Here's the painful truth

[GlennGanza]

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.

[TNValley]

I got into HD in 2002 around the time when the duopoly was gaining momentum. Like you've described I was fortunate to have been in the right place at the right time to get decent raises/offers.

The gorillas blaming "The Bundle" for everything is getting old. I've noticed how the gorillas have changed over the years; they're acute/chronic hd's and then add pharmacies, and now they've started opening their own walk-in clinics. Lean? Efficient?

I'm not too concerned about the veteran vs. new grad RN's in chronic hd. The new grads have to have a veteran RN "cover" them for several months before they can be left on their own. Even after then the "rookies" still freak out and panic when patients go bad or code. Which, in my opinion, isn't necessarily a bad thing because it keeps them from getting too comfortable and casual. The rookies are also terribly inefficient. A lot of people just don't stay in it long enough to get over the learning curve, the responsibility curve, the patient demands curve, the daily staffing ratio curve, the productivity (efficiency) curve, etc. etc. you get my point.

There's a DMZ here in the TN Valley area; the two gorillas mostly stay on their side of the interstate.