Second thoughts about accepting chronic dialysis position..advice?

  1. I have been offered a position in a chronic dialysis clinic..I have never worked dialysis so I will be starting from the ground up in learning everything....anyway..the clinic runs 2 shifts, not located in nor affiliated with a hospital and not one of the "big two" for profits, starting with the RN coming in at 5:30 a.m. & leaving "around 3:30 or 4" (4 10 hour shifts/week). RN is responsible for 10 patients (total number of chairs is 16). The clinic is not open nights or Sundays. The only holidays observed are Christmas and Thanksgiving. Benefits are offered and the training - for 3 months - is with a tech..then with another nurse.
    My concern is several nurses who work there are leaving the company around the same time - including the clinic manager- I'm told all are for "personal" reasons and have nothing to do with the company but it seems odd to me this turn over. This leaves me, as a nurse w/NO dialysis experience, in a situation where I will be one of several new employees coming on around the same time. I am also concerned the 4 10 hour shift are now going to be more like 12 based on another comment the hiring manager made. Maybe I am just nervous about moving into this area of nursing but I just get the feeling something is going on w/the company that is causing nurses to leave - some of who have been there for years according to the hiring manager. The home therapies and PD dialysis RN positions are open in addition to the clinic manager and then the in clinic RN position. I just think this is a lot of open positions at once for a clinic that is not expanding. When I applied none of these were open so in a span of 2 weeks 4 people have submitted their resignations....
    I have a job but it's part time and no benefits..I can hang in there until something else comes along..I am interested in dialysis..have been for awhile but I do not want to place myself or patients at risk w/my lack of knowledge about dialysis and now it seems like an unstable foundation to start off on learning...I know Techs are invaluable but they are not RN's and while I want to learn from the TEchs I also need an RN to rely on..I hope that makes sense. Am I over reacting here?
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    About Marshall1

    Joined: Nov '09; Posts: 1,002; Likes: 897


  3. by   CFrancine
    I've never worked in Chronics but to my understanding, what you describe sounds pretty universal with training and turnover. But I would keep looking. Go with your gut if it just doesn't feel right. Maybe one of the big two. At least with them there's a possibility of transferring if you don't like the clinic you're at.
  4. by   Davia
    Hello I feel your pain. I am a Dialysis expert. That is about how it is in the dialysis world. I started out like you. They hired me to clean up a clinic. It can be hard at first but remember you are removing fluid. So if you are ever in dought or a BP is low give some fluid. If you can't fix them send them to the hospital. You will have limited resources in the clinic. If they tell you the patient that 2 liters is all they can take in one time listen. If you take off to much the patient will vomit and pass out on you. What do u do give volume back. I could tell you all my trips/ tips but will take a while. Good luck you can do it.
  5. by   nurseontheway
    I started out as a new grad in dialysis. I had other nurses there but my training wasn't very good. It took me a good year to start feeling comfortable. If you have good techs they really are helpful. I have also learned that some dialysis staff travel together- if they found another clinic that pays better etc. they will tell their friends and will leave together. I'm not saying all of the time but I have seen it firsthand. Please feel free to ask me any questions about being a dialysis nurse. It is the only specialty that I have been in. Davia couldn't have said it better- listen to your patients. They know their body.
  6. by   Marshall1
    Thank you for the replies...I am still on the fence about this offer...
  7. by   nurseontheway
    Are you a new RN? I will tell you that the beauty of working in dialysis is the 4/10's. I love having a day off during the week. I also love not having to work on Sunday. You get spoiled and always know that you will have Thanksgiving and Christmas day off.
  8. by   Marshall1
    I am not a new RN just new to dialysis..I have been an RN for 26 years. The 4/10's were part of the draw for me since it's full time hours..I am only hoping it won't be over 10 hour on a regular basis..seems like that is a common complaint from dialysis nurses..all the extra hours.
  9. by   CFrancine
    Again, I can't speak for chronics but I've heard unless there are a ton of call offs, you leave when your time is done. Extra hours are VERY true in acutes. So you may be hearing that side of it and not knowing the difference. But again, depends on where you work. My primary job, it's manageable. My PRN job, they work them to the bone all hours of the night! I don't think I would be a regular staff there unless I was going to be jobless.
  10. by   GeauxNursing
    2 shifts are give or take 10 hours. For the RN. You have to stay in the afternoon till all patients are gone. Depending on transportation, this could be a wait. Not completely unlikely for a patient to sit in the lobby an extra hour waiting for their ride. On physician round days, my nurses stay closer to 12 hours, charting new orders, making appts, etc. So, 10 hours is a rough estimate.
  11. by   southernbelle07
    I've been an RN since 2011 and have my first 3 years of experience in pediatric home health. I went into dialysis because it was highly specialized and pays well. OT is usually available. I was in chronic setting for 8-9 months then accepted a position in Acutes because of the differential in pay and sign-on bonus of 20,000.00 offered. I've been in acutes since 6/2016. I started by dialysis career in 9/2015. I am still somewhat of a newbie. I will give you a breakdown of the pros and cons, but it is my opinion only.

