CocoaGirl

I had my CNN for several years, but decided it was too time consuming & expensive to maintain the 60 CEU's. There is no reimbursment from my employer for seminars, journals etc. & It is hard to find free CEU'S related to nephrology. There is no pay incentive to be certified other than "personal satisfaction". Before we were acquired by FMC all of the RN's were CNN certified & we would rotate each year who got to attend the ANNA conference....all expenses paid. Ahh those were the days

I feel that the staff RN(s) get the short end of the stick, so to speak, especially if you are the only nurse beside the clinical mgr. The RN is required to fill in for the PCT when they are off, but if the CM can't fill in for you then you can't have off. I was once informed that I couldn't have my vacation time off, that had been approved months in advance, because of a meeting that she had to attend. Well guess what....I went on my vacation as planned. Staffing coverage is NOT my responsibility. Staffing is cut so short that it is a chronic problem with this company. I do not believe there is a written policy about this matter.

If you are employed by FMC you are not allowed to transfuse in the outpatient clinic. This is a HUGE issue for our patients because they have to go to the lab to have a T&CM drawn (another needle stick). The patient will have to go the next day to infusion services have an IV started (yet another needle stick) & sit for 4 - 6 hours to receive the blood. Why? because of reimbursement issues. We used to draw the T&CM during dialysis, send the specimen to the lab & if no issues with blood availability we would transfuse that day during treatment or during the next treatment. The hospital would bring us the blood & it was so simple for the patient.

I have always been curious WHY FMC is not considered a Monopoly in the industry. FMC has the market in its back pocket since it manufactures their own machines, dialyzers, saline. They own Phoslo, Venofer & want us to push our patients to utilize the FMC pharmacy for their meds. The company acquires hundreds of independant dialysis facilities & now they are jumping into the vascular access business.

I can't say you will be on your feet all day, but it will be 95% of the time (unless you are lucky to get a pee break or a lunch). The RN does pre & post nursing assessments on all patients, administers all meds, sets up & tears down machines. Not to mention taking your own assignment of patients to start treatment on, monitor during tx & take them off. Most of the time you are the ONLY RN or licensed staff in the building. We have to do ALL the nursing paperwork, med reviews, diabetic foot checks, lab reviews, physician orders, order supplies & meds. UGH I'm tired just thinking about all I have to do.

I have been through a Fresenius acquisition, our unit was private & was bought out by FMC. It was a nightmare and still is, be prepared that staff who quit will not be replaced. Almost all of our support staff were let go: HR, unit clerk, receptionist etc. You will work short staffed, have LOTS of extra duties to take on and have limited support from upper management. The PCT's have had to pick up ALL of the water system testing & checks, mixing bicarb, doing pt labs, filing, chart audits, faxing (all the secretarial duties), stocking supplies, putting away the huge pallets of supplies when the truck comes etc. This is in ADDITION to taking a full pt assignment. Our unit has 3 techs & only one nurse. Sadly, you will learn very quickly that profit comes before patients & patient care.

Telling someone their patient is "Tachy". That usually gets a look or two.

FMC is famous for not being totally up front with potential employees about hours, traveling & training. Only certain facilities are training facilities & if you are hired for a different facility you WILL have to travel to the training facility for some of your orientation. Ten hour shifts often turn into 14+ hour shifts because a third shift gets added. Sorry, but this is reality at FMC.

Yep......the extra day(s) off is so not worth it because of the ridiculous hours that we work. I would really love to do the ten hour shifts I was hired for.

Sounds like we work for the same company. I know what you mean about having two 30 min breaks deducted when you don't even get to take one break. These hours are killer, I couldn't do two days in a row.

We work 13-15 hour shifts Mon, Wed & Fri. The days are very long, non-stop & there is no such thing as a 30 minute lunch break. (Even though the company knows we can't take longer than 10 mins) we still get 30 mins deducted. I could not do this job if I didn't have the next day off to recouperate.

The foot rests were removed last week & the patients do NOT like it at all. Our patients can't push themselves back in their chairs, their legs dangle and it is just uncomfortable for them. Each patient was given a memo that was written by corporate about the reasoning behind the removal of the foot rests & we have encouraged each of them to call the listed number to complain. What about the "patient rights" that CMS has indicated in the conditions for coverage?

The footrests in our area will be removed by technical ASAP according to the latest memo. Each unit will have to purchase "portable" foot stools for staff to tote around for each pt to use to get into their chair. I don't believe that they will be used for pts to rest their feet on since we will only be getting one or two of them for the whole unit. The entire issue makes zero sense & corporate just need let the footrests alone. I'm not privy to all the details of the accident that occurred to make this come about, but my guess would be that if there had been adequate staff (that was not rushed) the incident may have been prevented.

