Working in an outpatient vs in-hospital dialysis

StarBrownRN · Sep 30, 2016

It's a individual decision. However, just from a liability standpoint, I'd rather be an RN in acutes than chronic. In chronic you are responsible for too many patients and too many techs. It isn't possible to safely supervise that many people simultaneously and the company doesn't provide enough time between patients to adequately assess them and the tech's work; even when everything is going well.

Personally, acutes is my preference.

AlabamaBelle · Sep 30, 2016

But, on the other hand, in acutes your hours can be ridiculously long. Then management gets upset when you have overtime, even when management scheduled you for 40 hours with 2 on call days and getting called back in. Gotta keep that productivity going.....

SmilingBluEyes · Oct 2, 2016

It's a individual decision. However, just from a liability standpoint, I'd rather be an RN in acutes than chronic. In chronic you are responsible for too many patients and too many techs. It isn't possible to safely supervise that many people simultaneously and the company doesn't provide enough time between patients to adequately assess them and the tech's work; even when everything is going well.
Personally, acutes is my preference.

So interesting the differing points of view. In my view, the outpatient clinic rocks. The techs and nurses are an amazing team and we have each others' backs. I trust my techs implicitly and they don't fail me. I know my patients well, they are often like family. You see them every other day, and while they are not all fun and nice people, at least I know them and their idiosyncrasies and I can deal.

In the hospital, your schedule is beyond unpredictable. You may come in at 5 and think you are leaving at 3 or 4, til they admit a couple patients needing dialysis. Now, your day may go on til 1 am or later. And you go home, only to be called a couple hours later, BINGO: there is yet another patient in ER needing dialysis after admission. You have to do all the work, set-up of your machine, etc with no help... (if you have no tech)......and you are responsible for your techs there, if you are lucky enough to have them.

And being called off for low census. Too much like the inpatient nursing I left behind. Not too willing to go back to that.

It's truly all about what you prefer, and enjoy. Like I said, outpatient dialysis is much more preferable to me for its predictability and outstanding teamwork environment. And you don't get called off. Your paychecks and PTO accumulate predictably. I like that.

fragino · Oct 6, 2016

Do you have friends/family that depend on you enough that you need a semi-dependable schedule? Then acutes is definitely not for you. If you like unpredictability and constant change, then acutes is for you. Depending on the area you work in, you may not even work in the same hospital day to day. StarBrown is right in that most DaVita clinics barely give you enough time to assess your patients. On the other hand, it is chronic care. You see the same people all the time and after awhile you know exactly how they are doing by just saying hello to them most of the time. On the other hand you can learn a lot of really cool stuff in acutes.

StarBrownRN · Oct 10, 2016

SmilingBlueEyes makes some good points about the unpredictable schedule of acute care. I was fortunate to work with great techs that I trust; but at the end of the day, a tech--no matter how experienced--is not a nurse. Yet, they do a lot of nursing functions for which they are not legally entitled to do, but are not entirely responsible for the consequences of their actions. Techs giving wrong amounts of heparin or an unnecessary saline bolus happens all the time and the nurse is responsible for the adverse effects. I was tired of that aspect of chronic. Techs act first then tell you what they did. I had to set-up my own machines and run a pod and be charge for 3-4 other pods in Chronics. And if a patient had excess bleeding or any other complication during/after treatment, there was no telling when you would leave. So, at least in acutes, I don't have the added liability of supervising techs who precepted me.

AlabamaBelle · Oct 12, 2016

Our acutes program does not have techs. Our training was in a large city with a large acute program with techs. What a luxury to have someone set up your machine and access your patient! We are RN only. Many times there is only 1 RN and there will be 2 patients. This is a recipe for disaster, in my opinion and in fact. On one occasion, I had 2 patients running and one patient started having trouble breathing 45 minutes into treatment. I had to call a RRT (a 1 person RN team) that was taking wayy long. Wound up just pushing the code button to get help faster. Never lost BP or HR, just couldn't breathe. The outcome was fine. Just a scary position to be in. Thankful that the other patient was having a smooth run!

nurseontheway · Oct 17, 2016

I have always worked in a chronic unit. I like the fact that the schedule is more predictable- I work 4/10's and we are closed Sunday. There is no on call and we are closed on Thanksgiving, Christmas and New Years Day. If my kids were not younger I wouldn't mind the unpredictability of acutes. I have also been told that acutes are based on census and that you may not be able to get all of your hours. I guess if you had chronic experience you could bounce back and forth if need be.