Switching Roles?

[DialysisRN34, BSN]

I have been in dialysis for fifteen years. I have been a unit manager for the last five years at one of the big two. I have been offered a role as a manager of a home therapy program. I was wondering if anyone can give me insight on being a home therapy manager. Is it less stress than in-center? Do you have job satisfaction? Any information will be greatly appreciated.

[fragino]

I have no personal experience. But since no one else has answered yet, the only think I've heard is the word "boring." So it may be less stressful but the day may drag.

[Guttercat, ASN, RN]

If you've been a unit manager for a few years, I have an inkling of the burnout (lifesucking24/7job) involved in that postion.

I've not been involved with HH programs, so I cannot give any advisement.

I can only offer my best wishes going forward, for what it is worth.

[DialysisRN34, BSN]

Thank you for your replies. Burnout is an understatement!!! I love dialysis and can't image doing anything else, but the expectations of the management role are overwhelming to say the least. I am still expected to function as a nurse (run the floor 3 days a week) and run the unit from an administrative role. I have few resources to draw on and I am asked to do more and more every day. With my type A personality (I know a nurse with a type a personality it is unheard of) I kill myself to meet all of the company’s expections. I really want to step down into a charge nurse role, but can't afford to. I am the breadwinner for our household and it takes every dime I make to support us. The home therapy role is a lateral move (financially) and I am thinking a change of pace. I am hoping that it rejuvenates me and allows me to gain skills in dialysis I have never been exposed to. However, I am nervous that I will be jumping from the frying pan into the fire. If anyone just has insight on being a home therapy nurse that would be helpful. I love to teach and I know that is something home therapy does a lot of. Thanks again!

[Guttercat, ASN, RN]

Thank you for your replies. Burnout is an understatement!!! I love dialysis and can't image doing anything else, but the expectations of the management role are overwhelming to say the least. I am still expected to function as a nurse (run the floor 3 days a week) and run the unit from an administrative role. I have few resources to draw on and I am asked to do more and more every day. With my type A personality (I know a nurse with a type a personality it is unheard of) I kill myself to meet all of the company's expections. I really want to step down into a charge nurse role, but can't afford to. I am the breadwinner for our household and it takes every dime I make to support us. The home therapy role is a lateral move (financially) and I am thinking a change of pace. I am hoping that it rejuvenates me and allows me to gain skills in dialysis I have never been exposed to. However, I am nervous that I will be jumping from the frying pan into the fire. If anyone just has insight on being a home therapy nurse that would be helpful. I love to teach and I know that is something home therapy does a lot of. Thanks again!

If it is a financially lateral move, then at face value it would seem like a no-brainer. However, if you are the only dog in the game, does that mean you are on call 24/7? If a patient has an issue when they are dialyzing at home on a Saturday night at 11PM (because they were at a ball game or the shopping mall all day), who will be responsible for fielding their call and taking care of the problem?

If it is a strictly M-F 8 or 9-5 postion, then I would think it might be a nice change. I also suspect (due to decreased medicare coverage and reimbursement) we are on the cusp of a huge nationwide push away from clinic-based hemo, and more and more into HH.

I think this is why we see The Big Two developing HH programs, and even branching out into areas beyond dialysis.

I am interested in if there is current data and projections that might show clinic-based dialysis is expected to shrink, not grow, despite the projected increase in numbers of renal patients in the next two decades.

[Marisette, BSN, RN]

Home therapy programs are growing everyday. As a clinical nurse, there is travel and call involved. Also case management, because anything that happens in the home can potentially impact your HOME dialysis patient. Issues with patient compliance can be challenging. If your are the only RN coordinating a home therapy program, you may be wearing many hats. That is, you will be secretary, nurse, biomed technician, stock person... If you are managing other RN's, it's quite similar to managing in the chronic facility. Perhaps, less staffing issues, but there is pressure to promote home therapies to increase census and provide quality care. Why not give it a try? You can always transfer out if you don't like it. Don't worry about boredom. There is no boring nursing job. There's stressful, more stressful, and intolerably stressful. It's no different in dialysis.