Hemodialysis Nurse : Forced to work overtime or face abandonment?

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I have been an administrative supervisor, and although we can ask for up to 16 hours of work in a day, more than that is against the labor laws. We must be given 8 hours off between shifts. This is in AZ however, but I think it is a Federal Law.

As others have already mentioned - acute dialysis is unique and requires a special skill set. On call days can easily stretch out to become a 16 hour shift or the nurse goes home after 8 hours or so and gets called back in the middle of the night.

Staffing acutes is not easy. Hospitals that are on the smaller side and have good nephrologists will try everything so the on call nurse does not have to stay late or work overnight. I had worked in one hospital (also outsourced to a big company) that rarely called us in at night. However, I did have some long days on holidays (post thanksgiving emergency dialysis) and regularly had to HD on Sundays.

As other mentioned - if you hire too many people, nobody gets enough hours.

Every effort should be made to stay within 16 h of work time. But because dialysis schedules after hours as "on call" they can get away with staff working even more than 16 h per day.

Having said that - a nurse can refuse to accept an additional tx if unable to operate the machine safely/concerns for safety.

There are also other creative solutions at times. There is not much you can do about lithium overdoses as they require lengthy tx. But if it is your garden variety high potassium/ fluid overload I had high volume days on call where the nephrologist cut the tx to 2 h instead of 3 or 4. That way they would get the needed emergency tx but not a full one. Draw back - they might have to get HD the next day. This is only possible if the nephrologist agrees and finds it permissable and writes orders that way.

My preference would be to have more staff (prn / per tx) and a law that closes the loophole of people getting paid for "on call" , fall under "on call" but actually work 16 and more h . I do not see this happen any time soon as the profit margin is getting smaller and employers have very unrealistic ideas that focus on "numbers"...

I left acute dialysis because of frequent on call and not agreeing on staffing.

I agree with you Nurse Beth. I am a dialysis nurse and I was once employee for a contracted dialysis company. One time I was on call, had done 3 pts on 2 different hospitals on 1:1 and was asked to do an emergent dialysis on a pts that went to a ER. I was exhausted and fatigue. I refused to do the patient. The manager kept threatened me with disciplinary action if I didn't comply and I told her that I will seek legal advice and she stopped it. You have to stand on your rights. And you know what.... I was not fired or reprimanded by the chief of nursing at all, but I did resigned and sent in my resignation letter that situation among other unsafe practices they had. So you have to stand for your rights.

Specializes in Med/Surg/.

On this I believe Nurse Beth answered this already....But again I will say the abandonment is NOT arriving to work or taking your coat off!.. These employers are simply trying to scare the $#*& out of you......You HAVE to get report and finish with the off going Nurse....Now you are officially their Nurse! Anything else is lying to you for scare tactics. Here is a prime example from 1989 at a hospital in Odessa TX. I was at work at 7p-7a. Charge Nurse an agency Nurse been there a long time well liked. She saw we were one short on a nurse and called to get the Sup. to get her another nurse. She had NOT excepted her assignment yet from the previous charge nurse before she made her call..She also stated to the Sup.that she was not going to take report and except any pts. until she had a nurse or she was going to go home... She WAS within her right to leave and go home if it had been necessary and they could NOT charge her with abandonment because she had not taken over the pts with report. And lo and behold within 10 mins. we had another nurse and all was well. She took report etc. Now why do I remember that because we ALL stood there and watched this Nurse with a big backbone tell them what she wanted with no exceptions. She was not going to put herself or her Nurses in a bad situation....Now I will say that is a Charge Nurse who had a great deal of respect from us all. So many of them now are mice not lions and rarely every try to remedy the situation. The Chiefs have put the fear of God into them....I don't have the answer but you do have to decide whether your LC/Life is worth all of this as the story of the 38 y/o Mom ended in tragedy. Gook luck in the future......

Specializes in Tele, ICU, Staff Development.

Me, either, friend! I think state legislation is needed to manage unsafe staffing as well as nurse patient ratios (not the OPs question, but just throwing it in here ?

