Duncan6

And this is part of the reason I'm heading back to FMC next month. If it wasn't an infection control issue I might just hug the 2008T,LOL. Staffing is also a huge reason I'm going back. In the almost 2 years I've been here I've only had 1 other nurse for 6 months and she left in January. I'm staying long enough to train the new nurse and that's it. I'm at a rehab hospital and they didn't have a dialysis program previously so there was no one here with dialysis experience to talk them out of Tablo.

Thanks for all the info from everyone. I have used pto for low census in other jobs, but it was more or less left up to us- if I could find legit work I could stay. It just doesn't matter here. I'm still debating staying or going. It's happened twice- once in September and once in October. If it happens again I'll probably have to go elsewhere.

Thanks for the feedback. It sounds like this isn't an uncommon practice. @JKL33 I agree with you. I don't have a lot of good options right now, so I'm staying where I am unless something comes along unexpectedly. It does irritate me that it all seems to be what is beneficial for the company. I'd take it unpaid, but I just can't afford that- espcially as often as it's happened lately.

I've been in nursing 28 years- and this is a new situation for me. I started a job as a dialysis manager at a rehab hospital over a year ago. I spent the majority of the year running dialysis txs by myself and then training a staff nurse. For over a year I couldn't take vacation, call off sick, etc. As of August, my staff nurse was fully trained and I took a week of vacation. The total time I've taken is around 70 hours but, due to being required to use my PTO during low census, I've used 111 hours total this year and only have 32 hours left in my bank. We're at low census again and they want me to cut 20 hours this week. My PRN nurse is talking about quitting because she was told when hired she could get plenty of hours, and now I either take 20 hours of pto myself, or she gets cut for the week. It's frustrating- but is it typical? It seems like an employer shouldn't be able to use my benefits for their gain. Thoughts?

Interviewed but passed on the HT position, ended up also requiring coverage of a clinic over an hour away from home. They do want me to consider coming back to incenter. Tempting but 4am start time and pay decrease is holding me back. However, I am currently on week 3 of no patients. The first week I found a lot to do, now every day I'm trying to figure out how to fill 8 hours. I've been auditing charts and doing the occasional diabetes education when needed, but that doesn't really fill up my day. I spoke with another dialysis manager at a sister clinic in our company and he's on 8 weeks of no patients. I know a lot of people are way too busy and would see it as a relief, but this is painful.

Depends on your area of the country. There are no pay scales or anywhere to find max rates. I don't think they really want you to know. As of 2023 I was making $37 with 20 years of dialysis experience- 28 years total.

The last 5 years I have left and returned to outpatient dialysis twice. The first time I left was just a mistake- I didn't ask the right questions before I took the job. I'm now a dialysis manager at a rehab hospital. Really small program, fairly low stress, pretty good pay. Staffing is a pain, but that's anywhere for the most part. Truthfully, I hate to even complain, but it's kind of boring. I miss outpatient, working with a team, having a full, busy day. I left outpatient mostly because the 4am start time was killing me. I keep in touch with several managers at outpatient clinics due to my current position and I became aware of an opening for a home therapy nurse at one of the clinics and I think I'm interested in pursuing it . I have done some PD, but over 20 years ago. I enjoy the teaching aspect and 1:1. It also would let me have a more regular schedule than HD while being back in strictly dialysis. (I am so not a rehab nurse.) I'm just talking with the manager now- haven't officially applied. My concern is that I've been at my current position for just over a year and I'm starting to think that maybe I'm just looking for something that doesn't exist and I should be happy where I'm at. Maybe it's just nursing in general that I'm dissatisfied with? I don't want to jump to another job and feel the same way I do now in a year. because it's not the job specifically but nursing in general. One good thing is that I don't feel like I'd be leaving the hospital in a bad spot- one of our local acute nurses is chomping at the bit to manage the program and really I think he would be fantastic, so the program wouldn't suffer.

I think that's fairly typical for acutes. When I did acutes- albeit 20 years ago- I often got stuck late into the evening/night with patients coming in the ER, etc. It's why I wouldn't consider doing it anymore.

