by SnipRN SnipRN Member

Specializes in Dialysis. Has 3 years experience.

I need some advice. I've just passed my one-year mark as a dialysis nurse, and I'm seriously considering leaving my position. I love the actual job. I love my patients. But I am so frustrated by the utter lack of management and shady HR/payroll practices at my clinic.

A few examples: When I graduated nursing school, I agreed to start on there as a tech until I passed the NCLEX. That meant--starting out at tech wages. I was OK with this, as I was told that all new nurses start out training as a tech, and I was guaranteed an RN role as soon as I passed the boards. I took the NCLEX roughly 3 weeks later, passed, and was immediately granted a 'title change' at my job and started working as a nurse. Great, no problem there--except that my company did not compensate me as a nurse for another 3 months. That was not part of the contract, that was due to my manager's incompetence. I had to pester him over and over, and finally went above him to corporate level, in order to get my promised wage.

Just for further thought: A fellow graduate started working there about a month after I did. She had not passed her boards yet, and also had to start out training as a tech--but was granted full RN wages from the moment she first clocked in. She did not pass her boards for another month or so after I passed mine. In all this time, she was being paid nurse wages, and I was paid tech wages. Seems fair, right?! ?

Now here's another thing: I have never received a performance evaluation there. Granted, this is my first nursing job, but I am not new to the workforce. In all of my previous roles, I was given an initial performance evaluation at around 3 months. At this job, never happened. Now, here I am at my one year mark, and I had to remind my manager that I am due for my annual review, plus the raise that was part of my contract. That was last month. I still have heard nothing.

My contract also spelled out a $5000 sign on bonus. I have not seen a dime of it. I was also told that I would be reimbursed for my state license fees. I turned in all of the appropriate paperwork the day that I received my license. Do you think that I ever received that reimbursement? Nope.

I'm becoming increasingly frustrated, and I feel that my manager just keeps sweeping things under the rug. Our corporate office is across the country, so we have no real support there. It honestly seems like he doesn't know what he's doing. The other day, I overheard one of our techs complaining that her annual review was more than 3 months overdue.

In my opinion, the lack of performance evaluation is also a patient safety issue. For example-- we have two new-ish techs (started with us in January). Both of them have beena little slow to catch on, but one of them is utterly incompetent. I don't trust her to initiate treatment without direct supervision. This has been brought up to the manager multiple times--by myself, the other RNs, and a few of the more experienced PCTs. I don't know if we're just desperate, or what, but he has yet to intervene, even though there have been several very serious near-misses with this particular tech. It is to the point now that if she is assigned to work my side of the unit, I will take a pod instead, and have her stock, clean, and do basic tasks that do not require direct patient care. My point in all of this is, perhaps if the manager had actually reviewed her performance at the three month mark, he would have seen that she is not fit for the job, or at least come up with a performance improvement plan. Now, at nearly 7 months later, he is finally understanding how unsafe she is, but has to create a 'paper trail' with HR in order to remove her.

I'm sorry for the long post, but I guess I needed to type that out, to give myself a little clarity. Is my clinic just very poorly managed, or have any of you dealt with these issues in your clinic? Would you stick around for this? More often than not, I am running as both a tech AND a nurse, and I often have to come in on my days off to complete my monthly charting. Is this just standard in the dialysis industry?


Has 20 years experience. 39 Posts

Have you brought this up with your manager's boss and/or HR? Keep that paper trail going and journal the days and time you addressed your issues, and not necessarily your coworker's issues, with the boss.



Specializes in Dialysis. Has 3 years experience. 19 Posts

I ended up leaving. It was not a good place to work. I miss the patients, but overall I am so relieved. Thank you for your response. 



Specializes in retired LTC. 7,735 Posts

Sorry things had to come that level. BTW, if your back wages are worth it, you might want to consider contacting your State Dept of Labor.

Or a lawyer to help you out with all your contract issues.

Don't let the stinkers get away with pulling one over on you!