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Which would you take? Acute Dialysis RN or Acute Care for the Elderly RN


Ok, this is my second post because I need help.

I am a new grad interested in eventually becoming a CRNA, however, the job market is tough and so far I've had no luck with ICU positions.

I have two job options that sound promising...one as an Acute Dialysis Nurse for DaVita and the other is as an RN on an Acute Care for the Elderly floor - both are at hospitals. Any opinions?

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

I guess all any of us can do is give our personal opinion, which may or may not mean anything to you....

I would take the acute care for elderly in a heartbeat. First, I love the elderly :heartbeat.

But probably more to the point, I have always avoided dialysis assignments. My personal experience (and only my personal experience) has been that a large percentage of dialysis patients tend to be noncompliant with their diabetic or other chronic illness lifestyles. I struggle with that issue. We can only do so much teaching when our words fall on deaf ears.

The elderly :heartbeat, on the other hand, for the most part are so grateful for care and concern. It's so rewarding to care for them and you feel as if you're actually making a difference. Huuuuge generalization, I do realize. But again, just my opinion.

86toronado, BSN, RN

Specializes in neurology, cardiology, ED. Has 5 years experience.

I also would choose the non-dialysis job, but for a different reason. The acute care floor sounds like you may run across a lot of different disease processes and their co-morbidities in the elderly population. This should give you a broader base of practice if and when you go to apply for an ICU opening later on.

Like 86tornado said, I would take the ACE as I think I would find it more interesting. Also, for a number of reasons I would rather stick needles in my eyes than work in a dialysis unit.

Perhaps a nurse working in dialysis will weigh in....I would be interested to hear their ideas.

ijuanabhappy, ASN, RN

Specializes in School Nursing. Has 10 years experience.

I would choose Acute Care for the Elderly RN. I am thinking of possibly doing the CRNA thing too and I am debating whether to take an extern position in med/surg at a huge teaching hospital or a patient tech position in the IMCU dept of a smaller hospital. Decisions, decisions. I still have a year of nursing school to go. Have you thought about telemetry? When I did a day rotation in MICU, one of the nurses said if your goal is to get into ICU then it is very helpful to first go into telemetry.


Specializes in Telemetry, ICU, Resource Pool, Dialysis. Has 11 years experience.

I would definitely caution you against the acute dialysis position. Frankly, I'm surprised that a new grad would even be considered for that position. Dialysis isn't rocket science, but it is a very focused specialty. Acute dialysis frequently involves very sick, unstable patients. Acute nurses often work very autonomously, leaving a new nurse with nobody to turn to for help. Acute nurses are also frequently required to be on call for emergencies.

A better starting place would be the acute care unit. As other posters have mentioned, you will get a variety of patients, and learn lots.

Thanks everyone! Your replies are so helpful. I would like to work on a Telemetry floor but every job I've applied for says they are taking people who either have experience, at least as a tech:(

I'm thinking of getting my ACLS and Telemetry certification. Has anyone done this prior to getting a job and did it help with the job search?

DeLana_RN, BSN, RN

Has 23 years experience.

I have to agree with everyone else, take the Acute Care for the Elderly position, which will give you general med/surg experience, something you will need if you want to further your education.

Dialysis is just too specialized for a new grad, especially acute contract (which means, you're not a hospital employee but work for the outside provider - DaVita - and therefore are truly on your own. If you wanted to do this kind of work, you should at least get a year of chronic dialysis experience in a clinic before doing contract acutes. And again, I wouldn't even recommend that for a new grad. Get some med/surg first!)

As for your telemetry question, I'm surprised to hear that. I worked on a tele floor as a new grad and they didn't require previous experience (they taught courses there; at the time, ACLS wasn't even required for the stepdown unit, although that has changed since then). Before you get ACLS on your own (which can be quite expensive) I would ask if it would help if prospective employers have the requirements you describe (i.e., in lieu of experience).

Best of luck to you,


Very informative responses! Thank you.

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience.

I have a friend who is a CRNA and she was required to have a lot of ICU experience before she applied.

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