Indiana University Nursing vs Davita Management of Nursing

[NDXUFan]

1. At IU, there are at least 7-8 RN's on duty at the Indiana University Home dialysis clinic.....

2. At IU, the dialysis clinic Nursing staff enjoys good wages and plenty of time off....

3. At IU, the vast majority of the Nursing staff has been there at least 20 years and many have been there over 30 years, a few have been there 35 years.

4. At IU, the Nursing looks at long-term costs, instead of short term costs.....

5. At IU, the Nursing staff has a great amount of power to make decisions......

6. The IU staff teaches home dialysis how to correctly clean fistulas, the IU infection rate for fistulas is zero.

7. I would do anything the IU Nursing staff would ask me to do. This includes getting up at 4 am to receive a treatment at the clinic and afterwards to have my fistula looked at, by a IU nephrologist/surgeon...... at the IU Hospital in Indianapolis. If you are curious, it is a 120 mile drive one way from my house to IU.

8. The IU Nursing staff looks out for the Home dialysis patient and is constantly reading the latest research. Many in medicine, I have noticed, could care less.

9. The best thing is last, they always ask me how they can improve, and honestly, I cannot think of anything. My RN case manager jumped my case about my blood sugar scores, my three month scores and she was right. The issue is that I was not getting enough sleep or I put off sleeping. The IU Nursing staff said that controlling blood sugar without the proper sleep is nearly impossible... With sleeping, my A1C score tanked to 5.4. Without her, might have lost my vision in the long run, that would have been a disaster.

I like Davita Nurses, what I do not like is how they are treated. This is more about bashing Davita management. Making money is not evil and every group has to make money at some point. However, as my RN mom said years ago, 12 hour days is not good or healthy for the Nurse nor the patient, I would have to agree..... The Nurse also needs a meal break to control their blood sugar and to be able to think straight and rationally for the dialysis patient. It is also insane that the Nurse cannot get any time off, this is very unhealthy. I worked for a company like that and after a certain point, I really started to resent them. You mean to tell me that you cannot have enough staffing when you are spending how much on that drunkfest, every year? I know that many Davita Nurses resent the management excesses of Davita management and so do the Davita dialysis patients. Many Davita Nurses are fired for disagreeing with this style of management and many Davita patients are discharged for complaining about the crappy care that is dished out by Davita management. I have had many Nurses who worked for Davita say that they were afraid for the safety of the patients, that does not surprise me. The Davita RN is taking care of how many patients at time, again? Then, if something happens, it is all on the Davita RN, how goofy. You can better believe that management will not be taking the blame that the care standard was started by them in the first place. I would love Thiry and his management friends to have some of the care that he thinks is so great for us or take care of zillion patients at one time. When I was In-Center, I learned to put in my own needles and run some parts of the machine.

I love being at home and that is one less patient that the Davita RN has to take care of, God knows they have more than enough work to do......

[NDXUFan]

Chisca:

I would have to agree with your definition. I would not have an issue with Davita and Fresenius if they were in a truly competitive market, think just about every other industry or field, cell phones, cable, satellite dishes, grocery stores, etc. Davita profit is actually lower than the vast majority of the American business landscape, at 4 percent(Wall Street Journal. Most corporations have an average profit of 6 percent(Wall Street Journal). Yet, the Davita stock price is much higher than most American corporations.

One of the main reasons that Davita is a monopoly, along with Fresenius, is that they are constantly buying out other dialysis clinics, nursing clinics and other forms of medical care(Wall Street Journal). In addition, under law, Physicians have a fiduciary duty to the patients that they serve, as comparable to an attorney, not to other third parties such as Davita or Fresenius. It is an incredible conflict of interest for Physicians to take money from Davita and Fresenius, which is a conflict of interest with the primary individual, the patient. It is also a conflict of interest for the dialysis staff to wheel free meals in front of dialysis patient, whom they lecture about food all day long. Again, if enough dialysis was being given, this would not be a issue or problem. When I worked as a county police officer, we were not allowed to take anything from anyone, ever. Every year we were required to disclose a conflicts of interest statement and I think individuals who hold someone else's life in their hands should be required to be held to at least that minimum standard. My RN sister said that every single day, they are given food by drug reps, every single day of the week. "If we wanted breakfast on Saturday, the drug company would bring that as well." Money in the dining of the medical establishment works, otherwise the drug companies would not be paying billions per year in these allocations, they are not doing it because they are nice people. They maybe nice people, but, they are doing it to further an economic interest, the selling of very expensive medication.