I would agree with all your assessments of tablo. I had a tmp alarm the other day, I could have worked on it, it most likely just needed flushed and it did an end tx. So frustrating! Outset also pushes cross training. I have not been able to find any hd nurses, and the rehab hospital wants a dialysis nurse that will work the floor also. That didn't happen. No surprise. So they want me to train rehab nurses for dialysis. "Tablo says they can be trained in 4 hours". I don't think so. I have to explain repeatedly how much more there is to learn than just setting up a machine. I've been trying to stay positive with the machine, and there are some things that are good about it, but more often than not I'm frustrated with it.

Wow! So sorry for all of your situations! I'm just checking back in and realizing I had more replies. ? I ended up leaving in July to take a dialysis manager position for a new program in a rehab hospital. Most of the time I love it! I run pt treatments MWF, do my management stuff, some marketing, education, develop curriculum for cross-training rehab nurses to HD, help out with admissions when they need it- so some nice variety. Doing it all by myself right now, but max census for me is 4, so pretty doable- 2 in the morning, 2 in the afternoon. I'm in the process of hiring another one or 2 RNs so I can have some coverage in case I'm sick or actually want to take a vacation-and maybe expand to 6 days a week- but I don't have to be worried about getting called to cover other clinics or call-offs. I work M-F, usually 8-4:30. If I have 2 shifts of patients I might work a 10-12 hour day, but then I can leave early other days, or just take a day off. If I run pts afternoon only, then I don't go in until 9 or so. If I just have 1st shift I come in early, but leave early, too- around 3. There are weeks I don't have any patients at all, so plenty of time to work on all my things. Other than missing my old patients and coworkers, I don't regret leaving the outpatient clinic at all!

@Krissi MacInnis Kelley Thanks for your feedback. I have been with my rehab hosp since July, running treatments since September with Tablo. I have some annoyances and I do prefer a traditional HD machine, but it works for the rehab setting. Did you get any kind of training? Some of your issues have fixes that they should have covered. My company is national and they sent me out to Las Vegas for a week of manager training to run the program and learn the machines. We have a national group of dialysis program managers and we ask each other questions all the time. I also have the Outset customer support for technical issues. I'm sorry you have had such a bad experience! 1. Melting cords should not be happening- can you talk to your facilities director or whoever is over maintenance? I have never had that happen. 2. I had machine issues for a while, but we've worked out the bugs. I do agree it's geared too much for home use- it takes away too much of my clinical judgment and technical know-how. I have to outsmart it and prevent any issues that might arise. 3. I don't mind the uf increments too much, in my setting being within 50ml is acceptable. Acutes may be a different story. 4. The acid cap alarm is weird- do you have a contract with Outset? They have a 24/7 customer support number/email and you should have a Field Service Specialist who can fix those issues. 5. You can recirc- just hit pause treatment, and it will ask if you want to end tx or take a break. Choose take a break and it should walk you through the steps. Just use a recirc cap and makes sure the saline line is open (it already should be) like any other machine. It will leave an option to resume treatment. 6. There is an option to skip the draining into the bag at the end. If you are in the step-by-step mode it will give you the option to drain or skip draining. Before checking it off, click on skip draining and you should be fine. 7. Not sure what the cartridge issue is- I've never had that problem. I know my clinical specialist from Outset recommended that once you push the cartridge into the green bars, use your hand to push the cartridge firmly into place- starting with the venous chamber area and then across finishing with the blood pump area. Maybe that will help? And did they tell you that you can adjust the blood clot timer? You can change it from 3 minutes to 10 minutes to allow you time to work on needle issues, etc without feeling under the gun. That has helped save my sanity more than once. If you have access to tablohub.com it has a lot of training videos on it that may help when issues arise, I believe it also has the user guide. Hope this helps- best of luck to you!

@intergrativenurse Thanks for the info. The concept looks really cool, but I definitely have some concerns.

I know this is an older thread, but any updates on pros/cons of Tablo? Looking at a Dialysis Program Manager position at a small rehab hospital. They are currently using Fresenius, but will be going to Tablo when the FMC contract runs out.

