New Grad Dialysis RN seeking advice

[affablyeaseful]

Hey all, I'm new to allnurses but have been lurking here periodically over the last two years. Finished my BSN and got licensed in June, and recently began working in chronic dialysis for one of the big two. My situation is rather unique in that I was hired along with 2 PCTs and another RN to start working at a new clinic that isn't open yet. It's been a positive experience so far and the staff and my manager at the clinic I'm training and working at have been just great.

I mainly have two concerns which both come from the reading I've done on this site from people who have had extremely negative experiences in dialysis. First is that I don't want to get pigeonholed in dialysis for my entire nursing career. I'm still excited about just being fortunate enough to even have a job right now so soon out of school (necessary with the extremely large amount of debt/loans I've acquired, this is my second bachelor's degree and career change). Dialysis is also interesting to me and I feel is a good fit now because I'm not a person who really loves the hospital a lot and I definitely wouldn't want to work there for the long haul unless it was to gain experience or in the ED. I've read that it's difficult to switch to other areas of nursing after dialysis, but also that it's possible to switch to acutes after 6 months and begin earning clinical hours towards obtaining a CCRN. Would this allow one to work in settings such as med-surg, ICU, or PACU? I have some credits towards my MSN and hope to finish it in 3-5 years and eventually work as a NP in an urgent care or in the ED. What do you guys think would be the best way to build my experiences to accomplish this?

My second concern is about the scheduling. I was hired for 40 hours per week and I believe we will have 3 shifts on some days. I wouldn't mind doing a couple or even 3 16 hour shifts per week if it meant I only had to work 3-4 days. I am only concerned about being forced into 60+ hour weeks like some have wrote about here... Has this been anyone else's experience doing chornic dialysis? Thanks for reading and I appreciate any advice you guys can offer =)

[westieluv]

Generally, you will not be forced to work overtime in chronic dialysis if you have enough RNs to fill all of the shifts because unlike in acute dialysis, the chronic unit closes at the end of the day so you can go home.

Most of the posts you see here about ridiculous amounts of forced overtime in dialysis come from those who work or have worked in acute dialysis, which is a whole different animal since hospitals are 24/7 institutions and patients need dialysis at all hours of the day and night.

When I worked in chronic dialysis, I was never forced to work overtime, and I did it for both of the Big Two. When I worked acute dialysis for one of the Big Two, I worked as long as 20 hours in one day. That was not the norm, but 14-17 hours was fairly common in the program that I worked for because nurses would get hired and then quit because of the crazy hours and then we would be chronically short staffed.

Best of everything to you, I'm glad that you are having a positive experience so far. As far as getting pigeon holed in dialysis nursing, a lot of dialysis nurses that I know started it, love it, and have no desire to do anything else. I worked in some other types of nursing before dialysis and am now working in hospice, so I have not had that particular experience. Go with what you feel. If you truly like dialysis, you will always be able to find a job and you will possess a highly trained skill that is sought after. Travel dialysis RNs make really good money because of this.

[all4success]

I have been in dialysis for some time now and we all have our good and bad days. I do not see myself doing anything else. Yes, I have had some bad experiences, but what specialty doesn't? For me the good outweigh the bad. We have worked short for several months but we did it with smiles on our faces knowing our manager was trying his hardest to hire and/or find coverage and he did just that.

Negative experiences are more likely to be posted due to the need to vent. It is rare for people to post positive experiences. Changes in dialysis or dialysis needs are not predictable. If a unit continues to run poorly, that is the fault of management. It takes a strong RN to run a clinic floor in chronic HD and strong management to support the RNs and PCTs. It is management's job to make every effort to try to improve poor conditions. I have to agree with westieluv. If staffing is adequate, the unit runs smoothly. If staffing is temporarily inadequate, it calls for overtime. However, staffing inadequacies should always be temporary.

Here is a piece of advice: If you look for the negative, the bad, and the horrible, you will eventually find it and then you will say, I knew it”. Have a positive outlook, for life's experiences are what you make them.

