Questions about Acute Dialysis

westieluv · May 15, 2016

I can only answer based on my personal experience, and one thing I have learned through the more experienced dialysis nurses on this forum is that acute programs can be run completely differently, depending on your employer and management.

When I worked acutes for one of the Big Two (Fresenius and Davita), I was not supposed to leave the patient's side, even to go to the bathroom. Because of the type of access that dialysis patients have while on a treatment, a dislodged needle could cause a patient to bleed out and die in the time span that you are using the bathroom. What I did if I absolutely could not wait, was to have one of the hospital staff nurses sit and not take their eyes off of the access and rush like a race horse to do my business. I really wasn't even supposed to do that, but nature calls, ya know...and the shortest treatment I ever ran was two hours, so what can you do?

We were supposed to take a lunch break between treatments, never during one, obviously. I usually skipped lunch and just shoved my food in my mouth in about five minutes between treatments so as not to prolong my day, but I don't recommend this, it isn't very healthy. We got docked 30 minutes anyway, unless we could document why we absolutely could not take a lunch break, and we usually could, it just made the day longer.

We did have to take call (often!) on the days that we were scheduled, culminating, occasionally, in working some insane hours, like 6am-2am. Literally. However, I am told by those here who know more than I do that this is not the case in all acute programs and some of them actually care about their nurses and avoid this type of nonsense. If I was considering jumping back into acutes, I would want very detailed answers about how scheduling is done, amount of on call that is required, etc., although a manager can lie. I was told that I would be working four ten hour days and would have to take on call "once in a while and every other weekend". LOL, although it is on me that I didn't ask for details about what "once in a while" meant, that was dumb. On call was three weeknights a week and every other weekend, while still being scheduled for four days a week and "hoping" for a ten hour day. I almost always got called in when I was on call, too.

They didn't normally schedule us for on call on our days off, but believe me, they still called and badgered and cajoled us to do it, because we were perpetually short staffed.

Because of this, if you can even get your general schedule in writing before you accept the position without ticking them off, all the better. Then at least you have something tangible if you feel like you are being asked to do a lot more than you were told upon hire.

We did get OT when we put in over forty hours a week, which was every week.

Oddly, I enjoyed acute dialysis because of the autonomy and only having to run 1-2 patients at at time. Had I been in a better run program, I would probably still be there.

Twinmom06, ASN, APN · May 16, 2016

I'm currently doing acutes for one of the big two, and we've lost 7 nurses in the last 6 months mostly due to the amount of hours. I don't work less than 50 hours a week. I'm "scheduled" for 4 10's but its usually no less than 12's and most of the time I don't drag myself in the door till 9 pm. Call is one night per week and one weekend per month (for the moment), but I'm sure as the last 3 nurses transition out of acutes and into the clinics it will be more nights per week.

I'm fortunate in that I have a husband with a 9-5 job as he has basically taken over the care and keeping of the kids, pets and house. I get OT after 40 hours, and if we stay more than 3 hours past our shift end we get call pay.

As far as potty breaks are concerned, it depends on the facility. One of the facilities I work in we have several regular patient rooms that our patients are transported to for their treatments, and there is a bathroom in the room. Since the patients are not allowed out of bed, I just use one of those bathrooms. Lunches, our office and storage room is across the hall, so we are back and forth in and out I just step over there to eat and drink since we can't do that in the treatment rooms. One of the other hospitals does not have facilities as such, so I wait for the Nephrologist to make their visit - they will relieve us to go to the bathroom, or I'll get the nurse or aide to stand there and watch if I REALLY have no choice.

TEXASWAG, MSN, RN · May 21, 2016

I am going to tell you the honest truth about what I either experienced or observed working acute dialysis. For bathroom breaks, good luck. I resorted to using the patients bathroom....sometimes. Now this is when i had to wheel the machine to the patient's room. I saw other dialysis nurses who brought in snacks to eat in the room.

You will probably last about 6 months to a year because the long hours are horrendous. Davita will work you 60-80 hours a week. You won't have a life.

westieluv · May 21, 2016

Fresenius will also work you to the breaking point. I know, because I worked for them doing acutes. I could have worked every day of the week and taken call every day of the week too, had I wanted to. We had a huge turnover of nursing staff, it seems like they would get trained, get on their own, start taking call, and then quit within a few months. I tried to stick it out and lasted almost a year, but very few of our nurses did. The only ones who did were either single with no kids at home who didn't care if they were at work all the time because they had nothing else going on and liked the money, or those who were married with kids but were in a financial pinch and depended on all that OT to pay the bills. I fit neither of those categories, so I didn't feel the need to give my entire life to my job and split.

