patient allocation

corky1272RN · Mar 5, 2009

I feel your pain!! This is the same thing that is happening in my clinic. We do have teamwork ethics but, the pts get put on late all the time!! My clinic is the pits!! Whe are always out of supplies, that should not happen! I am so sick of it and am looking for another job. Thanks for letting me vent!

:banghead: :down:

munki32 · Mar 5, 2009

Hi There,

Well feel free to vent away,at least I know that I am not alone! How long have you worked at your clinic? I am stuck where I am for the time being for a few reasons.Starting to wonder if its the place for me though. Its not easy being criticized by colleagues,and then your patients too after they have sat in a waiting room getting more and more frustrated. Are you looking for another Dialysis post or getting the hell outta Dodge?

corky1272RN · Mar 5, 2009

I have been at this clinic since last June. I am getting out of dodge!! Chairtimes are about to change on monday, this has happened about 3-4 times just since I got there. We are very understaffed!! It is soooo terrible. :crying2:

Lacie, BSN, RN · Mar 7, 2009

I run an 11-chair unit with 3 shifts. I work 1 RN and 2 PCT's on the floor and never more staff than that. Each pct takes 4 pt's and the RN takes not only the balance of pts (3) left but also does all the assessments, gives meds, troubleshoots, careplans, call the docs, makes pt appointments and referrals and etc, and etc. If your only taking 3 pt's then in all honest that's not a bad ratio by any means. I have had to open with just myself and 1 tech many times and still managed to get them on time because of a last minute staff call in or late. We manage to get our pt's on timely and off timely. On occasion if a machine issue or other complication then they may get on late but otherwise what I have found when things run really late it comes done to time management. If your relatively new to dialysis it does take awhile to get the time management down. I chart when rinsing back, have the machine stripped before I even pull the first needle. Soon as it's pulled then I set up for the next then move to the next coming back to pull the second. You'll find your niche and your groove to time management. It's not going to fall in to place in a matter of a few months. It took me a year or more to find mine. I started having pts come in 15 min prior to start time that way they are running on the machine by thier scheduled times. Pt's are always going to moan and groan if running late. Like I ask them "Do you complain like this to the doctors office when you wait?" I generally just respond with a "We do the best to our ability". If you allow thier complaining to get to you then your only stressing yourself out. Let it roll off your back when they do and just do your job to the best of your ability. Most dialysis pts arent a happy lot to start with and you'll be thier scapegoat for the brunt of it most the time anyway even when they get on at thier time. If nothing to complain about they will manage to find something most of the time depending on the pt.

soulofme · Mar 7, 2009

I run an 11-chair unit with 3 shifts. I work 1 RN and 2 PCT's on the floor and never more staff than that. Each pct takes 4 pt's and the RN takes not only the balance of pts (3) left but also does all the assessments, gives meds, troubleshoots, careplans, call the docs, makes pt appointments and referrals and etc, and etc. If your only taking 3 pt's then in all honest that's not a bad ratio by any means. I have had to open with just myself and 1 tech many times and still managed to get them on time because of a last minute staff call in or late. We manage to get our pt's on timely and off timely. On occasion if a machine issue or other complication then they may get on late but otherwise what I have found when things run really late it comes done to time management. If your relatively new to dialysis it does take awhile to get the time management down. I chart when rinsing back, have the machine stripped before I even pull the first needle. Soon as it's pulled then I set up for the next then move to the next coming back to pull the second. You'll find your niche and your groove to time management. It's not going to fall in to place in a matter of a few months. It took me a year or more to find mine. I started having pts come in 15 min prior to start time that way they are running on the machine by thier scheduled times. Pt's are always going to moan and groan if running late. Like I ask them "Do you complain like this to the doctors office when you wait?" I generally just respond with a "We do the best to our ability". If you allow thier complaining to get to you then your only stressing yourself out. Let it roll off your back when they do and just do your job to the best of your ability. Most dialysis pts arent a happy lot to start with and you'll be thier scapegoat for the brunt of it most the time anyway even when they get on at thier time. If nothing to complain about they will manage to find something most of the time depending on the pt.

