or our patients. That's why we stay.

    Feel free to vent ANY time, Girl ! PM me if you want or need to.. I'll be here for ya !

    I'll try to support you any way I can.. I know how trying it is when you're new and learning !
  4. by   jnette
    And THANX sooooooo much for the Hug A Dialysis Nurse thingie !

    I LOVE it !!! Never have seen one of those around here ! KOOL.

    Appreciate you !
  5. by   Allaroundnurse
    I agree that it will take you 6 months to feel comfortable in the unit. Our training program for new grads with no dialysis experience is the same as for a PCT at first. You go through the didatic where you learn the why then work with an experience PCT preceptor to learn the how. We try to use the same work rotation so that you are only with one preceptor.

    Once you are able to turn 4 patients and this can take from 6 to 8 weeks, you start learning how to respond to problems like low B/P, chills, etc. from the Charge Nurse. Once you are comfortable with responding to problems the CN starts on troubleshooting the machines.

    Then you start charge nurse training. Here you will learn about assessments and what to do with EDW and access problems. Sometimes you can get more of all of this while you are training depending on how fast you learn the PCT aspect.
    For the first 6 months you are never the only RN in the building so that you can ask questions.

    Remember that nurses are usually always slower than the PCT's. The only exception is a PCT who goes back to be a nurse. As a nurse we are constantly assessing as we work so that always takes longer.

    A PCT's challenge is to try to get faster so don't let them make you feel like you can't keep up. They will be able to work faster.

    Hope this helps. Remember to ask questions and don't feel that you are asking stupid questions because there are only stupid answers.
  6. by   Hellllllo Nurse
    Jnette and Allaroundnurse,
    Thanks for your replies and advice!

    Jnette-

    That "hug a dialysis nurse" gif is a picture of a metal sign I purchased on eBay. It is on the wall to the left of my computer. It is really high quality. I love it!

    I also have a sign that says "Caution: Nurse with ATTITUDE" with a picture of a syringe.

    I appreciate you, too!
  7. by   jackib
    I work in a unit in which we rotate through acute and all chronic areas. Our main chronic unit is 12 stations and runs 2 shifts MWF and 1 shift TTS, there is also a 4 station isolation unit and a 2 station home training unit We have 2 off campus units as well which run 6 stations each. Our acute unit is 5 beds, and from here we also do "all out of the units" ie ICU CCU etc.

    The staffing is mainly RNs but we do have 5 Ens as well. The Ens do not go to the acute unit or the education unit. They take a pt load but are not allowed to cannulate, perform assessments, give drugs (in accordance with legislature).

    In the main Chronic unit we have 5 staff to 12 patients. We try to have no more than 3 patients/dialysis trained staff member.

    I believe that what needs to be taken into consideration when asking this question is what is the patient mix like; how many co morbid conditions do they have; how compliant are they (food, fluids medications); what sort of age group are we looking at (I must work out our average pt age again - thinking about it it has to be over 70 years); what sort of access; what is their tolerance for dialysis: how do they travel - what is the liklihood of gettting them there on time for their appointment; how much education, review and reinforcment do they need, and what about emotional support. The list is endless.

    Just a bit of an Australian view
  8. by   penem10
    Hi, I am new to allnurses.com and consider this nurse discussion invaluable. I have worked in my hospital affilitated dialysis unit for 4 years as a staff RN. We have 10 patients per shift outpatient and we have 3 shifts of patients. We are in a rural community. The nearest dialysis units are 25 miles away and 50 miles away. Our staffing includes 3 RN's with 2 technicians. The technicians only set up the machines, prime, tear down. The nurses are responsible for every other aspect of care. We are also responsible for inpatient, acutes. The RN on call must go to the hospital to do these patients. This pulls the nurse off the floor. But basically we maintain the 3 Patient to 1 RN ratio. Judging from what I am hearing, we are not normal. In fact, are we over staffed? Any responses?:uhoh21:
    Quote from Diva
    Congratulations and welcome to the world of dialysis!!! Dialysis can always use RN's especially those with a strong nursing background.

    Your orientation/training sounds like it is what it should be. I always feel that a newly trained dialysis staff person is doing well when they can do a 3 x 3 patient assignment, safely, with minimal assistance from co-workers. This usually takes 3-4 months of actually being out on the floor. Successful turnovers from shift to shift are a matter of being efficient and organized.

    Taking charge responsibility after 6 months is according to the individual. Some can do it and others are stressed by it. If you feel you need more time, or more charge orientation just ask for it. It also depends on the size of the unit. I would not want a great nurse with 6 months dialysis experience in charge if it would shake his/her confidence, and possibly start second-guessing their choice of specialty.


