[gambroRN]

I'd like to know if there are any acute dialysis nurses that could share with me what their typical work day/schedule is like. Our day is getting crazy....we do up to 4-6 pts/day in acutes and we are on the floor working for sometimes 18-20hrs with no break. There are 4 fulltime RN's. We do call one nite a week and one weekend a month, plus we work another Saturday per month.
I'd appreciate any ideas you could share that I could offer my coworkers.
Thanks so much.....

[TELEpathicRN]

I work for an FMC acute HD unit and we have 11 or 12 RN's, not all of them are full time, 5 are part time. We have a 9 station unit and have dialyzed up to 27 pts/day in the room, not to mention the remote patients that are done in the ICU's. We cover 4 hospitals, 3 are all within about 10 miles of each other, but the 4th is about 35 miles away!! It varies as to call, ours falls by a set rotation and sometimes you go 2 weeks without call. We have to work every-other weekend!! The pay is pretty good and we actually get an acute diff and an evening diff+call pay. Sometimes we work 16+ hrs/day. Have been on call and got paged on my way home from work at one hospital, and got paged to go do an emergency potassium. It isn't a predicatable job at all. If it weren't for me liking the majority of the staff I work with, I would leave!! I love dialysis, but don't want to go back to chronic.

[gambroRN]

Thanks Telepathic for sharing - it sounds like you guys are pretty organized. We do not have a room at the hospital to do dialysis in, so we are lugging the machine plus a reverse osmosis machine with us to the pt's rooms. We are now down to 3 fulltime RN's - the other two got fired for refusing to work 24 hrs a day. I love dialysis too - but the chronic setting is starting to look pretty good to me. Set schedules, no weekends or holidays.
I don't know.....decisions, decisions.......

[TELEpathicRN]

know what you mean, @ two of our hospitals we don't have a dialysis unit, and have to go to the pts room for HD. We have our water system on our machine. We have to push it around with all our stuff on there. One hospital has a huge ramp that you have to go up to get to the elevators to go up to the other floors... It is hard to get that machine up there and is hell on the way down!! I am thankful that our program is organized(for the most part).

[Hellllllo Nurse]

I work in chronic, and it is just crazy. We work EVERY holiday except for Christmas Day. Staff comes in at 4am to 7pm the day before Christmas to dialyze everyone who normally would get done on Christmas day. I work 10 hr shifts, including q o Sat.

I am getting worn out working to the maximum of my physical capacity every shift. Some of our pts are way too sick to be dialyzing in a free-standing chronic unit. They are so unstable. They need 1:1, which really is dangerous in that other pts get neglected. I thought maybe acutes would be better, but sounds like it isn't.

For those of you who have worked both acute and chronic, how do they compare?

[jmtmom]

Hi everyone,

Helllloooo nurse, it sounds as if you are really overwhelmed. That makes me a little nervous because I will also be working at an outpatient chronic unit. I just completed my second week of orientation (my first week on the machines). But I don't start precepting in my actual clinic (42 chairs) for another week or so. Right now they have me at a 15 chair clinic to learn set ups, tear downs, run ons, run offs, and cannulations. This clinic seems to be okay as far as work load. Well staffed.

I'd like to know what I have to look forward to. What makes your days so crazy? Are the patients crashing left and right?

I really hope things start to get better for you. What area of nursing did you come from before dialysis?

medsurge

[gambroRN]

I just want you all to know that I think this is great that we can bounce ideas off of one another.....it makes a hard job more bearable. I have done med-surg floor nursing, telemetry, PCCU, ICU and float, also chronic care setting. I still love dialysis the best, but the days are long...sometimes to the point of exhaustion. I have worked in both the chronic and acute settings, and there are pros/cons to each. Sometimes I like acutes better, sometimes chronic. Different strokes, I guess. But, I feel that nursing ingeneral is pushing every one of us to the limit. I guess you just have to take a stand and say enough and only do what you feel you can do safely, both for yourself and the patient. ANd if you get fired for it....oh well!

[TELEpathicRN]

I prefer acutes. Actually, I love acutes!! All nursing jobs are physically and mentally draining. The pts in acutes (regular HD pts) are usually complex...our ratio is 1:3, sometimes, it is 1:2. We aren't assigned pts, everyone just works together as a team, one nurse cannot be responsible for the care of more than 3 pts. These pts receive NUMEROUS antibiotics, and some of them are getting blood transfusions, etc.. We also get ICU pts(off vent, usually stable, emphasis on usually)..alot of times they will work you to death(ex: may be post op, in alot of pain and you have to repeatedly call the ICU nurse to bring them something for pain, and they wait about 2 hrs until they bring it!!! Makes me soooo mad, but it is in our job description that the hosp staff are responsible for their pts BG's and PRN's while they are in dialysis. We can't give any pain meds except Tylenol!!).

Give acutes a try, If your chronic unit is as understaffed as most are, you probably could transfer back to your old job if you didn't like acutes!!