Acute vs. Chronic Dialysis

csrn2011 · Aug 22, 2014

I worked in an acute unit full time for 1.5 years and I work PRN in one now. In an acute unit no one will be scheduled to run on Sundays or major holidays but there will be someone on call in case of an emergency. Someone will also be on call every night. In my experience you either work a lot of hours or not many. Very few weeks do you work 40 hours. You do get to learn about peritoneal dialysis and therapeutic plasma exchange which is pretty cool.

peacelilly · Oct 3, 2014

Start as a per diem so you can see how the unit functions. Are they working dawn til done or are they on split shifts? How much call is involved and how is it scheduled? You will learn a lot, but the hours can be challenging

Nechic01 · Mar 13, 2016

Started in chronics, then did home dialysis and now acutes and PRN to some chronic clinics. I will list it for readability.

CHRONICS

Pros- designated breaks and lunches. Ability to use restroom, (not during changeover). No call.

Cons- Since techs can make our breaks your bay/pod you're day may be hell b/c others don't work as hard as you. I hate pt care to be compromised b/c a tech has an attitude or bad work ethic. Don't mess with my patients care. Lol

PD/HOME UNITS

Pros- Build very close relationships with your patients and physicians. Train patients daily or 1-2 weeks so personality is key as well as good teaching ability. Great retirement job

Cons- Cannot ever escape your patients. Same patients for life as long as they chose home dialysis. Hard to take off due to the training schedule of patients. You can't really be sick or be off during the 1-2 weeks of training a patient. You have to follow a strict daily regime so the patient can learn best. Can get boring and can lose some acute nursing skills.

ACUTES-My favorite. Why? I love the autonomy, I work so hard and b/c I get to work alone with my patients their treatment success is based on my ability and knowledge and that's all in my control. I control learning more and working hard. I have seen some lazy nurses in chronics that let their patients tank every shift but not in acutes...you'll rarely ever see that. Every acute dialysis nurse I have come in contact with was the best of the best. Work ethic of those around you is amazing.

Pros-Money is the best, never boring, every hour/day can be different, you do every type of dialysis inpatient (HD, PD, Apheresis, CRRT, SEQ, etc.) Work alone a lot, if your patient is awful-you'll be done with them in about 4 hours no worries. Close relationships with MD's and their NP's. You feel like superwoman sometimes, ICU like, learn so much everyday. Awesome autonomy and is advanced dialysis. The best of the best dialysis nurses are in acutes. No room for a lazy nurse or tech. The docs would find a way to get you out b/c you are one-on-one with their patient. Less personalization than home units. You get to clock it, work your butt off and clock out. Your patient may or may not be there when you return the next day. I see my old patients from all the units I've worked in again as inpatients.

Cons-Call, long unanticipated hours/you don't leave until everyone is dialyzed. Don't make personal plans on working days or if on call. The minute you thought you were about to clock out, the phone rings and the ER just got a patient for you. Sometimes there are a lot of folks to be dialyzed and you don't have enough machines or staff. While chronics may only triple shift, you are there an illegal amount of hours. Pt's are critical and you may have too many. Stand up for yourself with your limits and protect your license. Pt deaths are more. You can't get attached like in home or chronics. It's acutes for a reason. Codes. No known history of patient accesses and most of the time they can't tell you (intubated, etc.) You gotta go with your knowledge. You are alone at 2am on call and can't get an AVF stuck, clots, blown, collapsed, etc. The MD's don't stick and can't help you. They get peeved when they have to drop a line in someone at 2am. Just part of working alone.

A lot of info....apologize if it is a bombardment. Hope it will help

My heart and passion is dialysis.

