Apheresis exp. required for Inpatient Dialysis RN?

Guttercat, ASN, RN · Aug 30, 2016

DaVita is an excellent organization.

I understand the frustration with the modern, outpatient dialysis workflow. It can be a source of great frustration for those that enjoy a more abstract work environment.

As far as apheresis goes, it might be more difficult to land a position in an Acutes program that utilizes apheresis if you have zero Acutes experience to begin with. It takes a special breed of nut to do Acutes...and actually like it despite its downsides.

I've seen more than a few outpatient nurses hired into Acutes who discovered that they hated it, and then left within a year. You might be better off pursuing an Acute position that does not require Apheresis, and proving yourself in the basics first. You are still young in the nursing field, and still finding your way to what works best for you and where you can best be an asset to your patients, to yourself and to your employer. Finding that sweet-spot is tough.

P.S. PACU often has worse call requirements than Acute dialysis. Something to keep in mind.

CCK RN · Aug 30, 2016

DaVita is an excellent organization.
I understand the frustration with the modern, outpatient dialysis workflow. It can be a source of great frustration for those that enjoy a more abstract work environment.

I thank you for your constructive reply; unfortunately, you and I have a difference of opinion with this statement. I've been with this company for a cumulative 7 years, most of that time spent as a tech; the crappy pay/benefits, lousy hours, ridiculous micro-management by a non-nurse supervisor, over-regulation of nursing activities, and lack of sufficient RN training when the time came has all just turned me off to the outpatient environment entirely. Most days, I feel like I'm treated (still) as a Tech, by both my manager and the other staff; just with a lot more to lose now. I do not feel like a nurse; I do not feel productive; I am not supported in my role (I can't even tell you how many times I was scheduled alone/in-Charge before I made the 12-month mark, which is entirely unfair to me and not safe for the patients). I realize that not every ICHD unit is the same; unfortunately, this has been my experience and there's never any way of knowing if a different unit is better, the same, or worse. This is not why I busted my behind through nursing school!

Now, I realize also that I started out complaining mainly about the atmosphere itself as being my biggest gripe, but that's not the entire truth; I loved the work-environment as a Tech, most days. I never "minded" the crazy turn-overs and could usually find someway to make the best of the chaos, provide great patient care, help my co-workers as needed, and get through the day. It frustrates me that now, as an RN, I am stuck doing the Tech work on top of the nurse work; not only do the Techs I'm regularly scheduled with not do their own work most of the time (they're big on sitting around the nurse's station on the computers), but they cannot do my work, of course. I was never that kind of Tech. I don't mind hard work or long hours, and I enjoy being challenged as a nurse, but not at the expense of my patient's well-being or my own mental stability! Another reason that I want out is the hours of operation at my particular unit are no longer conducive with my home life; I had a baby in December, and finding adequate child-care has been almost impossible. I cannot open the unit at 0430 or close at 1100 any longer (my husband works a second-third shift, and no daycare is open at those times). So, when I was presented with an opportunity to apply for a PACU position at an amb. surgicenter with regular hours, I jumped on it. Of course, now that I wasn't offered the position (clearly because I have no exp., I understand that), I am just trying to figure out where to go from here. I would love to end up in a position where I can utilize more of my nursing knowledge, and maybe even some of these ACLS skills I recently acquired; I want to feel like an actual nurse, finally. (Just to say, I do realize "regular" hours in nursing is an arbitrary notion; I get that Acutes hours are also long and unpredictable, as many programs have on-call requirements. But, I would be willing to try it; I need a change, and am not afraid to make certain trade-offs with shift hours if it comes to it).

As for the Acute dialysis position, the one I tried applying to that mentioned the Apheresis exp. is at one of the few hospitals in my area whose Acutes program is not owned by my company; again, I jumped on the opportunity, only to be rejected immediately. So I was looking for someone to be able to tell me, if Apheresis is something that most Acutes programs do daily; if the Acute RNs are performing the therapy themselves, or if there are separate Apheresis RNs on staff (I guess this might depend on the HCO, because after some googling, I do see that Apheresis and Acute dialysis RNs may or may not be the same individual). Most, if not all, of the other local hospitals' Acute programs are owned by the company I work for, or require a BSN (which I am working on). My mom did Acutes for almost 40 years, so just by growing up the child of an in-patient dialysis RN, I know at least somewhat about the work she did and the hours; also, I personally know a few nurses who left the company I'm with for hospital Acutes and love it (they have way less HD experience than I do, but more time in the "nurse" role, so I can't help but feel frustrated by that as well).

