Tell me about your week in Acute dialysis.

Anna S, RN · Jul 3, 2018

I loved the patient care in acutes, but the hours and working conditions were awful.

One shift, I had to work 22 hrs straight, without a break. Most days it was 17-19 hours. One co-worker quit right after she had been required to work 24 hrs straight. And yes, this is legal. I read my many pages of my state's Dept of Labor, Wage and Hour division web site.

Shift starts at 6am, ends at 6pm, but call starts at 6pm. I would be getting calls at 5pm telling me how many pts were already in ER, waiting for me to start call.

One pt after another can come into ER, needing dialysis. Whomever was on call had to just stay until all the pts were done, or until regular shift started at 6am, and staff scheduled that day came in. I covered two hospitals. Docs would be upset, feeling that their pts took priority over other doc's pts.

Tore my meniscus when I had an on-the-job slip and fall- due to faulty, leaking RO machine. A kidney became available for transplant that evening, I was on call. No one could cover for me. Mgr called "everyone." If I didn't stay, pt supposedly would not get transplanted, and would lose the kidney.

I worked 18 hrs with my acutely torn meniscus.

Much of the equipment was in really bad shape. Old, and jerry-rigged. Did not function properly.

Equipment and supplies were kept on several different floors of the hospitals, requiring many trips back and forth, hauling tons of stuff all over the hospitals.

These are just a couple of stories from that job. I have many more.

It was awful. I worked there a year. We lost a nurse a month that year. All resigned.

Hopefully, others have had better experiences.

Chisca, RN · Jul 24, 2018

You won't require training so acutes will hire you in a heartbeat. What they won't emphasize, as Anna S pointed out, is what happens when you work all day and take call that night? My current personal record is 22 hours straight. No, I didn't volunteer for it. Call will kill you.

ldyjstce · Aug 4, 2018

Worked for years in-center and PD. Just took my first Acutes job at the end of March. I was promised a rose garden and the first month was wonderful. Now, I am not seeing that rose garden. I did a 37 hour day (LOL) when 1 RN was on vacation and 1 RN was out of town while the 3rd RN had not been trained at our hospital. I also did a 17 hour (day) where I ended up in the ER of the hospital and no one could be found to cover my call. So I am wheeled down to the ER by the house supervisor and am still on call while getting IV meds for my massive migraine. In-center HD was a pain and the constant on call of PD wore me out . . . Acutes, however, is beast unto itself. At this point in time, I am seriously considering travel dialysis RN positions.

Twinmom06, ASN, APN · Aug 5, 2018

I also work acutes and my personal best was 21 hours after dialyzing 9 floor patients (with only 2 machines at the time so 4 shifts of patients) when the doc decided an OD needed a full 4 hour tx instead of a CRRT. I've done my share of 14-16 hour shifts, but have also done my share of 6 hr shifts with only 1 or 2 patients and then going home at noon or 1pm after starting at 6:30 am. I take call 1-2 nights a week and one full weekend (6 pm Saturday night to 6 am Monday) per month. I have a terrific boss that will rearrange staff and even come in to cover if someone gets stuck all night and is supposed to work the next day. She will also allow us to go home and get a few hours of sleep before coming back to dialyze a 1:1 treatment. All in all I enjoy my job (most of the time). I've had 4 clinic interviews and can't get hired, so for now I'm where I'm at.

Naturally Brilliant, BSN, RN · Aug 12, 2018

Oh wow, you guys have some real horror stories for lengthy days!

At my company as a full-time acutes nurse I do three shifts in a day (meaning three patients). I'm still relatively new to dialysis, only been in it for about 5 months (~2-3 months all by myself), so the whole process takes a long time. I feel like I spend half my time either setting up machines, breaking down machines, or paperwork and charting, rather than actually dialyzing the patients. For three patients, I'm at the hospital for 17-18 hours. Some of the night-shift floor nurses will see me, and they'll be shocked that I'm still there! lol

When my days are just that long, and I'm getting out at 2:30 am, it's best that my work days are spaced out, otherwise I'm on like 3 hours of sleep before I have to do a whole 'nother 3-patient-day all over again. But the flip-side is that if my days are spaced out (let's say Monday-Wednesday-Friday) then my days off are spent catching up on sleep and getting ready to go back to work the next day. So it's starting to feel like work is taking over my life. All in all, dialyzing is relatively straightforward (though not easy per se). I'm not a big fan of the schedule, though. When I worked in ICU, I worked all three of my nights in a row (Friday night/Saturday night/Sunday night) to get the differential monies, as well as to have four days off. Sure, the Sunday nights suuucked because I'd feel tired, but at least when I was off I knew I could spend some time mentally away from work.