ladynesh, BSN, RN · Nov 10, 2017

Started in chronics, then did home dialysis and now acutes and PRN to some chronic clinics. I will list it for readability.
CHRONICS
Pros- designated breaks and lunches. Ability to use restroom, (not during changeover). No call.
Cons- Since techs can make our breaks your bay/pod you're day may be hell b/c others don't work as hard as you. I hate pt care to be compromised b/c a tech has an attitude or bad work ethic. Don't mess with my patients care. Lol
PD/HOME UNITS
Pros- Build very close relationships with your patients and physicians. Train patients daily or 1-2 weeks so personality is key as well as good teaching ability. Great retirement job
Cons- Cannot ever escape your patients. Same patients for life as long as they chose home dialysis. Hard to take off due to the training schedule of patients. You can't really be sick or be off during the 1-2 weeks of training a patient. You have to follow a strict daily regime so the patient can learn best. Can get boring and can lose some acute nursing skills.
ACUTES-My favorite. Why? I love the autonomy, I work so hard and b/c I get to work alone with my patients their treatment success is based on my ability and knowledge and that's all in my control. I control learning more and working hard. I have seen some lazy nurses in chronics that let their patients tank every shift but not in acutes...you'll rarely ever see that. Every acute dialysis nurse I have come in contact with was the best of the best. Work ethic of those around you is amazing.
Pros-Money is the best, never boring, every hour/day can be different, you do every type of dialysis inpatient (HD, PD, Apheresis, CRRT, SEQ, etc.) Work alone a lot, if your patient is awful-you'll be done with them in about 4 hours no worries. Close relationships with MD's and their NP's. You feel like superwoman sometimes, ICU like, learn so much everyday. Awesome autonomy and is advanced dialysis. The best of the best dialysis nurses are in acutes. No room for a lazy nurse or tech. The docs would find a way to get you out b/c you are one-on-one with their patient. Less personalization than home units. You get to clock it, work your butt off and clock out. Your patient may or may not be there when you return the next day. I see my old patients from all the units I've worked in again as inpatients.
Cons-Call, long unanticipated hours/you don't leave until everyone is dialyzed. Don't make personal plans on working days or if on call. The minute you thought you were about to clock out, the phone rings and the ER just got a patient for you. Sometimes there are a lot of folks to be dialyzed and you don't have enough machines or staff. While chronics may only triple shift, you are there an illegal amount of hours. Pt's are critical and you may have too many. Stand up for yourself with your limits and protect your license. Pt deaths are more. You can't get attached like in home or chronics. It's acutes for a reason. Codes. No known history of patient accesses and most of the time they can't tell you (intubated, etc.) You gotta go with your knowledge. You are alone at 2am on call and can't get an AVF stuck, clots, blown, collapsed, etc. The MD's don't stick and can't help you. They get peeved when they have to drop a line in someone at 2am. Just part of working alone.
A lot of info....apologize if it is a bombardment. Hope it will help
My heart and passion is dialysis.

I really appreciate your experience. I am still in the STAR program with Davita. I am shadowing nurses in Acutes right now and hopefully will begin RN training in Chronics soon. I am really liking the Acutes tho. I was a med/surg nurse at a Level 1 trauma center specializing in surgical,ortho, trauma pts. So dialysis is new to me.

Twinmom06, ASN, APN · Nov 10, 2017

ACUTES-My favorite. Why? I love the autonomy, I work so hard and b/c I get to work alone with my patients their treatment success is based on my ability and knowledge and that's all in my control. I control learning more and working hard. I have seen some lazy nurses in chronics that let their patients tank every shift but not in acutes...you'll rarely ever see that. Every acute dialysis nurse I have come in contact with was the best of the best. Work ethic of those around you is amazing.
Pros-Money is the best, never boring, every hour/day can be different, you do every type of dialysis inpatient (HD, PD, Apheresis, CRRT, SEQ, etc.) Work alone a lot, if your patient is awful-you'll be done with them in about 4 hours no worries. Close relationships with MD's and their NP's. You feel like superwoman sometimes, ICU like, learn so much everyday. Awesome autonomy and is advanced dialysis. The best of the best dialysis nurses are in acutes. No room for a lazy nurse or tech. The docs would find a way to get you out b/c you are one-on-one with their patient. Less personalization than home units. You get to clock it, work your butt off and clock out. Your patient may or may not be there when you return the next day. I see my old patients from all the units I've worked in again as inpatients.
Cons-Call, long unanticipated hours/you don't leave until everyone is dialyzed. Don't make personal plans on working days or if on call. The minute you thought you were about to clock out, the phone rings and the ER just got a patient for you. Sometimes there are a lot of folks to be dialyzed and you don't have enough machines or staff. While chronics may only triple shift, you are there an illegal amount of hours. Pt's are critical and you may have too many. Stand up for yourself with your limits and protect your license. Pt deaths are more. You can't get attached like in home or chronics. It's acutes for a reason. Codes. No known history of patient accesses and most of the time they can't tell you (intubated, etc.) You gotta go with your knowledge. You are alone at 2am on call and can't get an AVF stuck, clots, blown, collapsed, etc. The MD's don't stick and can't help you. They get peeved when they have to drop a line in someone at 2am. Just part of working alone.
A lot of info....apologize if it is a bombardment. Hope it will help
My heart and passion is dialysis.

What she said about acutes. I've been doing it for 2.5 years and I love it!

StarBrownRN · Nov 11, 2017

I think everyone should experience both, but I find that nurses who are really nurses and into Evidence-Based practice and critical thinking like acutes.