Many in dialysis complain that dialysis patients do not pay enough for dialysis. The issue that I have with this is that the dialysis schedule makes it nearly impossible to work and have private health insurance benefits. At the age of 38 and I had been an athlete for years, I felt like I had been hit with a baseball bat after my first dialysis treatment, can you imagine what someone who is 60 or 70 years old would feel? The human body or kidney removes fluid slowly and not all at one time, like dialysis. The human body is not made to work in this fashion...... Not enough dialysis is being given to eliminate the feeling of exhaustion in the dialysis patient, I know, I lived it at 38 years old. Honestly, it is worse than when I was running 6 miles per day to get into the Marine Corps.....

Another issue that I have is that dialysis patients not be allowed to get off of the machine to use the restroom. As a person who runs their own dialysis machine, not sure why they are not allowed to use the restroom, it would only take a few minutes, what is the issue here? At current standard, they are only getting 12 hours per week, if they were getting dialysis four days per week, as has been suggested by a number of Fresenius Nephrologists, this would not be an issue.....

One of my suggestions would be to have a patient rep, who would take complaints and confront patients who are constantly late. As a patient rep, I would not tolerate people showing up 30 minutes late. This type of behavior is childish, rude, and inconsiderate. Yes, I would understand if they were just coming from a physician's appointment, as we all know, they are generally running late. When I knew I was going to be late because of a doctor's appointment, I would notify the clinic a few weeks beforehand.

[NDXUFan]

I realize that many Nursing people really try to make dialysis bearable, sadly, my complaints are directed at a small minority. If the small minority behaved as the majority, there would not be an issue or issues. Unlike the Nurses, management really does not have a clue in how to run a dialysis clinic..... I know and realize that the Nursing staff is being told what to do with individuals who have no clue. I met some very good Nursing people at Davita. Yes, I know that everyone of you would like to be a former dialysis nurse, no one has fun in dialysis, not nurses, doctors, or patients. It is like the police officer who tells you not to run the red light and then turns on their lights to get past the red light, without it being a true emergency, such as armed robbery or assault. I hated those guys and anyone who abuses taxpayer dollars.

[fragino]

Getting food EVERY DAY from drug reps? Really? Staff bringing food out to the dialysis floor for the patients? Really? Not allowed to go to the bathroom? Really? I would like to hear from ANY dialysis staff on here who have personally seen any of these things in the last five years.

Yes, nocturnal is way better for the dialysis patient and it is rightly getting more popular but most of these patients can't even tolerate sitting in the same chair for three hours in the clinic but they can sit in their living room and snack and drink the whole day.

If IU could really figure out how to profit from expanding their outpatient dialysis services, they would have done so and quickly run Davita/Fresenius out of town. IU like everybody else is run by bean counters. If the money is out there to be made it would have been done. IU by June 2009 received an endowment of $1.3 billion and that's with a bad economic year.

"Undoubtedly, the difficult economic environment affected the endowments of all institutions of higher education in the past year, just as it has at Indiana University," said IU President Michael A. McRobbie. " Indiana University Foundation - IU Endowment Rises In Market Value National Rankings

You cannot seriously compare the fiscal models of IU with Davita or Fresenius.

[Chisca, RN]

The future is now. This device weighs 4.7 kg.

Debiotech and AWAK Enter into Joint Agreement for the Development... -- LAUSANNE, Switzerland and SINGAPORE, October 31, 2013 /PRNewswire/ --

[NDXUFan]

My RN sister said that they received food from drug reps, every single day at the physician's office, most of my family is in Nursing.

Dragonfly: The other day I went to dialysis and after about 1 1/2 hours through my treatment, I had to use the restroom, for a bowel movement. They told me that if I get off I can't get back on, I told them I still had 2 hours to go, what am I suppose to do? They said to hold it... Hold it for two hours, they are crazy. Are they allowed to treat us like that? We choose to get off and can't finish treatment and we stay on happen to let it go and sit in it until we are done? Really? I would love to see them sit in a chair and hold it for all those hours, personally I would just love to see them sit in a chair for 3-5 hours. They have also started to cross our tubing over our bodies, is that right? It makes me feel uncomfortable. Also I crochet and make baby blankets for donation while on the machine, the way they have the tubing I can't move my arm. I have a huge bruise on my arm from them trying to fix my needles. The next time I went there I was talking to the PA and the Tech that did this to my arm came over and started listening in on my conversation and when I started talking about my arm (for some other reason) he interrupted and the PA walked away and I couldn't remember what I was going to say to her. Then one of their Techs kept hitting on my daughter. It is getting crazy at the center now, I wish I was brave enough to put my own needles in and that I had the room, I would so do hemo at home.

