differences in dialysis between UK and US

DeLana_RN, BSN, RN · Jan 6, 2007

Hi, there,

you're probably aware that the U.S. has quite a different health care system, mostly private, but not all hospitals are for profit (although most are private). ESRD is the only disease where universal coverage applies, funded by Medicare - the government-regulated insurance that covers retirees, some disabled individuals, and - as I mentioned - all ESRD pts*.

Outpatient dialysis is usually provided by for-profit companies, the largest of which are DaVita and Fresenius. They receive their funding from Medicare (and some private insurance). Inpatient/acute dialysis is sometimes provided by these companies as well, if they have a contract with hospitals that don't have their own dialysis departments. Larger hospitals (like mine) usually dialyze their inpatients; the nurses are employed like any other hospital nurses and paid according to the same guidelines (private hospitals usually pay a bit more than non-profit, but this varies).

HTH, feel free to ask more questions. BTW, I don't think that you need to work in a hospital to be able to do dialysis in the U.S.; since you have previous experience, you should be able to work either in a clinic or hospital dialysis setting (some even hire and train new grads!)

Good luck!

DeLana :)

*The reason for this: Before Medicare covered ESRD, many pts had to die for lack of insurance; there were infamous committees that decided who was "worthy" to get dialysis, usually young and employed pts. Sadly, it has so far not occurred to anyone that you can die just as easily from heart, liver, and other diseases that many people have no health care coverage for :uhoh3:

hemorn1 · Jan 18, 2007

Not all patients are covered by the Medicare ESRD act. They are only covered if they "qualify" for Medicare.

I agree that you would not have to work in a hospital before joining a dialysis facility. Most facilities would be thrilled to get a nurse with experience!

suzanne7575 · Jan 19, 2007

thank you both, I would love to go straight into Dialysis again but i cannot see them petitioning a foreign nurse somehow, although i guess there is no harm in asking. Do dialysis units working for the private companies get paid well compared to hospital nurses? and do they tend to offer sign on bonuses and benefits at all?

Many thanks

Trauma Columnist · Jan 19, 2007

I work in a Fresenius unit and there are no sign-on bonuses but they do have health insurance, sick time, PTO (paid time off), retirement. In my area, the wages are higher by $2-3/hour for dialysis units.

DeLana_RN, BSN, RN · Jan 19, 2007

I've done both outpatient dialysis and now inpatient/acute; the outpatient unit did pay about $2/hr more than the hospital (I had to fight to get the same pay I made two years ago in outpatient!), but I believe the inpatient nurses with years of experience/tenure make more than clinic nurses. It's a topic not to be discussed, I can't just ask them

We have several international nurses - I'm one - and I see no reason why you would not be hired. I don't know about immigration/visa requirements, though, since I've been a permanent resident for many years.

Good luck! Keep us posted.

DeLana :)

P.S. Most hospitals pay sign-off bonuses, one that's too far for me to drive would have paid $7,500 (!) for full-time dialysis nurses with 1+ years experience. Outpatient did not pay bonuses in the past, but that may have changed with the increasing nursing shortage.

hemorn1 · Jan 21, 2007

thank you both, I would love to go straight into Dialysis again but i cannot see them petitioning a foreign nurse somehow, although i guess there is no harm in asking. Do dialysis units working for the private companies get paid well compared to hospital nurses? and do they tend to offer sign on bonuses and benefits at all?
Many thanks

I was working for Gambro and we actually recruited some RN's from India a few years ago. They worked as PCT's until they took their licensure exam in the US. I live in Oklahoma, and I think RN's in dialysis make a little more than staff nurses in hospitals. However, nurses (at hospitals and acute dialysis) can make $30-40 an hours if they are willing to work doubles on the weekend. Some give sign on bonuses, most have good benefits which they consider part of your compensation package. Insurance runs pretty high, especially if you are insuring your whole family, not just yourself.

wintersunrise · Jan 21, 2007

You may be in for a big surprise in the US. The Acute/hospital dialysis nurse is typically on call rotation and can work as many as 24 hours in a row. The outpatient nurse may start her shift as early as 3:30am, and works as many as 13-16 hours in a day. The patient/staff ratio depends on staffing for the day. Most units are in need of nurses with experience! If you have any kind of dialysis experience you will also be training other nurses....that probabely won't stay long!

The days are long, hectic, and sometimes very stressfull. I believe you really have to love being a nurse. The pay is ok, but could be better. The patients vary...depending on the area (acute/chronic) and location (rural/inner city). Some are educated, intelligent and willing to learn the disease process (ideal), others are uneducated, mentally challanged, and resistant to any health care! Not to mention physically or verbally abusive to nurses. Some patients are out to blame others for their misfortune.