I can't help but worry that my decision to stay with this company for my first nursing job may have hurt my chances of getting hired anywhere else. Even med-surg positions want 1+ years of exp. If I can't even be considered for an interview for an Acute position outside of this company, how am I supposed to feel? Does my decade+ of HD experience help me or hurt me? Have I doomed myself to outpatient dialysis nursing or nothing-at-all?? I'm interested in the possibility of learning Apheresis, but don't see how that's possible if I can't get hired into a program that does it. This is why I've been feeling so beat up and hopeless lately; starting to really think that my AS/Nursing Diploma was a big, expensive mistake. I know I'm complaining a lot, and for that I apologize, but I need to vent this off a bit to folks who understand... so, again, thank you for reading.

Chisca, RN · Aug 31, 2016

Can you find out the name of the supervisor of the acute unit and schedule an interview? My boss would hire you in a second as she is trying to crosstrain the hemo nurses to the apheresis unit that has been merged with our department. Emphasize the fact that you already are well experienced in extracorpreal blood based therapy. Human resources didn't put that requirement there, the nurse manager did. What boss wouldn't want someone who required little orientation? From what I've seen apheresis therapy is not a hard transition for someone with hemodialysis experience. You just need a chance to sell yourself.

nutella, MSN, RN · Aug 31, 2016

I wanted to add my 2 cents...

I think working as a RN as opposed to a tech you realize the crappy deal that nurses get in chronics. Generally speaking, I think that techs have the better deal in that setting.

I worked in acutes (not anymore) and I can tell you that if an employer asks for apheresis experience it is likely that the acute nurse also runs apheresis tx that could include a variety or procedures for example stem cell collections, therapeutic apheresis, perhaps red blood cell exchanges and so on. Most likely they want somebody with experience for those positions and a lot of acute dialysis positions will prefer a nurse with critical care experience for acute dialysis/apheresis.

Your BSN will make you much more marketable and I think that if you are half-way done it might be better to stay with your job, perhaps reduce hours if you have to and finish your BSN first. After that, you need to look for positions that offer training in acutes. A lot of hospitals have outsources acutes to F or D but some of them still run their own dialysis dept. With acutes you have the problem of unpredictable hours and potentially long days with frequent on call (which was the reason I left acutes). Acutes can be a spring board to get into other jobs like intensive care. I know several acute dialysis nurses who applied to ICU position after working in a hospital for a while and got hired for the ICU because they were known to the staff, got along well, and seemed very capable of handling ICU including CVVHD.

PACU is not easy to get into and also usually requires some acute care experience.

If you are mobile you might want to consider applying where they have a greater need so you can land a first job.

CCK RN · Aug 31, 2016

Chisca, I had that thought myself after the initial app got bounced back to me; I reached out to a friend who works at the hospital (not a nurse), who I know is familiar with at least some of the doctors in the Acute unit, but not the supervisor directly.. I might try asking her if she could at least get me a name, and from there do what you said. If my friend can't help me then I'll need to get creative and figure it out another way.

Thank you for your helpful reply, you've reflected all my sentiments about this matter exactly; I feel that if I could just speak with the manager directly and have the chance to "sell myself", or at the least get my resume through to a person who will actually look at it with human eyes, then perhaps I'll have a better chance of reaching the outcome I desire; the fact that it's more than likely a HR computer auto-rejecting my app is incredibly frustrating. You've given me at the least a flicker of encouragement, and I do appreciate it!

CCK RN · Aug 31, 2016

nutella, I appreciate your perspective, and agree that working as a HD Tech for so long prior to becoming a Chronic RN has contributed to my disdain of my current work circumstance. As a Tech I enjoyed, and prided myself, on supporting my Nurse "teammate" in any way I possibly could; now, as the Nurse, the Techs do nothing beyond what is required of them. (And yes, I have tried several times speaking constructively with them about this, only to be dismissed without consideration. To them, I am still a Tech too, just with a different color PPE..)

I hear what you're saying about the BSN, and agree that is it my highest priority now to finish it ASAP; if that means I have to stay where I'm working until I get it, then that's what I'll do, as long as I can bear it. But I can't shake this feeling, that I know if there is even the chance I'd be a little happier somewhere else, then I need to keep applying for positions elsewhere. I also have heard of nurses following the track of Acutes to ICU/CCU, and if I could get to that point eventually, then I'd feel like I actually succeeded somewhere; I will never succeed as a nurse if I stay where I am. I think the sooner I can distance myself, the better... hence this Acutes position I'm extremely interested in.

