Accepted dialysis clinic position, now having second thoughts - advice please?

westieluv · May 10, 2016

I wonder if you have been reading the comments here about the hours in acute dialysis as opposed to chronic dialysis. Acute dialysis hours can be insane depending on the program that you work in and you never know from day to day if you will have an eight hour day or an eighteen hour day. The hours in a chronic unit should be much more stable and predictable unless your unit has nurses who call off a lot. I used to work in a chronic unit for one of the Big Two and we always got out on time because other nurses were scheduled to take over or it was time for the unit to close and everyone left, patients and staff.

I am starting a job in a chronic unit at the other of the Big Two next week and that unit runs the same way. I would not even consider the position if it didn't. I used to work acutes and I will never do it again because of the crazy hours.

adsmithrn · May 10, 2016

I beg to differ. i have worked chronics for over 10 years. there are days, just as in the hospital, that you may end up staying later to "catch up" i think prioritizing and time management play a big part in how your day goes. also, it depends on other factors in the clinic, such as staff call ins, reports, pt no shows/ reschedules, unexpected events, etc... no 2 days are alike, some longer than others...

westieluv · May 10, 2016

So we've had two very different experiences working in chronics. I only had to stay over once when our last patient of the day had to wait longer than usual for his ride, and I worked in a very busy, twenty chair, three shifts six days a week clinic.

Good to know, thanks!

RNinthemaking15 · May 10, 2016

I'm In chronics and have set hours. We have patients off the machine by a specific time daily. Going to dialysis at one of the "Big two" has been my smartest move as an RN. Good luck!

Guttercat, ASN, RN · May 11, 2016

Depends heavily on patient census. If the last shift of patients is light, you will most likely be out of there by 3-4 PM. If that last patient shift is medium to full, you could be there until 5PM. (As a side note: Tues/Thurs/Sat patient-loads are usually lighter than on M/W/F.)

Plan on being there 15 minutes before shift starts, and, depending on patient census, until.... whenever. Factor in commute time as well.

Also think about how they schedule staff: will you routinely receive consecutive days of off each week, or will you be two on, one off, one on, one off, one on, etc.? That makes all the difference in whether or not four "tens" (which are often longer) are doable over the long haul.

Good luck! Dialysis is great if you get in the right program and with a good group of colleagues.

diabo, RN · May 11, 2016

You'll be fine. Chronic dialysis is like no other animal. We try to save lives where ever we are and most of the time we get little of no feedback. Not so with this job. For many of these patients, dialysis is their only social outlet. Greet them with a smile. Crack a dumb joke. You you will have to be firm, But they will learn to trust you, and that's when you can help them the most.

Lucky724 · May 11, 2016

Thank you for all the replies..I contacted one of the people who interviewed me & pushed for more concise information since I had the feeling she wanted to say more when I was there for the original interviews but was hesitant because others were in the interview as well. I found out that this particular clinic only runs one shift but "staggers" a PCT and an RN to come in about 30 min after the first one (this rotates among staff) RN's can leave when the last patient is out the door, not when treatments are complete & everything is ready for the next day. This clinic has had a high turn over rate of RN's in the past year..2 left shortly after completing the company orientation, a few others that were there also left w/in the past month (1 week apart) so at this time there are a couple of LPN's, one RN & one new RN that is just out of the company orientation & starting training to the facility. The home dialysis nurse left as well & the program for this facility was closed. The longest RN there (about 2 yrs) said for 4 months she was the only RN so she was literally working 6 days a week. There is currently no FA or person in charge - other facility managers are helping to cover so the one RN who has been there for about 2 yrs is doing multiple jobs. The MD who oversees these patients is extremely unhappy as a lot has fallen behind because of the turnover. I asked why the other RN's left - mostly, it seems, it was the expectation of working more than 4 days a week - to cover for someone on vacation or out sick & the consistent 12-16 hour shifts. The schedule rotates as far as days off but there doesn't seem to be a pattern to it other than every Sunday off & working every other Sat under "normal" circumstances. She also said RN's are expected to cover other clinics in the area which are about 40 - 70 miles one way when needed. I was also told training would be at the clinic I was hired for but that may not be the case & the clinic that orientation will be held is 80 miles one way for me. There was more but you get the idea. I asked her why she stayed - she said it was mostly because of the patients, the money & the fact she lives "very close" to the facility. I appreciated her being honest & told her so. She said she feels if the leadership teams were more upfront about the expectations, etc that the turnover would not be so high.