Are there any infection control recommendations for caring for a C-Diff positive patient in the chronic setting? Our unit has an alert & oriented nursing home resident who is obese & requires a hoyer lift to transfer into & out of the dialysis chair. Due to the hoyer lift size it will not fit into the patient bathroom. The resident is incontinent of foul, liquid stool that soils through their adult brief & clothing almost every treatment day. The patient is colonized with c-diff and has had treatment multiple times. We have been instructed by the area manager (non-medical) & the clinical manager that this patient will be changed in the chair by the staff when this occurs. There is no isolation room, this is an open unit with patients only a few feet away. (of course we put up privacy curtains during the changing process). Sometimes the stool ends up all over the hoyer sling & hemo chair. It is gross & smells up the whole unit, but what really concerns me is the risk to other patients. The alcohol based hand sanitizers are NOT effective against the clostridium spores. It takes a minimum of 3 staff members to do this changing process due to the size & immobility of the patient. (we only have 4 staff in the unit, period). We suggested that if the patient is incontinent to send them back to the nursing home and dialyze the next day at another unit since we are only a 3 day a week clinic. The patient would have an 45 minute drive back to the nursing home & have another 45 minute drive back to our unit. I feel like the clinical manager is not taking the risk to staff or the other patients seriously. Any suggestions??????

Management did away with our pillows & cases (our pillows were only 1 yr old & in excellent shape). The clinical manager put out a memo to each pt about the pillows being an "infection control issue" and they are to now provide their own pillows from home. We have had several patients ask how bringing stuff from home will improve infection control. The staff were specifically warned not to mention to the patients that the reason was the cost for the disposable pillow cases. So now not only do we work with bare bones staffing but now we have to deal with patients bringing in black garbage bags full of their belongings into the treatment area. I'm not joking about the garbage bags, some bring in two pillows (one for their head & one for their arm), one sometimes two blankets, their snacks, ice, headphones etc. I agree that bringing things from home is just gross (some of our patients hygiene is just not good). FMC is all profit driven, management could care less about patient comfort or safety, their actions toward patients speak volumes.

FMC does make a profit from every medicare pt, the last newsletter put out to all employees boasts about the profit margin & the increase that was made on each tx. Every medicare pt in our clinics has a secondary insurance to pick up the 20% not covered. Believe me when I tell you that before any new patients steps foot in the door they better have insurance or our area mgr will not allow us to accept them. I agree with the above posters about needing competion in the dialysis market, FMC has the entire market in my area.

I too received the union letter, but no one has approached me yet. Do you think a union will make any difference? One of the "old timers" at a nearby clinic told us to be careful about this union issue because in the past employees have been fired or "ran out" for trying to organize. Something needs done & soon.

I agree with you TraumaRus, a portable O2 tank will not last that long & the patient will run out. This is the issue we are dealing with in the clinics, who is going to be held liable if something happens? Can the non-medical area mgr who is making this decision be held responsible (which I doubt)or will it fall on the RN? I plan to discuss this with our medical director. I am really upset by this, the patients who need the oxygen are our most fragile and elderly ones. I can't even imagine them trying to bring enough oxygen to last 5-6 hours. The small tank they bring now are about enough to last for the trip to & from dialysis.

I was curious how other units provide oxygen for their chronic O2 dependant patients or do they have to bring their own O2 for tx. I'm not talking about providing O2 in an emergency situation but O2 dependant patients. There is currently an issue with this at the clinics in our area, our area mgr feels pts need to provide their own O2 since "dialysis is like going to a doctors appt & physician offices don't provide O2". We have concentrators but not enough for everyone. Any advice on how to handle this? We have requested another concentrator for our unit and this is the response we got from management, they can not justify buying another one. We have one small O2 cylinder to use in an emergency, but not for routine O2 during tx.

I just read a company email that FMC is boasting a "9% increase in revenue to $1,876 million & dialysis services revenue also increased 9% to $1,677 million" for the second quarter of 2009. But when the employees at our clinic asked a few months ago about a cost of living raise, our area manager reported to us there is no need for a cost of living raise since the cost of living has not gone up. ARE YOU KIDDING ME.... is anyone else annoyed by this? Fresenius is bragging about profits when the staff are overworked, under paid and can get a maximum annual raise of only 3% (which no one ever receives since this leaves no room to "improve"). FMC also reported a $17 increase in revenue for EVERY dialysis treatment during the quarter. Our clinic is so understaffed, the patients get marginal care (we do the best we can with what we have). Just another great example of profit over patient care and safety. I honestly don't know how the "big wigs" can sleep at night with the injustices this company does to their patients and employees. UGGGGHHH.

