I am a Canadian RN. I have been working in dialysis for four years -- chronic and acute. I've been hoping to move to the US to work. I was just checking out jobs at Davita for acute dialysis. The description stated that the ratio nurse:patient is typically not more that 1:5. Is this not excessively high for acute dialysis? I know I am spoiled as all patients who are deemed too acute to dialyze in our unit (an inpatient unit) are treated 1:1 in ICU.
I realize that not all acute dialyis treatments are completed in the ICU in the US, but if you have 5 acute dialysis patients having treatment at the same time, where would you be set up? Do you have any aides or are you responsible for everything during the treatment.
When I dialyze a patient in the ICU, I am responsible only for the dialysis. The assigned ICU nurse is responsible for everything else to do with patient care. While I do more than I have to do when I am there, there are certain treatments for critically ill patients I cannot do as I am not trained. When you are completing treatments on such patients are you responsible for ventilators, central lines, etc., as well or is there another nurse to care for such things.
If you have experience in acute dialysis: good, bad, ugly. Please share. I'd like to go in with my eyes open. Thanks for your time.
I actually just graduated from school and have had my license for a few weeks. I'm scheduled to transfer in 4 weeks and was told to expect up to 8 weeks of training to include other modalities such as peritoneal dialysis and apheresis. Starting range for a new grad RN in acutes in Houston is low $30s. 3 days on, one day on call ($50/$75 on call pay for weekdays/weekends respectively), no more than 3 shifts of patients per day. Ratio is 1:1 if it's in the patient's room or 2:1 on the unit. They don't use techs except for patient transport and taking care of machines.
When I initially applied to DaVita I had a phone interview, a panel interview, an interview with the facility administrator, and 2 shadow days at different clinics. Their hiring process is so slow. For the transfer, I just had a telephone interview with a recruiter and a interview with the administrator. Stick with it through the process. It's a pain, but it's worth it. As for machinery, I assume you are talking about dialysis machines. I have only seen Fresenius machines in use. My clinic uses 2008k2 machines, but I've seen some newer models at newer facilities. Water systems vary from clinic to clinic. It's all some form of reverse osmosis.
Hi MarkTX, I realize you have not started in acutes yet, but I assume you've spoken with nurses in acutes. Have you asked them how difficult it is to get vacation time? Are you often paid in leiu of time off because of no nurses to cover off for vacation? Thanks
I work for a large hospital. Our ratios are 1:1 in the ICUs or if we are working by ourselves. 2:1 for floor patients only if there are more than one of us working.
I have spoken with several of the acute care nurses. The common theme I've noticed is LOTS and LOTS of hours. One nurse I spoke with said he knew another nurse who cleared $200,000 last year. Obviously the money is great, but he wasn't talking about it in a positive way. I didn't ask specifically about time off, but I think the implication is that they are short on acute care nurses right now and that always makes it difficult to get time off. They also said that for the day they are on call, the generally get called in. There is a maximum amount of PTO you can have (don't remember how much), so they will allow you to cash out once a year. The hospital is where the money is at. I was just given my new position here at the clinic and I will be making $5/hour more in the hospital. The nice thing is that if I have time and choose to pick up hours in the clinic later, it's at the higher rate of pay.
My understanding is that a handful of units still reuse dializers. For whatever reason, EVERYONE is required to be trained regarding reuse safety and every unit has a spill kit for renalin even if they don't reuse. Don't plan on ever being in a reuse clinic/hospital, but it is possible.
Specializes in Nephrology, Dialysis, Plasmapheresis.
" No more then 3 shifts of patients per day"...
3 shifts of patients is easily an 18 hour day... And I know from experience that they expect you to do that without questions. I was often told when I worked for them, "You know if you don't stay late and do this other patient, they could die."
I'm sure you're right. A recurring theme from every acute nurse I spoke with was lots and and lots of hours and crazy long days. Nurses are ultimately responsible to ensure their patients get the care they need and sometimes that requires an extra long day. Anyone who can't do that needs to find a job that isn't bedside. The occasional 4th shift patient that is going to die without dialysis is expected and understandable. When it becomes a regular occurrence, that's when you need to have a conversation with your manager and be prepared to move on if that is really important to you.
TravelLusting
36 Posts
Thanks MarkTX, I am glad you've had such an excellent experience with DaVita. It is certainly good to know that it is not all bad.
How much training were you given when you transferred from chronic to acute?