The money would be great - no doubt - & it seems a lot of dialysis nurses get satisfaction from the patients which would be wonderful but having a family I am not sure THIS clinic is the right choice. I still have some time to decide but I understand better why they are always advertising.

diabo, RN · May 11, 2016

Yeah, I understand. My daughter charges a very busy NICU unit with two kids and busy hubby. This place could be a nightmare and wouldn't be fair to you or your family. Our hospital owned chronic unit takes care of 100 plus patients but is fully staffed by RNs and LPNs. with no techs. It's managed differently than the private units, I'm sure, and I'm probably spoiled. Don't give up on dialysis, but your family must come first.

westieluv · May 11, 2016

I don't understand how a clinic that only runs one shift has nurses working 12-16 hour days. The longest treatment I have ever seen was five hours, and only a very few of those, so with prep and clean up eight hours would even be a stretch, unless you are talking about nocturnal treatments or that clinic has add-ons every single day.

Marisette, BSN, RN · May 12, 2016

Thank you for all the replies..I contacted one of the people who interviewed me & pushed for more concise information since I had the feeling she wanted to say more when I was there for the original interviews but was hesitant because others were in the interview as well. I found out that this particular clinic only runs one shift but "staggers" a PCT and an RN to come in about 30 min after the first one (this rotates among staff) RN's can leave when the last patient is out the door, not when treatments are complete & everything is ready for the next day. This clinic has had a high turn over rate of RN's in the past year..2 left shortly after completing the company orientation, a few others that were there also left w/in the past month (1 week apart) so at this time there are a couple of LPN's, one RN & one new RN that is just out of the company orientation & starting training to the facility. The home dialysis nurse left as well & the program for this facility was closed. The longest RN there (about 2 yrs) said for 4 months she was the only RN so she was literally working 6 days a week. There is currently no FA or person in charge - other facility managers are helping to cover so the one RN who has been there for about 2 yrs is doing multiple jobs. The MD who oversees these patients is extremely unhappy as a lot has fallen behind because of the turnover. I asked why the other RN's left - mostly, it seems, it was the expectation of working more than 4 days a week - to cover for someone on vacation or out sick & the consistent 12-16 hour shifts. The schedule rotates as far as days off but there doesn't seem to be a pattern to it other than every Sunday off & working every other Sat under "normal" circumstances. She also said RN's are expected to cover other clinics in the area which are about 40 - 70 miles one way when needed. I was also told training would be at the clinic I was hired for but that may not be the case & the clinic that orientation will be held is 80 miles one way for me. There was more but you get the idea. I asked her why she stayed - she said it was mostly because of the patients, the money & the fact she lives "very close" to the facility. I appreciated her being honest & told her so. She said she feels if the leadership teams were more upfront about the expectations, etc that the turnover would not be so high.
The money would be great - no doubt - & it seems a lot of dialysis nurses get satisfaction from the patients which would be wonderful but having a family I am not sure THIS clinic is the right choice. I still have some time to decide but I understand better why they are always advertising.

Usually, Hemodialysis in the chronic setting has stable hours that don't vary much. However, if they told you all this, believe them. Apparently, this is what happens in this facility.

Guttercat, ASN, RN · May 12, 2016

I don't understand how a clinic that only runs one shift has nurses working 12-16 hour days. The longest treatment I have ever seen was five hours, and only a very few of those, so with prep and clean up eight hours would even be a stretch, unless you are talking about nocturnal treatments or that clinic has add-ons every single day.

The OP mentioned they were expected to cover outlying units. My guess is that once they wrap up for the day, they have to be available to float. Since she or he mentioned these units are 60 miles or more away...it does not sound like an optimal situation.