I have never worked dialysis but have worked other flavors of nursing, mostly hospital.
Interviewed and was offered a 4 days/week position in a chronic clinic for one of the "big two."
I accepted but am now having reservations about moving forward - not because of the salary or benefits - but because of the hours. I was told shift starts at 5 a.m. and ends between 3-4 p.m. most days..which I could deal with...but reading posts on here and elsewhere it sounds like 10-12 hour days are more like 14-16..if this is something that happened once in a while I could manage it but not all the time of working 14 plus hours a day. Overall this job can provide a lot of financial stability for me and my family..I was interested in it as well...because it would be something new. I have no problem working hard but do not want to be spending 14 hours at working all the time. 12 is more than enough most days. I don't want to start something only to be looking for something else in a few weeks or months.
Anyone who works at a dialysis clinic ..your honest feedback would be very much appreciated.
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.
Oh, my, that hadn't even occurred to me, because that was never done when I worked chronics. That would be awful, almost like working acutes. I would not go for that either.
No, according to the people at interviewed with and the nurse I spoke to a few days ago the first group of patients come in around 5:30 and start treatment around 6, they finish up between 9 and 10 then the next group of patients are placed on - but all, can't be started until she has assessed them. She said they are never done before 4 "for sure" This in not a hospital based clinic and they run up to 24 patients at each "session" I think a lot of the running late is patients running late but also only have 1 (& now one in training) RN to do the assessments on the patients before they start treatment. She also said care plans, foot checks etc being behind are one of the reasons the MD is so upset. I asked her "on average" how many hours are you here (the job is suppose to be 4 10 hour days) She said "11-12 easy" Maybe, as others have posted, it's just not well run...
Ok, that explains it then. The "sessions" that she spoke of are what I've always known as shifts, so this clinic runs two shifts, in the vernacular of the clinics where I have worked. Now I can see where you could put in a 12 hour day, especially if there is one nurse for all 24 patients. I have never heard of a ratio like that!
I worked in a busy clinic with 20 chairs that ran three shifts a day (last shift of patients came on at about 3:30-4pm) but we had two nurses to split the floor, so we each had 10 patients each shift if everyone showed up for their treatments. How could one nurse do 24 assessments each shift and get the patients on in a timely manner when they have to be assessed and machine settings checked before they can start their treatments? I can't imagine that the patients weren't upset too, since this must delay their treatments and cause them to be there extra long, when many of them don't want to be there in the first place.
As far as getting care plans and foot checks done with that kind of staffing....lol!
The MD medical director who allows such a thing is an idiot - the 'big two' have the easy availability of getting travelers in to help out - heck Fresenius has their own travelers!
I worked in chronic dialysis for 7 years. In that 7 years, i had to stay late once or twice due to patient complications needing antibiotics or waiting on rides. Chronic units close and usually you are not there late, you develop an excellent relationship with your patients as you spend more time with them, than their own family, it is very rewarding. Staff in chronic dialysis becomes like family to you and teamwork is usually excellent.
I like a challenge and a constant change and prefer a more acute setting, so after working in icu 2 + years i went back to dialysis on the acute side. Now these hours are a whole other story! Acute dialysis you leave after all patients are done, and you never know when another will be added, so you may be walking out the door after already 14 hours in and get a stat treatment for high k this now turns into a 20 work day. Doesnt happen all the time but does happen. I work at one of the busiest hospitals for dialysis in st. Louis areas and winter months are very long days. I HAVE NEVER EXPERIENCED THIS IN CHRONICS!
Stick with it, dialysis is a great kind of nursing specialty with a while different stress level, that doesnt leave you 100% emotionally drained at end of the day. Good luck and welcome to dialysis world
They never mentioned travelers just that employees are expected to help in other clinics once they have been there 6-12 months. I am still on the fence. Maybe now the other RN has started - that makes 2 - it wouldn't be so bad but has to be a reason nurses aren't staying or are leaving to the point the one RN was by herself for months before they were able to hire anyone else. It sounded like the MD is contracted - not sure if that's the correct term - as he has his own practice and dialysis clinic - just much smaller scale. As of yesterday there is still not a FA and no one interviewed for the position. So really, no actual leadership is in the building..as a new employee that also makes me hesitant. I'm still on the fence..
