Inpatient vs. outpatient dialysis

[gam3rchic]

Hello everyone, i'm new to the forums but have been reading them for a bit learning stuff about HD. I have a question but first, some background info on yours truly:

I've been a nurse for 2 years now and have had a hard time finding my niche in the nursing field. I do love taking care of people, but i've worked on some crappy floors (managers wanting to make my life hell, etc.) and i've been personally searching for a specialty that I truly enjoy. I've done a little bit of everything in the 2 short years i've been a nurse: cardiac intermediate (post CABG, etc), ICU, homecare (peds patients), and now i'm doing long term acute care. Honestly, I think i liked ICU best, but the floor was full of witches and the nurse manager had it out for me so i left only after 6 monthes. I liked the technical aspect and the more challenging patients, but i don't think i want to go back, just b/c i had such a bad first experience.

I'm doing long term acute care, and it's ok, but not something i want to do forever. Besides, my husband is applying for a killer job that we will end up moving 3 1/2 hours away if he gets it (and we both hope he does!) so that means i have to get ANOTHER new nursing job (seems like I get a new nursing job every 6 monthes....oh wait, that's b/c I DO! ). I've been seriously thinking about HD b/c I think it will be a good fit for me. I used to do plasma apheresis before I got out of nursing school and really enjoyed it and was excellent at it. I like working with machines and i enjoy the sicker, more complicated patients that HD would throw at me. So my question is this: should I start out doing inpatient or outpatient HD? I've heard some negative things about outpatient on the forums, but to be honest, the politics and workday of it kinda reminds me of how the plasma bank works and it was stressful, but i'm the kind of nurse that I can't sit still for long. I enjoy being busy and would prefer running my butt off then being bored.

But I also like codes (i know, that's kinda sadistic:devil:) so i think maybe working in the hospital would be better b/c I get the even sicker people that would code time to time. I would appreciate any input and advice. These forums have taught me so much about HD and I really enjoy reading the posts. Thanks!!!!!! (Sorry so long......)

[southerngirl67]

I have been an hd nurse for 11 years. I started out in outpt. I am now an acute nurse. I suggest working with chronic patients for a while before you transfer to the hospital. Outpatient units have more resources to train you correctly. Unfortunately, in the hospital you are usually the authority on ESRD patients, esp at night when you are called in to take care of a critical patient.

It is very rewarding for me, but most people really love it or hate it. There is no in-between.

[DeLana_RN, BSN, RN]

I have also worked both outpatient (5 1/2 years) and now inpatient (7 months) dialysis.

It sounds like you would be well-suited for dialysis, your apheresis background is a definite plus - the hemodialysis (HD) machines - or peritoneal dialysis (PD) cycler machines aren't that different; a machine is basically a machine*. Also, your cannulation skills will help a lot - like apheresis, HD uses large bore needles.

Since you have recent acute care experience, I don't think you have to start in an outpatient clinic; if you can find a good hospital unit that will train you, you will be fine. I had a lot of problems with hospital policy and procedures after being away from acute care for several years (we didn't even have Pyxis then!); this will obviously not be a problem for you. One of the best nurses in my unit started there as a new grad! In inpatient/acute dialysis, you will deal with both routine HD and PD, and also with very sick pts in acute renal failure, hyperkalemia, or pulmonary edema; some are dialyzed in the ICU or ER, where you take the equipment. Codes aren't common, but they do occur (and IMO, it's much better to deal with a code situation in the hospital - in an outpatient unit, you (and the other staffers) are the code team, and typically only with BLS and calling 911. Now that's scary!! I admit I don't like codes ) Keep in mind that in acute dialysis you will typically be expected to pull call shifts (nights and/or weekends).

In outpatient, on the other hand, you can be very busy. Turnover - when the first shift of patients have to be taken off the machine and the second shift put on - is an extremely busy 2+ hours of your day. You will usually have your own assigned pts plus work with PCTs and/or LPNs. You will have other duties such as testing the water, calling the MD and writing orders, regular progress reports on certain patients, checking their meds, etc. A big drawback for me were the hours: I had to be there at 5:00 a.m. (which meant getting up at 4:00, and I'm most definitely not a morning person)! Some clinics do have more civilized hours, if this is a problem for you. A big plus in outpatient: you really get to know your patients, althought this is to some extent also true for our "frequent flyer" inpatients.

HTH. I encourage you to look into dialysis, it may just be the niche for you. And you will find out very quickly. Like pp said, you will either love or hate dialysis - I have never met someone who could take it or leave it

Best of luck to you,

DeLana

*And I have no technical aptitude... don't ask my how I survived my training