I'm hoping that by following Chisca's advice, I will actually be able to communicate with the nurse manager directly; if that happens and I'm still told that I'm not qualified, then so be it. But if I can sell myself right, then maybe I'll have a chance. I know that I could learn Apheresis, as I've always done pretty well with training for new skills in the past; I feel like I will enjoy the acute atmosphere (I loved working at the hospital-based unit I started out in as a Tech, I loved helping the nurses push their machines up to the patient's room or down to the ER as needed, I've missed it ever since it ended!), I'll appreciate the autonomy and working closely with ICU nurses and doctors. I guess I'd never encountered an Acutes program that also had Apheresis before, which is why I was unsure if most programs required this experience for hire. I am willing to follow this through and see what happens. Again, I appreciate your 2-cents, thank you for chiming in.

nutella, MSN, RN · Sep 2, 2016

nutella, I appreciate your perspective, and agree that working as a HD Tech for so long prior to becoming a Chronic RN has contributed to my disdain of my current work circumstance. As a Tech I enjoyed, and prided myself, on supporting my Nurse "teammate" in any way I possibly could; now, as the Nurse, the Techs do nothing beyond what is required of them. (And yes, I have tried several times speaking constructively with them about this, only to be dismissed without consideration. To them, I am still a Tech too, just with a different color PPE..)
I hear what you're saying about the BSN, and agree that is it my highest priority now to finish it ASAP; if that means I have to stay where I'm working until I get it, then that's what I'll do, as long as I can bear it. But I can't shake this feeling, that I know if there is even the chance I'd be a little happier somewhere else, then I need to keep applying for positions elsewhere. I also have heard of nurses following the track of Acutes to ICU/CCU, and if I could get to that point eventually, then I'd feel like I actually succeeded somewhere; I will never succeed as a nurse if I stay where I am. I think the sooner I can distance myself, the better... hence this Acutes position I'm extremely interested in.
I'm hoping that by following Chisca's advice, I will actually be able to communicate with the nurse manager directly; if that happens and I'm still told that I'm not qualified, then so be it. But if I can sell myself right, then maybe I'll have a chance. I know that I could learn Apheresis, as I've always done pretty well with training for new skills in the past; I feel like I will enjoy the acute atmosphere (I loved working at the hospital-based unit I started out in as a Tech, I loved helping the nurses push their machines up to the patient's room or down to the ER as needed, I've missed it ever since it ended!), I'll appreciate the autonomy and working closely with ICU nurses and doctors. I guess I'd never encountered an Acutes program that also had Apheresis before, which is why I was unsure if most programs required this experience for hire. I am willing to follow this through and see what happens. Again, I appreciate your 2-cents, thank you for chiming in.

Another option - if you want to get out of there but no option of apheresis or such - might be to ask for a transfer to a different clinic.

You are probably right that the techs will continue to see you as tech and perhaps there is a touch of jealous - because you advanced your knowledge and got licensed....

So - perhaps the easiest step which would also mean you keep your benefits and so on would be to transfer to a clinic where you have not worked as a tech? I am not sure how many clinics there are in your area but it might be an idea to look into it. Or different modality like home dialysis/ PD ?

I am sure that you would be able to learn apheresis given that you have worked in dialysis but if your area has moved on to hire mostly BSN nurses they may favor them over you - even though you may be the better candidate to train. Also have somebody look at your resume to make sure that there is nothing in there that looks "bad" like grammar, writing and so on. I could also be a good idea to look at your social media like FB and make sure that there is nothing on there that would work against you.

It can also help to network more through a professional organization.

CCK RN · Sep 4, 2016

I appreciate your advice about considering a transfer, nutella ... unfortunately, I have entertained this idea with my Administrator in the past, several times, only to be met with an unwavering "no". He won't "allow" me to transfer, because he claims we are short-staffed (which we are, but that's partly because he cut my hours drastically after I returned from maternity leave in May, meanwhile he hired 2 inexperienced RNs for full-time; they are still training, I actually precepted them both today... talk about rubbing my nose in it). So basically, I am stuck working unsteady hours without the hope of transferring, for an Admin that I strongly dislike, for a laundry list of reasons I won't bore you with (I believe their might be some discrimination going on, but that's a different topic entirely...)

I still have not been able to find out the name of the nurse manager of the Acute unit at the hospital I am interested in; in the meantime, on Thursday I sent an email stating my interest in the position with a cover letter and my resume attached to the nurse recruiter, whose email was on the HR website. I have not heard anything back yet, but will keep trying until I get a response.

I think my resume is pretty solid, it appears a bit heavy on the 'tasks' of my work history (plus I never received any awards in school, but my GPA was decent enough); I can't afford to have a professional look at it or revise it, but several peers have complimented me on it so I've been sending it out to any and all postings I feel are appropriate. My FB is safe also, no damning pictures or anything like that, and I'm always very careful in what I allow myself to be tagged in. Still, good advice, I do appreciate it! And thank you for the encouragement, I really do feel that I would be a great candidate to be trained in Apheresis, however as you said I'm at the mercy of the HCO to give me a chance without a BSN. I suppose all I can do is keep up what I've been doing, hammering away at my remaining credits and staying active in the job search.