    Expect to work and study hard during you OJT, but my guess is that you will love it. Dialysis nurses are in great demand, and most don't leave the specialty. Dialysis is a small community, so set out to be the best. Again welcome and the best of luck.
  9. by   wmarat
    Hhello!
    I've been working in semi private community unit. We have 24 stations including one isolation and running 24 tx. simultaneously. Usually, we have 5 RNs on the shift plus two techs.
  10. by   Diva
    Hi & Welcome. I don't believe that you are overstaffed. If you can still maintain a 3:1 ratio even when the on-call nurse is out of the unit doing an acute, I think you are fine. I believe it is your hospital affiliation that must mandate an RN providing care rather than technicians. With the nurses providing treatments, giving meds, charting, etc, they do have a full plate.

    I think you feel you are not normal due to the fact that many of the other posters work for one or another of the dialysis chains. The ratios that the chains run are much higher than a private or non-profit unit. I think 4:1 is the norm (what happens when there is a sick call??)

    After 4 yrs, I am sure you will stay in dialysis a while and love it.


    Quote from penem10
    Hi, I am new to allnurses.com and consider this nurse discussion invaluable. I have worked in my hospital affilitated dialysis unit for 4 years as a staff RN. We have 10 patients per shift outpatient and we have 3 shifts of patients. We are in a rural community. The nearest dialysis units are 25 miles away and 50 miles away. Our staffing includes 3 RN's with 2 technicians. The technicians only set up the machines, prime, tear down. The nurses are responsible for every other aspect of care. We are also responsible for inpatient, acutes. The RN on call must go to the hospital to do these patients. This pulls the nurse off the floor. But basically we maintain the 3 Patient to 1 RN ratio. Judging from what I am hearing, we are not normal. In fact, are we over staffed? Any responses?:uhoh21:
  11. by   osprey
    I work in an 18 bed unit; both chronic and acute pts. in a hospital. We have both outpatients( not stable enough for the clinics ) and pts from the inpt. population. Our ratio is usually 1 RN to two pts; perhaps 3pts if all are very stable. We have three shifts of pts; the first shift on by 0700 and the last going on about 1800;then some overnight pts and of course the ever present acutes who pop up out of nowhere and need emergency hemo. We have nurses who do 8 hr shift (7-3 or 3-11 and 12hr shifts 07-19 / 19-07) The team leader has no pt assignment on the day shift and more often than not has one on the 3-11 shift. Our usual amount of off units is 2 -3 per day; except the last few weeks we have been up to 9/day. ICU and CSU mainly; with a few od's just to make sure that we could do hemoperfusion. Our orientation is 6 weeks long; class room only for the first week, then both(classs and practical) the next week and then mainly with a perceptor for the last 3 weeks.By the time you are out of orientation, you can do most things, including all trouble shooting, pts and machines and do the 2 pt assignments. We tell them that you won't feel like you really know anything for at least 6 months and feel comfortable in a year. They usually don't do charge for a year and then will also be trained to do the offunits. We also have techs; they do primarily set up off unit machines, but will help in unit to set up machines for the change over times if we are busy; but we do everything; set up, put on, assess, hourly rounds, meds, rounds with MD's, problem solve etc. If its there, we do it. The clinics here have a 1:3 ratio and the pts there have to be really stable or they go back to the home base (hospital) until more stable. Its really great to read these comments and questions from the forums; I'm glad that I found it.
  12. by   nurse dolly
    Quote from lee1
    What is the nurse/pt ratio at your centers??? How many pts do you take care of at one time on machines????
    we are responsible for setting up and monitoring 4 patients at a time in between doing assessments on all 10-20 patients plus all medications on 20 patients , plus help anybody who might need help with their patients. By the way I am an LVN at a 21 chair dialysis unit. We usually work with a charge nurse who is an LVN and 4 techs and then me. Today was a day from hell I dont know how they expect us to truly take care of these patients with so little staff. Our turn around started at 9:30 am and the last patient was put on at 1:00pm, the day started at 5:30 with the first patients coming on at 6:00am and ended with last one off at 4:30 pm .



    :uhoh21:
  13. by   penem10
    Hi, and thanks for the reply. When we have a sick call the nursing supervisor tries to fill it by calling off nurses in. Usually we all cover each other if we can. However, there was a time last week when we wound up with only 2 RN's and 2 techs for the normal load of patients. This occurence has spurred me on the look into what is safe and what is not. We have been told by my nurse mgr for ever that we need 3 RN's on at a time, but all of a sudden on that day last week it was ok to have 2 RN's on and 2 techs. I have not been able to find any standard form of staffing. Especially in NYS.
    Quote from Diva
    Hi & Welcome. I don't believe that you are overstaffed. If you can still maintain a 3:1 ratio even when the on-call nurse is out of the unit doing an acute, I think you are fine. I believe it is your hospital affiliation that must mandate an RN providing care rather than technicians. With the nurses providing treatments, giving meds, charting, etc, they do have a full plate.

    I think you feel you are not normal due to the fact that many of the other posters work for one or another of the dialysis chains. The ratios that the chains run are much higher than a private or non-profit unit. I think 4:1 is the norm (what happens when there is a sick call??)

    After 4 yrs, I am sure you will stay in dialysis a while and love it.

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