Chronic/Acute?

NephroBSN, BSN, RN · Mar 3, 2006

I am not familiar with Dialysis. When a dialysis nurse says he/she is an acute dialysis nurse or chronic dialysis nurse, what are they saying? Different specialties? Different areas? Different kinds of patients? How are the day-to-day job duties different? examples?
Just trying to learn more about this interesting area of nursing. Any info you can give me is appreciated.
--Robert

Acute hemodialysis nurse= hospitalized patient with End Stage Renal Disease. Sometimes really a chronic patient, maybe in with pneumonia, total hip/knee repair, fistula placement gone awry and now inpatient. Or in ICU with MI, S/P major surgery and in Acute Renal Failure. Drug over dose.

Acute dialysis patients can truely be ACUTE or they can be less so. Sometimes they are dialyzed in their rooms but if they are in ICU they are dialyzed there. They dialysis nurse is responsible for dialysis only just as the US tech is only responsible for the ultrasound. Acute dialysis nurses are on call usually for cases in the middle of the night and weekends. Although some companies might rotate all their nurses into the acute program, even their chronic nurses.

Chronic hemodialysis nurse. Works is a chronic outpatient unit. Some hospitals have chronic units too. These patient's live in the community or in Nursing homes, etc. They are stable by and large. Some of them still work. They dialyze three times a week. Mon Wed Fri or Tues Thurs Sat.. Once in awhile they might only come two days a week.. They are usually dialyzed for 3-4 hours each treatment.

Some units also have a nocturnal program .The patients still dialyze three times a week except they do it over night for 8 hours.

An acute nurse is usually alone and must make her judgements independently. She has orders of course but an expert acute nurse knows what to do in cases that might go bad. Nephrologists many times don't really understand the process of dialysis. The acute nurse might only dialyze two patients at a time. She needs to be able to know the looks of a bad rhythm on the monitor . Some have to be ACLS certified . But the ICU nurse is still responsible for her patient. The acute nurse is just performing a treatment. Now that's not to say that the acute nurse wouldn't alert the ICU nurse if her patient was going bad.. But we can run NS in at 300-400 cc per minute. That usually brings someone back quickly.

A chronic hemodialysis nurse takes care of up to 10-15 patient in a free standing clinic with patient care techs who are trained to initiate, monitor and terminate dialysis. The chronic nurse usually has a group of patients that she "manages" on a day to day basis. Although she usually gets to know all of the patients in the unit as the chronic nurses rotate sections of the unit. Most units are in the 20-30 station range although some can be much bigger and some can be as small as 11. Usually there are 2 or 3 "shifts' of patients each day.. Chronic nurses work anywhere form 8-10-12-16 hour days. Acute nurses can work long days too if an emergency patient pops up. Acute nurses dialyze until they are finished for the day.

Chronic nurses manage weights, fluid removal, meds given in dialysis by lab values. Alert the MD if major changes need to be made. They monitor assess maturity, assess placements etc..They also remind patients of dietary/fluid restrictions, we can be social workers too sometimes.

The ESRD population has grown by about 9% every year in the recent past and shows no signs of letting up..Diabetes, hypertension, heredity, auto immune disease, drug abuse etc are some of the leading causes of ESRD. As you can see those afflictions are rampant in the USA. If you go into dialysis you'll never lack for a job. It really takes about a year to feel like you understand it all. Therefore dialysis nurses are a premium.

Find a dialysis unit near you and ask to shadow a dialysis nurse you might just fall in love. As I did back in 1986....

Mantibob · Mar 4, 2006

NephroBSN

Wow! What a great reply to my question. I have a much better understanding now. Thank you.

You probably guessed why I was asking. I work on Tele and the Dialysis RN just out of no where said - "Have you thought of being a Dialysis Nurse?" "You are very compassionate with your patients and they like you - these are qualities that make a great Dalysis Nurse". Of course I was flattered, but it got me to asking the nurse a little about the job - next thing I knew she was taking my name down and giving me her boss's phone number to call for an interview. I really do not know what to expect or even if I should interview, I just graduated and have only been on the floor seven months.

Any advice? And thanks again for your great response to my questions.

--Robert

NephroBSN, BSN, RN · Mar 4, 2006

NephroBSN
Wow! What a great reply to my question. I have a much better understanding now. Thank you.
You probably guessed why I was asking. I work on Tele and the Dialysis RN just out of no where said - "Have you thought of being a Dialysis Nurse?" "You are very compassionate with your patients and they like you - these are qualities that make a great Dalysis Nurse". Of course I was flattered, but it got me to asking the nurse a little about the job - next thing I knew she was taking my name down and giving me her boss's phone number to call for an interview. I really do not know what to expect or even if I should interview, I just graduated and have only been on the floor seven months.
Any advice? And thanks again for your great response to my questions.
--Robert

Here's my advise... Go for it.. Again ask if you can shadow someone for a day. At your own expense, of course, but it might be money well spent.

IMHO Become a chronic nurse first. Do it for at least a year before/if you decide to be an acute nurse. Remember sometimes as an acute nurse you'll be all alone at 0200. Yes, you have resources but wouldn't it be wonderful to know what to do all by yourself..hehehehe.

Dialysis takes awhile to "click" for most nurses. Stringing the machines can be a bugger but once you've got it you wonder how come it took you too long.

I didn't know you are a guy. I believe this field is great for male nurses. It is techinical, machines, IV sticks, troubleshooting machines and assesses to keep a guy happy. You know, they say guys are fixers.. Please don't be offended by my comments. I like working with guys, I think they make great dialysis nurses.

If your goal is more automony as a nurse you'll find it in dialysis. You really can be a close knit team. MD, nurse, techs, SW, dietician. Also, if I were younger I'd be an NP in this field. No on call, work M-F. Have a fairly stable group of patient you can follow and manage. A group that does get better with time. Of course they don't live forever.

As an aside I worked oncology. I got so tired of taking care of patients for years and watching them slowly go downhill and die on me.. Sorry to put it that way.. Seems all my good care and caring was for not. Now dialysis patients die too but not usually in the outpatient setting.

Good luck. Do apply you've got nothing to lose. Give it the old college try. But don't be discouraged. Give yourself a chance to learn dialysis. It takes time but as with all good things that take time it's worth the time you invest in it.

krups · Mar 4, 2006

I just discovered this great forum. I have been in dialysis almost 7 yrs. I started as a new grad. My only regret is not having some hospital experience even if it would have only been 6 months. Since dialysis is all I know as an RN I can tell you some days I love it, and some days I don't. However, this would be the case with any field of nursing I am sure. My setting is chronic outpatient. The clinic runs M-W-F two shifts. It does take at least a yr to really feel comfortable at the job. Once you learn the machines you could put pts on and take off in your sleep. It all looks crazy and difficult in the beginning, but the repetition makes it easy to learn. Patience and compassion are traits that will serve you well in dialysis. All clinics are not created equal, and having a good group of RN's & PCT's that get along really makes a huge difference. Through the yrs I have worked with the good & bad. Right now it is mostly good, so hopefully it will stay this way for a long time. If the field interests you at all then I advise you to look into it because there are many opportunities for the future and your nursing career.

Robert, I was hired at about the same age as you. I hope to retire as a dialysis nurse. Hope this helps a little. If you have specific questions then this looks like the place to ask them.

Mantibob · Mar 6, 2006

Krup,

Thanks for the info and advice. I WILL be looking into dialysis.

Mantibob · Mar 6, 2006

NephroBSN,

Great advice! Thanks again.