I'm currently not a member of any professional nursing organizations; I know my state has one, but they charge a yearly subscription. Is it really worth it for the networking possibilities? I do think I could stand to look into this, I have fallen out of touch with many of my classmates (having a baby, can't go out for dinners/drinks, you know :\) and don't communicate regularly with nurses outside of my current place of employment. My professional references are solid, but distanced from me in terms of location and career advancement (several of my past supervisors will speak well for me, but are practically ready to retire), so it would be great to do some networking... thanks again!

westieluv · Sep 5, 2016

OP, have you considered seeking employment as a apheresis nurse minus the dialysis? I mean, find a job just doing apheresis, get trained, work there for a period of time, and then try again to get into the acute dialysis program that you want to be in? I realize that this would mean changing employers again in a year or two, but then you would have the entire package that they are looking for and they should snap you right up.

On the other hand, you may find that you really enjoy the apheresis position and want to stay there. Honestly, it doesn't look like a bad gig, I remember the apheresis nurse from our local Red Cross coming in and running patients when I was working inpatient med/surg and she loved her job. She wasn't dealing with chronic renal patients and all of their "idiosyncrasies" (to put it diplomatically) most of the time and she highly recommended her job to all of us burned out med/surg nurses.

I'm not saying that just because that nurse liked it you would too, just maybe something to think about since you seem stuck between a rock and a hard place right now. I don't think you would have any trouble getting hired because of your recent dialysis experience, and they would certainly train you as most nurses don't have apheresis experience coming into it. As I said, the Red Cross hires nurses for this type of work, I'm not sure who else but you could just go to a site like Indeed.com and do a search for apheresis positions in your area.

BTW, for what it's worth, I agree with you about D*****. I won't go into detail, but I will never work for them or F******** again. $$$$ over patients, just like so many other organizations these days.

nutella, MSN, RN · Sep 6, 2016

OP - if your administrator "refuses" to support a transfer because he is short staffed you may have another option as well. If you work for D and they have open acutes position in your area/hospitals/acute rehab you would apply through the portal and you can also touch base with your FA's boss. It is not reasonable to try to hold people for an extended period of time because they are working the unit into the ground and staff runs away.

So - be smart about it. Make sure you have good reviews since you started there. If you are training new nurses it means that you are capable, have knowledge, and obviously trustworthy. If that FA is good friends with the acute's program manager, he may even discourage that person from interviewing or hiring you because he is selfish.

If you have seriously discussed it with him and he gave you that answer perhaps you should write an nice email to your manager and cc his boss the group facilitator and write about your situation. Not in a complaining way but more like "I am very grateful for all the opportunities I had so far with D... and I have made huge personal and professional progress. To further my career, I would like to work in acute dialysis and apheresis. " and then write nicely about you had a discussion with your FA and that it seems that there is no option for you to advance your career, which you find very sad as the company's core values also include continues improvement (you want to improve and broaden your scope and advance your career) and fulfillment.

If you do not want to rock the boat you can also call the acutes program directly, talk to the clinical manager or clinical coordinator - whatever applies and say something like "Hi. my name is xxx , I am a teammate in the chronic unit and very interested in getting to know more about the acute program and if it includes other modalities like apheresis, stem cell collection, and blood exchange or similar. If they are talkative ask if you could drop by to look at it in person as you would like to apply if a position open. You might be able to go there, introduce yourself and look around a bit. If you make a good impression and you connect that could help you big time - you can point out that you have a cert for ACLS and why you think you would be great in acutes.

CCK RN · Sep 7, 2016

OP, have you considered seeking employment as a apheresis nurse minus the dialysis? I mean, find a job just doing apheresis, get trained, work there for a period of time, and then try again to get into the acute dialysis program that you want to be in? I realize that this would mean changing employers again in a year or two, but then you would have the entire package that they are looking for and they should snap you right up.

I have considered this as an option; unfortunately, at this time I haven't seen any Apheresis positions posted in my area, but as you suggested, I added it as a saved search on Indeed (I check that site almost daily anyway) and hope to see something open up! I realize that working for an employer like Red Cross would almost certainly require some degree of travel, which I am not against, however right now it doesn't look like there is anything even remotely local. I will keep looking ... I really do think that I would enjoy Apheresis, either on its own or in conjunction with HD, if I could only secure a position that's willing to train me and let me prove that I can do it!

BTW, for what it's worth, I agree with you about D*****. I won't go into detail, but I will never work for them or F******** again. $$$$ over patients, just like so many other organizations these days.

Thank you for this. At the least, just knowing that I am not the only one who feels this way about these two 'Corporate Healthcare' giants is encouraging, and reassuring for me that I'm doing the right thing by taking steps to get away from it once and for all and move forward as a nurse.