Micu Rn Wanting To Get Into Hemodialysis

missmacrn · Feb 9, 2005

I hope I can answer some of your questions. I will have to think back to when I worked in the U.S as a dialysis nurse. I have been working back in Canada for 5 years in dialysis and it is quite different from nursing in the states. Yes, it is quite possible to get hired without experience. You will get trained on the job. I was hired at Fresenius without experience. If you are in a outpt. clinic as I was you will probably be open Mon-Sat. I worked very early days, 12 hour days. The pay was, if I remember, comparable to the pay I made at the hospital. In the outpt. clinic you have techs. I think we had 2 or 3 techs and 2 RN's for a 12 station clinic. Any full time job and completing an MSN program will be challenging! A lot of the next questions all depend on the type of clinic and how much staff there is in your unit. We didn't take call because it was strictly outpt. If dialysis was required they went to the hospital off hours. Where I am now we require an on call nurse from 1 am until 7am. (we are opened from 7 a.m-1 a.m) We also need a Sunday on call. from Sat 1 a.m until Mon 7 a.m which is split into shifts.

I hope I answered some of your questions. Dialysis is really a great place to work. You don't get near as many "codes" but be aware that they do happen. More so where I am now. I work in an acute hospital setting. I still love it. No nights and Sundays off! (just the odd on call. We have 90 nurses working in our program though!!)

Good luck in whatever you decide.

I have been in MICU for 4yrs now, planning to take CCRN in MAY 05 and i'm considering a change from bedside nursing. I have had enough of the Code "Blues", "Browns, "Green" and every other color in the spectrum. I am also completing my MSN FNP, but may not work as an NP because of all the medical/legal beauracy, added responsibility with little if any substantial pay increase. I see dialysis as a way to still use my critical care skills, avoid a lot of the physical patient care duties and contiue to be in a demanding career field with good earning potential. If any experienced Dialysis RN would please answer the following questions for me.
1. Is it possible for me to get hired without any dialysis experience?
2. What type of hours/days off will I be looking at?
3. How is the pay compared to general practice RN?
4. What is the typical patient to nurse ratio in the outpatient clinic?
5. Do you get paid time off and is it hard to schedule time off?
6. Is it possible to complete an evening MSN program and work full-time in outpatient dialysis?
7. What is the typical call that one might be obligated to take?
8. Considering between FMC, Gambro or Davita for employment who would you choose and why?
Please answer at you convenience and add any "FYI" that maybe help in my future decision.
Thanks In Advance,
Your Fellow Nursing Colleague :chuckle

nosonew, BSN, RN · Feb 17, 2005

I have been in MICU for 4yrs now, planning to take CCRN in MAY 05 and i'm considering a change from bedside nursing. I have had enough of the Code "Blues", "Browns, "Green" and every other color in the spectrum. I am also completing my MSN FNP, but may not work as an NP because of all the medical/legal beauracy, added responsibility with little if any substantial pay increase. I see dialysis as a way to still use my critical care skills, avoid a lot of the physical patient care duties and contiue to be in a demanding career field with good earning potential. If any experienced Dialysis RN would please answer the following questions for me.
1. Is it possible for me to get hired without any dialysis experience?
2. What type of hours/days off will I be looking at?
3. How is the pay compared to general practice RN?
4. What is the typical patient to nurse ratio in the outpatient clinic?
5. Do you get paid time off and is it hard to schedule time off?
6. Is it possible to complete an evening MSN program and work full-time in outpatient dialysis?
7. What is the typical call that one might be obligated to take?
8. Considering between FMC, Gambro or Davita for employment who would you choose and why?
Please answer at you convenience and add any "FYI" that maybe help in my future decision.
Thanks In Advance,
Your Fellow Nursing Colleague :chuckle

Okay, fantastic! A 6+yr chronic hemo nurse here...

1. Yes. I know Davita will hire without experience, and likely all the others. (BTW, Davita just bought Gambro)...Most nurses DON'T have dialysis experience, so most are hired without it.

