Dialysis Staffing

GeauxNursing · Mar 2, 2008

yea we are doing work without pay in the morning as well, how else can we have everything ready? the clock-ins are closely monitored to the second. so silly. i know our CEO can afford and extra 15 minutes.

ratios: we are 4:1 seems to be fine.

redwoodrn · Mar 4, 2008

I am in California and am also looking for the state regs for nurse to patient ratios in dialysis clinics. I also want to know what the PCT to patient ratios are. Lately we have been understaffed, and I want to know if I am risking my license as well as quality of care. Anyone know?

norcalidiot · Mar 6, 2008

The below statements came from The Sunrise Review Process a study that was done by the State of Washington in 1999. In this study they talk about a bill sent to Congress in 1999 to come up with a way to protect nurses in dialysis centers. After reading the study I would under no circumstance work as an RN in a dialysis facility because it is the RN who is ultimately responsible.

Many centers require formal education or provide education and testing. Unlike several other states such as Oregon, California, Texas and New Mexico, Washington State has no requirements.

Q: What is the patient to technician ratio?

A: Most facilities work at about a 4 to1 patient ratio.

DeLana_RN, BSN, RN · Mar 7, 2008

It seems that most clinics use the 1:4 ratio. I agree, that's a lot. Been there, done that (even RNs occasionally had to do a "pod" of 4 stations in my former clinic - oh, my, turnover was a nightmare :uhoh3: ).

What concerns me more is that many of you seem to be working off the clock - this is wrong (shame on your employers!) and could put you at risk if something happens (worker's comp wouldn't cover you for something that happens off the clock - this could be as simple as slipping and falling). Your manager(s), who are undoubtedly aware of this, are also putting themselves at risk for letting it happen (not that I feel sorry for them. Shame on them!)

DeLana

penem10 · Mar 10, 2008

In some states the department of health will put forth standards of nurse/patient ratio for dialysis. In others, it is the state board of nursing.

kidneyhelper · Mar 11, 2008

I know I cant help with this,just wanted to share. I work in england in NHS dialysis unit our ratio is 2:5 (1RN+ renal assistant: 5patients) it is quite managable but since the FMC take over our ratio 1:4 for RN's and 1:8 for renal assistant, means 2 RN's are sharing for 1 renal assistant, and this is ridiculous. It is not our choice to go on private , its so happen that our NHS cutting down the budget, and we think everything FMC provided were cheap...We started as early as 6am for day shift coz our unit is running for 24 hours for 6 days

jnette, ASN, EMT-I · Mar 11, 2008

Does anyone have any ideas or suggestions on where to find the guidelines for staffing ratios or how to have them changed? I have called the Renal Network for my area & was told to check with the board of nursing. I had no luck there either, I have looked for info from CMS and can't find the regulations. We currently work a 4:1 PCT / pt ratio, with one RN. It is horrific. A neighboring state less than 5 miles away has a mandatory 3:1 ratio. Both of the clinics are owned & run by FMC and we do share staff. The problem is that no one wants to work in the 4:1 ratio clinic when they can work a 3:1 ratio for the same amount of pay. We have tried to talk to our regional manager (who has no medical background) about this issue & it got us absolutely nowhere. Now, to make matters worse, techs are working off the clock in the morning to get their assignments ready because the regional mgr told them they aren't allowed to clock in earlier than 6am. The first patients come into the unit at 6:45am, it is not enough time unless we start to cut corners & not follow policy. I know that this is not legal for FMC to do this, but this is a big company with lots of $$$$$$. Please any suggestions would be helpful, everyday feels like we are hanging on by a thread & the patients are the ones who are paying the price. HELP!!!!!

Just one of the many reasons I left dialysis ( or FMC, to be more honest!).

Loved dialysis, hated the company, and from what I hear, none of the "big ones", for profit companies out there are any better.

4:1 ratio is pretty much common, though.. I've heard of worse. Never heard of 3:1, and ESPECIALLY not with FMC !!! :eek:

Wonder how THAT happened???? :confused:

I don't get how they can do things one way in one facility and entirely different at another, but they always have... and again one of the multiple reasons I left.

Along with the usual "regional management" not having ANY medical background, much less a CLUE about dialysis. :angryfire

CocoaGirl · Mar 13, 2008

jnette the reason that there is a 3:1 ratio in the neighboring state is that it is a state mandated ratio set by the kidney commission, believe me if it were up to FMC they would be 4:1. I know 4:1 is usually the standard, but with the acuity of the patients, all of the other BS that FMC wants done & the new inexperienced staff it is not a safe situation. (especially for 1 RN). We try to do the best that we can but everyone is stressed & burnt out.

Lacie, BSN, RN · Mar 13, 2008

When I worked for Davita the ratio was 4:1 (non-differentation to roles), it didnt matter what your role was as long as you were a body to open and close the building. Most times it was 1 RN (charge/giving meds/paperwork/and taking pts) then 2 pcts (always short). Best thing I ever did was LEAVE! I'm now with another company (not FMC or Davita). Our state mandate is 4:1. I now work 3:1 and the charge does NOT take pts therefore isnt counted in that ratio. There is a heaven lol. Just goes to show management can make the difference in keeping thier nurses happy if they actually try which is something I didnt see in the biggy companies. I work a KRU facility and will be moving on to acutes soon (thank goodness). But if I had to stay in chronics I love this company.

jnette, ASN, EMT-I · Mar 13, 2008

jnette the reason that there is a 3:1 ratio in the neighboring state is that it is a state mandated ratio set by the kidney commission, believe me if it were up to FMC they would be 4:1. I know 4:1 is usually the standard, but with the acuity of the patients, all of the other BS that FMC wants done & the new inexperienced staff it is not a safe situation. (especially for 1 RN). We try to do the best that we can but everyone is stressed & burnt out.

I hear you, Cocoa.. believe me, I do. Been there, done that, and after nearly ten years could take no more and left while the leaving was good.. and the right thing to do.

When I worked for Davita the ratio was 4:1 (non-differentation to roles), it didnt matter what your role was as long as you were a body to open and close the building. Most times it was 1 RN (charge/giving meds/paperwork/and taking pts) then 2 pcts (always short). Best thing I ever did was LEAVE! I'm now with another company (not FMC or Davita). Our state mandate is 4:1. I now work 3:1 and the charge does NOT take pts therefore isnt counted in that ratio. There is a heaven lol. Just goes to show management can make the difference in keeping thier nurses happy if they actually try which is something I didnt see in the biggy companies. I work a KRU facility and will be moving on to acutes soon (thank goodness). But if I had to stay in chronics I love this company.

Good for you, Lacie ! :up:

mmurphy · Mar 16, 2008

In New Jersey i nurse ot 3 patients is the standard. It is defined as the standard by the New Jersey Department of Health.