So I don't know how this'll play out longer term. *shrugs* Right now the pay's great, I run into overtime without really trying, and management isn't pressuring me to get done faster, so I'm adjusting where I'm at. If it physically or mentally becomes too much down the road, though, I could switch to part-time or re-evaluate how I feel about dialysis. We'll see :-)

Twinmom06, ASN, APN · Aug 12, 2018

Oh wow, you guys have some real horror stories for lengthy days!
At my company as a full-time acutes nurse I do three shifts in a day (meaning three patients). I'm still relatively new to dialysis, only been in it for about 5 months (~2-3 months all by myself), so the whole process takes a long time. I feel like I spend half my time either setting up machines, breaking down machines, or paperwork and charting, rather than actually dialyzing the patients. For three patients, I'm at the hospital for 17-18 hours. Some of the night-shift floor nurses will see me, and they'll be shocked that I'm still there! lol
When my days are just that long, and I'm getting out at 2:30 am, it's best that my work days are spaced out, otherwise I'm on like 3 hours of sleep before I have to do a whole 'nother 3-patient-day all over again. But the flip-side is that if my days are spaced out (let's say Monday-Wednesday-Friday) then my days off are spent catching up on sleep and getting ready to go back to work the next day. So it's starting to feel like work is taking over my life. All in all, dialyzing is relatively straightforward (though not easy per se). I'm not a big fan of the schedule, though. When I worked in ICU, I worked all three of my nights in a row (Friday night/Saturday night/Sunday night) to get the differential monies, as well as to have four days off. Sure, the Sunday nights suuucked because I'd feel tired, but at least when I was off I knew I could spend some time mentally away from work.
So I don't know how this'll play out longer term. *shrugs* Right now the pay's great, I run into overtime without really trying, and management isn't pressuring me to get done faster, so I'm adjusting where I'm at. If it physically or mentally becomes too much down the road, though, I could switch to part-time or re-evaluate how I feel about dialysis. We'll see :-)

Eventually you will get faster. You will learn how to chart while your machine turns over and goes through test, and you will learn how to break down and set back up and have the next patient on within an hour. It takes a good year to be comfortable in the job. I can take off a catheter, close my chart, pack up and move my machine and have the next patient on in. 45 minutes (if I'm staying in the ICU), an hour at most if I have to hold needle sticks. Good luck!

Naturally Brilliant, BSN, RN · Aug 13, 2018

Thanks!

What's up with y'all not taking breaks, though?

I always just take a lunch break either between my 1st and 2nd, or my 2nd and 3rd, patients. If the patients get dialyzed later, then too bad so sad. I'm not going to end up getting bad headaches, dizzy, and downright ill not having eaten or having taken a break between dialyzing patients. And if any company were against giving breaks, I don't have a clue how they'd retain employees.

Twinmom06, ASN, APN · Aug 16, 2018

Thanks!
What's up with y'all not taking breaks, though?
I always just take a lunch break either between my 1st and 2nd, or my 2nd and 3rd, patients. If the patients get dialyzed later, then too bad so sad. I'm not going to end up getting bad headaches, dizzy, and downright ill not having eaten or having taken a break between dialyzing patients. And if any company were against giving breaks, I don't have a clue how they'd retain employees.

I take a break - once I have my 2nd round of patients on, I'll go eat in our office (which is across from the treament room). Once they are on I have 3-4 hours time to chart and eat. Between 1st and 2nd round, I'm usually getting report on the 2nd round and setting up for turnover. Afternoons tend to run a bit slower. I'm usually charge, so I'm getting discharges out,making supply orders etc in the AM.

shinyhappy1, BSN · Aug 18, 2018

Maybe it's my area, but my experience hasn't been as bad as the others. Yes, I've had one 21 hour shift and several very long shifts, but that is because there are sometimes delays, which can often be avoided if you do things like call the hospital to be sure your patient is ready and an order exists. Often, long shifts are because I agreed to do a third patient. They might beg us, but they don't force us, so it really is up to me if I want to do that.

We do have required on-call shifts, but I negotiated to work one full day every other week instead. Because of this, my schedule is 3 days one week and 4 days the next. I get a 4 day weekend every other weekend, which I also negotiated for.

Many dialysis companies need people pretty badly. I decided to use this to my advantage by negotiating away the parts of the job the bugged me, because, at the end of the day, i definitely know I'm needed and wanted.

shinyhappy1, BSN · Aug 18, 2018

Also, I always take my break between patients. We're required to. If we don't, we have to file a "justification" for why it wasn't possible.

Naturally Brilliant, BSN, RN · Aug 19, 2018

I wish I had more support during machine troubleshooting issues or complications. I have a little bit of anxiety when it's my third patient of the day - and that means nobody is there at the hospital to help me - and I have a fistula I can't access. I'm worried that someday I won't be able to access it and the patient won't get dialysis at all. And another time, this patient kept on moving so their arterial/venous line pressures were in the high 200s, so I was mere inches away from the machine and stressed out for hours on end ready to lower the blood flow rate and expand the parameters to avoid the dreaded alarm. Heck, I ended up getting air into the venous chamber after I pushed Epo into the arterial chamber, so now I'm too scared to give IV push meds like Epo into the circuit unless it's like the last thirty minutes or so. I'm deathly afraid I'll clog up the machine again.