I'm considering changing specialties from dialysis to employee health. Our regional hospital has an opening and after 28 years of nursing, I'm ready for a 9-5 schedule and a more laidback atmosphere. I'm heading into my 50s and don't want to get up at 0300 anymore! I applied for the position, but the description was super general. Is anyone out there working for a hospital that could shed some light on the basic expectations of the job? My background is primarily dialysis (16 years), diabetes education, and I was a clinical coordinator for an endocrinology and weight management practice for a while. Thanks for any information!

Thanks for your feedback! It sounds like we aren't in too bad of shape considering what everyone else is dealing with!

Our current CM is leaving once her CRNP license is approved, so they have been trying to hire a CM for a while now. Not many options to go with. They are now considering hiring a nurse from out of state with lots of management experience but no dialysis experience. The other RN at the clinic and I have concerns. We need a strong manager that can handle difficult staff, and generally, we can handle most day-to-day issues, so having someone without lots of dialysis knowledge may be OK. However, that means we have no coverage for vacations/call-offs for a good 6 months to a year. All the clinics in our area are short-staffed, so no float nurses are available. And it just seems like a huge learning curve to come into a specialty like this with no idea how a clinic functions. In light of this, I am trying to put together a list of questions to discuss with the current leadership. Does anyone have any experience with working under a CM without dialysis experience? Any other questions or concerns I should be raising?

Another update- just because it helps me feel a little better- even if nobody reads it! I still have not heard from the DO. No call, text, or reply to my email. He was in the clinic last week and made a big deal in front of the CM and staff saying he would call me that afternoon- never did. They are now in the process of hiring a CM from out of state with several years of management experience, but no dialysis experience at all. So there's that.

The DO texted me on Sunday-Easter morning! To say Happy Easter and I'll call you Monday. How about leave me alone on Easter and just call me Monday? I waited all day Monday- he never called. So when I got home I emailed him. I told him I had been updated on the situation, and that I would pass on the CM position even if there are other options for me to reapply and I reviewed my reasons. I then got an auto-reply that he is out of the office until next Monday the 17th. I'm starting to feel better about getting passed over.

Venting a bit this morning. I have now been waiting 3 weeks for an offer. One of the clinics our region received and IJ and so I figured that was part of the issue, I assumed our DO was just wrapped up with that. Frustrating but understandable. In the meantime, though, I am watching valuable time slip away that I could be using to train with the outgoing CM. She's working today so I mentioned that I still haven't heard anything. The DO was supposed to be here Thursday to talk to me but never showed. She then shared that the problem is that I didn't pass my initial assessment after applying. Which is humiliating. And then the DO won't even just tell me so I know what's going on. The CM says both the DO and her have tried to around it but the company has said no. "My chances of leaving the position within the first 18 months is higher because of my score." Nevermind that my superiors recommended me for the job and I have 16 years of dialysis experience, 5 of those with the company at this clinic. Kind of bummed out. I was starting to look forward to doing something new. I guess there is an option on the table that I could apply for a different CM position and take the test again, and then they would transfer me to my clinic. But would really be embarrassed to not pass twice, plus really annoyed my DO couldn't just be straight up with me.

@TraumaRus We are in a rural area and are the only clinic in 20-25 miles. We have providers from 3 different organizations due to our central location, so we stay pretty steady- it's unusual for us to have such a low census. I will say we have added 3 new patients in the last 2 weeks, so it looks like we're on the upswing. All of our clinics within driving distance have full-time managers at this point, so there is no floating from that standpoint. We are pretty well staffed compared to other clinics, so we are offered shifts elsewhere to make up time if we want to, but most of them are an hour away, so we don't do that all the time. And unfortunately, we've found that when we go to help we are given the crappiest assignments and are not given much assistance as far as the layout of the clinic, where supplies are, etc. We have a part-time secretary and now they are considering letting her work from home due to health issues- but not sure how she would actually do the secretary stuff from home... We did have one clinic close a couple of months ago. It opened right before covid I believe and never built a census above 15 patients. Everyone else has been around for a while and we have been assured that no one else in the area is closing. It's always a challenge to cover illnesses, but doable- usually the CM covers when one of the RNs is out. And the techs cover for each other. We used to have float pcts but haven't used them in well over a year. We are really fortunate that we have a lot of long-term employees who call off very rarely.

