How do you staff your Fresenius?

westieluv · Nov 13, 2014

The chronic FMC unit where I worked was also starting to go to the model where the nurse takes a row of patients for herself and is still responsible for another row. I didn't get that. I mean, a tech only has the duties of a tech to worry about and they each had four patients. I, as the nurse, had to run my row of patients, oversee the treatments of another row of patients, and still try to complete care plans, foot checks, med passes, rounding with doctors, and all of the 101 little things that pop up during a normal day in a chronic dialysis unit.

Is there anything about that that sounds fair?

One reason why I am no longer in dialysis. The more the companies focus on the bottom line and squeaking every last little penny out of each treatment, the less I want to be one of their guinea pigs, or rats in a maze, or whatever analogy you can think of to describe what they are doing to their nurses.

Guttercat, ASN, RN · Nov 13, 2014

How is one supposed to take a section of patients, simultaneously manage another section, and still oversee the goings on of the unit/techs and all that that entails as Westie described?

Do they have a charge RN that is managing the daily flow of work-- phone calls, interventions, MD communication, paperwork, and patient issues?

10:1 as a primary RN (without performing put-on's and take-off's) is entirely reasonable, but I sincerely question the rationale behind also giving that RN a full section of patients to run simultaneously. If all you have to do is pop over and do pre-post assessments on the other section, then that's doable. But not if you are expected to also manage both sections as a primary RN.

westieluv · Nov 13, 2014

We did not have a charge nurse to cover those other duties, although there were four chairs in a row, meaning the the RN had four of her own and four more to oversee, and then yep, all of the other duties because the only other nurse had ten patients of her own on the other side of the room but she didn't have to tech a row.

That made it hard too, that the nurse in the front of the room never had to tech a row but the nurse in the back did. NOBODY ever wanted to work the back, obviously, so at least they rotated us back there, but yeah, that's how it was. We had to tech a row AND manage our daily flow of work--phone calls, interventions, MD communication, paperwork, and patient issues. They did have a tech come in and take over the RN's row for the second shift of patients, though, so at least then you had the last four hours of the day to try to catch up on everything that you couldn't get to during the morning shift.

DialysisRN34, BSN · Nov 15, 2014

In the great words of Elmer Fudd: " ve-w-w-wy-ve-w-w-wy-carefully".

In all seriousness, ratios for staffing, unless specified by state law, are open to interpretation by the company. According to the Condition of Coverage regulation, staffing rations are decided by patient "acuity". So, who decides what the current patient census acuity level is, and what is the safe staffing for whatever stated acuity? The regulation don't specify who makes those decisions. So, there is a understood industry standard of 1:4 for CCHTs and 1:12 for RNs, however if the company wanted ratios to be 1:15 then legally there is nothing stopping them. I am fearful that is the direction we are going!!!

Guttercat, ASN, RN · Nov 15, 2014

In the great words of Elmer Fudd: " ve-w-w-wy-ve-w-w-wy-carefully".
In all seriousness, ratios for staffing, unless specified by state law, are open to interpretation by the company. According to the Condition of Coverage regulation, staffing rations are decided by patient "acuity". So, who decides what the current patient census acuity level is, and what is the safe staffing for whatever stated acuity? The regulation don't specify who makes those decisions. So, there is a understood industry standard of 1:4 for CCHTs and 1:12 for RNs, however if the company wanted ratios to be 1:15 then legally there is nothing stopping them. I am fearful that is the direction we are going!!!

It's become a fascinating industry to observe from the business perspective.

Once it was noted that there was $$ to be made (guaranteed ROI), dialysis became the realm of some really, really savvy and cutthroat business entities. They are in it to win it, and in it to make a fortune.

Now that there are ever-diminishing returns due to declining reimbursements, they naturally look to the easiest way to cut costs--staffing is the most logical avenue, as staffing is the single greatest expenditure in day-to-day operations.

The line of "safe staffing" will be continually pushed.

TNValley · Jan 30, 2015

Yep, 1:15 for 'Bama. I see this magical 1:12 number being floated around, but it's just a fairy tale around here. Although, there are some 10 and 12 chair clinics. I worked a 10 chair clinic in TN once upon a time, it was almost like being on vacation at work compared 1:15. I kissed turnover/change out/pt shift change/etc. goodbye and have been happily working 1:15 nocturnal for the past three years. Before I got to transfer to nocturnal I was working 1:15 on days, two shifts of patients Mon-Sat.

Anna S, RN · Feb 4, 2015

Years ago, Fresenius sent a out a survey to nurses who used to work for them, and asked why they quit. I was one of them and took the survey. Most nurses (including myself) cited having to be both a tech and a nurse at the same time, thus having way too much work to do, and less respect from techs, as the main reason they quit. That was my main reason, and that's what the survey showed.

For a while there, Fresenius was saying "Let nurses get back to nursing" and weren't even allowing nurses to do "tech duties" at some clinics.

Looks like they're going backwards.

I predict more nurses will be leaving chronics, and there will be a need for more travelers again.

TNValley · Feb 4, 2015

No no no Anna S, not the "T" word There was a big push in 2014 to eliminate agency/temp workers in clinics everywhere. As for "Traveling" staff, that means float, right? All new hires as of last fall are float staff. Yes, you've got your home clinic, but the new normal is that you'll be floating to any facility in your area that's short (shorter) staffed than your home clinic. There was an "area schedule" that was in effect in the TN Valley last summer due to several clinics having open positions. This was in effect for RN's and CCHT's. It was good to get out into some of the other clinics that were needing help, but it's not something I'd want to do all the time. Speaking of surveys, corporate sent out a brief employee engagement survey last fall. I keep asking/looking for results, but my clinic manager says there haven't been any released yet.

Loveyourkidneys · Mar 26, 2015

Gonna be hard to explain in court why you were responsible for that many patients. Tx state regulations say if a nurse is in a bay of patients as the primary tech he or she is responsible for only those four patients. That includes pre assessment, tx initiation, monitoring, meds and post assessment. There is still supposed to be a charge nurse do rounds to verify rx, goal access.

Lucky724 · May 22, 2016

I see this is an old post..but was curious as to if you still worked for FMC?