starting Acutes dialysis without experience.

[ffliper27]

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.

[ffliper27]

thanks for that info. I'm not worried about the long hours per se. I have good physical stamina :-). And I really don't have family commitments etc, that would require me to be home at a specific time. But as I mentioned in previous posts, it's the safety issue that concerns me. Like most of you guys have said, 12 weeks is not sufficient to train an RN with no dial exp. I sure as heck do not want to put a patient's life in jeopardy due to inadequate training, but also my RN license.

[schnookimz]

The best physical stamina in the world doesn't prepare you for acutes. I worked 7am to 3am yesterday.

[westieluv]

But as I mentioned in previous posts, it's the safety issue that concerns me.

I just read schnookimz's post and wanted to say that I think that being forced to work hours like that is just as much of a safety issue as not completely knowing what you are doing. I worked a day almost that long last week and by the last patient I was so tired I was a little blurry eyed. I prayed, forced myself to think clearly, and drank caffeine, because I didn't want to put the patient in any danger, but it really was way too long to work as a nurse taking care of people in any capacity. If I do quit this job down the road, the days like that will be the reason. They aren't every day or even every week, but they are really rough.

[schnookimz]

I totally agree. It's not safe or productive. By the end of the day, everything takes twice as long to do.

[NurseRies, BSN, RN]

I totally agree. It's not safe or productive. By the end of the day everything takes twice as long to do.[/quote']

They Should really adjust their program. I have worked for 6 acute programs after being a traveler for a while. I believe that 24 hour days or 18 hour days , can be avoided 95% of the time in a well run program. There are a few ways to do this. Hire more staff obviously, and cross train them with chronics so that if there is a dip in census, staff can fill in at the outpatient units. All it takes usually in 2-4 full time nurses extra. They could also hire a couple nurses that did 12-12 shifts, or 10-10 etc, to take over the late add ons. If you're on call, don't start until noon. If the census is that busy, they obviously need more nurses. They could also take some nurses from outpatient units and cross train them to fill in here or there for a half day. I have worked programs where 18+ hour days were common. That was because of disorganization and inability to retain staff. Any company that is frequently paying tons of overtime and having their nurses do 3 shifts is probably poorly managed. Anyways, just my two cents.

Nurses will complain either way. Too many hours, or not enough hours. If your acute program is adequately staffed, you should be thankful! And during weeks of low census, have a back up plan for hours. I always keep a flexible prn job on the side. If your program is training a revolving door of unqualified people who quit immediately after training, I would run!!! Acutes and chronics are nothing alike. I do miss getting off work at 4:30-5, and never a minute later! (Chronics) but I love being able to sometimes sit down, and be in complete control of my patient'a outcomes! (Acutes)

[Guttercat, ASN, RN]

Oh dear lord. No.

Unless this is a well-backed inpatient program, meaning there are plenty of people to call for help day or night, or you are working alongside other Acutes nurses while you are "on," do not do this.

Acutes is a different animal, most especially if you will frequently be responsible for running the inpatient dialysis circus independently, with no other dialysis RN's on site.

Keep in mind a couple of things:

1.) If you are to be functioning independently, as in you are the only dialysis nurse on shift at any given time, learning how to set up and run a dialysis machine and plug a patient into it is the very least of your worries.

2.) You need to be extremely confident in your skills and knowledge, because every blasted department in the hospital will depend upon you to know your stuff, and how it impacts their work specifically, because many of them must plan their treatment decisions within the context of ESRD. They do not "know" dialysis. It's not necessarily their gig. And, I do mean all departments, from the ICU docs/RN's to the floor nurses to the internists to the attendings to the surgery department to the flow coordinators to the housekeeping staff to the dietary department to the ED personnel to the Interventional Radiology/Special procedures folks (yes, that is a big one) and even tothe podiatrists. Yes, even podiatrists.

3.) Here's one. Say you are called out to the hospital at 1 AM. You arrive in the ICU to find a patient on multiple vasoactive drips, with multpile concomittent problems, but needs dialysis... now. The patient also has a crappy dialysis access that only kind of works. The ICU doc is breathing down your neck and depending on you, because at this point adequate dialysis is the only thing that will keep the patient from dying in short order. You look up at the cardiac monitor and have to address the fact that their rhythm is really twitchy as dialysis progresses. Do you have a firm grasp on how everything you are doing, and everything the patient is doing, and how everything in those bags dripping into the patient all interact? While you are contemplating this, the entire dialysis circuit clots off without even a hint (in the last five minutes) that it may occur. Now, the only viable access the patient has (a crappy temporary IJ catheter) is also full of sludge and non-functional because you were trying trying to pull 800ml fld.hr at a pump speed of 250ml/hr without heparin.

At the same moment, you get a page from the ER stating you have another critical patient hitting the floor in five minutes, and how soon can you get them going?

Acute dialysis can be about the best job in nursing there is (I personally love it), but no way in hell would I do it with twelve weeks of training/experience. My patients, the hospital staff, and myself, deserve better.

[fragino]

The 12 weeks may be your orientation and initial training period. After that you may have your own patient workload but will not be working alone for at least 6 months. I would clarify that. It may not be as bad as you think. If the situation is that you will be working alone after that 12 weeks, I would probably not be comfortable about taking that job.