starting Acutes dialysis without experience.

westieluv · Nov 16, 2013

I work in acutes and, like you, I had zero dialysis experience when I started, but several years of med/surg and intermediate cardiac experience. In my opinion, 12 weeks is in no way enough orientation to do this job if you have never done dialysis before. I wasn't on my own for almost five months, and I am told that I didn't even get the full orientation that my company (Davita's biggest competitor, hint, hint) normally gives. I am now several months into it and I still have frequent questions for my co-workers and manager, and I am still learning the routines of the various hospitals and physician groups. It is tough, and I am still learning new things about dialysis everyday and still don't have full confidence, which I was told normally comes after about a year.

I would never want to do this job with no dialysis experience and only 12 weeks of training. I know I would end up quitting, because I have wanted to quit several times as it is, except that I am determined to stick it out until it gets better. I know it is doable and that the only way to get good at it is to stick out the tough times.

I am not trying to be ultra-negative, just being honest. I have been told that Davita does not like to give (pay for) extensive training so they try to lure people who have been trained by my company away. I think I believe it after reading your post.

ffliper27 · Nov 16, 2013

thank you for ur input. Now, i'm beginning to think twice about it. However, I still would like to give it a try. Can you tell me what is the worst case scenario that could happen?

Ex: a pt is so sick that he/she codes while dialyzing?

Since ur in the acute setting, u'll be working by yourself at the hosp. But if something were to happen to the patient while you're giving treatment, will you not have the help and support from the hospital staff RNs? Will you be left to fend for yourself?

That is my biggest and scariest concern.

Thanks for your feed back

Chisca, RN · Nov 16, 2013

Alot depends on what prior nursing experience you have. Any ICU, ER, procedural area experience? How mechanically inclined are you? Setting up a machine and troubleshooting water issues can be daunting. You should have help when needed if your pt crashes but many times that ICU nurse has alot going on besides the patient you are working on, in fact they may think that they don't even need to come into the room very often since you are there. 12 weeks with no dialysis experience could be a rough road to travel.

westieluv · Nov 16, 2013

thank you for ur input. Now, i'm beginning to think twice about it. However, I still would like to give it a try. Can you tell me what is the worst case scenario that could happen?
Ex: a pt is so sick that he/she codes while dialyzing?
Since ur in the acute setting, u'll be working by yourself at the hosp. But if something were to happen to the patient while you're giving treatment, will you not have the help and support from the hospital staff RNs? Will you be left to fend for yourself?
That is my biggest and scariest concern.
Thanks for your feed back

Well, this has been my experience: The staff nurses in the hospitals will help you a lot of the time in whatever capacity that they can, but they do not know dialysis and cannot help you with knowing what to do if your system clots, your pt's BP starts to bottom out, and other such problems that can and do occur while you are running patients in the acute setting. They expect that you know what you are doing and can handle any issues that come along. They would definitely come running if your patient coded, and the code team would take over, just as they do with any other patient.

Patients do code on dialysis. This has not happened to me yet, and I hope it never does, but it has happened to some of my co-workers. So many acute dialysis patients have so many other co-morbidities, that dialysis can be precarious for them. I always err on the side of caution, just as I did when I was a floor nurse. Before I will let a patient's BP bottom out, for example, I always give them fluid back and back off on the UF rate, or the rate at which we remove fluid from them. I have been taught that in the acute setting, goals cannot always be achieved, due the the patients' often critical status. For example, if the doctor orders 3 Kg of fluid taken off and the patient is not refilling their vascular space as the fluid is removed because of their poor condition, their BP will plunge and you have to know what to do and understand that 3 Kg is probably too lofty of a goal for them. Of course, it is imperative that you okay any changes that you make with the nephrologist, since you are technically disregarding their orders, but luckily, most of them understand and trust your judgment and will be fine with it, especially if it prevents something dire from happening to their patient.

What is still hard for me is when I am alone at a facility and start to get add-ons. In acutes, it is not abnormal to start the day with 1-2 patients to run and end up with 3 or 4, or worse. Chances are that your manager would send you help or come and help her/himself, but it can feel like the world is on your shoulders if you aren't totally comfortable with dialysis and you keep getting more added to your day.

I still say that 12 weeks is not enough training, and I know that my co-workers would agree with that.

ffliper27 · Nov 17, 2013

Thank you so much for all this input. As I said, Davit will be giving me a call in 1 wk. So I have this time, meanwhile, to think about accepting this challenging position. I feel that I have basic critical thinking skills, but still, the thought of working with very acutely ill patients is of high concern to me. Maybe i'll take the job, and if at the end of my 12 - 14 wks orientation I'm not ready to be on my own, I may ask if I can instead work in an in-center chronic clinic. I'm not sure what they would think/say, if I were to propose this to them.

