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.

I work 4 days shifts a week 6am-6pm. I am also scheduled an overnight on call shift once a week. I can't tell you how many times I have worked worked 6pm-6am while on call, went home at 6:30am, had all day, then had to be at work at 6am the following day. I will admit it is very rough! But I have functioned well off 3-4 hours of sleep many times. Drink your coffee, eat right, drink lots of water, and double check everything you do. I'll bet you'll sleep fine the night after that shift!! If you can't see straight, call in yes... but I think you'd be surprised how many of us are regularly functioning with very little sleep. People with babies???

The 7-3, 3-11 wouldn't work for us. No one wants to work 5 days a week here, plus would you be on call one of the days and then have to work the next day? It's a nice idea though. One program I was familiar with only went to one large university hospital. They had 2 7pm-7am nurses that worked every night. If there was nothing to do, they ran equipment, were trained to disinfect ROs, did quality control, stocking, and revised P and P's. I love that idea... But most programs won't go for that since they don't produce revenue.

If you can work for a fully staffed acute team, with reasonable call shifts, good management, and great pay, you can make it work. There are quite a few people on my team who have been doing it for 10+ years. We work 3 shifts plus one on call a week. We still have turnover, but that is happening all over in nursing. I don't work for one of the big two. Our management tries very hard to get us out on time, get relieved, educate doctors regarding working with us to ensure reasonable add on times, cutting times if late add on.. etc. the doctors act as our peers and work with us to try to keep the nurses happy and not overworked .

RNs in Denver make between $35-45/hr. New grads starting around $25-30/Hr. Cost of living here has gone way up in the last 5 years, so cost of living compared to hourly rate is kinda crappy... Some nurses in my specialty with experience make $100k /year, this does include call back pay and some OT which comes with acute dialysis .

I ran a patient on a nitro drip today, asked the nephrologist if he had ever heard of nitro being contraindicated for dialysis. He said he had never heard of that. As we all know, many nephrologists are different, one believes in mannitol, one doesn't. One dialyzes after contrast on ESRD, one doesn't. Anyways... I think if the patient chronically wears a nitro patch they should keep on with what works for them. Some patients require a lot of Antihypertensives to stay away from Stroke level BPs. So I would never take off a patch without talking to MD.

I have never heard of this... I don't think I would trust this without speaking to a nephrologist or a pharmacist.

It's pretty amazing , I imagine that a lot of our patients will still need traditional dialysis for a long time. Many of them are elderly, handicapped, use walkers. Also important to remember that acute dialysis treatments will always be needed. Unless they can come up with a self running machine. What about the patients that need dialysis for 8 weeks. There's also plasmapheresis. They've experimented with its use for certain cancers, encephalopathy, many autoimmune disorders. I don't think the days of extracorporeal circuit therapies are anywhere near over.

In my opinion, starting with LPN, then to ADN, then to BSN is way too complicated . If you can make it work, just do the BSN if it works for your family and your life. You could always work part time as a CNA or other work during BSN school, I did it for many years, although no kids, but some in my class did. Just don't spend too much on tuition. Once you pass NCLEX, no employer cares where you went to school. Look at pass rates and school ratings.

No way would I be okay with that. Are you open 7 days a week and 24 hours a day? I would tell them that you've paid for it already and are entitled to vacation time. I would maybe even look up your PTO policy and workers rights for your state.

Are you in a traditional 3 12s nursing job? If so I would be very very upset. One of the best things about nursing is being able to take long breaks and more vacations. If I was getting denied vacation requests that i put in 5 months ago, I would find a new job.