2. Depends on the unit you work in. If it is a 6 day unit, it is more flexible. If it is a 3 day unit, like mine...I need/have to work MWF 5a-close. That could be 3pm, 5pm, 8pm. Just depends on patient census and staffing.

3. I am paid far better than any other nursing job I could get in my town. And the benefits are tremendous!

4. In my chronic center, we have 12 chairs, 27 patients (3 shifts) and 2 nurses, 3 techs. We don't have any other help. A very part time dietician and very part time social worker. It is ALOT of work, as I am literally on my feet from 5a-3p with a 30 minute break for lunch...then things slow down and I can get my paperwork done.

5. Yes. PTO and EIL (Extended sick leave) Davita pays for your long term disability, and I highly recommend the staff member get short term disability (they pay a small amt per check)...Also, you fill out a form to request off...the earlier you request off, the more likely to get it off. I have never had an issue and we have few staff members.

6. Yes. Davita pays 3000/year for furthering your nursing education. I am working on my BSN and then will go for my MSN. I do most of mine on-line now, however, scheduling around schooling is more up to your administrator of the facility. They are all different. That would be a great interview question to ask them. (How they handle that).

7. In a chronic center, there is NO call. However, if you choose to do Acute Dialysis...I believe there is call. However, I don't do that (due to young children...no time for that) so I don't know that answer.

8. DAVITA, DAVITA, DAVITA! Why? Excellent company, great core values, great mission statement (all of which they live, eat and breathe daily), FANTASTIC CEO Kent Thiry...who has been tremendously successful in turning a failing company in 99 around to a very, very profitable company today. Benefits...401K, Stock Options, Profit Sharing, Bonuses, Education Reimbursement-up to 3K per year, also, they have programs for your children to get $$ for college, starting in 6th grade I believe, plus they do a "Village" thing where if a Davita employee has a severe problem (death of child, illness, severe disability, tragedy, etc...) other employees can donate $$ or even PTO to that person, and Davita matches, doubles, or triples the $$ for them. TALK about taking care of their employees! Plus, there are great training programs, and ALL employees go to a Davita University...where everyone employed by them meets the CEO, Kent Thiry. There are other benefits...health insurance at a minimum cost, etc... I just can't remember them all.

They have a "One for All, All for One" philosophy that they truly do live by.

Well, off my soap box...I have NOTHING but good things to say about them, and I am not an administrator, nor am I paid to say these things...I am a chronic hemo nurse in a small town in Kansas...I have been here since 98...learned much, had many changes, and learn something new every day!

Good luck!!!!

