DaVita(Alabama)-looking for Staff RN New Grad will train

anurseadvocate · Apr 22, 2012

My experience and my opinion, as a result of my experience with many RNs new to Davita --The federal requirements are minimal for RNs to be in charge of a unit. My ONLY advice would be the following.. (1) Remember you have a license, therefore, you need to make sure that you are very well trained/educated and are aware of the Davita policies and procedures, as well as the federal level regulations for diaysis clinics. I have seen, all too often, nurses get pinned to the wall because they did not know the facility policies which should include the regulations. (We always wrote our policies and procedures from the governing regulations of state/federal and local.) Often after the classroom training you are put on the floor with a preceptor. Many preceptors have developed bad habits over the years, many have NOT. Many technicians, the same applies. Therefore, IMPORTANT to make sure you are conducting correct practices. According to my contact at CMS (federal agency that oversees dialysis faciities) the most frequent cited deficiency is in infection control. (2) Alot can go wrong in a matter of seconds when treatments are not correctly administered, when physician orders are not implemented, etc -- therefore, a patient can die in a matter of minutes. There is so much to learn about complications and considering each patient is indivdualized to their own medical problems, even more important that you understand the process... It is NOT a cookie cutter treatment.,..ALthough many units, for instance, set the BP parameters the same on all machines as I have seen and heard from staff. Just always remember it is your license that is on the line ...

Guttercat, ASN, RN · Apr 22, 2012

I saw a posted job at DaVita in one part of Alabama that they are looking for New Grad will train. Any idea why they are looking for a new grad with this kind of specialization? Are they having hard time looking for RN's with dialysis experiences? Pls let me know your point of view here. Thanks!

Easy.

New grads are cheap.

With the dying off (Davita and Fresenius combined now own 80% of the market share) of not-for-profit and hospital owned dialysis centers, nurse staffing has been reduced to skeleton crews not only in number and RN-to-patient ratio, but in quality/experience of candidates.

It used to be you didn't get into dialysis without at least six months (usually one year) of acute care experience.

It's all about controlling costs and increasing profit margins.

anurseadvocate · Apr 23, 2012

I would, as I stated, be very aware that you have a license to protect. I recall, that the regulations only require 6 months of experience to be in charge --- be careful because lives are in your hands if you are put in charge and alot of things can go wrong with the dialysis machine, you need to be able to trouble shoot, as well as identify potential problems with patients.

Tish88 · Apr 23, 2012

CMS Conditions for Coverage ESRD final rule:

4. Subpart D (Administration)

a. Personnel Qualifications (Proposed 494.140)

494.140(b)(3)(ii)

"proposed new qualifications for the charge nurse, who would be required to be an RN or licensed practical nurse (LPN) with 12 months of nursing experience, including 3 months of dialysis experience. We also proposed new qualifications for the staff nurse, who would have to be an RN or LPN and meet the State practice requirements."

(3)

Charge nurse. The charge nurse responsible for each shift must—

(i)

Be a registered nurse, a licensed practical nurse, or vocational nurse who meets the practice requirements in the State in which he or she is employed;

(ii)

Have at least 12 months experience in providing nursing care, including 3 months of experience in providing nursing care to patients on maintenance dialysis; and

(iii) If such nurse is a licensed practical nurse or licensed vocational nurse, work under the supervision of a registered nurse in accordance with state nursing practice act provisions.

(4)

Staff nurse. Each nurse who provides care and treatment to patients must be either a registered nurse or a practical nurse who meets the practice requirements in the State in which he or she is employed.