You ultimately need to do what's right for you, but if I worked for a clinic where one nurse had to cover 24 patients, even if it is hopefully a temporary thing, I would wonder about who decided that this was ok, because it is not. Agency nurses/travelers should have been brought in once they knew they were going down to one RN, and IMHO, there's no excuse for not doing so.
Also, even though they don't have an FA, there should be a regional manager who is directly involved until an FA is hired and trained. Someone should be overseeing the operation on a local level.
I agree..I think the other clinics that are close are in turmoil as well so this one is getting "leftovers" I am going to reach back out to the recruiter directly tomorrow to see where the staffing is since I was interviewed and decide from there. Since I haven't ever worked in a dialysis clinic I wasn't 100% sure what was normal and not..but now, reading posts from those on here, I do and plan to ask a lot more questions tomorrow. I'd really like it to work out but not at the expense of my license or patient safety.
The turnover & missing manager tells the story. I have been in dialysis over 20 years & got into it because of the schedule.
If it is a facility that has 2 patient shifts, then you will usually be at work 11 hours total.
3 patient shifts will depend on how they staff the unit.
Some turnover for newbies is common, as dialysis isn't for everyone.
It will take you at least 2 years before you will have enough experience to feel like you've "got it".
The best part is knowing your patients & working with a good multidisciplinary team.
The worst part is problem patients, ifyou have a dysfunctional team, the factory like work, & the financial constraints from CMS on dialysis. Dialysis is a small community, ask around about the best facilities to work for, the company with the best training in your area. To get started, you may have to take the lesser facility, then transfer. Inner city units are usually the toughest. Go on the CMS website &look up the grades of your facility. They only report on Medicare pts, so it's not a complete story, but will help educate you on some of the quality standards. Good Luck to you!
UPDATE: I was contacted by the recruiter again...I explained to her my concerns about why I wasn't willing to move forward with the position..she tells me she completely understood my position but wanted to let me know they have hired another RN who already started, corp. sent someone to handle things that had fallen behind due to staff turnover, the MD who oversees things had his concerns addressed and things are much more stable. She invited me to contact the 2 original people I interviewed with to confirm what she was saying..she said they really would like me to join the company, feel I have a lot to offer them/they me..etc. She said that most nurses find the job easier in some ways then working the floor at a hospital..which is interesting as several said that during the interview with me..she said it's challenging etc. but they work about 11 hours average and its rare for the days to run over that. I told her I would get back with her. The salary is not a problem, nor the benefits..my question..to those of you who have experience in chronics..now that the staffing and MD concerns have been addressed and are resolved or currently being resolved..do you think it would be a better setting for someone new to dialysis?
UPDATE: I was contacted by the recruiter again...I explained to her my concerns about why I wasn't willing to move forward with the position..she tells me she completely understood my position but wanted to let me know they have hired another RN who already started, corp. sent someone to handle things that had fallen behind due to staff turnover, the MD who oversees things had his concerns addressed and things are much more stable. She invited me to contact the 2 original people I interviewed with to confirm what she was saying..she said they really would like me to join the company, feel I have a lot to offer them/they me..etc. She said that most nurses find the job easier in some ways then working the floor at a hospital..which is interesting as several said that during the interview with me..she said it's challenging etc. but they work about 11 hours average and its rare for the days to run over that. I told her I would get back with her. The salary is not a problem, nor the benefits..my question..to those of you who have experience in chronics..now that the staffing and MD concerns have been addressed and are resolved or currently being resolved..do you think it would be a better setting for someone new to dialysis?
Once a clinic is run down with a revolving door it is hard to keep staff. There is usually some coming and going with the staff that stays getting overworked and starting to call out sick, which in return makes it worse and newer staff will leave. When you are new you depend on your preceptor and other nurses to support you. The problem I have seen is that the patients were all on time with their tx and assessments and meds were done but documentation was lacking behind, leaving nurses with hours of overtime to catch up on documenting. This is how the 10 or 11 h day becomes a 13 or 14 h day.
If you have doubts and have a good job now perhaps think about it more. Perhaps there is a smaller clinic that is more stable. Also, with short staffing they will call you all the time once you are off orientation and will try to get you in early for this and that.
westieluv
948 Posts
Oh, my, that hadn't even occurred to me, because that was never done when I worked chronics. That would be awful, almost like working acutes. I would not go for that either.