Inpatient dialysis

BrantleyRN · Apr 23, 2019

You are right to say the hours are less structured... it is impossible to know how many patients will need running on any given day, especislly if you do multiple modalities (HD, PD, CRRT, Apheresis)

However there is more autonomy and a closer working relationship with the nephrologists. Also I just like the hospital setting personally.

There is also an on call part to the acutes job for emergencies, someone on the team needs to be available 24/7.

I manage a team of acute nurses in Utah and am an acute nurse myself. I am very open with new hires on the requirements and what to expect.

10GaugeNeedles, BSN · Apr 23, 2019

On 1/23/2019 at 12:20 PM, nurseontheway said:
I have worked in a chronic clinic for many years and am thinking about applying for an inpatient position. I know that the hours are less structured. What are the differences/benefits of working in an acute setting versus a chronic one?

I don’t do chronics. But for acutes (and it will vary by region and company how things are run)...

autonomy: you run your own show. It’s all you. No techs. You setup, break down, the whole deal. There’s a bigger assumption that you will have full control and do it right so, know your policies. But you do feel a greater weight of responsibility.

Solitary: you will be surrounded by people that don’t know dialysis. You rarely see your coworkers. We stay in contact via text and phone but, there’s no “work family feel” you get as a bedside nurse. You might find it lonely, you might find it liberating. But it feels very solitary. And you will hear every misunderstanding about dialysis by nurses that you can imagine. you really get to understand how specialized your specialty is.

variety: you’re all over the place and each shift feels different since you could be in 3 hospitals over a shift. It rarely feels routine. I work nights so, often have hassles with missed orders, getting heparin, consult is not the same as the on call which can be annoying, lots of little things specific to nights. It’s always the same but it never feels the same or routine.

It’s always your fault: and this is likely just nights. Day shift bumps some one to run overnight. You show up at 0100 and they want to know why you are so “late” cause, you know, we are just sitting around playing cards n stuff. LOL. But it does get to you with the whole blame game. And your manager generally does the same thing by saying you are supposed to call ahead for ETA or you were supposed to wouldcouldashoulda. well, you generally don’t know your eta till later but, that’s the line they give you cause you are blamed for everything and the boss is getting hassled by the hospitals and nephrologist. But all cr@p rolls downhill and you are at the bottom capiche?

Satisfaction: you do an incredibly life saving job. Often at night, you showing up and running the treatment literally saves lives directly. It can be SUPER satisfying. You get to see t waves shrink, oxygen coming off, follow up abgs go from life threatening to stable, potassium goes from life threatening to WNL. And YOU fixed it. For me, that’s the coolest part. I get to directly fix life threatening medical problems and often, I’m the only one in the whole hospital that can do it. HOW COOL IS THAT? Also, you get to introduce new ESRD pts to their new life style. You get to explain what they can expect in this new world of dialysis. This person is about to have aHUGE life change and you get to help them but understanding what is going and what to expect. You have a VERY real impact in people’s lives.

Overtime: at least in my market, you can literally work as much as you want. I could work 7 days a week 16 hrs a day if I really needed the money and it didn’t kill me. My point is, they generally have no problem with however much overtime you want to tolerate.

Learning curve: acutes really is different and you won’t know till you go.

Theres more but, that’s my 2cents. I wouldn’t do anything else in nursing.