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.

In California, all you need is a high school diploma and I've seen techs be hired with just that qualification.

Timing is everything. A few years ago, the big 2 would not even talk to you unless you have experience. Now they are hiring straight out of school. It may change again later but I don't see that happening anytime soon, not in my area anyway. Some of the smaller companies are a little pickier and will only hire with dialysis experience or at least some med-surg or equivalent experience.

Do you have friends/family that depend on you enough that you need a semi-dependable schedule? Then acutes is definitely not for you. If you like unpredictability and constant change, then acutes is for you. Depending on the area you work in, you may not even work in the same hospital day to day. StarBrown is right in that most DaVita clinics barely give you enough time to assess your patients. On the other hand, it is chronic care. You see the same people all the time and after awhile you know exactly how they are doing by just saying hello to them most of the time. On the other hand you can learn a lot of really cool stuff in acutes.

angelmp228, what state are you in where you can sign off the assessments?

It does take a couple of years to finally get out of the task mode. My rule of thumb when I'm talking to new nurses and PCTs is that when in doubt, clamp it. If it's clamped in error, the machine stops and you have time to think it over. If it's opened in error, you have a mess and hopefully the machine stops before it becomes a crime scene.

That's because, like most others, those who like their jobs don't usually seek a forum to complain. I worked in cardiac telemetry for four years and have now worked in chronic outpatient dialysis for the last four for one of the big two in various settings. I still like my present job a lot better than my old one thank you. I really liked and still miss cardiac telemetry but I don't miss spending most of my time doing toilet work, lifting 300lb patients in and out of bedside commodes because they are on diuretics or kayexalate and I really really don't miss feeling like my patients and I are in danger because we are always short-handed in an acute situation. Yes, there are negatives to working chronic dialysis and for some people that outweighs its disadvantages. As always, the people you work for or with will 99% determine if you will like your job or not.

Yes, some clinics run extra treatment days on Mondays and Saturdays. Yes Mondays sometimes got worse.

That's it. Almost anyone can be trained but are they someone we want to hang around with for most of our waking lives.

Sodium modeling is gone for us.

Med/surg nurses are the bomb. Others may get more notice and glamour but like coleebee said..."mad respect" to all y'alls. westieluv is right on with the differences.

With your work history and with enough dialysis experience there is no reason why you can't work both acutes and chronics. With chronics you may be taking care of up to 12 patients at a time (maybe more), but they are generally stable. Your acute is unstable enough to be in the hospital and may range from simple fluid overload to a post open heart, still in the ICU with multiple vasoactive drips. A person with experience in chronics but not a lot of experience working with tele/step-down/icu patients may have a harder time transitioning to acutes.

It sounds like you work in acutes since you take weekend calls. Try working in a chronic facility. The hours may be more predictable although they generally work Monday-Saturday. I went from tele to chronic dialysis. I am way less stressed. For now anyway.

Since you came from med-surg/tele, you've probably worked a lot with heart failure patients and their chronic fluid overload problems. It helped me a lot to have that experience. Your experience with dialysis depends on whether you are going to work acutes or chronics. westieluv seems to be describing working as a dialysis nurse in acutes. Chronics are a lot more predictable. Your schedule/hours/patients do not change very much and you usually have other staff and nurses to work with, whereas in acutes if you take that machine down to a room, you are by yourself. The most PIA thing you have to learn is how to work and troubleshoot that machine. Each of any individual clinics are run like an individual franchise and can vary very wildly. Some are great places to work and some can use some help.

Most chronic facilities run their patients as scheduled. Your hours should be very predictable. On the other hand, I've heard that acutes are feast or famine. Sometimes you may not have enough hours to get a full-time check and sometimes you'll get more overtime than your body can handle.