HD nurse acute/chronic are specialized area of nursing but we are paid less and if you're getting good pay now, soon you won't be. Reasons: 1. economics- supply and demand Back in early 90's, there's so many small companies, one will give me a dollar more and one year after, one offer me more just to get me aboard. And there's more willing to pay me as I get more experienced Now what, there's only two 800lbs gorilla left. Pay is stiff in a corporate and statewide basis, if you deserved a higher raised from your manager, they can't give it to you because it is above than the corporate wide standard pay scale. 2. Changes in health care- ask yourself, is changes for the better or for the worst when it comes to your salary? 3. Misconception- other RN,especially young and new grad...thought I'm setting in the corner doing nothing, so they wanna be like me. They take entry level salary. Then what happened. Push comes to shove, they fire experience RN. With so many entry level salary coming in, thus I become a liability instead of an assets- there's a still economics to this equation If you are not in this situation yet, you might still be in a state where there are still many dialysis companies competing, enjoy your big pay now and while it last, soon the duopoly is coming near you.