2 job offers, 2 different clinics, a few questions since I'm new to this specialty

[Lucky724]

I am not a new RN (over 20 yrs experience) but am new to dialysis..I have 2 job offers in hand which literally came with in an hour of each other and I am grateful for both..I didn't expect either one so I am not sure, not having dialysis experience, which would be the best option given my learning curve..

First one is a M-F home PD program. This program is small (10 patients) but the thought is it will grow. The patients are already established on the program. There is some travel to other facilities for training and sometimes going to the patients home but it sounds like that is when the training of the patient is happening. None of this is a concern for me however, I am really not sure there is enough work for myself and the FT LPN (who has been running this program since it's inception and is very,very good. The patients know her, she them and she has worked in dialysis - PD and HD for 25 yrs). My new boss is very nice, would be easy to get along with - as would the LPN. The pay is in the mid 50's plus mileage since I have no experience. My concern is being bored since the patients that are on the program are established and unless someone comes in for their scheduled follow up, it seems like the LPN just hangs out for the day, talking to others in the clinic, cleaning/straightening up... The hours would be 8:30 to 4 or 5 unless I'm traveling then they would vary. I am a person who likes to stay busy. I am also not thrilled w/a M-F schedule. The boss made it clear that if I needed time to go to an appt. it was not a problem. She assures me the program is set to grow w/some ideas that are in formation. I get the sense the program was thought to take off more but this clinic is located in an area where there are 2 other clinics from a major competitor as well as one hospital offering dialysis AND 2 renal docs having their own clinics.

The second position is in a small clinic (15 chairs I think..) and is HD. I am not clear on the difference between acute and chronic dialysis patients, but I am assuming since these patients come several times a week and have for years its chronic. The schedule would be 4 10 hour days starting at around 0600. I would work with an LPN who, again, has done this "forever" and seems really savvy. The boss is direct and I like that. She made it clear she has not problem working the schedule around for the the RN's (there is one now and then me if I take the position) but she expects, and rightfully so, that when someone is scheduled to work, they work. I don't know anything about the training program as yet, but I do know that the clinic was purchased by one of the larger dialysis companies (that is the competitor on a big scale to the other place I was offered a position). This job is about 35 miles from my home. The first one is about 15. This position pays MUCH more. My only concern with this position is the 10 hr days would REGULARLY become 12 or more. Even though the money is a LOT more, I value my time. I do not expect to go in, work 10 hours and leave. I know enough about healthcare to know you have to be flexible and things happen but if this were something that happened regularly it would be a problem. It doesn't sound like it is here though. The buy out doesn't concern me because, frankly, I wouldn't know the difference between before and after. I think I would have more to do here. Though the boss here said the RN, once trained, doesn't really take an assignment, ends up being like a charge nurse, overseeing everything.

I have a few days before having to make a decision..I know nothing in life is iron clad but I'd like to give this a real shot..I just don't want any job to BE my life, just PART of my life but I also don't know what the future of dialysis is..more in home or more clinic..or where a newbie like me would be better served and able to better serve.

Any advice would be greatly appreciated.

[traumaRUs, MSN, APRN]

You are very wise to question these positions:

Home modalities of dialysis - be it PD or Hemo are the wave of the future: the companies can bill CMS (Medicare) more for home than in-center.

Chronic outpt hemo does have long hours. You need to ask how many "shifts" of pts run in the 15 chair unit? If two - then the hours would probably be close to 10 hours/day. If three shifts, you would be looking at longer shifts.

Turnover (the time between shifts) is very routine, technical but routine.

For PD - yes once they are established pts, they are pretty stable. Again, CMS allows companies to bill higher than anything in-center so the growth factor needs to be figured into this too. I would ask how they are growing their PD population?

[MJB2010]

I work in a chronic clinic. I love the patients and the job itself, you really do get to know them well. I was offered 3 ten hour shifts, instead I am working two 15 hours shifts and one 12 hour shift. I am exhausted. I love my coworkers and the training was really excellent.

My advice would be to ask to shadow for a full shift at both jobs. Put yourself in the environment and see which one feels right.

At the clinic the training will be good and you'll be busy all the time, which you said you like. And the money is better. But you'll never see a 10 hour shift.

[madwife2002, BSN, RN]

In my Unit you work 10 hour shifts and rarely do you work more than the 10 hour shifts. Overtime is frowned upon on most occasions.

PD is growing and you would be starting out in a speciality which could put you in a strong position for promotion. It is not a stressful environment but you will see the patients numbers growing as TraumaRus stated it is the way forward as the companies are seeing $'s.

Dialysis is totally money orientated

[Lucky724]

I found out there are two "patient" shifts run each day..never 3. The nurses/techs work 10 hour shifts and rotate weekends (Sat). Does this sound like there would be on a consistent basis - much over time? I was assured it rarely happens and the 10 hours shifts are indeed 10 hours. This is going to be a big change for me so I'm trying to get as much understanding as what is expected as I can.

As for the home therapies...sounds like there is still a lot in the air w/this particular program which makes me a little hesitant because if this program was closed there would not be a transfer to another unit as there is only one and it's already well staffed...