Torn between Dialysis and med/surg for my first job

[NurseyMomma]

(Sorry its so terribly long but I desperately need another nurse's advice)

Hello,

I'm a newly licensed RN and its hiring season over here in Tx. I so far have had a few interviews but 1 job in particular has officially offered me a position at their dialysis center through Fresenius. I know that dialysis is a specialty so I'm somewhat reluctant about taking the position as I am a new RN with no other medical experience other than nursing school. I was offered $26/hr which is on the lower end but will suffice in my book. The benefits are good, 5 wks vacation, set schedule M, W, F, 5:30a-5:30p or maybe longer, and 10 wks class training with 1 day a week at the facility shadowing a tech to learn the machines. Sounds great right???

Well, I have my doubts about this job due to the fact that it is a specialty. They have been known to hire nurse grads, however, I question the amount of nursing knowledge, foundation, and support I'd be receiving there. Since I do not have any other nursing experience (ex. med/surg or any other basic nursing care), I wonder (even after training) if I will be able to identify when a patient is too overloaded, under loaded, or about to crash?? Am I going to be subjected to responsibilities that I don't feel adequately qualified to perform?? Will I be left to oversee too much that I don't feel comfortable with due my inexperience? I've heard of new RN's loosing their licenses because of dialysis. Either they made a wrong move and the patient crashed and died or they didn't have the intuition that a veteran nurse would have to identify when a patient was going downhill, and in turn, the patient crashed and died. I also question the company's moral. There is no clinical manger so they are using the area manager to complete my hiring process and because she is overseeing 5 other centers, she's overworked, impossible to reach over the phone, and is promising to do things that she still hasn't done yet. I've also met the nurse manager at the facility I'd be working at and she several times forgot my name, thought I was an LVN even after I told her that I was an RN and didn't even ask me questions or look at my resume during our interview (which she rescheduled with me twice and showed up 30 mins late to), she just told me I was hired.

It truly seems that they are just wanting an able body to fill an empty position and is not really interested in my knowledge, skill, experience, or comfort level.

I did however receive a call back from a hospital that I applied at that has been my 1st choice hospital to work at since before I finished nursing school. I've had 2 clinical rotations at this hospital so I'm familiar with their core values and the culture there. The position is for a med/surg unit and I have an idea that the shift will be 7p-7a which is not my favorite shift, but I feel like it would be best for me to start off on. Especially so I can drop my daughter off at pre-school in the am and see her a little bit before I go into work. The interview is Monday and I'm excited but scared at the same time. I have a feeling that they will not offer me more than what the dialysis center is offering me because a friend I graduated with just started there at $25.50/hr, and that is evidently the starting rate for new grad nurses at this hospital. I would be worked like a dog and expected to work doubles..which I am definitely not interested in and have no energy for. Sorry, but I suffer from severe anemia and I'm terribly out of shape so I cant possibly work 14 and a half hour double shifts 3-4 times a week. A minimum of three 12 hour shifts spaced apart is all I would be able to stand, trust me. This position would be the best choice for my future nursing career as I would learn so much and be exposed to a vast range of nursing skill and knowledge that all nurses definitely need no matter what field or specialty the end up in. The dialysis center would limit me to only dialysis nursing knowledge and ,therefore, I'd only be hire-able in that field of work.

I am just torn between these two very great, but very different positions that have both their pros and cons. I definitely need more Nursing insight on which job a new nurse should take, so, I'm asking anyone to please come forth and give me any advice as It would be EXTREMELY appreciated.

I know I will ultimately be making this decision on my own but I feel that there is so much I still don't know about the nursing profession.

Many Thanks,

HB

[Chisca, RN]

Door number 2.

[schnookimz]

Interesting that you think dialysis locks you into only doing dialysis. When I took my dialysis position my attitude was much more, "yes!!!! Now I'll have a skill that no one else has and it will for sure make me stand out when it's time to move on!!"

You'll definitely be working 12-14 hour days at the clinic. Just bc you're a 12 hour shift you stay till your work is done. It won't be exactly 12 hours.

[KimberlyRN89, BSN, RN]

Hello, I am a 'old' new grad (spring 2013). I am just wrapping up my 10 week orientation on a med surg dialysis floor so I felt that maybe I could offer my 2 cents.

I think dialysis is great and you can learn a lot of things in this area. Unfortunately this is such a terrible market and I don't know if it would be wise to turn down a firm job offer for an interview that may not lead to an offer. From what the dialysis nurses tell me on our unit ( our dialysis unit is contracted out to Davita) , chronic dialysis is a much better and stable place for a new grad to start so it will help them learn their skills and then the transition to acute dialysis won't be so rough. But ultimately, the choice is up to you. Whatever you decide, best of luck!

