Dialysis Staffing

Very reason I left dialysis!! It was killing my own health as we couldnt get away even to get a drink of water or use the bathroom most of the time. I repeatedly got pyleonephritis and was diagnosed as chronic. I left the field last June and now work in a home health care as a clinical manager. Guess what no pyleo for almost a year now!! My body doesnt hurt every day when I get home and most of all I get to see daylight when I go to work and daylight when I get home lol. Never again!! I get a full hour for lunch and go home everyday for that. Best of all I'm making about $100.00 more weekly then I ever made even as a DON of a dialysis unit.

Most states (not sure about Michigan) the staffing is one RN for 12 chairs, 13-24 would require 2 licenses. Technicians are 4 pts to 1 tech. Its sad but in the medical field right now you will get whatever you will allow, with no consideration to patient safety. As an RN, what you are saying by accepting these conditions is "I can handle this". If something goes wrong, your license is at risk. We all need to stand up and say we are NOT going to accept these conditions!

I agree with Maxinel. Often we are handed a plateful that we don't want..e.g. short staffing.. but we manage to get work done, etc., sometimes not. But as long as upper management is aware that we can do the job being shortstaffed, then they will continue. Remember, with the bundling around the corner, we are going to see more and more units who are not being given enough staff to meet patient safety needs. Many states do not have staffing ratios for dialysis facilities. However, if the state comes in to do a survey and/or complaint investigation and they cite a deficiency it could be the result of not enough staff and they should be written up as such. It is NOT an excuse, in any way, but providers are for profit.. most of them and that is the bottom line. My suggestion is that you document EVERYTHING --- number of staff, including RN, techs, etc... then document any preventable occurrences that happened or even potential ones.. Keep this for your records.. Also, put in writing to management that you are concerned about Patient Safety. You might need this documentation at some time such as when a major incident occurs and your management or corporate person states "we knew nothing of problems this facility was having, no one notified us there was not enough staff, etc."... When push comes to shove the bottom line is that many of us will not be protected by our employer.. sad but true.. have seen it happen all too often. Also, if patients get together and support staff by writing a letter stating they believe there is short staffing as their needs are not being met,, this often works (Have seen it happen)... As an RN you can also, time permitting, go to each patient and check machine entries with orders e.g. BFR, UF rate, etc... when there are alot of mistakes, or even wrong bath.. this is often an indicator that there is not enough staff and staff are rushed and under too much pressure.

I am also a Michigan dialysis nurse. The company I work for states on their website that the ratio is 1:12 for RNs and 1:4 for PCTs. We have a 10 chair unit and it is me and 2 techs. On the days we run one shift of patients, it can be me and one PCT for 8 pts, with no secretary or clinic manager in the building. Of course, that's when adverse events occur.

I worked dialysis in the 1970s and early 80s. I was the kidney stone queen from lack of fluids (no breaks.) I do get breaks now but they are short.

the units that i am familiar with that are 15 chairs run wtih two RNs - floor/meds/cath RN and charge RN paperwork,,,and 4 techs usually.. so guess that is good staffing.

I was so glad to read the above posts. It left me feeling vindicated. I just left my dialysis nursing job because I was routinely overworked and we were understaffed and the FA never did anything about it even when nurses and techs quit. The techs that left were not replaced, and the new hire nurses were had no dialysis experience - we were left to train them in addition to getting the daily work done. It left me working from 4:30A to past 7PM mon., wed., fri., and sat., never able to take a full break on time.

One thing that isn't discussed, many dialysis nurses can tell you that just because you have ample staff (another RN and plenty of tech.s) you can be saddled with nurses who will sit on their rear-ends while you do all the work.

redsox07....I just left a facility like that! All I could think of everytime I went to work is...."Why am I putting my nursing license on the line like this?". Once I answered the question for myself, I gave a months notice. Are you or have you every sat through a family's lawyers deposition? They make you feel guilty even when you aren't. Ask yourself one question. Do you go to bed satisfied and wake up with enthusiasm? If you can't say "yes" then it's time to move on. Best of luck!

Wow, I feel lucky! I work in an 18 chair clinic, full on Mon, Wed, Fri and not so full on the other days. We usually have at least 2 RNs on any day, in addition to the CN, and techs fill in. Our schedule is pretty diverse, some days we have 3-4 RNs and 1 or 2 techs, depends on who has time off, etc. We ALWAYS get a 30 min break AND a lunch, and we never work overtime, unless it's waiting with a patient for a ride to show up. We all work well with each other, helping tear down machines, bringing set ups for each other, etc. It's a real team effort. I feel bad for those of you working so terribly hard! However, it doesn't mean we don't work hard, there are many days a week when I go home and have to shower because I've sweat so much during the day - it can definitely be physically demanding!

Try a non profit unit. The one I work in used to be pretty bad, but all new management has got us up to full staff. One Rn per 7 pts and one tech or lpn with the rn, then we usually have a float tech or lpn between 2 teams. All our patients get on treatment on time and the second pt shift gets on timely manner now too. 10 hr shifts and we are usually out on time, maybe 30 minutes over occasionally. Our pts are happy now too.

we have 15 -20 chairs and 1 nurse the other is usually filling in for techs or in patient at the local hospital. we are chronically understaffed with less than 30 minutes between off time to on time including machine testing and patient hold times. all but the fastest techs have trouble keeping up with that pace let alone tossing a nurse into the fray several times a week due to tech shortages.

michigan is a non -licensure state meaning any person with 10 minutes of training can give injections ect. nothing worse than going to your doctor or dialysis unit and finding out the person giving you an injection or other medical proceedure hasn't finished high school. nice way for the politicians to fix the nursing shortage. this state is scary as far as medical care is concerned.

michigan also has no guidelines on dialysis patient to staff ratios that said most facilities are 4 to 1 with no rn to patient ratios.

i love my job in that the patient interaction makes the crappy job almost worth it but the job is dangerous to the patients as well as the staff. i am looking for other work unless there is a change soon which i ain’t holding my breath on. starting pay is real close to the 20 dollar mark for a rn.

sorry to hear your stories. I feel SO lucky to be working in our facility that we get to take 30 minute breaks and lunch. Though Mondays, Fridays and Saturdays are considered heavy in our unit, still we manage to get it through. We have 16 chairs (2 are for hep B patients who usually show up often) and have around 1 charge nurse, and 10 RNs (no PCTs in my country). We might be having lots of nurses this time but we get to lose one or nurses in a month, we'll be experiencing the dillema too.