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Solutions for Acutes?

Posted

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

Our acutes department is really struggling. I don't know how many RNs have been hired, trained, and then quit, just in the past year or two, but it's at least eight. We are swamped with treatments and we are all going in to work everyday expecting nothing less than a twelve to fourteen hour day--and that's if we hustle and skip lunch. Then there's the on call. Work fourteen+ hours only to know that you could get called right back as soon as you get home...or before you even get home.

Does anyone here work for an acutes department that figured out a way to retain nurses and have as normal as possible work days, as in, eight to ten hours? Does anyone work in an acutes department where the on call problem has been eliminated, and if so, how did you do it? Almost every nurse that gets hired in our department hates the on call, and probably 75% of them quit because of it. Is there a solution? Anything? I am not that young anymore, and I just don't think that I can take working 50-60 hours a week anymore. I hate to throw in the towel like the others, but what can be done?

Any suggestions or shared experiences would be very welcome!

Chisca, RN

Specializes in Dialysis. Has 37 years experience.

If you find an answer I'd love to hear it. My former ICU colleagues are experiencing the same turnover so I don't think it's just dialysis. We recently had to swallow a cut in the on call pay and a cut in the weekend differential.

Are there enough patients to justify two shifts? I know large inpatient units often run round the clock, and schedule shifts similar to the outpatient unit.

The other option would be to hire a couple of per diem on-call nurses, but I doubt tptb would go for that.

In our old system, all the nurses (including outpatient) took turns taking call (6pm-6am).

Dialysis is trying to do too much with too few nurses. I'm done. I just sent something to a resumé specialist because I can no longer keep up with the baloney.

Dialysis is trying to do too much with too few nurses. I'm done. I just sent something to a resumé specialist because I can no longer keep up with the baloney.

I'm so sorry to hear this. :(

Renal used to be such a great field in nursing.

The (dialysis) times they are a' changing....

westieluv

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

Dialysis is trying to do too much with too few nurses. I'm done. I just sent something to a resumé specialist because I can no longer keep up with the baloney.

I just applied for a position with the hospice company that I used to work for, and if they call, bye bye, dialysis. I can't take it anymore.

Edited by westieluv

Dang. Losing both Westie and Frans from the dialysis ranks--and at the same time-- makes me sad. :(

You both have impressed me as very talented and conscientious over the years. My best to both of you as you go forward. I can't say I blame you for striking out. The dialysis field has changed drastically.

westieluv

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

Thanks, Guttercat, you are very kind.

I am very conscientious, maybe that's why I can't justify being forced to work 17-18 hr. days and running patients when I'm so tired that I'm bleary eyed. One little mistake, like forgetting to clamp a CVC port, or forgetting to do my last 2 hr. water check on the RO...or whatever, just because I'm so fatigued that my brain is fuzzy, and I could bring great harm, if not death, to a patient, not to mention lose my license and my ability to make a living. It's just not worth it. If any of us complain about the long hours and fatigue, our manager acts like we're being wimps. Seriously...how many people do you know who would willingly work 17 hours straight without complaining or searching for a different job?

Anyway, thanks again. I really hate to give up on something that I worked so hard to learn, so I may just try to cut back to fewer days a week in acute dialysis if the hospice job doesn't pan out. Time will tell. I'm not quite desperate enough to go back to working the floor on a busy hospital unit...yet.

Frans, I'm also sorry to see that you are throwing in the towel, but I really do understand why. I remember how excited you were about making a difference in the lives of your chronic patients, but unfortunately, it sounds like the corporate culture of dialysis and the daily, grinding routine of doing the work of at least two nurses has had the same effect on both of us. Best to you as you seek something more conducive to a better quality of life.

Westie, I've had those nights of getting called in as soon as my head hits the pillow (after a 16 hour day of flat-out running), where simply finding the on-button on the machine takes a great deal of mental concentration. Absurd, isn't it?

I know very well what that is like. I think marathon days like that are to be expected, and might be even good for you on occasion--gets the juices flowing and keeps us sharp. But it is unsustainable over time.

I was very fortunate in my last position that I had a clinical manager that did her best to assure that we had enough rest.