Most units have 4 pts/pct. We have a new CM and she is trying to pull the RNs off the floor/pts. so that only pcts have the pts. Lacie...I don't know about you but it sounds like you're out of compliance and if the State walked in they would close down that unit. I know with FMC we're trying to get all units to where the RNs do not take pts..but its a hard road at some units. Just a thought.

munki32 · Mar 7, 2009

Hi Lacie,

Thanks for the tips:up:. I am going to try and improve my time management. I think part of the problem is that my colleagues arent supportive. They seem to enjoy watching the juniors tun ragged. They forget that we have been there a few months and they have been there several years.

If anyone elas has any tips on improving time management it will be greatly appreciated. I have asked my colleagues for tips but their attitiude is very much "you've either got it ,or you havent, and not everyone is cut off for dialysis". Useful eh? :rolleyes:

Valerie Salva, BSN, RN · Mar 7, 2009

Imo, the timing of how the pts are scheduled makes or breaks a unit.

If each tech has 4 pts a shift, pts should be scheduled so that each tech has a pt to put on @ 0600, another at 0620, another at 0640 and so on. Also, they need to be scheduled so that they come off ot tx in a similar fashion.

The door to the lobby should be closed and locked- the pts should be called into the unit as they are scheduled- if they just all pile in willy-nilly, it screws everything up.

With a lot of pts, if you bring them in early all the time, they come to expect it- then demand it.

When a nurse has to run from one preassessment/dialyzer/bath check to the next- there is no time to give a med or two before going to the next assessment. This also screws everything up, imo.

I have been the only nurse in a 16 chair, three shift unit with 4 techs and everything has gone well.

I have been one of three RNs and three techs in a 12 chair unit that was a nightmare.

Now, I am the only nurse in a 10 chair unit with 3 techs and it is pretty rough-

So, how can a unit with more staff and fewer pts be so much rougher than a unit with less staff and more pts?

It's all about the pt schedule and the timing.

Lacie, BSN, RN · Mar 7, 2009

Most units have 4 pts/pct. We have a new CM and she is trying to pull the RNs off the floor/pts. so that only pcts have the pts. Lacie...I don't know about you but it sounds like you're out of compliance and if the State walked in they would close down that unit. I know with FMC we're trying to get all units to where the RNs do not take pts..but its a hard road at some units. Just a thought.

depends on your state. In Florida as long as there is 1 body to work with every 4 pts is all the ratio requires. It doesnt matter if RN, LPN, or PCT. Therefore it is in compliance to have only 1 RN and 1 pct for 8 pts here. Not the ideal but the way it works. When I was with Davita it was even worse so I dont complain too much now as considering my working conditions are significantly better then where I was. Also we dont have to try to meet SWC's sending staff home. At end of day if there are 3 pts left and 3 staff they stay to finish the work in the unit whether it be stocking or what not. If I could hire more staff I would but as you know Corporate controls that!!

Oh, state has been in and we passed with flying colors :)

corky1272RN · Mar 7, 2009

I know that scheduling is part of the problem for my clinic! Right now our pts are scheduled 15 min apart and 20min in btw each shift. The 20 min includes the pt holding sites, cleaning/stringing the machine, and getting pretx vitals on the next shift pt. I have only been there since June and the chairtimes have changed 3 times without success. Our new FA is going to redo the schedule of chairs (which should be implemented next week) which she told me had 45min in btw each shift (though I noticed that most of them have only 30 min) and 15min for each pt hookup. Ex:pt A @0600, pt B @0615, pt C @0630, when pt A ends @0900, pt D comes in that chair @0930 or 0945. This all is depending on no problems which is almost impossible for dialysis pts. There is 1RN charging (me) and 3 techs for 12pts. Almost all our pts run 3-3.5hrs. :trc:

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