What are Dialysis Clinic Staffing Norms?

[JpedRN]

I need to hear some words of wisdom from those with more experience than I. I have worked for over 6 months in a dialysis clinic that is owned by one of the for-profit corporations. We have 60+ patients, are open 6 days a week with three shifts of patients per day. With only 2 RN's and 3 PCT's on staff, (not per day, but the only staff available to schedule per week) we are expected to work from 4am to 6pm 4-5 days a week providing direct patient care while short PCT's and nurses. Then without a nurse manager, or clinical coordinator, we are expected to complete and maintain all CMS case management requirements, paperwork etc.

I am finding it nearly impossible to feel effective, or feel like I am practicing safely as a nurse. Both of us (RN's) have repeatedly requested more staffing and hear that all the surrounding clinics are short staffed so we need to just "deal with it". There is no plan to hire additional nurses at this time. For some reason this answer does not feel acceptable. Just because it is possible to operate understaffed does not mean it is safe. Neither the clinic manager or regional managment are nurses or hold licensure that would put them at risk for liability. I have 2 years critical care experience prior to coming to dialysis. Perhaps I was nieve, is this standing operating procedure in most clinics? I don't want to be a job hopper or a whiner, but I really thought it would be different, and I feel I am jeapordizing my license and fear for my patients every day. I actually enjoy the role of dialysis nurse and the patients, and I don't object to doing my share of paperwork, but if mandatory overtime and understaffing is the norm, then perhaps this is not the specialty for me.

Advice?

[Valerie Salva, BSN, RN]

Are you working for FMC? They are known for purposeful short-staffing and running nurses to death.

Most units staff with one nurse for every 12 pts, and one PCT to every 4 pts.

One of the biggest problems I've seen in actual pt care practices is staff that get into the tunnel vision mode of chasing "dry weight" numbers. It is more important to look at the pts' BP, and how they feel during and after tx.

A lot of units are what I call "crash & cramp" units- because of chasing that dry weight number and not basing tx goals on individual pt assessment.

Units which are chronically understaffed often turn into "crash and cramp" units because staff are too busy running around like chickens to pay close attention to how their pts respond to tx, and to adjust tx accordingly.

After you get some experience under your belt, you may want to move into acute dialysis, where you will have only one pt at a time. Chronic unit are always busy, busy, busy no matter what the company.

[Lacie, BSN, RN]

I left a position in June for these very reasons. I was not only the only FT RN but the Clinical Manager. I had only 2 full-time PCT's and occasionally had the fortune of a per-diem RN and/or tech if I was lucky. My pt load was 45 to 48 average running 6 days a week. I was responsible for all scheduling, careplans, bone and anemia management, labs, consults, access monitoring and working the floor open to close. This was my 2nd job in dialysis and I had hoped it would be better moving to another company. NO such luck lol. After 16 months of it at the 2nd dialysis job I was so fried, I was over cooked!!! I took a 5 month sabatical from nursing with exception of doing a few flu clinics and found myself a nice little desk job in HH. I have 90 pts on my team to monitor but you know it's a heck of alot easier and I get to actually sleep at night now. Like you I came from a critical care background and it was very hard for me to succomb to the converyor belt mentality. Dont get me wrong I loved doing dialysis and working with the pts but felt abuse, used, and beaten. I have never felt like that in my 30 year career as an RN until I went into dialysis. It's a whole nother world in there. I love what I'm doing now and feel like I am really getting to be the "advocate" so many companies portray to be but never are.

[JpedRN]

Thanks for the replies. I don't feel like I am the only one in the boat. I am trying to juggle all the case management roles as you did Lacie, and I doubt I will last long in this environment. I didn't get educated and licensed to work in a sweat shop mentality environment. I have talked to a couple local peers and it comes down to Dialysis centers being "ambulatory outpatient clinics" where there are only reccomendations for staffing, but no regulations. Nursing is my calling, I think I just need to chalk this experience up to finding my niche.