I finally got to the point where taking call on my days off was the best solution over the long term. I didn't mind being called in so much if I had not been working all day.

Chisca, RN

Specializes in Dialysis. Has 37 years experience.

Shouldn't this thread be in the Collective Bargaining/ Nursing Union sub forum? ;)[h=2][/h]

NurseRies, BSN, RN

Specializes in Nephrology, Dialysis, Plasmapheresis. Has 7 years experience.

I believe I have the answer. No more corporations running our specialty...

I left dialysis full time because of the crazy hours. It wasn't just that we worked 60-70 hour weeks but then we would work some 30 hour weeks. I hated that too because I didn't want to use all my vacation time to make up the hours. I still work PRN in an acute unit and they are about to trial a second shift that comes in at 10am and works until 10 pm.

NurseRies, most all of Medicine is now "Corporate." Just take a look around you at the number of hospitals that have been gobbled up under one umbrella of some "group." It's the same old fight since back in the day of industrial monopolization and the fight for acquisition of raw materials and cheap labor. We've not learned from history, so history is doomed to repeat itself: Regardless, the denizons of dialysis will still make out like bandits, and so will their children's children.

In Acute dialysis (and chronic), we are reduced to two or three major players fighting amongst each other to gain territory and contracts. Unfortunately, the laws regarding monopolization is little more than a tiny, annoying fly to these guys.

What we now have is a ******* match between these companies as they jostle to gain ground on their competitors. That includes promising the moon to facilities for which they they win contracts to. How they will accomplish this moon roping is ultimately left to lower and middle management, and, of course, those of us on the frontlines of direct patient care. And now we have a culture that goads frontline staff into 19 hour shifts as "routine" because, you know, we are all "team players."

I think a couple of the big players know this is unsustainable in today's market, and so have branched out beyond dialysis.

In my (limited) opinions and observations, the realm of chronic dialysis will be more and more shifted to home Hemo as a result of declining reimbursement. Acute programs will eventually-- again-- be the domain of individual hospitals and/or the Corporate groups running them.

We recently had an issue with a nurse being called back in, after a 17 hour day. She had just arrived home, and was called back. She told the Renal fellow, that she needed at least a few hours before she came back in to do the treatment. The nursing office was called and was told that she refused to come back in. However, because we work for the hospital and not a dialysis company, and the hospital is union. We are bound by the contract which states, no hours over 16, and at least a 8 hour break before a nurse can come back to work after working 16. The nursing office has to now contact other nurses if this happens

idialyze, BSN, RN

Specializes in Dialysis.

We recently had an issue with a nurse being called back in, after a 17 hour day. She had just arrived home, and was called back. She told the Renal fellow, that she needed at least a few hours before she came back in to do the treatment. The nursing office was called and was told that she refused to come back in. However, because we work for the hospital and not a dialysis company, and the hospital is union. We are bound by the contract which states, no hours over 16, and at least a 8 hour break before a nurse can come back to work after working 16. The nursing office has to now contact other nurses if this happens

Unfortunately, the Big Guns in dialysis have no such hour limits, I worked a 22 hour shift once. Now it's ONLY chronic for this Old Bat!

I held a position with on-call and we worked 3-12's and had 1-12 on-call per week on a day we were not scheduled to work. So we worked a max of 4 days per week leaving 3 days to live life. We were never called in on a day we worked unless we offered to be on-call. Even though many days were long (16 hours after getting out late) it wasn't as terrible as the situation you describe. Plus on call compensation was really good.

Acutes is horrible. These big companies work the nurses nearly to death, and we allow it. Davita or Fresnius are both not concerned about patient safety. But have something happen and the nurse will get the blame. I know of dialysis nurses working acutes who work 60-70 hours a week.....even 80 hours in one week. Crazy, sad, horrible and not safe.

westieluv

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

This is exactly why I had to get out. Acutely ill patients who require dialysis are way too fragile for a nurse who has been working for 14+ hours to be responsible for, and I also got tired of management becoming angry or trying to shame me if I rightfully questioned this practice.

You hit the nail on the head when you said that the "Big Two" care nothing about patient safety. They are all about the $$$$$.