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 highly appreciate the DaVita Acutes program I work for. We have a fantastic team of people that ensure no one has to work extended shifts (beyond 13 or 14 hours) if they don't want to. Call is never scheduled for a night when one is scheduled to be on the next day, and we have terrific management.
Also realize that much of it has to do with patient volume, and the contract specific to any one hospital. That goes for Fresenius as well. No one Acutes program, whether the hospital contracts out or retains sole ownership, can be extrapolated across the board.
Specializes in Nephrology, Dialysis, Plasmapheresis.
If you have a good acute team with low turnover, then third shifts should be a rarity. Fourth shifts should be out of the question I think. 24 hour shifts? That is just plain unsafe and there are ways around doing that. I'm sure there are good teams out there and I guess you won't know what it will be like until you join one.
All I can say sure is, never expect to get out on time and you won't hate your job.
Hi Guttercat, Thanks for your input. I am looking forward to the change to acutes, but a bit apprehensive about the long hours.
I've worked my share of 16 hour shifts, but not on a regular basis. I hope when I make the move, I find a program like yours.
Do you mind sharing which state you are located in?
Thanks
The State doesn't matter as much as the hospital contract (assuming it is an acute program run by an outside entity that is contracted to deliver inpatient dialysis services).
The hours, call, and patient volume will vary wildly no matter where you go in the U.S.
Do your homework to find the right fit for you. There are many programs where working 18 hours is the norm. This works great for some people, because they are interested in call pay and their situation/lifestyle fits with that sort of workload and schedule.
I like the feedback here. As a traveller on myacute assignment, I don't quite get the impression lining with the comments here. There is barely any hours, staff nurses in the dialysis unit seem to feel travelers are taking their used to 'overtime' and when they are not on call, they will still rush to do the patients to be done by the call person. On top of that, error in scheduling leading to a lot of cancellation of shifts. The unit is over staffed. They really don't need travelers as nurses are competing for hours when census is not so good with limited locations to cover. Glad I do belong there, looking forward to be done and leave.
Hi Mark! Can you share your experience working in Davita? What's the the daily work routine, the nurse patient ratio and the number of hours per shift? I am planning to apply with them and I don't have any Dialysis experience. I read with some job openings that they are willing to train. Thank you and hope for your reply! :)
Hey RN017! Where are you located? The daily work routine is as follows:
Arrive at unit and locate the pile of papers that are orders for the day.
See how many nurses are currently working in the unit and how many are doing bedside treatments
Decide whether to work in the unit or bedside based on how many treatments are needed of each and how many nurses are working in those roles.
Physically take the papers with the orders for the patients I plan to treat that day and begin checking labs/filling out paperwork/talking to doctors about possible changes to treatments based on changes in lab values since the orders were written.
Either call a transporter to pick up the first patient or go to the storage room and grab a mobile machine.
Turn on the machine and start rinsing (15 minute wait).
While rinsing, set up machine for treatment and assess patient.
Finish paperwork necessary before treatment.
Begin treatment.
During treatment:
Document vitals every 15 minutes
Educate patient regarding maintenance of their access, dietary modifications, treatment options, etc. Remember, some of these people have never had dialysis before.
Document dressing changes/meds/I&Os etc in the computer
Start looking up labs/orders for next patient
After treatment:
Return blood, flush catheter/hold fistula/graft until hemostatic, bandage appropriately.
Call transport to pick up patient or clean machine and move it to next room.
Rinse and repeat.
Most acute dialysis units will not hire a nurse with no dialysis experience. Ideally they want someone who has worked in chronic dialysis and the ICU. This has become unrealistic in some areas, my own included. We recently hired a couple new grad nurses with ZERO experience, but we were desperate. I transferred from chronic dialysis and was grateful for the background knowledge. I would highly recommend at least 6 months in a chronic unit just to get really good at placing needles and understanding policies and procedures before you are in such an independent place as acute dialysis.
We do 2:1 ratio in the chronic unit. We can do 3:1 if we have a tech. This varies by state and hospital policy. Bedside is 1:1 and is generally ICU or a patient with some type of isolation that they can't come to the unit (think TB or C. diff type of stuff) or if they are generally unstable and we want them close to their nurse. We don't give any meds other than those directly related to dialysis. We don't take any orders for any doctor other than a nephrologist. If a patient needs to go to the bathroom during a treatment and just can't wait, we either give them a urinal/bedpan, or end the treatment early and have their nurse pick them up. A shift can be 5 hours with just one patient or they could beg you to take a 3rd shift and you end up working close to 20 hours. You might think you will only have a 5 hour day, then at the last minute you get orders for a treatment in the ER and you're there another 5. We also have to be on call once a week. The on call person has to be available for times when there is no one available in the hospital to take a stat patient. It could be at ANY tim It pays $50 for a weekday or $75 for a weekend plus your normal pay if you get called in. Just like any part of the nursing world, where you work, who your coworkers are, and who your boss is plays a big role in how happy you will be with your job. I find myself feeling kind of burnt out and generally not very happy with where I am, but the money is good and it really is a good job if that makes sense.
Wow! Thank you for that detailed explanation Mark! I really appreciate it. I recently moved here in CO and applied for Davita. I am already scheduled for a phone interview. If you don't mind, can you also share your experience with the whole interview and hiring process? I am a bit apprehensive since Dialysis nursing is somewhat new to me. I applied for an Staff RN position wherein they are willing to train. I hope you could give me some tips on what kind of questions will they throw you for the phone, panel and facility administrator interview. Thank you again!!!
I recently moved here in CO and applied for Davita. I am already scheduled for a phone interview. If you don't mind, can you also share your experience with the whole interview and hiring process? I am a bit apprehensive since Dialysis nursing is somewhat new to me. I applied for an Staff RN position wherein they are willing to train. I hope you could give me some tips on what kind of questions will they throw you for the phone, panel and facility administrator interview. Thank you again!!!
Guttercat, ASN, RN
1,353 Posts
I highly appreciate the DaVita Acutes program I work for. We have a fantastic team of people that ensure no one has to work extended shifts (beyond 13 or 14 hours) if they don't want to. Call is never scheduled for a night when one is scheduled to be on the next day, and we have terrific management.
Also realize that much of it has to do with patient volume, and the contract specific to any one hospital. That goes for Fresenius as well. No one Acutes program, whether the hospital contracts out or retains sole ownership, can be extrapolated across the board.