Inpatient Oncology to Outpatient Dialysis?

[MSJRN813]

I am looking for some advice regarding a change in my nursing career. I have been a RN for about 2.5 years now. My first 6 months I spent as a RN at a long-term care/rehab facility. From there I went to a very large, busy, teaching hospital on a very busy inpatient gyn-oncology floor. I have been there for 2 years now.

I am looking for a change. The hospital setting has become too stressful and the demands put on the nurses are becoming increasingly difficult and unreasonable. Though I dearly love my co-workers and patients, the setting is too high stress. I hate the feeling of dread and nerves that comes over me before every shift!

I have looked into doctor office positions, but there are none available in my area.

I am looking for more information regarding outpatient dialysis. There is a place near my home that is hiring for both a hemodialysis RN and a peritoneal dialysis RN. I have a little bit of peritoneal dialysis experience. How is the training? What can I expect as far as workload/stress in the outpatient setting?

Any info. or other ideas for a change would be greatly appreciated!

[missladyrn]

Is the position with FMC or Davita? If you post in the dialysis section under specialties, you might get a lot more responses. In my case the training was very good, but the company I work for is shady. The told me I would get mileage for training, told me my shifts would be 10 hours, told me a lot of things that turned out to be blatantly false. There are some questions you need to ask before accepting the position. How many shifts of patients, will you have your own pod, how many RNs in the building and how many techs, how many patients per shift. This is all info you need to make an informed decision. Best of luck!

[Guttercat, ASN, RN]

Agree with missladyrn, cross-post this in the dialysis forum.

As to your question, it depends upon the company, the size of the unit, the nurse manager and how he/she runs it.

There are so many variables to differing units, that it's very difficult for any of us veterans to say yay or nay on your decision.

Dialysis is neat for several reasons, some of which are:

Failed kidneys affect every body system, so you remain "in touch" with a multitude of pathophysiologies.

You are able to develop a relationship with your patients over time.

You become less intimidated by tubes and buttons and wires.

Nephrologists are usually a great bunch to work with.

Outpatient dialysis can be heaven or hell. In general, look for a smaller unit (10 or less stations). Also, consider acute inpatient dialysis.

Keep in mind that with the new "bundling" reimbursement, and state and federal guidelines/oversight, RN's in outpatient dialysis clinics are stretched to their limits with greater and greater demands. Paperwork has grown exponentially; gone are the days of a concise, monthly summary you enter in on your patients' charts. Now, you will be filling out page after page of material, monthly and annually. They're very much like the MDS careplans in a nursing home. Problem is, there are no "MDS Careplan Coordinators" in dialysis units, the RN is responsible for tracking these. Some units provide the RN's with "paper days" each month to complete these, but most that I know of require the RN to get it done in between the running they're already doing.

Also, staff to patient ratio is bare-bones in many units.

Go in with your eyes wide open. It's a GREAT specialty, but no two units are alike.

[just keep swimming]

I agree with the previous posts and stress that if you are looking for a less stressful environment, you should look at a smaller unit. I have 36 patient that i see everyday so I am constantly running and breaks are not easy to come by. Dialysis is something you either love or hate...if you love it, you put up with the stress. As for peritoneal I don't have any experience but I would assume there is still a ton of paperwork but less running and less pt contact. Good luck!

[madwife2002, BSN, RN]

Guttercat-great advice

[Marisette, BSN, RN]

I agree with the obove post. Even within the same company, dialysis clinics may be very different. Ask about staffing for the facility you will work for, number of nurse to pt. ratios, tech.s in unit. Personally, I feel the corporate take over by large dialysis companies like Davita, and FMC has made dialysis nursing very stressful. High pt. to nurse ratio, excessive paperwork and a mentality where MBA's and administrators are valued more than nurses. There are multiple layers of management , i.e , team leader, clinic manager, area manager, operations managers, vice presidents.... The companies are for profit and managers WILL get their bonuses. At the facility I'm employed, we count syringes, bandaids, and boxes of gloves, dressings. We have patient care technicians that are responsible for non patient care responsibilities because the company eliminated techs. who were responsible for stock and other ancillary care duties. Registered nurses are responsible for patient care, performing dialysis treatments if a tech. calls in sick, completion of care plans, supervision of patient care technicians and problems their patients may experience during hemodialysis treatments, and implementing a series of what they call algorithms to achieve medicare outcomes or goals. The algorithms are policies and procedures nurses follow to administer medications to manage anemia, bone disease, etc.. according to the patients blood test results. I feel some nephrologist basically come in to the facility to make rounds, or wave at the patients because the nurses are indirectly (through algorithms) changing medications dosing etc... God forbid you make a mistake with an algorithm. They have compliance policies that dictate when to wear mask gloves, face shields, mask, when to touch and not touch dialysis machines, wash hands etc.. and depending on your clinic manager, failure to comply, will get you a verbal or written warning.

In the acute care area, be prepared to take on call, also driving to multiple facilities, working pm's or nights. In the peritoneal area, you will also take on call,and sell or market the program. If you patient census is low, they will decrease your working hours or move you throughout different facilites. Again, here there are numerous algorithms to follow and non compliance by patients is blamed on nurses failure to train or educate. Nurses are also responsible for billing for services, treatments, insurance forms etc... because these nurses work independently and don't get much help from secretaries, techs, etc...

Compensation for on call is poor at a flat rate, but not compensated for time spent on the phone. Patients on peritoneal dialysis will require some home visits. Recently, the dialysis companies have also decreased social work and dietitian hours to meet theri profit incentives.

In this economy, we are lucky to have a job and I wonder if the work loads for all nurses is difficult everwhere. I guess it comes down to what you consider to be stressfull, but I thought I send you some specific info. to help you decide. Good luck.