So, if we follow the new regulations, a new grad nurse can not be in charge for atleast a year. I agree with Guttercat - new grads are cheap!

anurseadvocate · Apr 23, 2012

I guess I have alot of concern regarding the COnditions as they are stated and thanks for presenting this as I could not fully remember. I have spoken to, known many and experienced observing new RNs in a charge position who are not fully educated as to problem solving maching difficulties. Of course, many RNs rely on technicians to do such. I am reminded of one unit where there were only a couple of experienced technicians --who were, in fact, familiar with trouble shooting -- one day, these two staff had left and fairly new staff (techs) were on duty. Machine problems popped up and the RNs were so very new that they even could not resolve the problem. They ended up calling one of the techs. My only statement is to make sure you are fully educated so that you provide safe care and are familiar wtih the policies of the unit --- I have also heard that Davita often has not provided RNs (new) extensive training due to staffing -- just remember - you have a license and you can lose your license --remember, providers will not stand behind you in a situation where there might be a law suit -- or patient negative outcomes/death -- just take a look at various situations that have recently been made public where patients experienced negative outcomes or death.. Staff were used as scapegoats as MANY of us believe ----

MJB2010 · Apr 23, 2012

When I started in Dialysis I was told I could not be left alone in the building for at least 6 months post training. I was left alone my first day OUT of training. It was terrifiying and extremely dangerous. I complained all the way up the ladder and nothing was done. This was pretty much par for the course at that center. I ended up putting it in writing and only then was it addressed, the other nurse at my center was told she had to work every Saturday for the next 6 months due to me not wanting to be in the building without another RN. She was made to think it was my personal preference not the company policy and the only other RN who could have been there with me( the manager) refused to work Saturdays. So this really got me off on the right foot with the other nurse.

You really need to look out for you, and look out for the patients. The company is out for the profit period. I did not work for Davita, but the big two are one and the same as far as goals. Money money money.

anurseadvocate · Apr 24, 2012

I have had so many complaints for nurses regarding very similar situations.. You are thrown on the floor without sufficient training to deal wtih emergency situations. As I said before, only a high school GED is required to administered a life-sustaining treatment -- Technicians are often NOT familiar with the patient's medical history or problems, therefore, a cookie cutter training is not appropriate.. I think I mentioned in one post, some place, that often facilities have the same parameters set on all the machines.. HELLO. one patient might have low BP, for that person, at 100 systolic whle another is ok..I have seen too many times incidents happen because staff do not individualize the treatment. Once an RN told me, actually more than once, that the technicians 'make their own judgement calls'.. This IS frightening, esp if they are using the cookie cutter training they learned..

RNtobeinSoCal · Nov 22, 2012

I'm a new grad in dialysis & have spoken with fellow new grads (even some w med-surg experience). it is HARD and so much depends on your preceptor. we are hired because we work for a FRACTION of what an experienced nurse makes. i also get the sense this is where older nurses go to ride out their careers - no night shifts (unless you have nocturnal at your facility), but overall, a set schedule.

Hope you're doing well wherever you landed.

SantaRN · Mar 6, 2013

Interesting post..........I have had several areas of practice in my career and just recently started dialysis. I have always heard that dialysis is a critical care 'specialty' area, like ER, ICU, etc. Most of my practice has been in ER, but dialysis is a different world altogether! There are not too many emergency scenarios that I would not be comfortable handling, but I feel like a new graduate nurse most days I am in the dialysis clinic.

The machines are complicated- the techs are experts at those, but don't have the nursing education to process exactly what/why they are doing what they do. I would NOT be comfortable alone in the clinic by myself as the only nurse- its not a nursing thing so much as I am not experienced enough to trouble shoot the machines if something were to go wrong.

I taught clinical nursing for a few years and had a few students who were dialysis techs studying to be nurses. Those girls, along with a few clinical experiences of my own got me interested in trying it. I have met many, many nurses who started in dialysis and have never done any other type of nursing.

I think one reason any of the dialysis clinics are willing to take new grads is the same reason anyone is willing to take new grads, ie- they have a nursing license! There is so much training with dialysis and it takes so much time to learn, even with my experience, I am not so sure I am that much further along training wise as some of the brand new grads :-)

lawandaluxnurse, ADN, BSN · Mar 6, 2013

Everyone is cheap and using skeleton crews. I don't care if it is an acute care hospital to a dialysis clinic. It sucks all the way around!