NurseRies

About half of the nurses that leave acutes to go to chronics come back to acutes within a year. That has been my experience, but then again, about half never come back, so my advice is go for it! You can always come back to acutes if you don't like it.

Thanks for the comments! I got my CDN when I worked outpatient, then got the CNN when my acutes manager asked me to. I didn't plan to get both, but apparently since I was doing a little educating and precepting, they preferred the CNN. For the record the CNN is more suited for acutes and CDN outpatient for sure. I am up to renew next year and not sure if I will keep them both. It also seems like it may be about who you know to get a job. There's a couple of ICUs I think I could get into with the right nurses recommending me, but the question is would I be ready? I mean they do hire new grads in some of the smaller ICUs , so that is a possibility maybe, with the right training.

Hi everyone, I have been in dialysis for 7-8ish years, depending on if you count all the overtime. I LOVE it... Have done chronics for 2 years, then acutes for the rest. I have learned PD, become charge, been a traveling dialysis nurse, learned plasma exchange, and taught classes to hospital staff about dialysis. I have both certifications, CDN, CNN. I am wondering if at 10 years, it might be time to try something new. I'm thinking either ICU, or step-down/progressive care. Has anyone else every done it? I know dialysis will always be here for me, but I am wondering if I am reaching a point where things are becoming too routine. The only place to go from here in management, which I want no part of. I love teaching patients, but I want to continue to learn new skills and be challenged. Has anyone gone to ICU from acute dialysis? with no other experience?? I also like the idea of just 3 12's... I average about 45-55 hours a week in dialysis now.

Try the mometrix CNN review book, amazon has it for $50-60. That's all I did to pass, the core curriculum is too big and more of an outline format, which was minimally helpful to me. What will really help you pass is your experience and knowledge. If you are reading through the material and a lot of it is new information, it will be very hard to pass. The mometrix review guide was all I needed. Hope this helps.

I love dialysis , started as a new grad and planned to leave, but here I am 6+ years later... I figure there's plenty of time to go to icu or tele later. Doing acutes give you some basic hospital nursing skills, it's all what you make of it. When I'm in icu , I ask a lot of questions, and looks up the IV drips. You see all kinds of patients in dialysis, learn all you can. L and D nurse is right- the pay is incomparable to most specialties. That makes it hard to leave too, but keep in mind that we work unpredictable schedules and have longer days. I avg 50 Hours a week by choice to make more money. There's always work for me.

I don't know that it's any different then a Jane doe who needs blood to live. They don't question giving her blood do they? I don't know for sure, but I would guess that they assume everyone is a full code and wants everything done unless they can find other means to prove it. I am sure this is covered by liability . If I do a patient emergently with no family, the doctors signs the consent and writes something like "medical emergency, no family available, patient unable to sign".

I traveled without any problems and I only knew HD. Most programs don't expect you to do it all, that would probably be too much training anyway. On my assignments they just gave isolation patients, ICUs, and a couple programs had me working with techs in the dialysis room. No one even asked in the interview about crrt or PD. It never hurts to ask though, I learned how to set up the cycler in about 5 sessions. It's very simple, you learn alarms as time goes on. I think manual exchanges were more tricky then the cycler but it's all easy. Crrt programs are so different everywhere you go, it's just too much training. Fresenius uses a different cycler then Davita, so there's that too. Travel nurses are not expected to know crrt or PD even in acutes, certainly not TPE. With Davita acutes, I often got 1-2 days of training. No time for anything except HD. Fresenius gave me 1-2 weeks of training and was more organized.

I've never heard of a post transplant clinic. I have done dialysis in several large cities. Don't they just see their nephrologist once every few months? Or who do they meet with normally after a transplant?

Hello all, I am curious about someday starting my own staffing agency, specifically for dialysis nurses. I live in a big metro area and I know there to be at least 40 outpatient clinics and 30 hospitals that provide dialysis to patients on a daily basis. My concern is the contracts. Can large corporations such as health one and Davita realistically sign contracts with a small business to hire nurses for per diem work? I know when I was a traveler, a lot of large corporate hospitals had exclusive contracts and could only work with American Mobile, as an example. I have contacts and know people in the area, but I don't know about jumping through the hoops of an international company hiring a self-employed/small business RN to cover their staffing needs. For the record, the needs are most certainly there. Many hospital programs constantly have dialysis RN travelers, and outpatient clinics are always needing coverage for vacations and mass exodus. With a highly volatile census in dialysis, I think even with a full staff, most programs would require extra help on a regular basis for busy weeks. So, can I break the corporate chains?

I used to wear running shoes , expensive one, but for extensive standing and time on feet , I now west danskos. Some ppl hate them but I find that they support my lower back. I had them fitted to me at the walking company store. They last me about a year - year and half and my feet or back never hurt. I too work those hours. Warning- they do take a couple weeks To break in and feel comfortable.

Oh my... I hear you. I have seen those patient who continually have high K while in the hospital. I think some of them cheat on their diets, but others of them I believe have some major problems with glucose control. It's usually the brittle diabetes where we can't control their K, also could it be an access issue or poor clearance for some reason? The persistent high K cases amaze me!

In my area, if patient miss a week of treatment or even 2 treatments, then show up at clinic, some clinics will send them to the hospital because they do not know their current state of health. Sure enough they'll show up with EKG changes and a K of 7.4.... It's frustrating but that's acutes and it will always be acutes!!! Eventually the FF pass away... Seen it time and time again, it's usually the young ones.

I imagine the ultra filtrate would be a small amount at a time since they are wearing it everyday. Like a colostomy bag or drain, the patient will have to go to the bathroom and drain it. Kind of like how we all go pee. I wonder if there would be wasted fluid as well from whatever they're using as a dialysate ?

I understand. I get the same negative comments about dialysis. I am an acute care dialysis nurse and we do a lot of bedside care as well (at least I do). But yet we still get people that apply and come to work for us trying to get away from bedside. I guess the point was, less patient load, procedure based specialties can have more realistic expectations of what nurses can do. Bedside care on a floor with 4-7 patients is just way too much. But I think we both can admit, our environment is probably more doable the telemetry or Med surg. Although I trade a lower patient ratio for longer hours and limited help. I just think the OP sounds like she doesn't want to talk to anyone , especially patients. I did not know OR nurses spent a lot of time with awake patients. My friend that did OR had a different experience.

Call off and move on. Trust someone who just lost her Dad and wishes I had more opportunities to visit him the hospital. You sound like a good, loyal person with great character but just tell them it's a family emergency, it's all true.