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Any CM's doubling as floor RN?

by foxyroxyrn foxyroxyrn (New) New

I work in a small clinic with 12 chairs, MWF 2 or 3 shifts depending on census. Averaging 24-26 pts. We have 3 techs, myself and the CM. It was my understanding that when the CM left we would hire an RN and I would possibly train to be the CM. Have only been in dialysis for aprox 2 years. Well now the CM is stepping down and I have been offered the CM job only I will be BOTH the floor RN and CM! Is this even possible? Have been told that the census is too low to have both. The CM fills in for the techs frequently plus I have so many other concerns, I'm baffled they would think this is possible. I would love to hear some feedback from any other small rural clinics out there to see what the trend is. Needless to say I'm really not sure now if I can do this?


The line of what is possible is continually being pushed in dialysis.

This does not surprise me. For-profit monopolization of the dialysis industry and the market (including declining reimbursements) means the frontline workers will be pushed to just at or just beyond maximum output. All day, every day.

While I think it is necessary for CM's to be an active presence on the floor, I would be very hesitant to accept this position.

You have a small unit, so it might be quite possible, but look at your end goal in the dialysis profession. Your goal is to do right by the company and your patients, right? What is the plan to accommodate future growth of your unit? Does the company have a definitive plan in place to provide you with support if and when the unit grows, or will you be left flapping in the wind unless and until they decide you can hire additional nurses/techs? There are many questions.

Taking on a CM position is a very big deal. Go forth with caution.

I agree with Gutter cat. To often staffing decisions are decided by numbers on a spreadsheet, not the reality of patient care unique to the unit.

Having managed a 'remote, rural' unit, I can identify with your concerns. I had staff RN. As the only RN, how do you manage your time regarding direct pt care, pt education and documentation, etc. and the CM duties.

How will you handle all of the unforeseen issues - staff sick day, holiday time, your personal time, etc.

Even with a plan for growth in census, you know your area, how easy will it be to hire and get that person up to speed? Is an LVN an option?

What is your relationship like with your regional manager? How/when will you have care plan and CQI meetings? The questions are many. . .

Here's a basic question.... do you feel that in your current role as direct care nurse that you have adequate time to provide the care that you desire to give your patients 90% of the time?

Like Guttercat, I have concerns about assuming so much responsibility.

Good luck and let us know what you decide.


Specializes in Nephrology. Has 6 years experience.

You learn a lot as a CM, but the situation you describe could end up being brutal. I would also recommended having a good out (another job that's a lock). There are many factors that you could consider in the instance, but the big one is "why do I want to do this"? In most cases I believe the only reason to become a CM is to get into management. It is a stepping stone and learning journey not a destination.