[kdunurse]

I don't think new grads should go into a specialty right away - at least a year of med/surg experience is the best thing to develop your nursing skills. It also sounds like the dialysis unit you interviewed with is poorly managed, which would make me run the other way. From what I've heard, there's a world of difference between well and poorly run dialysis units.

[TEXASWAG, MSN, RN]

Go for the hospital job. Atleast you will be able to see other areas in the hospital. New grads need hospital experience to build their career...in my opinion. Fresenius is all about dialysis. I work with some dialysis nurses who only do dialysis and that's it...dialysis. They have great skills when it comes to dialysis, but they feel that they can't do anything else. I'm sure they could work in other areas, but they would have to start from scratch. For them after working in dialysis for 10 years, they don't really want to start over as a med-surg nurse, or PACU or ICU. So, get that first year experience in the hospital and take it from there.

[NurseRies, BSN, RN]

I started as a new grad in outpatient dialysis, have now been doing acutes for a couple years. I wouldn't say it is the best route, but I didn't have any other choices. That was my one and only job offer.

I disagree though that people who have only done dialysis, only do that -dialysis. I take 2 patients in the dialysis room at the same time. So I am responsible for their care. I hang blood and FFP, prime antibiotics and start them on the different pumps, change patients soiled beds, give IV and PO meds, including narcotics, call and communicate with all kind of departments and doctors, check blood sugars, full assessment is require prior to initiation of treatment, draw labs, central line dressing change, cannulation skills, write telephone orders, document in the computer system, reposition patients and keep them comfortable, scanning meds... Etc.

I have used Meditech (both old and new versions), epic, Pyxis, McKesson, among others less used computer systems. I have worked in 27 different hospitals including level one traumas, rural community, long term acute care, private religious, and magnets. I take care of psych patients, ortho, cardiac, neuro, telemetry, post cardiac cath, patients who are throwing up and have diarrhea, patients with metabolic acidosis, not counting any icu patients that I see. I see drug overdoses requiring CRRT, more sepsis then I know what to do with, and cancer patients.

I am NOT saying that I could go be a med surg or icu nurse tomorrow! Absolutely not! But I am also not clueless to everything around me other then dialysis. I already have a lot of acute care skills. I would need to learn foley insertion, GI tube skills, IV skills, plus time management would be way different. I'm sure I would need to learn A TON! But I do not feel stuck. In fact many dialysis nurses I have worked with transfer to the icu, after they become close with the nurses on the units. the choice is yours. I love dialysis and to be honest, I do not want to take the pay cut and physical exhaustion of being a floor nurse, just for the sake of having the experience under my belt. I love seeing new things everyday and always being in a different hospital day to day!

[FransBevy]

Med/Surg gives you a jumping off point for everything else. Go M/S!

[joms45]

When I got my license. I was first hired at rehab down at Seattle. It was really hard for me since I was working on weekends double shift and 1 weekdays. There are times that I work Friday to Sunday and my feet went numb due to prolonged standing. I wasn't even able to take my breaks since I was new and still trying to get a hang of it.

3months had passed, and a dialysis center offered me a position. They offered lower than I was expecting since they will train me from the very basic. My rate when I was training was 21/hr. I still accepted the position because of first it is near my place and second that I will be focused in a field that someday I can be asked by any person about it and I can explain it in details. No matter how strange the questions are gonna be.

I am planning to have my CNN pretty soon and probably taking my masters in Nursing.

It is really nice for a new grad to start in a rehab to build up the foundation that have learned in school. Once it is up, you can probably go deeper by doing a specialization. Then afterwards, either go to med/surg or some critical care. That way you are all backed up by your general nursing skills and nursing education.

No matter what you choose. Be sure to keep on reading and never stop reading to update yourself. You can't learn everything in school. You need exposures to different areas in Nursing to be the best nurse there is.

[joms45]

and also bear this in mind, NEVER BE STUPID TWICE. Learn from your mistakes and move on.

[RaquelByrd-Rust]

I worked for Fresenius in Acutes and the money is great but they do not care about their nurses or pts ~ we were mandated to work 18 hours days and 24 hours+ were not unheard of. Sign on contract said I would not be on call bc of my shift schedule (12p-1230a) but I was on call at least 3 times a week. We were also supposed to always have another RN with us for 6 months (policy) but we were left on our own the very day we tested after orientation.

Once you have med surg or ICU experience under your belt, dialysis may be a good choice. But until you know enough about nursing period, DO NOT throw dialysis on top of it - they don't care if you lose your license!

As far as pay goes, I had no dialysis exp and was a fairly new nurse - base pay was $23.25 plus 15% on all hours worked. 30% more per hour for anything after 5pm and 50% for OT and holidays.

Benefits were good but even though we had sick/personal days, if you called in they said you couldn't bc there weren't enough nurses to cover your runs!