Lawsuits are an everyday occurance and reminder of what it is like to be in the good old USA. THis may sound grim, however, I try to find small enjoyable moments to keep me going, a simple 'thank you' from one patient may be it for the day! Good luck

DeLana_RN, BSN, RN · Jan 21, 2007

You may be in for a big surprise in the US. The Acute/hospital dialysis nurse is typically on call rotation and can work as many as 24 hours in a row. The outpatient nurse may start her shift as early as 3:30am, and works as many as 13-16 hours in a day. The patient/staff ratio depends on staffing for the day. Most units are in need of nurses with experience! If you have any kind of dialysis experience you will also be training other nurses....that probabely won't stay long!
The days are long, hectic, and sometimes very stressfull. I believe you really have to love being a nurse. The pay is ok, but could be better. The patients vary...depending on the area (acute/chronic) and location (rural/inner city). Some are educated, intelligent and willing to learn the disease process (ideal), others are uneducated, mentally challanged, and resistant to any health care! Not to mention physically or verbally abusive to nurses. Some patients are out to blame others for their misfortune.
Lawsuits are an everyday occurance and reminder of what it is like to be in the good old USA. THis may sound grim, however, I try to find small enjoyable moments to keep me going, a simple 'thank you' from one patient may be it for the day! Good luck

You're describing what is probably a worst-case scenario. Work conditions and pay vary widely, you have to choose carefully - but that's true with any job.

At my former clinic I used to start at 5:00 a.m. because the first patients were put on at 6:00; still early (and the reason why I don't work there anymore), but most of my coworkers liked those hours. A local sister clinic starts at 7:00 (workers)/8:00 (pts); another, staffed with early birds, starts at 4:00 (but this was the workers' - and patients' - choice!) Some clinics also have a late shift where nurses may start at 10:00 a.m. or so.

Nobody had to train anybody, we had a unit preceptor who was paid extra (and volunteered) for the task.

We worked four 10-hour days between Monday and Saturday; no Sundays. Other local clinics are only open M/W/F (up to 12-13 hrs).

Initially, clinic RNs did not have to take acute call at a hospital the company covers; when they implented this, many RNs left. It is not always a requirement.

I recently started a new job in a hospital inpatient unit; we are hospital employees and don't have to cover any other hospitals. The nurse : pt ratio is 1:1 (both in our 5-station unit and in the ICUs, where we dialyze very critical and vent pts), sometimes even 2:1 depending on pt condition. Yes, everyone has to take turns at night or weekend call, but nobody expects you to work excessively (e.g., if you get called out at night and are scheduled for the next day, you may usually come in late or not at all; we have enough staff to cover.) We have a lot of flexibility - some work 5 days/wk, some 4, some 3, and I'm per diem. Various hours, various call requirements.

There are great variations and one cannot generalize. Choose carefully, ask lots of questions. But you can find a position in dialysis that suits your needs.

Good luck!

DeLana :)

LadyNASDAQ · Jan 31, 2007

You are in for a big shock then!

We have Hemodialysis in hospitals as Acute, Chronic in all kinds of clinics and also, many cruiselines have Nurses like you that do this onboard. How about that kind of job??? Would be fun don't you think???

Dialysis isn't much different States vs. UK but we do have meds you may not be familiar with. Be aware that our meds and formulary are slightly different in Dialysis but outside of the Unit, you need to learn our meds.

If you decide to do in-house Hospital Dialysis, be aware that American Nurses need a lot of education especially meds given before the patient gets to you. Somehow a lot of floor Nurses and sometimes ICU Nurses forget to hold the anti-hypertensives and you'll find out soon enough that you have a bp you're chasing.

Last but not least, you are so welcome and we need you to come and help out. We have a huge national shortage so let me say thanks in advance for giving us a hand.

I work in ICU but I have run a Renal Dialysis Floor along with a Renal ICU combined as a travel Nurse for 2 1/2 yrs. Tough to do but we all worked together as a team and that's what mattered.

Hajnal · Mar 5, 2007

HI Suzanne!! Are you still in UK or you already work in USA? I am curious how you like it? I am from Romania, waiting to go in USA to work in hemodialysis. Are you going with O'Grady Peyton International?

mo-mo · Mar 14, 2007

Hi Suzanne! I also believe you won't have a problem finding a job in dialysis in the US.

On a different subject, I've heard that in Europe patients get longer HD treatments (outpt.) on the average, have longer life expectancies, and less incidence of Congestive heart failure.

Anyone know if this is true? Or know of other differences in practice?

Working in Hawaii, I see a lot of Japanese travelers and have one pt from here that goes to Japan for extended periods of time. They use small IV catheters (18 g and up!) as opposed to fistula needles and run for very long treatments (6hrs+) at BFR @200cc/min. They also feed pts on HD, check labs each treatment and hang banana bags prn (according to my pt that travels there)! They give meager amts of epo compared to our standards and maintain lower Hgb. I gotta say the Japanese pts I see generally look healthier than our average chronic pt here.

Good luck with you move, Suzanne!