I wish you the best of luck..

[nutella, MSN, RN]

OP - the crazy days and long days usually refer to acute dialysis because it seems that most acute dialysis nurses dialyze about 8 hours or so to get their hours in - just in case that there is no emergency HD coming in - and after that take call. Granted, I know of some acute programs that hardly ever get called out because they are located at a small hospital that does not deal with too many emergencies. But my experience is that I worked long hours on call especially on weekends and holidays.

In chronic dialysis things are different unless staff calls out a lot - which can happen when staff is already overworked and the clinic is generally run poorly or they have been understaffed for a while. Since you do not have emergencies, the schedule is set in stone. If your program has nocturnal it may be a different story as that always lead to some musical chair when somebody is sick or on vacation.

If you are otherwise satisfied in chronics I would say to put in at least 2 years in chronics before applying to acutes. In acutes you are by yourself when you dialyze in critical care areas, which means you have to be very proficient all around. Since you are a new grad I would think that in total it will be probably 2 years until you have seen most things that can happen and know how to deal with it.

After 2 years you may want to consider specialty certification to become a CNN - which shows that you have expert knowledge in this area. When you work in acutes it depends on the program how much exposure you will get in CVVHD, apheresis, stem cell collections, red blood cell exchange and so on and forth. I know about nurses who worked chronics, jumped to acutes after some while and actually applied to a position in the hospital in critical care or PACU or PCU and got a job there. It really depends a bit on your personality and the networking you do while working acutes. I know somebody who became a NP while working in acutes.

I loved dialysis and still think that acutes was one of my best jobs. However, frequent on call, insufficient pay rate, long days, and upper management that drove me crazy with their "productivity" talk while understaffing resulted in me leaving acutes and chronics.

It is true that you will be specialized but it is still possible to find something else - it depends on your area and the general jobmarket.

[eddie_RN_BSN]

I was a new grad 16 years ago and started working on a tele unit in a hospital. After six months of doing that, I started working in dialysis in the Acutes Dept. When I gave my notice to my DON, she said that I should not go into a specialized nursing field, like dialysis, until I had more experience in med/surg nursing. She thought that I was limiting myself, but she was wrong.

I worked acute/chronic hemodialysis clinical settings, worked 4 years doing 13 week contracts as a Dialysis travel RN all over the US and in Hawaii, worked day shift, worked nocturnal shifts doing incenter hemo treatments, I've worked for B Braun Medical who makes the Dialog hemodialysis machine and have traveled nationwide to install and educate the staff on operating the machine in clinics, I later got a PRN job in an outpatient surgical facility as a circulating OR nurse, worked as a Rehabilitation Nurse Liaison for an acute hospital, and now work as a State Surveyor for the Dept. of Health and still work PRN on Saturdays as a Dialysis RN for an outpatient clinic.

What I am trying to convey is that by working as a dialysis nurse, it doesn't make you unable to get other jobs in other areas of nursing in the future.

Working as a travel RN in acute dialysis, we did have very long days at times. I often had to perform 3 dialysis treatments, all at different hospitals, all 4 hour long treatments, plus adding in time for the machine to disinfect after each treatment, then your drive time to the next hospital, etc. your day ended up being 16 hours. But the chronic clinics usually have a set schedule for the nurses. 3 twelve hour shifts or 4 ten hour days, etc. They just usually always open very early in the morning.

So..... in dialysis.... most nurses either love it or hate it. I still love it and still work PRN in dialysis after completely changing nursing careers. You should consider working nocturnal hemodialysis especially while going back to school. Its lower stress and you only have one shift of patients and no turn over.

[fragino]

Chronic clinics can be so different from each other, even with the same company, even in the same city/town. It all depends on the staffing and management. While most people with positive experience do not post here, I can say that I've really enjoyed the last four years in chronic dialysis but it has also been four years of mostly short staffing and lots of overtime with one of the big two. I'm currently with a smaller company that boasts a small turnover rate. I will see how that goes.