I said that food was brought for the people who work in dialysis, not the patients, and it was wheeled out in front of their faces, pretty rude and arrogant. I am curious, would you tolerate sitting in a chair for 3-4 hours, 3-4 days per week? I sit in the chair at night for 6-8 hours, 5-6 days per week. If the food was brought out and the dialysis patient was starving, you would be lecturing them about the food content, as they were dying, do you ever give it up? Would you be willing to live as we do, would you be willing to live on the renal diet??? Whoever came up with that diet has a few screws loose...... Who gave you the right to lecture us, I think it is time for you to have a dose of your own medicine......

Dialysis was meant as a bridge to a transplant, not years of dialysis, moralizing and lecturing that have no basis in reality. As stated by the Senior IU Nephrologist, "The cause of diabetes is unknown." When I asked about the claim that 400,000 people per year are dying from obesity, he said, "ND, that is a bunch of foolishness." I had a number of hard math people look at that claim, they said it was mathematically incorrect.

You mean that they snack and drink and watch the television, like 99 percent of America? OH THE HORROR!!!! Maybe if you talk to them about the benefits of Nocturnal dialysis, you would not have obsess over their labs, that problem would go away. Better yet, have some Nocturnal dialysis individuals talk to them. I guess as when I was with Davita, Thiry was too worried about his own pocketbook and too afraid of a lawsuit, but Home Nocturnal is being done by some of America's best Hospitals and you can monitor them over the internet, yes, it is being done.

We will talk about fiscal models, I have to run to the store, I am looking forward to it. It is clear to me that dialysis patients have been set up to fail with standards that come from Alice In Wonderland.

[fragino]

No, they cannot tell you you have to hold your BM. You have a right to the time slot that you have. I would talk to the boss of the center and tell them that it's abusive to the patient. Patient abuse is an automatic report to the authorities. If the boss or RN or any health care personnel does not report it, it will cost them money and their job.

However I'm not sure if you can crochet while you are on dialysis. Those are steel needles in your very important and delicate fistula. Even buttonhole needles are sharp. Repetitive movements of the arms may cause you to infiltrate as you damage your fistula walls.

Food is not usually allowed on the dialysis floor. If it is being done so, then it is probably in violation of the center's policy. It is not only a cleanliness issue for the patients but who would eat food brought into the treatment area with all that blood around?

Yes the ideal would be to get a transplant. However, as you know, there are not a lot of kidneys available.

When a person is on dialysis, they can no longer do what 90% of Americans or other peoples do. They can no longer drink as much as they want, they can no longer eat potassium or phosphorus rich foods in mass or even moderate quantities. They should not eat those chips and other salty foods. They have a disease that has to be managed. I tell my patients that there is only so much that dialysis can do for you. Most of it has to be managed by you.

Everyone, profit or non-profits obsess over labs. It's the only way to know how the disease is being managed. Many patients lie. The best lie detector I've ever had is the hemoglobin A1c test (A1c). I get told all the time that 'yes, I check my sugar three times a day and take my meds, insulins and watch carefully what I eat.' When I tell them that their A1c is 12, they say, 'oh, I just ate something before they took my blood. I then tell them that it's an average of their glucose level of the last 60-90 days. It helps to cut through the bull. Are they really watching their potassium or phosphorus intake? Are they really taking their binders?

[madwife2002, BSN, RN]

I do not think it is acceptable for dialysis staff to be eating and drinking in front of the patients, not only is it not professional but it unhygienic.

NDXU fan I have worked in dialysis for many years, and when I read your postings, I get the sense that you are very angry! I think that the hand dialysis patients have been dealt is very harsh, the diet sucks but in order to keep homeostasis you have to try your best to adhere to the diet, the amount of meds you have to take is extreme, time spent sitting on the dialysis machine long and hard.

I have worked in dialysis since 1993 and haven't really seen many changes, PD would be something I may choose if it happens to me.

Transplants are few and far between, many centers I have been involved with only have 7-12 pts who are on the transplant list due to various issues.

Dialysis centers are run by a manager and the culture of the center is controlled by the manager. If you are experiencing poor treatment and poor care, then you need to approach the manager, Davita and Fresenius are huge companies but individual centers are controlled by the FA.

In the past 9 months in the dialysis centers where I work, I have not seen any drug reps, nor have I seen any food bought for us by drug reps.

In my previous company in 4 years we had food provided for us by drug companies in the past but this practice has since been stopped, we are not even allowed to take pens anymore

[fragino]

Heck I'm also angry, at what healthcare has turned into, at what I've seen happen, at what I've allowed to happen, and what I've had to do myself. I've slid into the protective cocoon of pragmatism and have tried to do the best with what I have and where I am. I don't have the energy or the enthusiasm to make a good crusader. I find that I cannot lean into the language of hyperbole that is frequently used. I cannot agree with it even when it states the side of the case I'm on. It feels like lying.

madwife2002 really makes a good point on how individualized the personalities of each facility can be depending on the who is in charge. However the FA may have the title but sometimes the nurses run it (whether as a nurse/clinical manager or floor nurse), sometimes the techs run the place and heck I've known of a place where the administrative assistant ran the whole place.

