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.

I have no personal experience. But since no one else has answered yet, the only think I've heard is the word "boring." So it may be less stressful but the day may drag.

The 12 weeks may be your orientation and initial training period. After that you may have your own patient workload but will not be working alone for at least 6 months. I would clarify that. It may not be as bad as you think. If the situation is that you will be working alone after that 12 weeks, I would probably not be comfortable about taking that job.

Sometimes despite all the strategies employed that's all that some can take off unless we can increase the time to 5 hours or nocturnal. I know, and you know that 4-8kg is way too much to even gain for most people in the first place. We've all tried telling our patients to limit their fluid intake and educate the heck out of them to etc., etc. But we know some just won't. That extra treatment is even counterproductive for some patients because they will just take that opportunity to drink and eat all they want and gain that 3.5kg you took off yesterday plus 1-2kg more overnight! We don't have a lot of docs here that like to use sequential.

Although the big two are very big companies that virtually monopolize the industry in the U.S., individual clinics can sometimes vary very wildly in their work environment. Transferring is a good option if you can. Look around.

Salary is just the bean counter's way of controlling cost. Why should THEY hire more workers to make up for an increased workload? Just make US work longer hours and more days. Unless someone is in an upper management job, I have never, ever seen a situation where salaried work was a fair deal for the regular front line worker.

Heck I'm also angry, at what healthcare has turned into, at what I've seen happen, at what I've allowed to happen, and what I've had to do myself. I've slid into the protective cocoon of pragmatism and have tried to do the best with what I have and where I am. I don't have the energy or the enthusiasm to make a good crusader. I find that I cannot lean into the language of hyperbole that is frequently used. I cannot agree with it even when it states the side of the case I'm on. It feels like lying. madwife2002 really makes a good point on how individualized the personalities of each facility can be depending on the who is in charge. However the FA may have the title but sometimes the nurses run it (whether as a nurse/clinical manager or floor nurse), sometimes the techs run the place and heck I've known of a place where the administrative assistant ran the whole place. I would have liked to work at a university-run Medical Center where profit is not always paramount. Where you actually have time and resources to do good nursing care and without the constant specter of managing profit/loss. But they're not anywhere near where I live now and even if I did, those jobs are hard to get because nobody leaves them for very good reasons.

No, they cannot tell you you have to hold your BM. You have a right to the time slot that you have. I would talk to the boss of the center and tell them that it's abusive to the patient. Patient abuse is an automatic report to the authorities. If the boss or RN or any health care personnel does not report it, it will cost them money and their job. However I'm not sure if you can crochet while you are on dialysis. Those are steel needles in your very important and delicate fistula. Even buttonhole needles are sharp. Repetitive movements of the arms may cause you to infiltrate as you damage your fistula walls. Food is not usually allowed on the dialysis floor. If it is being done so, then it is probably in violation of the center's policy. It is not only a cleanliness issue for the patients but who would eat food brought into the treatment area with all that blood around? Yes the ideal would be to get a transplant. However, as you know, there are not a lot of kidneys available. When a person is on dialysis, they can no longer do what 90% of Americans or other peoples do. They can no longer drink as much as they want, they can no longer eat potassium or phosphorus rich foods in mass or even moderate quantities. They should not eat those chips and other salty foods. They have a disease that has to be managed. I tell my patients that there is only so much that dialysis can do for you. Most of it has to be managed by you. Everyone, profit or non-profits obsess over labs. It's the only way to know how the disease is being managed. Many patients lie. The best lie detector I've ever had is the hemoglobin A1c test (A1c). I get told all the time that 'yes, I check my sugar three times a day and take my meds, insulins and watch carefully what I eat.' When I tell them that their A1c is 12, they say, 'oh, I just ate something before they took my blood. I then tell them that it's an average of their glucose level of the last 60-90 days. It helps to cut through the bull. Are they really watching their potassium or phosphorus intake? Are they really taking their binders?

Getting food EVERY DAY from drug reps? Really? Staff bringing food out to the dialysis floor for the patients? Really? Not allowed to go to the bathroom? Really? I would like to hear from ANY dialysis staff on here who have personally seen any of these things in the last five years. Yes, nocturnal is way better for the dialysis patient and it is rightly getting more popular but most of these patients can't even tolerate sitting in the same chair for three hours in the clinic but they can sit in their living room and snack and drink the whole day. If IU could really figure out how to profit from expanding their outpatient dialysis services, they would have done so and quickly run Davita/Fresenius out of town. IU like everybody else is run by bean counters. If the money is out there to be made it would have been done. IU by June 2009 received an endowment of $1.3 billion and that's with a bad economic year. "Undoubtedly, the difficult economic environment affected the endowments of all institutions of higher education in the past year, just as it has at Indiana University," said IU President Michael A. McRobbie. " Indiana University Foundation - IU Endowment Rises In Market Value National Rankings You cannot seriously compare the fiscal models of IU with Davita or Fresenius.

Comparing how things are done at a non-profit state University Hospital to a for-profit company is like trying to run Apple under United States Postal Service management concepts. It's great as long as you don't have to worry about costs, profits/loss or competition but that's not working out too well right now is it? I would really like to work in that kind of idealized environment. However there is a reason that Davita can run nine outpatient clinics in the Indianapolis area and IU can only run one. IU can't afford it.

The nice thing about dialysis nursing is that your patients are scheduled (for the most part). The days are frequently longer than 12 hours but they do have a rhythm to them. However unless you will be in a clinic where you will be working with other experienced nurses, you may not want to start in dialysis right away. However these are totally different kinds of nursing. Chisca is right in that you have to know what you like and what you want to do. Keep in mind that in a few years from now it may not always be what you chose today. You can always move on to other specialties later although that is sometimes hard to do.