HD Nurses: Major differences acutes vs chronics?

daquirigoddess · Oct 21, 2005

I am in the same boat. I am looking at starting in acute in January. I have 5 years experience with chronic patients.

Hellllllo Nurse, BSN, RN · Oct 25, 2005

Well no one is answering. It looks like I'm not going to apply to the acutes position after all. It is with the company I left, and they kinda su$%.

So, i guess I'm going to keep traveling and doing chronics.

kladouci · Nov 2, 2005

Hi

I am new to this forum but I have been a renal dialysis nurse for the past 2 years. I am from Canada as well, so some of your comments sound a little foreign to me. You made mention that on your chronic unit - please correct me if I am wrong - that your nurse to patient ration is 1:7? Wow. I am employed at our Regional Health Centre where our current ratio is 1:3 for most patients and those in ICU, PACU, and elsewhere outside of the unit are considered "off unit" are 1:1. Especially with antifreeze overdoses we can be pretty much at the bedside providing continual dialysis for up to 24 or more hours - this is not to be confused with CRRT - a completely different thing where I work. It is our responsibility to take the dialysis equipment, including RO machines up to the unit, assemble them and dialyse the patient. We take on call approximately 1-2 times in a 12-16 week period. Not bad. It is an excellent facility and I might like to invite you to come to Canada - Peterborough to be exact. I would love to hear more on how you operate in the States. Do your patients pay for their treatments? If so what is the cost and have you every come across a situation where someone was unable to pay and therefore had to withdraw? That would be tough. In Canada, anyone and everyone gets their treatments for free. What is your vascular access like? Mostly fistulas, grafts, CVC's?

I think you would enjoy the acute patients as you become extremely familiar not just with the process of dialysis, but with the setting up as well. I look forward to your reply.:)

Hellllllo Nurse, BSN, RN · Nov 18, 2005

Some pts' private insurance pays for their tx. Medicare pays for 80% of some pts' tx, and they have to come up with the other 20%, by themselves or with ins. I've had a few very wealthy pts who've paid for all of their tx themselves.

I had on pt from Taiwan. He was flying to and from Taiwan from Texas twice a week, as it was cheaper to fly to Taiwan for free dialysis than it was to pay for it himself in the US. His family owns several restaurants, so they are wealthy, but do not have health ins.

Nurse to pt ratio in most chronic units is actually 1:12. I have been the only nurse for 21 pts several times. Counting the dialysis techs, staffing is one staff person (nurse or tech) to 7 pts.

I am not going to get an apportunity to learn acutes, after all.

A friend called the acutes director, and she told him they have too many nurses and not enough hours for all of them.

I'd love to be able to work in Canada someday. :)

ch10 · Dec 11, 2005

Acute treatment prescriptions are different to chronic.

Chronic:

Our staff ratio is 1:4 in the chronic area. They are dialised at lower temperature, OCM and BVM are often used, Na+ at 135-136, all used high flux dialyser, all are treated free including drugs and EPO. We do not re-use kidneys. QB at 300-350, QD at 800, Kt/V is aimed at 1.4 (single pool) 1.2 (double pool) and 1.5 for diabetics.

Acute:

Smaller dialyser, QB 200-220, QD 500, Temp is higher at 36-37, Na+137-140, bloods are always reviewed every dialysis and HDX prescription change, coagulation is also reviewed (?minimal heparin), fluid assessed every dialysis. Most patients are filtered in ICU/ITU and transferred to HDX when stable. CVVHD/CRRT is also used. Kt/V is aimed at 1.7

ch10