Interesting turn of events. Our DO was at the clinic this week to give a hiring update to the staff- only one person has applied, no really great options. I was able to ask some general questions and he did clarify that even though the census is low, we would always have 2 nurses and a CM since we are 6 days a week. I talked to my CM again and reviewed some of my concerns. Then I was able to talk to the DO about those concerns and they both had the same answers which I felt were acceptable. He is also allowing me to work 4 10s if I want instead of 5 8s. He said that I was their first choice and he had been hoping I would accept. (He could just be saying that but he seemed genuine.) In light of that, I decided to pursue the position. I have applied and am waiting for an offer to before making a final decision. If I take it our current CM will be there through April, so I'll have a chance to train with her. She has also done a lot of work to update everything for the next person coming in so that it's as easy as possible to transition. Should have a final decision this week!

That's a lot of catheters! The only thing I can think of is if there was maybe a change in heparinization. Using less heparin, change in the manufacturer? You would think with that many clotting off there is something in common. What does you medical director have to say? We have also had a drop in our census. 12 chair clinic, down to 34 patients. I don't know that we've lost more than usual, but we aren't getting new patients. The rest of the clinics in our area also have low censuses. We only have two nurses for a 6 day a week clinic and they wanted to cut us back from 4 to 3 days, but we already don't get our hours and our CM is leaving next month and no replacement is hired so they're letting us keep our 4 days for now. We'll see what happens. Hope you get some answers!

Well, I don't think I'm going to accept the offer. My CM talked to me last Friday, yesterday she was in the office and told me and the other nurse that our hours were getting cut to 30 a week. Not enough patients and they don't think they need more than 1 nurse there each day. Then the CM said to both of us, "If one of you took the CM job, no one would lose hours." So they really don't want me in particular- they just want the position filled. And they wouldn't hire another staff nurse. I would be required to work as the only nurse 2 days a week, still have to work every other Saturday and cover vacations for the other nurse- while learning all the CM stuff- and we are getting ready to put a new water system in the clinic and the state should be showing up anytime. And we only have a part-time secretary, so would also have to be answering phones, etc on days she's not there. Yeah, not going to do that. So now we are both wondering if we are even going to stay there or not.

Hello again. ? A company would definitely invest in you! Every company is a little different with training. Most are pretty extensive. When I was in my orientation, we were sent for training weekly to an education site several days a week for 12 weeks, you went a little less each week until we were permanently in our home clinics- they did that for acute nurses as well. You are also assigned a preceptor until the orientation time is over. Most recently my company has changed things and there are more virtual classes and staying in clinic to train. We actually just had some new acute hires that trained with us for several weeks until going to the hospital to finish their orientation. I think Covid pushed a lot to virtual and companies figured out it was a lot more cost-effective to not have to pay for hotels, meals, and mileage. You have a great background so I would think you would pick everything up quickly, too. Definitely a good question for the hiring manager. When I was negotiating my salary last time I pushed for a higher rate than I thought they might take, but I had the experience and they need nurses so they are more willing to consider right now. Acutes are typically paid better, too, because usually there is call involved. I would let them know what you expect. You might be pleasantly surprised.

@Kyle46N- Great points! I'm pretty good at leaving things at work- but I know it's a whole different ball game when you're the one in charge. I've had two vastly different management experiences in my career. One was as an interim CM 20 years ago. I would have taken it permanently, but I was having my first baby and wanted to go part-time. Great clinic, a great staff- was really "easy" as far as a management job goes. The second time was 3 years ago- hired as a clinical coordinator for an endocrinology group. I hated it. I had worked there before as an educator and so I jumped at the chance because I loved the providers there. But there ended up being no training and new providers that joined the group were nightmares to deal with, the antiquated IT systems never worked and I ended up having to do a lot of the staff nurse jobs like PAs for insurance (that is soul-sucking work- bless the people that have to deal with insurance companies all the time!) So the stress you are mentioning is definitely a concern for me. I think this current CM position would fall somewhere in the middle.