Pros/Cons of dialysis nursing

seppuku · Jul 26, 2014

1) Yes its true you don't need dialysis nurse certification (CDN/CNN) to get hired. For my company, it is optional and we get a tiny tiny raise if we do get it.

2) There are more than 2 types of dialysis nursing. The main ones I can think of right now are acutes, chronics, home therapy, and peritoneal dialysis (or travel RN, if you like travelling). I've only done chronic, but I heard that acutes is much easier since you're only caring for one patient at a time. However, you have to do everything yourself including machine setup, cannulation, monitoring patient, and machine disinfection. If things go wrong with the machine or the patient, you are on your own and need to know how to fix it. Home therapy I heard it easier than chronic also but supposedly it's busier in the sense that you have more paperwork to do. I think chronic is the best place to start though because you get more patients, which leads to more exposure and faster experience.

I like chronic HD, and would like to try acutes but I don't like having to be on-call, just sitting at home waiting and wondering if some ESRD patient is gonna be admitted to the hospital and ruin the rest of my day

3) Well you definitely don't want all those need sticks to the fistula itself lol. It's not super bad like you'll lose your job if you do it somewhere else on the same arm though, as I heard that for some patients it may be preferable. For example, we had one patient who repeatedly had IV/blood draws done on the opposite arm and the accumulation of sticks/infiltration prevented it from being his last future AVF site. But really, I don't know anything about that. All I know is that we CAN draw it from the fistula so we're lucky

westieluv · Jul 27, 2014

I've done both chronics and acutes. Here is how I break it down:

Chronics:

Pros:

-- regular hours, as in, I get to actually go home when the schedule says I can go home, as opposed to the crazy hours of acutes

-- no Sundays (except for twice a year to make up for being closed on Thanksgiving and Christmas)

-- there are always other people around who know dialysis and can help if you don't know what to do

-- you get to know your patients very well so know more what to expect during treatments

Cons:

-- you have to oversee, and are ultimately responsible for, up to 36 treatments a day, depending on your facility and staffing

-- you are expected to get a bunch of RN tasks, such as care plans, foot checks, medication list reviews, monthly RN notes, etc., done on top of supervising all treatments, helping to tech as needed, and rounding with doctors. You can do the techs' jobs if needed, but they can't help with yours. Sometimes it is impossible to get it all done.

-- you get to know your patients very well. Yes, this can be as much of a con as a pro, because some patients are extremely difficult/nasty/inappropriate/noncompliant and you will have to see them three times a week, whether you want to or not. Most patients are very nice, but there are those few who you honestly hate to see come through the door.

Acutes:

Pros:

--you get autonomy, and your supervisor isn't always hanging over your shoulder

--you only have to deal with 1-2 treatments at a time, which is HUGE after working in chronics and having so many people running simultaneously.

--you get some extremely short days if you have few patients

--you don't know the patients except for the frequent flyers so they have no opinion of you nor you of them

Cons:

--there are times when you are the only person in the building who knows anything about dialysis, so there is no one to help you troubleshoot or to bounce things off of if you get in a bind. The hospital RNs and doctors expect you to know what you are doing at all times, and rightfully so.

--you will have days that are impossibly long. You never know when you leave your house in the morning what time you will be getting home, because there may be an add-on treatment at the end of the day, and since treatments are always at least 2 hours long, each treatment will add hours to your day. I have worked 19-20 hours straight in acutes.

--you have to take after hours on-call. This is usually the deal breaker for nurses who would otherwise work in acutes, and it is the reason why a lot of acutes departments have turnover like a revolving door. Nothing like getting home after a twelve hour day and getting called right back for another five hours!

Of the two, I prefer acutes, but our kids are grown and I have a very understanding husband. If I had younger kids with after school activities or wanted to know exactly what time I would be home in the evening, I would/could not work in acutes.

Compared to other types of nursing I have been in:

I like it infinitely better than floor nursing (I did med/surg and cardiac stepdown) and I will never work as a floor nurse in a hospital again.

I like it infinitely better than LTC nursing and at my age (almost fifty) I can no longer meet the physical needs of LTC nursing anyway, so I'll never do that again either.

I don't like it better than hospice nursing, but the only hospice jobs in my area are case management positions that require an 8am-4:30pm, Monday through Friday schedule, and I much prefer my fewer days with longer shifts in dialysis. I like having days off during the week and am not willing to give them up. I also work for one of the "big two" dialysis companies and have excellent benefits, plus I like knowing that if we ever move anywhere else in the country I would be able to transfer with the same company.

Hope this helps!

paramedic-RN · Aug 1, 2014

Hey guys,

Thanks for taking the time to reply! Much appreciated.

BBRANRN2013, ASN, RN · Aug 1, 2014

So how is peritoneal dialysis? Anyone?

Chisca, RN · Sep 11, 2014

Peritoneal dialysis is an added responsibilty in the acute setting where I work. We rotate assignments so if you are assigned PD you have anywhere between 2 to 10 patients you are responsible for setting up in the afternoon/evening and taking off in the morning. A machine regulates the therapy and you have to string, prime and program the machine. Maybe a mid day exchange which is done manually. Very tedious. Alot of lifting heavy bags of fluids and schlepping them around on a cart through the hospital, either to pharmacy for added medications or directly to patient rooms. If a patient requires 6 exchanges of 2,000 ml with a last fill of 1,500 ml that's 13,500 ml (30 lbs) just for one patient. In the morning you have manually empty two 15 liter bags into the toilet without spilling it on your shoes or the floor. Needless to say none of us volunteer because in the middle of the day the charge nurse feels you are an extra set of hands in the acute unit or you may try to squeeze in a bedside hemodialysis treatment. The only good thing is the patients seem more satisfied than hemo patients. Alot less angry than most hemodialysis patients.

Guttercat, ASN, RN · Sep 11, 2014

In the morning you have manually empty two 15 liter bags into the toilet without spilling it on your shoes or the floor.

LOL! :)

Ten out of ten dialysis nurses have splattered this on their shoes at one time or another. :)