Acute Dialysis Nurse:Patient Ratios

Chisca, RN · Sep 4, 2015

NurseRies could give you an informed answer. I have only worked acute dialysis in one city in Tennessee and as you know this is a big country. 1:1 in the ICU, 2:1 in the acute unit, 15 bed unit with one tech. Alot of call. On any assignment you agree to make sure the call situation is clear and in writing or you could find yourself very sleep deprived.

TravelLusting · Sep 4, 2015

Thanks Chisca. Any input NurseRies?

NurseRies, BSN, RN · Sep 5, 2015

Sure. I have worked for acute teams in Florida, South Carolina, Texas, California, and Colorado. I have never had a ratio higher then 2:1 in acutes. I have heard of some units doing 3:1 in acutes, I would prefer to stay away from those units. A few of the acute units I've worked in had ratios of 4:1, IF I had a technician helping me. That isn't so bad since the inpatient techs are usually really good. They do all the water checks, machine set up, put patients on, take them off, vitals. So I am able to focus on documenting assessments, giving blood, giving meds, calling doctors, etc. ICU patients have always been 1:1 anywhere I've worked and that's how it should stay. We are not trained to be ICU nurses, so those patients should not come to the acute unit.

Chronic is a whole different story. Usually the ratios are state-mandated. I worked chronic in South Caorlina and the ratio was 10:1. So we had 17 patients and 2 nurses most days, and would have 3-4 techs also. The techs were supposed to be responsible for their own pod of patients, but sometimes they would mysteriously disappear for a while. Seemed like no matter how much we complained, they never got in trouble because they were so experienced and it was hard to find replacements. I think the highest ratio I have heard for nurse to patient in chronic is 12:1. For technicians in the clinic, I think 4:1 is more then enough, however, recently I have heard that the big 2 (Fresenius and Davita) have been pushing the limits on this. The Davita clinics in Colorado have recently gone up to 6:1 ratios for techs. That is just not safe and too much, therefore, the nurses are going to be more stressed and picking up the slack.

I guess bottom line is that there don't seem to be any mandated ratios and it varies state to state. So just ask a lot of questions in your interviews and stay away from those higher ratios. If clinics and units are willing to push the limits with patient ratios, imagine what else they push the limits with. No thanks....

TravelLusting · Sep 5, 2015

Thanks NurseRies. Do you mind me asking, do you currently work for one of the "big two" or a hospital?

NurseRies, BSN, RN · Sep 5, 2015

I do not work for one of the big 2. I work for a physician practice now. It is great!! I have worked for them in the past.

TravelLusting · Sep 5, 2015

I remember speaking with you several years ago when I was first looking into dialysis travel nursing. That has not gone so well . . . for varied reasons we had to keep pushing off the travel date. Until now, we are finally ready to go and the only companies willing to work with a starting Canadian travel RN without a US SSN are ones that are not so trustworthy. So, I am searching for permanent jobs. Not really where I wanted to start, but it seems to be the best option. Would you recommend starting out with one of the big two or trying to find a private practice job? Thanks for your time and responses.

NurseRies, BSN, RN · Sep 5, 2015

I understand! Travel companies are shady in my opinion. I think that both of the big 2 give great training. I think it could be a good learning experience for a year or 2. From there you could search for the job you really want and with some leverage on your salary. If you think you have a good grasp of dialysis and what you may be worth here, then go for the best job! But if you want to just ease your way in, going with the big 2 isn't a terrible option. I highly recommend avoiding the one that starts with a 'D'. :)

TravelLusting · Sep 6, 2015

Thanks NurseRies. I was going to interview with D, but the more I read about them online the less excited I was. Thanks for answering my questions.

NurseRies, BSN, RN · Sep 7, 2015

Yeah it wouldn't be the worst thing... Some programs seem fine if they have good staff and management. But overall, their reputation in our specialty is not good. And I've talked to a lot of nephrology nurses in many cities!

TravelLusting · Sep 8, 2015

I would have tested the waters were I going on a travel assignment, but since I am now applying for permanent jobs, I figured I'd start with the one I feel more confident in. I've gathered through reading that the success/failure of most programs has more to do with the management than the company.

I hope Fresenius is as quick getting back to me as Davita was.

MarkTX · Sep 11, 2015

Hi TravelLusting and NurseRies. I am a RN with DaVita in Texas. They took me on in chronic outpatient as a new grad LVN, paid for my tuition while I was transitioning to RN, built my work schedule around my school schedule, and transferred me to a much better paying acute position in the hospital upon graduation. The benefits are nice and affordable, and they give bonuses twice a year (last year was almost $4000). They give the clinics a lot of autonomy so the experience you have at one clinic could be entirely different than you would have at one just down the street. I would definitely recommend DaVita and have helped several of my classmates get jobs here as well. Once you are a fully trained employee, you can pick up hours at any DaVita clinic (a little more difficult across state lines, but doable). You can try out different units and find one that is best for you, build rapport with the staff, and transfer over when the opportunity presents itself. There are plenty of things I could complain about as well, but they aren't big and I have worked in plenty of other healthcare environments. They ALL have problems.