jnette, ASN, EMT-I · Feb 22, 2005

Okay, fantastic! A 6+yr chronic hemo nurse here...
1. Yes. I know Davita will hire without experience, and likely all the others. (BTW, Davita just bought Gambro)...Most nurses DON'T have dialysis experience, so most are hired without it.
2. Depends on the unit you work in. If it is a 6 day unit, it is more flexible. If it is a 3 day unit, like mine...I need/have to work MWF 5a-close. That could be 3pm, 5pm, 8pm. Just depends on patient census and staffing.
3. I am paid far better than any other nursing job I could get in my town. And the benefits are tremendous!
4. In my chronic center, we have 12 chairs, 27 patients (3 shifts) and 2 nurses, 3 techs. We don't have any other help. A very part time dietician and very part time social worker. It is ALOT of work, as I am literally on my feet from 5a-3p with a 30 minute break for lunch...then things slow down and I can get my paperwork done.
5. Yes. PTO and EIL (Extended sick leave) Davita pays for your long term disability, and I highly recommend the staff member get short term disability (they pay a small amt per check)...Also, you fill out a form to request off...the earlier you request off, the more likely to get it off. I have never had an issue and we have few staff members.
6. Yes. Davita pays 3000/year for furthering your nursing education. I am working on my BSN and then will go for my MSN. I do most of mine on-line now, however, scheduling around schooling is more up to your administrator of the facility. They are all different. That would be a great interview question to ask them. (How they handle that).
7. In a chronic center, there is NO call. However, if you choose to do Acute Dialysis...I believe there is call. However, I don't do that (due to young children...no time for that) so I don't know that answer.
8. DAVITA, DAVITA, DAVITA! Why? Excellent company, great core values, great mission statement (all of which they live, eat and breathe daily), FANTASTIC CEO Kent Thiry...who has been tremendously successful in turning a failing company in 99 around to a very, very profitable company today. Benefits...401K, Stock Options, Profit Sharing, Bonuses, Education Reimbursement-up to 3K per year, also, they have programs for your children to get $$ for college, starting in 6th grade I believe, plus they do a "Village" thing where if a Davita employee has a severe problem (death of child, illness, severe disability, tragedy, etc...) other employees can donate $$ or even PTO to that person, and Davita matches, doubles, or triples the $$ for them. TALK about taking care of their employees! Plus, there are great training programs, and ALL employees go to a Davita University...where everyone employed by them meets the CEO, Kent Thiry. There are other benefits...health insurance at a minimum cost, etc... I just can't remember them all.
They have a "One for All, All for One" philosophy that they truly do live by.
Well, off my soap box...I have NOTHING but good things to say about them, and I am not an administrator, nor am I paid to say these things...I am a chronic hemo nurse in a small town in Kansas...I have been here since 98...learned much, had many changes, and learn something new every day!
Good luck!!!!

I've read a lot about Davita.. they do sound like a great company. I work for FMC... SUPPOSEDLY the biggest and the best.. but they are NOT "staff-friendly". :stone

It's all about the $$ with FMC.

imperial · Feb 23, 2005

Curious, what do you mean they 'are not staff friendly'...

My main focus is on education of staff who provide care to patients. I have been reading at the http://www.dialysisethics.org site many survey results (posted here, I believe) and am astonished at the mistakes that take place. I have mentioned already my concerns with the experience requirement of new proposed language in the ESRD regs, of only six months. This is frightening, especially, since I have seen posts at this board stating dialysis is a serious business.

I know of many patients in FMC units who basically are 'not' satisfied, but due to location/convenience, it is not reasonable for them to switch units. They are not allowed to question anything staff does. This is not okay. At the beginning, patients are told they are part of the team, however, once you provide input as to your care, you are cut off.

I know of one story where the district educator was doing training in one unit. However, this educator did not even wash those nasty hands inbetween patients, or touching machines. Additionally, taking the apron and touching the paitent's machine just brings all those contaminated areas on the apron to the machine. Obviously the educator had not one thread of cognizant awareness to infection control. So, how can one expect staff to perform appropriate tasks when the educator isn't. yes, an FMC unit, but I am sure this happens all over. And, yes, I know there are wonderful great sincere nursing staff out there.

jnette, ASN, EMT-I · Feb 23, 2005

Curious, what do you mean they 'are not staff friendly'...
My main focus is on education of staff who provide care to patients. I have been reading at the http://www.dialysisethics.org site many survey results (posted here, I believe) and am astonished at the mistakes that take place. I have mentioned already my concerns with the experience requirement of new proposed language in the ESRD regs, of only six months. This is frightening, especially, since I have seen posts at this board stating dialysis is a serious business.
I know of many patients in FMC units who basically are 'not' satisfied, but due to location/convenience, it is not reasonable for them to switch units. They are not allowed to question anything staff does. This is not okay. At the beginning, patients are told they are part of the team, however, once you provide input as to your care, you are cut off.
I know of one story where the district educator was doing training in one unit. However, this educator did not even wash those nasty hands inbetween patients, or touching machines. Additionally, taking the apron and touching the paitent's machine just brings all those contaminated areas on the apron to the machine. Obviously the educator had not one thread of cognizant awareness to infection control. So, how can one expect staff to perform appropriate tasks when the educator isn't. yes, an FMC unit, but I am sure this happens all over. And, yes, I know there are wonderful great sincere nursing staff out there.

imperial..

