Acute or Chronic Dialysis Nursing?

awheat · Jan 2, 2012

I would like to know the responses to this question also. I am a M/S nurse who starts at an outpatient dialysis clinic tomorrow - one of the reasons it looks so attractive to me is the repetition (not to say I do not have to be on my toes to intervene when needed).

FransBevy · Jan 3, 2012

I have never worked so hard in my life! Repetition? What repetition? I'd LOVE some repetition. I love it but no two minutes are ever the same here and you have to be A&OX3.

Guttercat, ASN, RN · Jan 8, 2012

I've been training for the last few months as a chronic dialysis nurse after spending years as a surgical/telemetry/ER nurse in an acute care facility.
I love my patients but I do miss the buzz of new faces and being in the middle of things.
What are the pros and cons of both?
Thanks so much!

Do you like to run your own show? Go acutes.

Do you thrive on multi-system puzzles? Go acutes.

Do you like to be the go-to person in facillitating problem-solving for several different departments, docs and RN's ? Go acutes.

Can you handle making a loose outline for the day, and filling in the blanks as you go? Go acutes.

I love acutes. Keeps my brain happy.

Caveat: no two acute programs are the same. I couldn't do acutes if I was "on-call- indefinitely" as some programs are run. I have steady hours, with limited and shared call, as opposed to many for-profit entities that contract with hospitals.

I go in at a certain hour and bust a hump to get it done before the call RN for that day takes over in the evening.

I like to think my patients are better off at the end of the day after I've seen them. In acutes there is that "instant gratification" in fixing a problem, that you do not necessarily see in the cattle-call that has become outpatient dialysis.

madwife2002, BSN, RN · Jan 8, 2012

I found that Acutes was the most boring job I ever did in my life! Sitting in a room dialysing a patient who is unconscious for hours on end. Pushing machines around hospitals and Dr's who decide they want a pt dialysed just after you have finished for the day and you are heading home.

No It just wasn't for me-but I am thankful it is for other nurses because it would be terrible if everybody felt the way I do about acutes

madwife2002, BSN, RN · Jan 8, 2012

I have never worked so hard in my life! Repetition? What repetition? I'd LOVE some repetition. I love it but no two minutes are ever the same here and you have to be A&OX3.

I agree it is hard work in a Chronic Unit, I dont think all RN's are prepared for the amount of work involved.

jb2u, ASN, RN · Jan 8, 2012

I only work acutes, but....

Pros of acutes...

1. You see a lot of the same patients, but you also see some new ones.

2. You actually get to see some pt's recover kidney function (acute kidney injury).

3. 2 to 1 ratio or 1 to1 ratio..baby!!

4. Good working relationship with the nephrologist.

5. You pretty much know what the orders are going to look like day to day.

Cons...

1. Being on call.

2. You never know how many patients you are going to have day to day.

3. Stat orders when everyone is already on the machine. Now someone has to come off.

4. Not getting your hours during the slow months, working over on the busy months??

5. You can get tired of seeing the same patients coming in time and time again because they missed their dialysis appointment, ate and drank what they wanted and now you get to come in in the middle of the night to save them from themselves.

6. Being called in in the middle of the night for a "stat" overloaded patient, only to come in and find them being wheeled back to dialysis, smiling, no O2, and asking "when am I going to get something to eat?".

Chronics (from what I hear)...

Pros...

1. You get to know your patients.

2. Repetition.

3. More controlled schedule (ie: you know who's coming, or at least who is suppose to come each day.

4. No call, holidays, or Sundays.

5. Get out of work with enough time to do other stuff.

6. I'm sure there are more, but like I said...I've never done chronics.

Cons...

1. A lot of repetition.

2. Same patients all the time.

3. (Don't shoot me, this is just what I hear) Some strong personalities from (many) Techs.

4. Early, Early mornings.

5. Higher nurse to patient ratio...but you do have techs running patients.

Keep in mind, one person's pro may just be another person's con or vice versa!! I always say it is worth trying out. You never really know until you do it. I love doing acutes. Yes, I wished I had a better idea of how the day will go, but I wouldn't trade it for a floor position even on the worst day!!!

Guttercat, ASN, RN · Jan 9, 2012

I only work acutes, but....
6. Being called in in the middle of the night for a "stat" overloaded patient, only to come in and find them being wheeled back to dialysis, smiling, no O2, and asking "when am I going to get something to eat?".

!!!

THAT, is my biggest peeve. ER doc calls nephrologist at 1150 stating "the patient's CXR shows pulmonary edema! (duh) He's fluid overloaded!" Nephrologist says, "OK, call the on-call dialysis RN." The nephrologist then rolls back over and goes to sleep thinking he or she was dreaming that the phone just rang.

On-call RN has just got to sleep, but has to rush in to meet a patient who's sitting up, smiling, has an spo2 of 93% on room air, and is asking for a sandwich. Hmmm, guess that ativan in ER cured them, eh?

I don't get as much of the "repetition" you speak of in acutes, however. Some FF's yes, but we serve a large area so it's pretty diverse.

I love acutes. The "repetition while running as fast as you can" of OP/chronic dialysis leaves me without much job satisfaction...zzzzzz.

Oh, and I'm on-call tonight.

FransBevy · Jan 9, 2012

Thank you all. I'll give this job a year and then think about the future.

talaxandra · Jan 9, 2012

I was wondering what kind of ratios (nurse and tech: patient) you're used to in both acute and chronic.

FransBevy · Jan 9, 2012

We RN's each get a 3 patient assignment and oversee 12 patients in all. Each PCT gets 3-4 patients. I'm finding it still overwhelming so we'll see.

talaxandra · Jan 9, 2012

Thanks for the quick response, FransBevy :) Does that mean you've got a 12-chair chronic HD unit, with four RN's and 3-4 techs? Sorry to be a little slow on the uptake - I don't transition from mights to days as well as I used to...