Pay per patient?

sipapu · Jun 27, 2005

Could you elaborate more on this? In our clinic a PCT would take care of approximately 8 patients in about 11 hours. Of course this is because of set up time, shift change, and tear down time. If problems occurred on the floor it could take longer. And, as the charge nurse in a 32 chair clinic I can barely begin my paperwork until the last patient is gone and my average day is 14 hours. If I understand you correctly, this means that if I were paid for 8 patients at $29 a patient I would make $232 a day. For a 10 hour day I would earn $23 an hour. But, for my 14 hour day I would make only $15 an hour. No way!!! Is this what your actually saying? I would like to know because I am interviewing for a Fresenius pay per patient job next week. Thanks in advance for your reply.

I am pretty new to dialysis nursing, I think I am gonna really love it though. The clinic I am working in is run by Fresinius and has recently gone to paying there PCT and RN who work in the clinic per patient.
So since I am new to the clinic I will be getting $29 per patient and this ratio is off the tech to patient ratio not the nurse to patient ratio. We average between 3.75 and 4 patient every 4 hours.
My question is has anyone else done this? If you have what are the benefits and what do you think are the problems with this system?
Everyone at the clinic is very nervous about it since no one has even recieved there first check using this system yet. Anyway, any insight you can give would be appreciated.

nosonew, BSN, RN · Jun 28, 2005

Interesting...first I have heard of this. I am Davita.. but hmmm. Will be waiting for updates on this ...

Redman · Jun 28, 2005

Ok now in our clinic we rarly if ever work an entire shift with this new system. If you are scheduled 530 - 1730 we are all gone by 1630 at the latest. The charge in our clinic doesnt take a patient load she is responsible for entering orders and doing her paper work. She also makes rounds in the clinic with our physician. I can only speak for the clinic I work in it is probably very different from one place to another.

The floor nurses pass meds and split up the Catheter patients to be put on (PCT can not put catheter patients on in Texas) and put out the various fires that always seem to come up during a shift.

Our Charge Nurse never has to stay after. I am not sure what is different about the system we have and the one you are in now. Currently all but one of our floor nurses is qualified to charge. So it is just roatated to the different nurses through the week.

The other benifit to this is that if the charge is behind the other nurses know how to enter orders and help her get caught up on paper work.

At the moment we are working basically 3 days a week. 2 16's which is 24 patients and one 10 which is 8 patients. so its 32 patients a week at 29 per patient so before shift differential ,which you still are payed but the formula they use is beyond me at the moment, and taxes you gross around $928 per week.

Now they take off 30 min for lunch and 30 min for dinner on the 16's anyway. And we are gone every night by 2130 so the 16 turns into a 14 and the 10 is actually 8.5 since we are gone every day at 1630. So that comes out to Gross 25.42 per hour starting out fresh out of school with no other experience. The Cap per patient pay is $34 they take into consideration critical care experience and all that and grade it on a sliding scale.

The thing I dont like is not having PTO or Berevment days. If you dont work you just dont get paid. Now in our clinic its pretty easy to swap days and make up your hours if you just want to take a week or two but, it might not be the case elsewhere.

sipapu · Jun 29, 2005

Thanks for the reply Redman. If you would be so kind, let me give you the picture in my clinic and then you tell me what I would make in this system. I'm assuming that on your 2 16's which equal 24 what your saying is that on each of those days the tech takes care of 12 pts (3 shifts) and 12+12 equals 24, plus the 10 hours of 2 shifts with 8 patients equals 32.

How many total chairs do you have in your clinic[/]?

In our clinic we have 32 total chairs and we do two shifts, so we see 64 patients a day. We are open 6 days a week and we usually work 3 days a week. So, each of my techs see's 8 patients a day X 3 days =24 patients a week. If I understand you correctly when I'm charging I would therefore make 24X29=which would be $696 dollars a week.

In my clinic I clock in at 0430 and I am ALWAYS the last to leave at around 1830-1930. When I round with the doctor I see 64 patients that day. However, on TTS, I see those same 64 patients, give meds to 20 patients and since we have 24 catheters I usually put on and take off at least 8 of them. I am blowin' and goin' the entire time at work and most people would say I'm fast and efficient but there is know way with the amount of patient care I do and case management that I could leave any earlier. So, I average about 40 clock hours (after they've taken an hour each day for breaks). So,is this what you are saying: that I would be paid $696 a week, which divided by my 40 hours=$17.40 an hour with no PTO benefits? What a sneaky way for the company to get out of offering vacation pay, which is a monetary value to your yearly earnings. Otherwise, many would be strictly PRN.

I am not taking a patient load, however, I often put on and take off more than any single employee in the clinic because I'm in TX too. My nurses are all LVN's and they are generally too busy to do anything more than the computer charges for their patients. I work with a pretty well trained staff and the shortest day any tech or LVN has is 11 hours.

