wordsmith

Trying not to be picky, but it's not "HIPPA", it's HIPAA, for Health Insurance Portability and Accountability Act. Thanks.

I posted this eight years ago (!): Nov 27, '09 by wordsmith, ADN, RN I worked for a doctor-owned facility that was bought out by Davita. There were lots of processes and policies that Davita put in place. OMG...Everyone from Davita was really nice and helped us get this stuff going, but just getting used to it all, holy cow. Lots more paperwork, lots more computer work, way more emphasis on infection control (and we weren't slackers in that dept. before, believe me). They get crazy about measuring heparin down to a 10th of a cc. Our administrator is working 60 hours and is so stressed out, like that other person said, trying to get us what we need and still trying to be a mom, I think eventually she'll quit or go back to being a floor nurse. Overall, though, I think it would be the same for any large company. Benefits are good. Free uniforms, your choice. Pay equitable. Kept same staff. Patients were really anxious and blamed all the changes on Davita even though we kept telling them that many of them were on the new emphasis from Medicare. Whatever. And now, today, 12/8/17: Boy, did I learn a lot after that. I'd already been working in dialysis three years, and I worked for the two sister clinics five more years, with floating to three other clinics in the state as far as 225 miles away, which was a lot of fun. It's the same thing that other people talk about though--the assembly-line mentality the company has. Every clinic is different, with the tone set by the FA (facility administrator). If the FA isn't organized and interested in making the patient schedule flow well, the whole clinic is disrupted and unorganized. If positions go unfilled and staff are stretched to the breaking point, there's little the FA can do except encourage flagging spirits and tired bodies to keep going. I eventually left DaVita because there was no support for the nurses from the FA, who had been a PCT. I moved over 200 miles away to take a job with Fresenius (much better $$) and immediately noticed a difference--their staffing was much better--they actually had someone who did labs and stocked supplies for their whole job! I worked on the floor for a bit and then worked in PD for a year until I got an amazing job out of dialysis entirely. Dialysis is hard work and underappreciated by everyone who has never worked in dialysis. It's a life-sustaining service that gets short shrift from acute care nursing. We have similar problems that floor nurses have. We administer treatments, we give IV antibiotics (frequently in multiples), send patients to the ED when they bottom out (and we don't have a rapid response team, either), and care for fistulas and catheters. I challenge any floor nurse to create a buttonhole access in an established fistula. Just go for it. But, there's so much crap in dialysis, too, and I don't know why. We don't get paid what floor nurses do, and I suspect it's because of Medicare and Medicaid reimbursement rates. But most of the patients make it worth it. If you get into a good clinic with supportive coworkers and a good administrator, and you like the work, stay.

Socialist medicine is good, to a point. The problem is where people have to wait for long periods of time for routine surgeries. Or when the "system" decides that when you're over a certain age, procedures and medications aren't going to be part of your treatment regimen because it's felt that in your age group, it's not sufficiently life-prolonging for the investment the "system" has made. However, socialist medicine is still better than the godawful patchwork that exists now. My beloved wound up declaring bankruptcy (#1 reason for bankruptcies, BTW, is related to medical bills) because of a series of events starting with an MI, prolonged hospital stays, etc. that lasted for a couple years, including extended unemployment. If this country had had socialized medicine, he wouldn't have had to do bankruptcy.

Uh, yeah, it IS that expensive, if you're working crazy hours and/or in an area where there is no physical nursing school campus. One of the on-line outfits charges about $2500 per class. I started taking the BSN classes and after $10,000 I decided to call it quits, especially after three attempts at trying to pass stats at the local community college didn't work out for me. So don't assume that it's that easy or expensive for everyone.

Sure they are...found in any dialysis center near you :) or any hospital that provides inpatient dialysis services. With the aging of the population, and more and more people getting hypertension and diabetes (top two causes of end stage renal disease), there will be people on dialysis. There aren't as many people on peritoneal dialysis as on hemodialysis, and there are only a handful of patients who do hemodialysis at home; most do hemodialysis at outpatient centers. It's a wonderful mix of chronic nursing, in that you get to know your patients well, and acute nursing--when someone gets sick, they get sick in a hurry, and patients do code on the floor, and you can be giving CPR when the paras get there. Or, if you have a DNR, a patient can pass away while there. Dialysis nursing is not for the faint of heart, although it can look almost monotonous and humdrum. At the same time, it can be lots of fun--much depends on the clinic and the tone set by your manager.