I now work chronic dialysis. Set hours, no Sundays or major holidays, and I'm surrounded by others who are knowledgeable in dialysis if I have a question or concern. It took working acutes to really appreciate what I have in the chronic unit. If you don't mind spending all of your working time with the same patients over and over for months and years and you enjoy dialysis, try chronics.

Twinmom06, ASN, APN · May 21, 2016

We have some long timers in our Acutes, however as they get older more are leaving to go to the clinics. The advantage to acutes vs. working a floor is this (this is my positive spin), yes I work 12-16 hours a day, but my only focus is the patient I'm dialyzing at that time. I'm not running around after 5+ patients, medicating them, toileting them etc. I'm not dealing with dozens of docs, residents etc... my focus is the current pt (sometimes two). Yes the long long days suck sometimes, and I am a member of the "OT helps pay the bills" club. There are advantages!

NurseRies, BSN, RN · May 22, 2016

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 .

westieluv · May 22, 2016

What I don't understand, is that both of the Big Two are always worried about cost and the bottom line, yet they have to be losing money hand over fist on training acute nurses and then working them under conditions that cause them to quit a few months later. When I worked acutes for Fresenius a few years ago, in the almost year that I stuck with it I saw at least six new nurses get hired, trained, thrown to the wolves, and quit, just during that time period. I read here and elsewhere of the same thing happening in other acute programs across the country, so how can that be remotely cost effective?

I never understood why our acute program couldn't have two shifts. The first shift works something like 7am-3pm, and the second shift works 3pm-11pm. Just knowing that your crazy day will have some kind of reasonable end to it would help immensely. Of course, they would still need someone on call from 11pm-7am, but that's a whole lot better than starting at 7am and not knowing if you will be going home before midnight like it was in our program. If I worked 7am-3-pm I wouldn't have minded taking call after 11pm, because I would have had time to go home and rest and have down time in between. Even if this system required a few extra nurses, it seems like if it caused an increase in overall job satisfaction and caused more nurses to stay then they would still come out ahead financially, especially if they could fill the extra spots with PRN staff who were paid a higher hourly rate but didn't get benefits, which I know are expensive.

There is one Fresenius acutes program in my area that has this system in place and guess what? They are the only acutes program in the region with either of the Big Two that rarely, if ever, posts job openings. Must be doing something right....

TEXASWAG, MSN, RN · May 22, 2016

I agree with you! Why work one nurse to death when you can have 2 nurses to cover the day? I once clocked in at 6 a.m. and clocked out at 2 a.m. the next day.....CRAZY!!! Someone once told me that the savings is in the benefits. They would rather pay benefits for 1 nurse as opposed to 2. Davita had a lot of contracts at many places. Most where in the city, but some where in these small towns that surrounded the area. Davita would have to have twice as many nurses to cover all of their contracts. So, in my area I really don't see Davita changing anytime soon.

nutella, MSN, RN · May 22, 2016

General rule is that you can not leave the machine or patient out of sight and go to the bathroom while the treatment is running unless you have another dialysis RN cover you. If the machine is running and lines become disconnected/needle out/ something else the patient will bleed out quickly, the loss of blood volume within minutes is huge. Also, a pat can become unresponsive and you would not catch it and so on and forth...the list is long.

So - no, you can not just run to the bathroom.

If you work in an acutes room and somebody else is watching your patient, you can of course go to the bathroom.

Lunch/dinner is usually between tx. If I had a really busy day I would drag the machine to the next patient, set up and take the break while it was re-circulating. Other times I would just drag the machine to the next patient and leave to eat and set up after...

Most places I worked the on call nurse would start the day late and stay until all tx were done.

Acutes is a job that will give you few hours or too many hours, there is not much in between. If there is a lot of staff it means that you may not get much hours when census is low. But it seems that because more people are leaving acutes (I left as well) there are now always enough hours....

NurseRies, BSN, RN · May 23, 2016

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.