NurseRies, BSN, RN · Nov 18, 2013

hello I have gone thru the 2nd interview at davita for an acute RN position. when I went to the job fair I told them that I had no prev dialysis exp, and they said that it would not be a problem, because they would offer training even without exp ( orientation is supposed to be around 12 weeks). based on how my interview went, I feel that I will be offered the position soon. I am just, however, little concerned. They said after the 12 week training, that we, the new acute RNs, will be pretty much on our own taking care of very sick patients. I'm concerned that while on my own, if something were to happen to the patient during treatment, I would not be too sure about how to handle that situation. Does anyone of you experienced Acute dialysis RNs have any advice? I have heard that in order to do acutes, you should definitely have about 1 yrs experience doing chronics. I really want to take the job, but at the same time, I think that I should decline the offer and try to start in chronics. Any advice would be greatly appreciated.[/quote']
Hello! I started in chronics and did that for 2 years full time before switching to acutes. The experience is invaluable for doing acutes. The reason why is that in acutes, you are often by yourself in a hospital, meaning, no other dialysis nurses. So, you don't have any experienced people giving you great advice, tricks of the trade, or how to fix a problem. In the chronic unit, you will do 32-50 treatments per day, you will come across A LOT of scenarios that you can come back to and pull from for experience. In acutes, you will do 1-4 treatments a day, and you will be alone, therefore, unsure of how to respond to things you've never seen. Floor nurses cannot help, they rely on you to know the nephrology and technical skills. I have seen many nurses start out in acutes and do fine, but It takes a special type of person with a tough skin and a desire for a challenge.
You mentioned worst case scenario. Well, many frustrating days occur. Usually, this involves technical problems.. You pull your machine and water machine from the 3rd floor down to the icu on the 1st floor, just to find out your machine is failing the tests and you can't use it, and have to start over. Or you started your 4 hour treatment and you immediately realize you have to pee. Many will tell you it's ok to use the bathroom, but there's a reason why they tell you to NEVER leave the patients room during a bedside treatment. Mainly because there have been rare cases where people bleed out in 3-5 minutes due to access dislodgment. Sounds rare, and it is, but basically, don't take your eyes off that patient!!! Another awful situation I heard happen to someone was when their patient coded and died during dialysis (not related to treatment), the nurse was new and very flustered. While going out to the nurses station to document and make calls, the patient's room flooded completely from the RO machine falling out of the drain. So now she had family all surrounding in the hallways while cleaning up a total embarrassing flood. She quit that week. Another thing to consider is that dialysis patients have been doing this for years, they will immediately know if you don't know dialysis. They have been doing this longer then most nurses. That can be intimidating if you are unsure or can't clear an alarm. I am sorry for telling you all the scenarios, but I do believe that if you have the chance, start in chronics. You will learn so much that will help you In acutes. It can be done in acutes, but you can tell someone who is new to dialysis. Even if they are a fantastic nurse with great clinical judgement, new people are so focused and intimidated by the technical aspects of the machine, that they often get discouraged. good luck! And if you are up for a challenge, go for it. But I am gonna just say it, 12 weeks is NOT ENOUGH!

madwife2002, BSN, RN · Nov 18, 2013

12 weeks is normal for chronics if you have prior RN experience, but for acutes I would ask for longer-discuss it with the FA and share your concerns. Although I would seriously doubt if you weren't ready that you wouldnt be allowed to go it alone!

No company, would want to put you in a situation where a pt could be severely injured or died because of your inexperience

ffliper27 · Nov 18, 2013

Thank you for all this info. I might just tell them when they call me this week that I changed my mind and would like to start in chronics. 2nd option would be to go thru the training and if after the 12 wks i'm not ready, to ask to be transferred to an in-center chronics clinic. I just don't know if they would be willing to accommodate me. What do you think? The company is Davita. One of their "core values" is team work. So hopefully they can live up to that value.

westieluv · Nov 18, 2013

I would tell them your concerns up front, rather than waiting until the 12 weeks of training is up and then asking to be moved to chronics. Training for acutes and chronics is very different in a lot of ways, in spite of the fact that they both do dialysis, so your 12 weeks of acutes training would not render you ready to work in an outpatient clinic and they would have to provide you with extra training, which they may not want to do. Also, what if you get to that point and they don't have any openings in chronics?

The other thing to consider is that if you accept a position in acutes, then they are expecting you to be an acutes nurse and they are anticipating another staff member for their acutes department and may be unhappy with you if you tell them that you don't want to do acutes after all after they have hired you for that job.

I would tell them up front that you would either like to start out working in chronics for the time being until you feel extremely comfortable doing dialysis nursing, or that you have been advised by other acutes dialysis nurses that 12 weeks is not enough training for a nurse to work acutes who has never worked in dialysis before.

Like I said, I work for the other company and was in exactly the same situation, and I got a full five months of training, and would not have complained had I been given more.

ffliper27 · Nov 19, 2013

Westieluv

How easy or difficult is it to apply for a position at "your company" ( If im correct, it starts with the letter F).

I really like the fact you stated about "your company" that they provide at least 5 months of training. Do they constantly have openings?

After reading all the advice from all you experienced RN's, I think I might decline the offer and tell them that I'd rather start in chronics.

westieluv · Nov 19, 2013

I just kept checking Fresenius' website (you were right! ) until there was a position posted in my area. I don't know if this goes for everywhere, but in my area they also post positions on Indeed.com so you could start with either of those options.

Fresenius does provide a lot of training, something that I made sure of before I committed to working for them. I was told that I would get 6 months of orientation and it would take a full year to feel really comfortable and confident, so they were up front about that and I appreciated that. My orientation got cut a little short because we were so short staffed.

I am learning that it is hard to keep nurses in acutes because of the extreme hours and the on call requirement. It is often like a revolving door, and when I look at Fresenius' website there always seem to be acutes positions open, even more so than chronics. Acutes has its benefits, but it is very hard in other ways. You must go into it with the understanding that you can never plan anything on a day that you are scheduled to work, even in the evening. As soon as you do that, you can bet you will have a day where you think you will be done by 6 PM but then you get one or two add-ons at the end of the day. If there is no one else, you have to stay and run them, and those can turn into some pretty loooooong days. We used to have a nurse or two who would plan things in the evening on the days that they worked and they quit after only a short time. It isn't for everybody.