Solutions for Acutes?

[westieluv]

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!

[Guttercat, ASN, RN]

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.

[Erikadawn RN]

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]

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!

[Loo17]

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.

[TEXASWAG, MSN, RN]

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]

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 $$$$$.

[zzrider]

I'm going to offer a somewhat different, more positive perspective on acutes. First off, I'm a new nurse, and acutes is my first and only nursing job. I'm not young and starry-eyed though: this is a second career for me, having come from a long corporate background that was 1,000x worse than what I've seen from my Big 2 employer.

I absolutely love acutes, and really can't imagine doing any other sort of nursing work. Yep, the days can be long. I left the house at 5 am this morning and got home at 11 pm (and I've had longer). I'm on the schedule tomorrow as well, but my manager put me on standby because she knows I was out late tonight and can cover the census in other ways. This happens regularly. I don't get the sense at all that our management views us as expendable pieces of machinery. They really seem to do everything they can to make the workload tolerable and safe, within the confines of still needing to get the work done. Management is effusively appreciative when someone steps up to go above and beyond. The nephrologists in our group also seem to be considerate of the nurses, and they don't order nighttime stats and bring in the on-call person unless genuinely necessary.

I don't see the long hours as much of a problem. Yes, we are treating fragile, acutely ill patients and have to be on our game. But really, acutes is about the easiest nursing job anyone could ever ask for - only one patient at a time (sometimes a tandem in the HD room), and there is very little in the way of physical demands. If you're organized and your patient is stable, you spend much of your time just sitting there logging q15min assessments.

Regarding the oft-heard grouse, "the big two only care about the money"... well, yeah. Don't you care about your paycheck? I sure do. I'm not highly inclined to volunteer to go in on a day off and work for free - is anybody? Of course the corporations are concerned about the money - it has to come from somewhere, and in these days of Medicare reimbursement cuts, that's becoming increasingly difficult. It's a problem that's easy to complain about, but there is no easy fix.

Maybe I just got lucky and I work in an atypical group. Whatever the case, I love it!

[Chisca, RN]

Honeymoon period.

A timespan during which problems known to exist are either not manifest or ignored, much like the newlywed period during which spouses are most cordial and passionate with each other. May be followed by a "mourning" period.

http://medical-dictionary.thefreedictionary.com/Honeymoon+phase

[Erikadawn RN]

I used to think the same when I first started, until I got so many unnecessary treatments, just for the sake of the Docs having someone to do for the day. Or wanting to dialyzeva a pt, when I'm leaving to go home and they've been there since yesterday

[Guttercat, ASN, RN]

I'm going to offer a somewhat different, more positive perspective on acutes. First off, I'm a new nurse, and acutes is my first and only nursing job. I'm not young and starry-eyed though: this is a second career for me, having come from a long corporate background that was 1,000x worse than what I've seen from my Big 2 employer.

I absolutely love acutes, and really can't imagine doing any other sort of nursing work. Yep, the days can be long. I left the house at 5 am this morning and got home at 11 pm (and I've had longer). I'm on the schedule tomorrow as well, but my manager put me on standby because she knows I was out late tonight and can cover the census in other ways. This happens regularly. I don't get the sense at all that our management views us as expendable pieces of machinery. They really seem to do everything they can to make the workload tolerable and safe, within the confines of still needing to get the work done. Management is effusively appreciative when someone steps up to go above and beyond. The nephrologists in our group also seem to be considerate of the nurses, and they don't order nighttime stats and bring in the on-call person unless genuinely necessary.

I don't see the long hours as much of a problem. Yes, we are treating fragile, acutely ill patients and have to be on our game. But really, acutes is about the easiest nursing job anyone could ever ask for - only one patient at a time (sometimes a tandem in the HD room), and there is very little in the way of physical demands. If you're organized and your patient is stable, you spend much of your time just sitting there logging q15min assessments.

Regarding the oft-heard grouse, "the big two only care about the money"... well, yeah. Don't you care about your paycheck? I sure do. I'm not highly inclined to volunteer to go in on a day off and work for free - is anybody? Of course the corporations are concerned about the money - it has to come from somewhere, and in these days of Medicare reimbursement cuts, that's becoming increasingly difficult. It's a problem that's easy to complain about, but there is no easy fix.

Maybe I just got lucky and I work in an atypical group. Whatever the case, I love it!

Acutes is the best gig going, in theory. I love it...when it works as it should.

The nephrologists (and the degree of accountability they are held to) can make or break a large(er) program. Especially when the format is room-to-room dialysis.

Be grateful your nephrologists are mindful of the team as a whole.

[schnookimz]

There needs to be requirements for the docs. There were so many times I would get home and get called in for a stat treatment for a non critical patient that easily could have been done the next day. NO REASON FOR THIS!!!!

[Guttercat, ASN, RN]

There needs to be requirements for the docs. There were so many times I would get home and get called in for a stat treatment for a non critical patient that easily could have been done the next day. NO REASON FOR THIS!!!!

In my experience, many times the nephrologists on call defer to the ER doc's recommendation-- especially if they'e been awakened at 11PM