Thanks for your feedback and nicely laid out points. Best, Nurse Beth

Specializes in Tele, ICU, Staff Development.
Twinmom06 said:
Having just come off an 18 hour shift due to this very situation, it is the responsibility of the on call nurse to take care of that last patient - often times after working all day. On call (at least for me, not sure for Guttercat or idialyze) is 6 pm to 6 am the next morning. So it could come to fruition that we wind up working 24 hours because of being on call. Guttercat I wish I could like this twice

It's the same arrangement Surgery, PACu, Cath Lab and others have..being on call after working all day. Brutal. Twinmom06, are you OK with it, or what are your thoughts?

Specializes in PACU, pre/postoperative, ortho.
Twinmom06 said:
Having just come off an 18 hour shift due to this very situation, it is the responsibility of the on call nurse to take care of that last patient - often times after working all day. On call (at least for me, not sure for Guttercat or idialyze) is 6 pm to 6 am the next morning. So it could come to fruition that we wind up working 24 hours because of being on call. Guttercat I wish I could like this twice

Totally unfamiliar with diaysis scheduling here, but wondering...Would it work better to have more staggered start times like surgery does or at least have the call nurse start later in the day, 1100-1200?

Twinmom06 said:
there is also the issue of space. The hospital I'm in 90% of the time (we fluctuate between hospitals) we only have 2 dialysis rooms (although one has 2 machines in it now). Our boss could put 5 of us there but if we don't get another room (sometimes we can borrow an empty ICU room although that is really scarce now) then we're there 18+ hours to dialyze the 10-12 pts per day. Sometimes we cut treatments to 3 hours but we can't always get the docs to agree to that.

To answer your question Beth - it is what it is. One one hand the hours are brutal, on the other, I'm not running around a floor after 7 patients, toileting/medicating etc. My only focus is the patient in the bed in front of me - since they are inpatient acute, they aren't allowed out of bed and if they need meds, their primary nurse from the floor has to come give them.

We are lucky in that we have a large space (for now) within the hospital so that one RN can dialyze two patients at a time, three if we get one more RN in to help out. It really helps for situations like add-on's. The only 1:1's we do are in ICU.

Guttercat said:
We are lucky in that we have a large space (for now) within the hospital so that one RN can dialyze two patients at a time, three if we get one more RN in to help out. It really helps for situations like add-on's. The only 1:1's we do are in ICU.

What do you do about isolation pts? Our hospital let's us cohort the same isolation in certain situations. If the patients are different iso's then we have to do 1:1 txs which slow us down

Specializes in Dialysis.

I have done Dialysis for over 20 years now, I have been a Acute Staff RN and a Director of an Acute Inpatient Unit that did 800 plus treatments a month. This problem is universal with Dialysis, not enough nurses to do the treatments, not many treatments so you get sent home, demanding Doctors and Directors who don"t care how many hours you have worked.

I worked a 20 hour shift once and got lost trying to drive home.

That was my wake-up call, and I resigned soon after that.

I started out in a Chronic Unit, and I went back to a Chronic Unit, they have they're own set of problems, but at some point, I can lock the door, and go home without a beeper!

Every body is different in what they are willing to do , and that's okay. I made more money in Acutes, but to me, the pay wasn't worth the risks I took.

I think doing Acutes gave me HTN, and sent me into menopause at the ripe old age of 46 no less( only half-joking here!)

I don't know if there ever will be a solution to these issues, but I know what worked for me!

It is considered employer abandonment not patient abandonment. With employer abandonment, you could lose your job if you refuse the patient. With patient abandonment, you accept the patient assignment but leave without turning over care to another RN. Refusing an assignment is not patient abandonment, they cannot threaten your license if you refuse an unsafe assignment, but they can threaten your job. Job vs. license.

RainMom said:
Totally unfamiliar with diaysis scheduling here, but wondering...Would it work better to have more staggered start times like surgery does or at least have the call nurse start later in the day, 1100-1200?

This is something I have given some thought to over the years (staggering shifts) as a possible solution to the Acutes dilemma. It might work in some programs, but not all.

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