I so appreciate the time you've taken to answer this but just want to be sure I'm understanding. Even if I were paid $34 dollars a patient, at 24 patients a week (again 8 a day X 3 days) I would still only be earning $816 a week. I agree $25.42 right out of school is good but I'm thinking they'd have to dream up something different to keep me on at my clinic. Even if I were seeing 32 patients a week at $34 a pop my weekly would still be $1088 divided by 40 = $27.20 with no PTO, less than market value for PRN.

One last thought. Now that the corporation has found a way to delete your PTO benefit that means that PRN work in the future will now be paid less, because the whole point of a PRN wage was to offset the approximate 28-32% of dollars a company spends on an employee in benefits packages. It seems to me that for someone new to nursing like you, these wages could be great in the short run, but what it "feels" like is that in the long run you will see less and less money over your career.

I hope some others will speak up out there. This new entrepreneurial system has some red lights on it to me for nursing salaries.

Ok now in our clinic we rarly if ever work an entire shift with this new system. If you are scheduled 530 - 1730 we are all gone by 1630 at the latest. The charge in our clinic doesnt take a patient load she is responsible for entering orders and doing her paper work. She also makes rounds in the clinic with our physician. I can only speak for the clinic I work in it is probably very different from one place to another.
The floor nurses pass meds and split up the Catheter patients to be put on (PCT can not put catheter patients on in Texas) and put out the various fires that always seem to come up during a shift.
Our Charge Nurse never has to stay after. I am not sure what is different about the system we have and the one you are in now. Currently all but one of our floor nurses is qualified to charge. So it is just roatated to the different nurses through the week.
The other benifit to this is that if the charge is behind the other nurses know how to enter orders and help her get caught up on paper work.
At the moment we are working basically 3 days a week. 2 16's which is 24 patients and one 10 which is 8 patients. so its 32 patients a week at 29 per patient so before shift differential ,which you still are payed but the formula they use is beyond me at the moment, and taxes you gross around $928 per week.
Now they take off 30 min for lunch and 30 min for dinner on the 16's anyway. And we are gone every night by 2130 so the 16 turns into a 14 and the 10 is actually 8.5 since we are gone every day at 1630. So that comes out to Gross 25.42 per hour starting out fresh out of school with no other experience. The Cap per patient pay is $34 they take into consideration critical care experience and all that and grade it on a sliding scale.
The thing I dont like is not having PTO or Berevment days. If you dont work you just dont get paid. Now in our clinic its pretty easy to swap days and make up your hours if you just want to take a week or two but, it might not be the case elsewhere.

bt/dt,RN · Jun 29, 2005

Thanks for the reply Redman. If you would be so kind, let me give you the picture in my clinic and then you tell me what I would make in this system. I'm assuming that on your 2 16's which equal 24 what your saying is that on each of those days the tech takes care of 12 pts (3 shifts) and 12+12 equals 24, plus the 10 hours of 2 shifts with 8 patients equals 32.
How many total chairs do you have in your clinic[/]?
In our clinic we have 32 total chairs and we do two shifts, so we see 64 patients a day. We are open 6 days a week and we usually work 3 days a week. So, each of my techs see's 8 patients a day X 3 days =24 patients a week. If I understand you correctly when I'm charging I would therefore make 24X29=which would be $696 dollars a week.
In my clinic I clock in at 0430 and I am ALWAYS the last to leave at around 1830-1930. When I round with the doctor I see 64 patients that day. However, on TTS, I see those same 64 patients, give meds to 20 patients and since we have 24 catheters I usually put on and take off at least 8 of them. I am blowin' and goin' the entire time at work and most people would say I'm fast and efficient but there is know way with the amount of patient care I do and case management that I could leave any earlier. So, I average about 40 clock hours (after they've taken an hour each day for breaks). So,is this what you are saying: that I would be paid $696 a week, which divided by my 40 hours=$17.40 an hour with no PTO benefits? What a sneaky way for the company to get out of offering vacation pay, which is a monetary value to your yearly earnings. Otherwise, many would be strictly PRN.
I am not taking a patient load, however, I often put on and take off more than any single employee in the clinic because I'm in TX too. My nurses are all LVN's and they are generally too busy to do anything more than the computer charges for their patients. I work with a pretty well trained staff and the shortest day any tech or LVN has is 11 hours.
I so appreciate the time you've taken to answer this but just want to be sure I'm understanding. Even if I were paid $34 dollars a patient, at 24 patients a week (again 8 a day X 3 days) I would still only be earning $816 a week. I agree $25.42 right out of school is good but I'm thinking they'd have to dream up something different to keep me on at my clinic. Even if I were seeing 32 patients a week at $34 a pop my weekly would still be $1088 divided by 40 = $27.20 with no PTO, less than market value for PRN.
One last thought. Now that the corporation has found a way to delete your PTO benefit that means that PRN work in the future will now be paid less, because the whole point of a PRN wage was to offset the approximate 28-32% of dollars a company spends on an employee in benefits packages. It seems to me that for someone new to nursing like you, these wages could be great in the short run, but what it "feels" like is that in the long run you will see less and less money over your career.
I hope some others will speak up out there. This new entrepreneurial system has some red lights on it to me for nursing salaries.