The staff at our unit do work together, or we would never survive. There is not time for breaks or lunch because we have such a long turnaround. In the moring our first shift starts going on @ 0700 and finishes @ 0800. We do nursing report and the techs then go back to chart on the first shift since there is not enough time to do all of it when the pts first go on, they do packs for the next shift, stock supplies etc. They are very organized and busy. Our first patients start coming off 0945 - 1000, the next shift of patients start going on at 10:30 and put on last until 1230. So between 1000 & 1230 each pod is taking off 4 pts, tearing down, setting up, (alarm testing alone takes 10 minutes), testing conductivity and putting on 4 more patients. In two of the pods the the second shift starts coming off at 1330. We only have three techs & one nurse. Our population of patients are elderly, many are in a nursing home & require alot of assistance to transfer or hoyer lifts. Only 6 pts are "walkie talkies". The RN pitches in where she can with whatever needs done but has her own duties also with meds, pre & post assessments, troubleshooting, trying to answer the phone, monthly med reviews, foot checks (my employer does not feel anyone but an RN is capable of checking feet), physician rounds plus all of the other reports & paperwork that the employer requires. The lull that GeauxNursing describes at their unit does not happen at ours (I wish). The techs are also trying to fit in water checks, bicarb, putting away stock etc. I am still curious how in the sample schedule a pt can come off @ 1000 and one go on @ 1015 in the same pod. The area manager does know that the techs come in & work off the clock in the am, but as long as the total area productivy numbers look good he doesn't care, I guess that would affect his bonus. Thanks for all the suggestions.

Scheduling is a nighmare. In the example schedule how do you take a pt off at 10 am & have another one going on at 10:15 in a different chair within the same pod? This is the issue we have with our clinic, there are no extra hands to help tear down, set up etc. Each tech must be able to function on their own in their section of four. We have 1 RN & 3 techs for 12 stations. There is no one to answer the phone which is always ringing off the hook. The techs come in & work off the clock in the morning just to get everything done before the patients go on. (this is another topic all together), management told the staff they could not clock in that early. There is no time for breaks or lunch we are lucky to go to the BR once a shift (really sucks when you have your monthly visitor). Please any scheduling ideas would be appreciated. How do other clinics get everything done in the am & how long do you have to complete everything? (machine set ups, water checks, mixing bicarb etc). Mgt feels it can all be done in 45 minutes, but if we get behind in the am the rest of the day it is he!!. This is why they come in early. I wish management would do this job for 1 day. HELP.

I totally agree with Lacie, I work with a few very good techs who honestly feel in 2010 they will not be working in dialysis. There is so much anxiety among the techs, and to top it off they have to pay for their test out of pocket & were told they will only be reimbursed if they pass. Sadly, FMC has policies that are not consistent with KDOQI guidelines and it is causing much confusion for the ones who are trying to study for the exam. On a side note FMC used to give a 5% salary increase to employees who were certified by BONNET etc, but as soon as the new ruling came out that policy quickly changed.

You must work for Fresenius, I personally don't feel that someone without a nursing background should be in a FA position. You did the correct thing, after all the FA doesn't have a license to lose, but you do.

Hello, our dialysis clinic was "acquired" about 2 years ago by Fresenius. It was the most unorganized and difficult transition that could possibly have occured. I wish I was exaggerating when I tell you that there was a mass exit of staff. This company came in like a whirlwind - changed everything: benefits, supplies, dialysis machines, equipment, staff and it was complete chaos and still is to this day. Many of the staff were without health insurance for several months because of the red tape that we had to go through. The FMC staff that were to help with signing up for benefits were a joke. I had to fill out the forms not once, not twice but 3 times to get coverage. This was the norm for several of my co-workers also, the papers kept getting "lost". You will learn very quickly that it is the FMC way or no way. Forget about being autonomous, you are a number to this company. The staffing ratios were changed to save $$$$$, no one in the nusing staff were let go, but then again so many of the experienced staff left there was not enough to run things. We STILL have agency staff to this day because no one stays long enough through orientation to actually get out on the floor. I wish I could say that things got better as time went on, but it hasn't. All we ever hear about is cost, cost, cost. The large dialysis companies make it so hard for the independant ones to stay in business & the government (CMS) changes will make things worse. Good luck to you.