I would have liked to work at a university-run Medical Center where profit is not always paramount. Where you actually have time and resources to do good nursing care and without the constant specter of managing profit/loss. But they're not anywhere near where I live now and even if I did, those jobs are hard to get because nobody leaves them for very good reasons.

[Chisca, RN]

"In the United States, for profit dialysis ownership of dialysis facilities, as compared with not for profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant. "

MMS: Error

[NDXUFan]

The transplant process is very hypocritical. If someone needs a transplant, their wallet is scanned for funds to perform so the hospital can profit to the average tune of $250,000. Yet, the same people who scan the wallet of the kidney patient, are the first to say that you cannot pay someone for a transplant. It is hard to believe that third parties are making decisions for the people that have the most to lose in a transplant, the person who needs the kidney and donor. It blows my mind that the very same people who scream about privacy between a woman and the doctor are the very same people who would have transplant decisions made by third parties with absolutely nothing to lose.

Simply put, the third parties who are making decisions for the individual and the donor, would not live that way themselves. It makes me laugh when the very same people who are making a fortune off of people needing transplants, would be loud and vocal about opposing people who would make money from being a kidney donor, being critical of people who are doing the very same thing as the third parties, making money. OH THE HYPOCRISY!!!!

Taking money from the drug companies is a major, major conflict of interest. The first job of a drug company or any other company is to make a profit, they are not working in the best interest of the patient. In fact, most drug reps do not have any science background, it is in Marketing.

No, not angry, just pointing out the hypocrisy is just so very easy. :)

[NDXUFan]

I would have to see the stats, but, it would not surprise me. For profit places like Davita and Fresenius have much higher costs in the long-term, because of the required costs of hospital stays from fistula infections from crappy infection control care. Madwife, I do agree with many of your points. You are right, dialysis care really has not changed in 30 years. Yet, with emerging technology, I do not think that people will be on machines in 10 years. In fact, it is going to be out patient and many in dialysis will lose their jobs and the cost of dialysis is going to greatly decrease. In fact, there are scientists in Japan that are using nanotechnology to work on a very cheap and good form of dialysis.... and I would have to guess it will be ready in the next few years.

I am on home dialysis, I am not in a center. I have dialysis 5-6 days per week and I pretty much eat and drink as I please. I have a great fistula and I have learned outstanding infection control from IU. The Nursing Staff at IU is wonderful and I know they really care about me and the other home dialysis patients. The reason that in-center dialysis patients have such a hard life is that they are on a treatment schedule is that is not anywhere close to reality and the real world. The bare minimum for dialysis should be 5 days per week, 6 is a good idea. Over 90 percent of dialysis personnel admit that they could not live as they demand from the dialysis patient, that really tells me something....

I know that dialysis is going to change radically in the next five years. Eventually, Davita and Fresenius are just going to be a bad memory.

[zero.]

Americans are a different breed altogether. If we told our patients that an extra hour would be beneficial I would guess 90% of them would say no. Also, most of my patients have a monstrous time trying to follow the minimum renal diet guidelines and an IDWG of >5% is the norm here. I have a patient who came in almost 8kg/EDW of 96 and when I asked him to come today for extra he said he was too busy! Many of my patients are my patients become of poor lifestyle choices and sticking a fistula into them and hooking them up to machine does not mean they're going to start pursuing health seeking behaviours.

Yes American patients are a different breed indeed. When American patients contact us when they plan on a cruise or a week's vacation in the Caribbean, we give them the requirements on booking treatments with our clinics. A lot deliberately skip the MDRO cultures and play dumb that they didn't know about it when we ask for it. Even their GP's say they don't know about it. I go the extra mile and give them more information (when in fact they can search for information online) and they refute that the cultures are unnecessary nonsense. Wow, how unprofessional of them. Maybe next time I would have to refer them to the CDC.

I have turned down numerous treatment requests because of deliberately skipping one or two of our needed cultures and then patients are scrambling to get them done 1 week before their departure. However I experienced the opposite from Canadian patients. I give them the requirements, and even before the set deadline, they send everything, complete, nothing pending.

It's not only Americans who have their treatments with us. In a day alone our dialysis floor is like a UN Security Council meeting with a mix of patients from the US, Canada, France, Germany, and UK.

We have our clinic requirements and vacation patients have to comply with them. The same way our patients comply with DaVita's or FMC's requirements when they go for vacation or further medical treatment in the US.