Pay per pt. in a clinical setting?? I work acutes and receive $200/treatment, with 6-7 weeks PTO/yr & bereavement leave. Sounds to me like they are decreasing wages and deleting all paid leave. No way, not for me!

MedicalZebra · Jun 29, 2005

Holy smokes... FMC thinks I'm only worth 30 bucks?! (Geez, I know the life of a dialysis patient is cheap... but I didn't think it was that cheap!)

As if the danger of forgetting things during a treatment isn't high enough already-- what's going to happen when there's a financial incentive to rush even more?

I'm in an FMC unit and so far we don't have this... I don't think our vet nurses will go for losing paid days.

Just curious... is this FMC's way of trying to cram extra shifts into the schedule?

sipapu · Jun 29, 2005

Thanks for mentioning that rush factor, those were some of my thoughts exactly when I was trying to figure out how any of us could possibly move any faster!

Holy smokes... FMC thinks I'm only worth 30 bucks?! (Geez, I know the life of a dialysis patient is cheap... but I didn't think it was that cheap!)
As if the danger of forgetting things during a treatment isn't high enough already-- what's going to happen when there's a financial incentive to rush even more?
I'm in an FMC unit and so far we don't have this... I don't think our vet nurses will go for losing paid days.
Just curious... is this FMC's way of trying to cram extra shifts into the schedule?

sipapu · Jun 29, 2005

What state are you in and, if you don't mind, what company are you with? I just had an acutes interview with FMC. The set up is a hospital room with about 8 beds, ratio is 2 patients to one RN. Each RN must float to ICU at least one day a week. Heres the pay at the bottom end of the scale (don't know the top end but from the above post at $29/pt to $34/pt in chronics don't think it would be astronomically different: First patient $120 based on 5 hours, second pt done at the same time add $30= $150 for two, thus 4 a day done this way = $300 based on a 10 hour day. When you float to acutes you only get the $120, so two a day would be $240. Doesn't make sense to me that your dealing with tougher logistics and sicker patients to make less money. So, a 3 day work week, which you'd still have to float would be $820 a week and a 4 day work week would be $1140. I figured it up several different ways against my current rate of pay and if I do my 3 in the chronic now and float to acutes an extra day I'm way ahead of FMC's offer. Even if I just worked straight acutes at my hourly and got the overtime I'm ahead. However, at your $200/pt I couldn't compare, nor does FMC's offer compaare to your wage. So, where do I need to travel to to get this kind of money? Plus benefits!

Pay per pt. in a clinical setting?? I work acutes and receive $200/treatment, with 6-7 weeks PTO/yr & bereavement leave. Sounds to me like they are decreasing wages and deleting all paid leave. No way, not for me!

sandrakclev · Jul 1, 2005

Do you know if they're planning on implementing the same type of pay structure for techs, or just for nurses?

Redman · Jul 1, 2005

Ok I am in Texas. The clinic I am in has 36 chairs with 1 isolation room we use for HBV positive patients. Each shift we have 3 nurses all RN and the charge nurse. Each tech takes no more than 4 patients.

The PTC do most of the sticks on fistula and grafts. In Texas the it is against the law for PTC to hook up catheter patients. This is different from state to state.

The only time I really feel rushed is shift change. We average between 6-8 catheters per shift and all patients have a set appointment time staggered 15 minutes apart.

We have our share of unexpected things come up. We just pick up the slack for eachother so the patients dont have to wait. The RN do have to drop down to work as a PTC from time to time. Some of the nurses seem to think that this means they do there 4 patients and thats it. I still pass meds help take off and put on catheters and all the regular stuff we normally do. It is up to the nurse though. MWF we work 530 - 2130 shift TThS we work 530 - 1730.

When it comes down to it I would do the job for free if I didnt have to feed my family and fight off the bill collectors. We try to make it as easy as possible for our patients because lets face it, the poor people are being stuck twice a day 3 times a week at a minimum for the rest of there days unless they get a transplant.

I am not sure how this new system is going to go, I honestly just want to see how my check changes. I hate not having PTO but, luckily its pretty easy to swap days with people to get your hours in and still get your days off if you want vacation.

Redman · Jul 1, 2005

The techs are on the same system at the moment. I am not sure of the pay scale for them I beleive it ranges from $12 - $17 per treatment.