Acutes to Chronic?

[westieluv]

I've seen threads here addressing the question of if someone should switch from chronic to acutes, but I'm wondering just the opposite: has anyone ever switched from acutes to chronic, and if so, was it a good move, and what did you like/dislike about the change?

I have been doing acutes for several months now, and I am finding it to be beyond stressful. First off, I don't yet have the confidence that comes with time, which, I know, just takes time. But the department that I work in is having a huge problem retaining nurses, as in, I am the only nurse out of four hired in the past year who is still there. Our manager is constantly asking us to work over, extra, and everything in between. We work almost every weekend and then still get called on our weekend off. My family is everything to me, and this is extremely difficult. I want to help but I need familiy time, and then I feel guilty because my co-workers have more to do if I don't come in. However, I know that if I do work every weekend along with the often 15 hour days during the week that I will end up getting burned out and quitting, so in the long run, it is better if I say no, but ooohhhh, so stressful!

So I'm wondering if it is less stressful in chronic, not in the sense of having less to do, because I know it is extremely busy from start to finish, but in terms of having regularly scheduled shifts, knowing what time you will be getting home, getting to know your patients very well and being able to send them to the ER if they become acutely ill, not having to work Sundays, etc.

I don't want to give up and quit the company entirely like everyone else has been doing, but this is so hard!

Any advice or suggestions would be much appreciated.

[Chisca, RN]

I have never worked in chronics but from my fellow nurses that have say the techs either make or break you. I don't know if you could interview the techs at the clinic you are considering but you could at least ask what the turnover is. If the clinic is replacing techs every 3 months it might not be the place you want to work. Worst case you could always return to acutes. Maybe stay PRN so at least your foot remains in the door. Acute dialysis sometimes reminds me of the phrase that was used with the convict labor system that existed in the south a hundred years ago. "One dies, get another".

[westieluv]

"One dies, get another"...lol. Yep, that's about how it's been lately in our department.

Thanks for your reply, Chisca, it makes a lot of sense what you say about techs either making you or breaking you. I hadn't thought about that, since I have never worked with an HD tech before. I imagine that any mistakes on the part of the tech come back on the RN somehow, that's definitely something to consider. The clinic where I would apply to transfer to is in the small town where I live and is only open M-W-F. Normally, they rarely post jobs there, but just this week I looked again and they have three tech positions open, which seems like a lot for a small clinic. I wonder if there is a management issue.

Anyway, thanks again for the insight. I am still considering the switch and was thinking of staying in acutes PRN if the chronic position opens up, partly as insurance in case I hate chronic, and partly because the clinic is so small, and I don't know how many hours the nurses get.

[Guttercat, ASN, RN]

Westie,

I am a firm believer that the program makes or breaks it. Inpatient can be the best, or the worst. Same goes for outpatient.

Personally, I get incredibly bored with the cattle-call that can be outpatient dialysis, and I thrive more in autonomous settings. But, that said, some inpatient settings can abuse call and overtime.

Overall, though, I find inpatient "less stressful" and "less boring" because one has more opportunity to problem solve and engage the brain.

[westieluv]

Guttercat, maybe it's my lack of dialysis experience and consequent lack of confidence, but I really think that the autonomy is part of what I don't like. I was told that I would not have to work alone at a facility for at least the first six months, but five months in I find myself on Saturdays (and most other days of the week) alone at a busy hospital with multiple patients to run and the ever present threat of add-ons, which I find stressful to the point where I have chronic IBS symptoms and obsess about work even when I'm not there. Don't even ask about being on call alone and the potential for getting called in and being alone with a patient who is difficult to cannulate, when I have had the opportunity to cannulate all of maybe five easy patients.

I have always worked in an environment where I have other nurses or healthcare personnel to bounce things off of or just share the experience with. I find acute HD nursing very lonely much of the time. The hustle and bustle and multiple employees present at an outpatient clinic seems like it would be much more comfortable for me. Maybe if I was more comfortable and confident in my HD abilities I would enjoy the opportunity to problem solve and engage my brain, but right now, working on auto pilot surrounded by experienced dialysis personnel sounds pretty good!

[Guttercat, ASN, RN]

Guttercat, maybe it's my lack of dialysis experience and consequent lack of confidence, but I really think that the autonomy is part of what I don't like. I was told that I would not have to work alone at a facility for at least the first six months, but five months in I find myself on Saturdays (and most other days of the week) alone at a busy hospital with multiple patients to run and the ever present threat of add-ons, which I find stressful to the point where I have chronic IBS symptoms and obsess about work even when I'm not there. Don't even ask about being on call alone and the potential for getting called in and being alone with a patient who is difficult to cannulate, when I have had the opportunity to cannulate all of maybe five easy patients.

I have always worked in an environment where I have other nurses or healthcare personnel to bounce things off of or just share the experience with. I find acute HD nursing very lonely much of the time. The hustle and bustle and multiple employees present at an outpatient clinic seems like it would be much more comfortable for me. Maybe if I was more comfortable and confident in my HD abilities I would enjoy the opportunity to problem solve and engage my brain, but right now, working on auto pilot surrounded by experienced dialysis personnel sounds pretty good!

I abhored acutes when I was new to it for similar reasons. However, once I acclimated and became very comfortable with my skills, I wouldn't trade it for inpatients. I loved it...except for call and "add-ons. Never did grow to love that aspect. :)

Maybe do outpatient for a while to gain confidence and then return to inpatient? However, remember that in inpatients, the techs do much of the hands on...so you won't develop some handy skills for inpatients as quickly.

Best wishes, it sounds like your call and schedule is not pleasant. Every Saturday and working "most days of the week?" Plus call days? That'd be enough to make anyone cut and run.

A well-run and well-staffed acute program is an absolute joy. Sorry you're going through this.

[ausrnurse]

I've done both and honestly, I found acutes to be really busy and stressful, and chronics to be really busy and boring (ie., not stimulating). I think the patients in chronic can be more abusive and demanding as well, since they are so hospitalised, but then again, there's also the reward of getting to know the lovely patients, and who end up thinking you are just wonderful - and make you look forward to the days they are on.