Davita Acute Nurse Interview

[five10fevr, ASN, RN]

I currently have an interview next week for an acute dialysis RN. I have never worked as a dialysis RN, but I have a few years of dialysis tech under my belt at a non-davita clinic. I currently work on a busy Med/Surg floor. What are everyone's thought going straight for acute's instead of starting in a chronic unit first? Does anyone know how acute nurses get paid? Is it hourly or is by case? I hear acute nurses are paid both ways. What is the starting rate in California?

I want to thank everyone for their input.

[madwife2002, BSN, RN]

Acutes is really different than Chronics. I believe in Davita you get paid hourly but sometimes things that happen in California can be different. You can ask your recruiter all these questions before the interview-just call him or her on Monday

[five10fevr, ASN, RN]

Thank you for the response. Do you think a non-dialysis RN will be okay starting in Acute's vs. Chronic's? I know everyone is different just wanting your opinion.

[madwife2002, BSN, RN]

Yes I think it is good to start in acutes

[Guttercat, ASN, RN]

Depends on the Acute program. If it is a large program, and you are working with more than one nurse, then you should be OK given you at least have some dialysis background.

If you are to be working solo, I'd say you should give it some serious thought before diving into Acutes head first. As the dialysis RN, you are the go-to person. Multiple departments expect and depend on you to be on your game, know what's going on, be highly skilled in problem solving for unique dialysis patient needs in an acute setting, and be highly organized and self-directed.

[five10fevr, ASN, RN]

Thank you for the input. Once I interview this week and figure out how their Acute program works. I can/will decide, if I am offered the job.

Anyone with additional feedback, it is greatly appreciated.

[schnookimz]

I started out in acutes and I'm fine. You will learn so so much. And even though you may be alone in the hospital, someone else is only a phone call away if you run into trouble.

[KidneyNurse2014]

Acutes is a lot different than the chronic floor. Where I live, no one starts in acutes before they have had at least a year on the floor. There are too many things that could go wrong or need troubleshooting and more times than not, you will be alone. Good luck though.....dialysis is a good nursing specialty.

[tom7044]

I am not being critical however DaVita is famous for hiring nurses for acute dialysis and offer training but often the training is with an acute dialysis staff nurse and it is so difficult to train a nurse on the job doing acute patients. Those runs can be second by second horrifying or uneventful but it is usually the first. Sometimes just trying to get the patient on circ. without them becoming profoundly hypotensive or experience some cardiac problem or their access is horrible or sometimes even clotted. Then their is the problem of heparin with clotting times every five minutes. Sometimes the MD orders no heparin and your focus has to be on not allowing the lines or the kidney to clot; sometimes you do everything just right and still every thing clots and you have a mess on your hands. If you are dialyzing someone in the critical care units with every type of drip possible and on a vent sometimes the Critical Care Nurses think that because you are a nurse you can deal with all of those issues and dialyze the patient at the same time. Rare but does happen.Then there is always the possibility of your patient just going into a full cardiac arrest when you least expect that to happen. Remember anytime you are dealing with extra-vascular circulation with blood pump which is both pulling and pushing a volume of blood the hemodynamics are going to change. Blood flow rates and dialysate flow rates are always being adjusted as needed. At least you have the principles of dialysis down. That is the important thing to know the basic principles of dialysis and go from there. DaVita does hire acute nurses that have no dialysis experience and have to be taught from step one how to string a machine prime the kidney check alarms and conductivity. Those nurses even the experienced critical care nurses are often overwhelmed and seldom stay with dialysis. The best training is good sound medical surgical experience then a structured classroom and practical hand on training usually in a chronic unit then transition slowly into the acute arena. Many hospital operated units (not company owned units) carefully select the right nurse and train them this way or send the nurse to a large medical center hospital that has a training program for dialysis nurses. This is sometimes a 6 week period. DON"t get discouraged even with this description of what the real world is like. Ask questions ask questions and ask questions then Read Read Read. I was a hemodialysis nurse for more than 13 years; 10 of those years as an an acute dialysis RN. You will find a talented, experienced, mentor that will do anything to help you learn and be comfortable. These nurses are not usually management but just staff nurses that love what they do; stick to them like glue. Good Luck!​

[schnookimz]

My experiences have been different than the previous poster.

I was hired with little experience and no dialysis experience but my training was great. I do feel adequately prepared for the most part.

The ICU nurses never expect me to manage anything else in the room at all. And I make it quite clear that I don't touch their things and they don't touch mine. :)

I've never had a patient go into cardiac arrest on me and never had a patient crash completely unexpectedly. You can usually see it coming and know that they're unstable. If they do crash out of nowhere, well that could happen to anyone! Bad luck is bad luck.

[Chisca, RN]

Acutes are a mixture of patients, some who are stable enough to be dialized in an in-hospital clinic and others who are so sick they are in ICU and you bring all the equipment to their bedside. It is those ICU bedside treatments that require a huge amount of coordination between the dialysis nurse and the ICU nurse. If you have never titrated vasoactive drugs how are you going to decide whether to back off on fluid removal, increase the levophed, or try some albumin? Is a patient with CVP of 3 with a dialysis order to pull 4 liters going to fly? Some ICU nurses don't understand why it's dangerous to try and wean a patient's ventilator while on dialysis. I have been asked by more than one ICU nurse why can't we draw an ABG from the "arterial" side of the dialysis circuit. ICU nurses are a mixed bag as far as experience goes and very few understand whats going on with a patient when they are on a hemodialysis machine. Some ICU's are so short staffed that you may not see that ICU nurse for awhile because they are so busy with their other patients. I travel between 5 different hospitals and I wouldn't describe any of the ICU's as well staffed. I think it would be very difficult to function in that environment if you don't have any ICU experience.

[schnookimz]

It's really location by location. ICUs that I go to are always fully staffed. Never had an issue with that and the nurses are always really knowledgable. But I completely admit I am luckily going to high quality hospitals with a lot of money in them and technology. Nothing is lacking.