I don't know which FMC clinics you are referring to, but that certainly is not the case where I am (re asking questions, genuinely being ENCOURAGED to ask, and to participate in their care).

I'm sure there are good and not so good clinics and educators everywhere, not that it justifies this particular educator's negligence.

We are careful to wash our hands and change gloves between patients, I can assure you,, but as far as the aprons go, that suggestion is a FIRST.. no we do NOT don new aprons between patients, as we are CONTINUOUSLY running to and from machines... they alarm constantly. We monitor vital signs q half hour, and go from patient to patient and machine to machine to monitor them.

During turnover it is chaotic.. we are swamped. We each have four patients, HOWEVER.. if a coworker is tied up with a bleeder or one who is hypotensive, another staffmember goes to her aid and helps with her other patients if she is not too tied up herself. When I say nonstop on the move between patients and machines, I mean exactly that. To think that we will stop and remove aprons between patients during this chaotic time is absurd. We would never get ANYTHING done, as we would be spending all our time exchanging aprons.. and just as soon as you have one on, you need to run to the next patient in distress... there is just no way. It is NOT feesible, or even do-able.

It is hard enough washing hands between patients when things get wild, and they DO get wild, believe me.. But, yes, we DO wash our hands between patients, absolutely. Another reason we intalled the etoh-gel dispensers, because there are times when these emergencies cannot wait for you to stand at the sink washing to the tune of Happy Birthday... when someone is bleeding all over the floor, you must be ready to jump right in there.

What you are suggesting is ideal, yes.. but would require that a staffmember have no more than one patient apiece.. two max. That way all this "perfection" could be done, but not when you have four patients, or a roomfull of patients.. as hte aptients are all in one room, and we run around this room like a guinea pic on a treadwheel ) and everything going on with them at the same time, perhaps even taking on a couple more when a coworker has her hands full with a patient crises (or two).

And you will NEVER see the day when a staff member is given only one or two patients.. just ain't gonna happen.

If our apron is soiled, certainly, it is removed and a new one put on.. but not just going from machine to machine because the minute you turn your head, you are needed right back at the first patient's machine for something else.

I would like to ask you this... have you ever worked at a dilaysis unit (chronic outpatient) ? You might want to do that for several months... (not just spend a day looking about)..get in there and see what is REALLY entailed, and do it yourself. Then come back here and tell me how you think all these ideal methods could best be implemented.

They all look GREAT on paper. But it is far from realistic. There is SO much more involved than just putting a patient on and taking them off after four hours. You have to work it to understand what I mean.

Yes, we are cognizant of infection control, and we do our very best to prevent cross contamination... but with as many patients as we have and the constant running between them to addresse their needs or answer the machine alarms, replace the acid and bicarb (which also require aprons and ppe) we'd have no time to get to the patient if we were to be constantly changing gowns or washing our hands every second.

Again... I say increase the staff so we can even more competently care for our patients.. but not expect us to be able to do all that is required of us in a given amount of hours in the day with all the things that go on at any given time. We are continuously pressured to not acquire ANY overtime and yet we have no control over a patients' rides being late, the transport service not showing up to pick said patient up.. patients having to hold their sites longer than usual.. hypotensive situations.. you name it. Everything always looks so good on paper.. but these many situations are never taken into account.

Sorry for the long rant... but I SO feel that it is not the staff who should be further burdoned and attacked... speak to the company SUITS, and demand better staffing for the improvements you seek. We all want the same here.. better care for our patients. But we can only give and do so much... our heads are already spinning from the minute we arrive at 0400 until we leave 12 or 13 hours later.

But the company administrators don't want to hear it. They will NOT increase the staff... remember.. it's all about the $$. :stone

End of rant.