Dialysis Staffing

Specialties Urology

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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!!!!!

As I read through the posts I see one thing in common. "FMC". I worked for the company for 6 years in different roles. PCT, Ward Clerk, Staff Nurse. During salary negotiations I was informed that my previous experience did not apply to the job I was going to be doing then when it was convenient for the company they banked on my previous skills and knowledge. Two months into my training which was supposed to be 6 months I was left as the only RN in the building in a 24 chair unit. I have been searching trying to find who regulates dialysis patient to staff ratio's, and if there is none who can I contact to suggest it. This is rediculous 1 RN (still in training)overseeing 6 techs and 24 pt's per shift for 10-12 hours a day is truely a burnout. I have brought the issue to the attention of upper management and all they seem to care about is they're saving money. It was a good thing that I clearly understand my job and handle stressful situations well.

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The best way to beat the system is to file complaints with the state, esrd network, and the FMC hotline. By doing this several times a week the area manager will be required to answer complaints that are annonymous, but still require an answer. Her or his time will be consumed with answering complaints, and not much more. When the problem is resolved the complaints cease. Everyone is happy, and can get back to work. I'll let you know if it works. So far it has. Managers hate paperwork.

While what you are proposing sounds good and might work the only thing it will accomplish is a pink slip for the employee. Corporations are bigger than any employee.

Sorry to say. And they will find out.

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I have done the complaint line numerous times, and it does work. One time I even used my name, and since retaliation is forbidden I had no problem with that. The area manager called me, and we discussed the pervasive problem on the phone.:smokin: Since that time the workload has been reduced to more manageable levels.

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If you look at the sidebar on the homepage, or go to the blog you will see about 100 posts from dialysis patients. This website owner is a dialysis patient as well as a writer. You just didn't look far enough. He is also a FMC patient, and has experienced all of the FMC nonsense, and the frustration you all have experienced. If you go to the blog you will see for yourself as he has dedicated his blogs to dialysis.

Sorry to say but patient's many times don't really understand what's going on. I've been in dialysis for over 15 years. Some patients don't know that it takes about an hour to get ready for them. They don't even know what meds they take. And if you tell them that their phosphorus is high they say they did have french fries the other day. And this isn't a new patient. They out right lie. Our scales are in the floor, they don't lie.

They are really like most other patient's very self centered.

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Our staffing ratio in acute unit is 2:1 and only nurses. Our problem is we are understaffed and forced to work 4 days a week and always have 48-60hours a week. In addition to this we are on call 7-10 days a month. You guessed it ........ FMC.........I am applying to jobs out of dialysis because I chose no longer to work under the conditions FMC subjects us to. How sad all nurses leave our unit and I have stuck it out in this unit for 6 years. No one ever stays.

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Sorry kiddo, but this patient really does know what is going on. As a mater of fact he runs his own machine at dialysis, and knows exactly what it takes to set one up. What kind of patients do you deal with that you are this quick to discredit them?

It isn't all about you, but rather all about them! Until you have been hooked up to a dialysis machine for four hours three days a week you have no idea what they experience do we.

They have all of the experience we don't. Setting up a machine for an hour is nothing like what they experience. I am certainly glad that I don't work with you wherever you are. I think that after 15 years you need to consider retiring you sound like you are burned out.

Have a good evening, and the best of luck to you, but I think our conversation on this forum is over.

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Specializes in Dialysis (acute & chronic).
As I read through the posts I see one thing in common. "FMC". I worked for the company for 6 years in different roles. PCT, Ward Clerk, Staff Nurse. During salary negotiations I was informed that my previous experience did not apply to the job I was going to be doing then when it was convenient for the company they banked on my previous skills and knowledge. Two months into my training which was supposed to be 6 months I was left as the only RN in the building in a 24 chair unit. I have been searching trying to find who regulates dialysis patient to staff ratio's, and if there is none who can I contact to suggest it. This is rediculous 1 RN (still in training)overseeing 6 techs and 24 pt's per shift for 10-12 hours a day is truely a burnout. I have brought the issue to the attention of upper management and all they seem to care about is they're saving money. It was a good thing that I clearly understand my job and handle stressful situations well.

CMS does regulate when a nurse can be "in charge" and I do believe it is 6 months as working as a NURSE (not your other jobs for the total of 6 YEARS) - You also should not have been left in the unit by yourself during this 6 month period. This is all in the new Conditions for Coverage.

I will try to find the # in the regulation that states this and I will try to post it.

After your 6 months, the regulations do say that only 1 RN needs to be present in the "building".

Good Luck.

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Specializes in Dialysis (acute & chronic).

Here is a part of the conditions of coverage:

"We 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."

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Specializes in Dialysis (acute & chronic).

CONDITIONS OF COVERAGE:

"We have revised the requirement formerly found at subpart U ( 405.2162), so that an RN must be present in the facility, and an LPN could still act as a charge nurse if he or she met the proposed qualifications. We did not intend for a LPN to supervise an RN, as suggested by the commenters.

The RN must be present in the facility when patients are being treated, as required at 494.180(b)(2). An LPN might act as the charge nurse but would not necessarily be supervising an RN. All dialysis nurses must adhere to their state practice requirements. We have modified 494.140(b)(3)(iii) to clarify this by adding language to indicate that, if the charge nurse is a licensed practical nurse or licensed vocational nurse, that he/she must work under the supervision of a registered nurse when required by the State nursing practice act provisions."

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Specializes in Dialysis (acute & chronic).

http://www.cms.hhs.gov/CFCsAndCoPs/13_ESRD.asp

Here is the link to read the conditions of coverage. You should know what is in this ruling if you are practicing in dialysis.

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Sorry kiddo, but this patient really does know what is going on. As a mater of fact he runs his own machine at dialysis, and knows exactly what it takes to set one up. What kind of patients do you deal with that you are this quick to discredit them?

It isn't all about you, but rather all about them! Until you have been hooked up to a dialysis machine for four hours three days a week you have no idea what they experience do we.

They have all of the experience we don't. Setting up a machine for an hour is nothing like what they experience. I am certainly glad that I don't work with you wherever you are. I think that after 15 years you need to consider retiring you sound like you are burned out.

Have a good evening, and the best of luck to you, but I think our conversation on this forum is over.

First of all I am not a kiddo. I have a college education too. Doesn't mean I understand nuclear physics. I've heard it many times. I work daily in HD. Please don't tell my I don't understand it from a patient's POV and that they understand the working behind it. They don't understand us any better than we understand them if we go by your logic.

I never said it was all about me. Where do you get that idea. I've worked in 13 states and just for just about every dialysis company. The big ones and the little one's.

I'm not burned out. HD is my niche. I'm again traveling for FMC. Through my regional VP. Dialysis isn't easy. Some people need to step up to the plate. I've been a nurse for almost 30 years. When I went to LPN school I wasn't molly coddled. I was told the truth. That nursing was hard work. I've never forgotten that.

I just got back from Australia and New Zealand. Wonderful vacation I couldn't have enjoyed without being a HAPPY HD nurse.

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It appears that you look down on kidney patients in general based on your most recent post's. Some of them actually try to help us with FMC.

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