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

[New Grad STL]

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]

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]

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.

[2BSure]

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]

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.

[pricklypear]

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.

[New Grad STL]

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]

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,

DeLana

[New Grad STL]

Very informative responses! Thank you.

[diane227, LPN, RN]

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