Tommy, I work for a disabled and senior services agency as part of state government and I absolutely LOVE this job. It's almost all paperwork. I also see clients in nursing facilities and try to get them placed in assisted living facilities, foster homes, hospice care, residential care facilities, or home with whatever assistance they need, rather than staying in nursing homes. Why? Because almost everyone can agree that nursing homes are not the best setting for most people, and clients usually want to go home. If they can do it safely, great. If not, we try to find the best alternative. It's a great job for someone who has a lot of experience in rehab, med/surg and other general experience, is getting older and just can't keep up with floor work any longer. I have an office with a door, use a computer, have regular daytime hours, and can pick when I go out and see clients. I can use my own car or use a state car. I'm pretty autonomous. State jobs don't pay as well as hospitals, of course, but the benefits are great, so take your pick. I can't say enough good stuff about it. If you see a job like this, go for it!

Over $5/hr. I was amazed at the increase. They took into account my total years of nursing, not just dialysis experience.

I just got hired by Fresenius. I've been working for Davita and can't believe how much better Fresenius pays. To be fair, I'm moving from one area where there's little competition to an area where there's more competition, but the increase in pay was remarkable. The background check was done and i'm waiting to get the drug screen done. I'm excited to go to work for a company with decent pay and benefits. Managers set the tone for the clinic, and I'm leaving an incompetent manager for one who seems to know what she's doing. Keeping my fingers crossed.

and telling me training will be at this clinic but also another one and possibly one out of state for a few weeks. Is this the norm for Davita? .There are two clinics in our area and we swap personnel back and forth sometimes. When nurses and PCTs train, they train at the larger clinic because they'll get more exposure to problems and unusual situations. Also, a few weeks into employment, Davita holds a theory class and for us it's at the larger clinic so we can have more people attend. If there's a new hire for the smaller clinic, the new person then goes to that clinic and finishes training. So it's not unusual to go to more than one clinic. Out of state, if you're licensed in that state and within a reasonable distance, that would probably be okay, too, but if you have to fly and stay in a hotel, I'd wonder about the amount they're spending on training you. Also, as a trainee, you are not supposed to work over 40 hours a week unless the manager approves it--and I've never heard of a manager OK'ing trainees doing OT. Hope this helped.

I hope this is encouraging--it's meant to be. My 30-yr-old son just got his BSN and was hired shortly after that at the hospital where he did his practicum. He treated the practicum like a long-running job interview and it worked for him. When I got out of nursing school in 1993, same thing, glut of nurses on the market, and had to drive 75 miles each way to work when I found a job at a hospital. Please hang in there--take any job you can, even if it's at a SNF. Broaden your horizons. Do flu shots during flu season. Volunteer at health fairs and BP clinics. Maybe your church will let you do some volunteer parish nursing, similar to community health nursing but with faith added to it. Good luck and take care.

Then the previous suggestions people have made apply--pharmacy, doctor's office, family or friend to do for the patient or assist the patient in filling the box. For sight impaired, same thing, or as the Braille-using person suggested, a Dymo labeler and having someone help out with what meds are what. Wonder if that person's pharmacy could label the bottle with just the name of the med with a Dymo labeler before putting it in the bag to make it easier for the patient.

Hi--I hope after a couple months you're a little more accustomed to the chairside Snappy. It's slow (it was part of the Gambro system and DaVita incorporated it into Snappy) and somewhat redundant with all the password stuff, but you do get used to it after a while. On one screen I've memorized the letters for "patient watching TV" and "no complaints" and stuff like that, and for entering the meds, so it goes a little faster. Supposedly the new program they're beta testing in some of the clinics is a lot better. It combines Snappy chairside, Snappy at the desk, and Duck.

As above, liability issues, time issues...check with your clinical service specialist and nursing board to see if it's dispensing. Yikes. I sure wouldn't do it, FA or no. I think my CSS wouldn't go along with it, either. Also, that's what home health nurses are for.

Funny how things vary. We always do bevel up, are not supposed to flip needles, but occasionally have to depending on the patient's access. We do use lidocaine by request on accesses; I understand that many clinics don't. I never heard of Tums on an access.

Anywhere from 8-12 hours depending on the schedule.