Switching from Chronic to Acute Dialysis

[Kturks06]

I am currently a chronic dialysis RN in Georgia and to be honest I am getting a little bored. I was thinking about going to acutes but wanted to know a little be more about it. Can someone share their experiences as an Acute Dialysis Nurse?

[westieluv]

I've only been at it for a few months so I'm no expert, but I really like it a lot better than floor nursing. One thing you really need to be prepared for, however, is that you will have days with some very LONG hours. I just worked 30 hours in the past two days. If someone needs dialysis and there is no one else but you, you will stay until the treatments are done, like it or not. For some people this would be a deal breaker, because they have to be off at a certain time and in acutes, you can never plan anything when it is your day to work. We have one nurse who has been at it for about 8 months and will probably be quitting soon because she gets angry when she has to stay past 5 PM. You cannot work acutes and have that mindset.

[DialysisRN12]

But WestieLuv it depends on where you work two. I'm with one of the big two in Chicagoland and we are setup that we are required to take two patients per day. Third is RN choice. On call days are only 14-15 hrs. I've worked 18-20 hrs on one day but that was by choice :)

[DialysisRN12]

Too* omg I'm tired lol

[schnookimz]

What else are you doing while waiting for the patient to be finished? Is there downtime or are you always running even at the end of the day?

[westieluv]

I don't run the entire day. Once I get a patient on and if the treatment is going well, then I sit in a chair at their bedside and observe, troubleshoot if necessary, and document VS and machine settings, pressures, etc. every 15 minutes. It's kind of a feast or famine job--you work hard getting equipment ready, calling docs for orders, and gathering data on your patients, and then you usually sit for 3-4 hours as described above. One thing I don't like is that I am someone who drinks a lot of water throughout the day normally, but our company's policy is that we are not supposed to have any food or drinks at the patient's bedside, so I get hungry and thirsty while running a treatment, not to mention that if you have to go to the bathroom, you are not allowed to leave the patient unobserved at all during the treatment, so unless you can get their floor nurse or if there is another dialysis nurse around to give you a two minute break to use the bathroom, it can get a little uncomfortable. These are not deal breakers for me, because I only work 3-4 days a week, but it is something that I am having to adjust to.

DialysisRN12, I agree that it probably depends on where you work how long of hours you work, I work for Fresenius, maybe other companies are different. However, when you say that on-call days are only 14-15 hours, well, that equates to my 30 hours in two days, so it sounds very similar.

[westieluv]

ETA: I misunderstood, you meant that you are on call for 14-15 hours but won't necessarily have to work. We are only on call for 12 hours unless it is the weekend. It's just that on regular days, if there is no one else available, it comes down to staying over or a patient not getting their treatment. Every other acute dialysis nurse that I have ever talked to says it's the same for them, it just goes with the territory. You must have a lot of extra help to be able to turn down a third treatment, that's great! We don't have that option. Of course, every single day is not 14-15 hours long, in fact I have had days where I just had to run one patient and was home by 1 PM and even rare days where there are no patients to run and I just bleach machines and do busy work. One thing about doing acutes, it is never boring because no two days are ever the same.

[Travel_Lusting]

I work at a hospital dialysis unit where we treat both acute and chronic patients.

westieluv, you said you do one patient at time. Is this so for all acute dialysis. Is this a 1:1 ratio for ICU patients. Also, you say some days you leave at 1 pm. If you work acute dialysis and there is no one to dialyze that day, will you lose hours? Do you still get paid for the shift?

[westieluv]

Three of our hospitals have dialysis rooms where we have the capability to run two patients at a time if they don't require 1:1. Our fourth hospital, however, is a LTAC and has no dialysis room, so all of our patients there are 1:1 by default. That is why we can put in 15+ hours by running 3 patients. In one of our regular acute care hospitals where we can run two patients simultaneously, it would be a shorter day. We do not get paid for the shift, only for the hours that we work. On the rare occasion when our census drops, most of us can make up the hours with PTO, because Fresenius is pretty generous with PTO.

[serenidad2004]

I work in a hospital unit. I do chronics the majority of the time but am on call one weekend per month (from friday at 8pm until monday at 5am.) If there is someone in acute who needs dialysis during the week myself and the other 4 nurses take turns.