Acutes vs. Outpatient

ageless · Feb 25, 2003

I don't know if "better" is an answer one can give because it would depend on the nurse's expectations. They are very different yet similar. Is there something more specific you would like to know?

gambroRN · Feb 26, 2003

Yes - sorry I should have been more specific - what I'm looking for is the pros and cons of each.

TELEpathicRN · Feb 26, 2003

chronics-same pts day in a day out, a few suprises every now and then, possibly a set work schedule, only working your assigned hrs, begging PCT's to do what they are supposed to do and being accountable for their actions.

acutes-never know who is going to roll through the doors anytime of the day or night, unpredictable pt scheduling, unpredictable work hrs, being on call, possibly having to work Sunday and most all holidays, all RN staff (most acute programs), only being accountable for your actions, starting pts on their first HD tx and getting them ready for dc to chronic unit, only dialyzing someone one time and thats all it takes get them out of trouble! Being called in at all hrs of the night for someone in ARF, or a chronic pt that has over done it with fluid or K+. Titrating drips in the ICU, having the pts code while on HD in the ICU or actually initiating HD on a pt that they are coding and then the pt has a heartbeat and spontaneous resps a few minutes later..pretty cool!!

Call me crazy, but I LOVE acutes!!!

babs_rn · May 2, 2003

I like my chronics. I like to be able to develop an ongoing relationship with my patients, who are amazingly loyal to "their" nurse. I know everything that goes on with them, have a hand in helping make their quality of life better and I get to see them again to see how things are going. I know who's a "tough stick" and I know the best areas to "stick" and I am responsible for seeing them through other things as well. I make the referrals to the SW and I assist her in helping to meet my patients' needs, trying to find ways to make sure they don't fall through the cracks in the system. I love my patients.

Hellllllo Nurse, BSN, RN · May 4, 2003

Originally posted by TELEpathicRN
chronics-same pts day in a day out, a few suprises every now and then, possibly a set work schedule, only working your assigned hrs, begging PCT's to do what they are supposed to do and being accountable for their actions.

My chronic unit is different. Lots of out pts are really too ill to be there, lots of complications and problems all the time.

The first week that I was orienting on the floor, there were three codes.

Had a pt go into PVCs while dialyzing last week, had another confused pt pull out his central line, twice. (Not on my shift, thank goodness). This pt is very ill, unstable and confused. He is brought in on a stretcher by paramedics to dialyze three times a week.

We had a pt have a severe panic attack while dialyzing last week, too. He had been sedated before tx, but jumped out of his chair w/ bloodlines attached, BFR at 400, started screaming, etc.

Frequent problems with clotted caths, LifeSites malfunctioning, etc.

I often have to stay late, have shifts cancelled and am called to work on my off days.

Pts are often no-shows, then come in when they are not scheduled, demanding to dialyze and we accomodate them. It really screws up scheduling.

We have a lot of pts who are non-compliant, substance abusers, homeless, etc.

We work all holidays except for Christmas Day. Pt's start coming in at 3am on Christsmas Eve to accomidate this. Our unit is closed on Sundays.

The part about begging PCTs to do their jobs and being accountable for them does apply at my unit.

Hellllllo Nurse, BSN, RN · May 4, 2003

Also, forgot to add- the second shift of our three daily pt shifts has chairs reserved for transient, one time only dialysis pts, and we get new and different ones nearly every day.

We do not hang blood on out unit. We do have HIV+, HBV+ and Hep C+ pts that we dialyze routinely.

babs_rn · May 5, 2003

If you can find a clinic with a MWF schedule (smaller towns, usually) you have greater continuity of care and a closer relationship with your patients. Not to mention every weekend off!

TELEpathicRN · May 6, 2003

Helllllo Nurse, I agree with you--a large majority of chronic dialysis pts come in unstable and sick as sh*t!! When I worked chronics, we have a man with no legs brought by ambulance Q M-W-F, he was always incont. of stool, and we had to clean him up!! Just had to catch it before he started playing with his BM and smearing it everywhere!!! Boy, you should have heard the other pts fuss about the smell!!! HA HA!! We had a code this evening in acutes and it is just mentally and physically draining!!! Pt had K+ of 6.5, brought to acute unit, NSR until 50 min before end of tx, ot went into V-tach from NSR, lost pulse, I had to shock him twice and do chest compressions. Thank god we got NSR after 10 mins of ACLS. Hope he will make it, but was real acidodic and drug abuser,fluid overloaded, etc....

gambroRN · May 6, 2003

So................I guess there is no "better" place to work - chronics or acutes - it's just depends on how well you can "go with the flow"?????I am currently working acutes - and we have our share of problems, believe me, esp on call when you are called in at 2am for a renal pt that is having an asthma attack! What is it about dialysis that keeps us here.? Are we crazy?

TELEpathicRN · May 7, 2003

I guess we have dialysis dementia and are crazy to stay in such a chaotic environment!!! Acutes are unpredictable to say the least.