    Chronic setting pros:
    you see the same patients 3x./week.
    this setting is somewhat routine(push heparin prior to treatment, routine meds given)
    get to know your patients
    usually a set schedule you'd work
    usually don't have to clean up patient

    sometimes seeing the same patients all of the time is not good
    the dialysis machine is very technical and takes patients to learn
    have to learn the water system
    the entire dialysis clinic is under the responsibility of the charge nurse which is the main RN and is running under the RN's license.
    the patient's status can change quickly and their blood pressure can drop within minutes
    have to rely on the PCT's which are usually more hands-on with the patients. Putting faith in their hands to closely monitor the patients.
    The RN and/or LPN is responsible for 10 patients(getting their assessments done, passing out medications and giving their heparin if ordered).
    The RN has a lot of responsibility.

    Acute Setting:

    The RN and LPN work more independently
    Nurse to patient ratio is usually 1:2 or 1:3 with the help of a PCT or 1:1 if it is a smaller hospital.
    will see frequent flyer patients but will also see new patients often.
    can be exposed to acute setting and other patient issue besides dialysis
    work closer with the MDs than in chronic setting.
    get paid acute differential and lots of OT usually available.

    Being on-call
    Patient is usually acutely ill, sometimes almost on their "last leg"
    sometimes have to clean up the patient after they use bedpan while in dialysis suite
    don't know the patient's "norms" as if you were in chronic setting.
    exposed to more "germs."

    Once again, these are just my opinions. I don't plan on being dialysis RN forever, but for now I love my coworkers and have my "favorite" patients. I love talking to them and their families during their hospital stay.
  12. by   Runnsun
    Southernbelle07 can I add you as a friend? I have a few questions, more specifically about pay range to request etc. I have interview with one of the big boys(pretty excited). I know that every specialty has its learning curve and personalities. I'm a 14 year seasoned RN nurse-I know I was told via the phone interview that my background gives me a "highly" transferable skill set for the dialysis setting. I have travelled for the last 2.5 years as RN and I am clueless to what is a solid pay rate for a seasoned RN -New to dialysis is. I did but again is that with shift dif/overtime etc. Any help would be much appreciated.

  13. by   CKPM2RN
    I'm looking into starting a dialysis career as well. I currently work LTC/SNF and the hours never end! The ratio is dangerous and you are entirely on your own as a nurse. The big draw to dialysis for me is portability--dialysis is literally everywhere across the US (and beyond). My husband is retired so a portable job could be an advantageous way to see the US. I also like the idea of chronic dialysis because it has "open" and "closed" hours. I do understand that you're done when the last patient leaves, but at least they do leave. The one thing about LTC I do like is getting to know the patients. I see that as a big plus although there will always be that one or two that you dread seeing--but again--they go home, they don't live there.
    Feel free to add your two cents if you have an opinion. ;-)