How is your inpatient acute dialysis unit run and staffed?

[drivesbarefoot]

Our unit is unlike any other inpatient acute unit I’ve worked at in the past mainly because we continue to run newly started ESRD and AKI patients as outpatients who have been discharged.  (Our unit is part of the hospital, we hospital staff and not run by either of the big 2).  The ESRD patients and sometimes AKI patients eventually get placed in outpatient units but it sometimes takes weeks and even months.  When our acute inpatient load gets heavy, it makes for a difficult day to say the least because we have our resident outpatients. Plus our site manager needs to spend so much time working on outpatient placement, monitoring URRs and other chronic monthly labs, care plans, etc but yet is expected be a resource, do patient care every day she works and also take call. 
 

We had 9 full time RNs but because of all the challenges with healthcare in general these past couple of years, we are down to 3 core staff RNs and utilize travelers. We also have a great group of LPNs and CHTs. We are about to lose another core staff RN (in this case our site manager who has managed to do a great job but is at the end of her rope) and this will definitely throw us into crisis staffing. I’m curious, anyone in acutes run outpatients as their “home” unit until placement? And what are your site managers typical duties in a “normal” acute inpatient unit that doesn’t run outpatients?  Also, are there any independent hospitals that offer great incentive call pay?   Sorry this got long and thanks for your response in advance!