Would You Do This?

[westieluv]

I work in an outpatient dialysis clinic for one of the "Big Two" dialysis companies. We have three shifts of patients each day, sixteen each on first and second shift, and eight on third shift. During the first two shifts, I am usually the sole nurse in the building overseeing sixteen treatments simultaneously. You might think that it's outpatient so no big deal, but these people are not stable. Here's an example of a day I had recently:

One patient had BP in the 60/30 range at the same time as another patient was having chills and developing a low grade fever while another patient had a resting BP on dialysis of 215/108 while another patient was vomiting due to hypotension....all at the same time with me as the only nurse in the building.

Any of the above could have turned out very badly, and I had all of them to deal with at once. There are also 3-4 techs working with me and I am reminded at least weekly that they are all working under my nursing license and that I am responsible for anything and everything that they do while on the job. If one of them doesn't follow policy and a patient crashes or gets an infection, it's on me. If one of them makes a major mistake that causes harm to a patient, it is on me, and so on and so on, yada, yada, yada.

Long story short: would you stay at this job? Does this sound remotely safe to you? Would you feel guilty about quitting if you were offered something better?

[Carabella]

It does not sound that safe!

I am also not thrilled about the reminders about staff working under your license. If you have other good options and you want to leave, it is your life! You have to be happy with your job.

[SmilingBluEyes]

I think you already know this is unsafe, I would not be comfortable with your situation.

[westieluv]

Thanks, you're right. I have been a nurse for a long time, and I instinctively know when I feel like my license may be in danger. With this job, I feel like my license may be in danger and I don't want to go out with that kind of a bang, if you KWIM.

[quazar]

I would leave. As far as feeling guilty, you are not responsible for the employment choices of others, and you are also not responsible for staffing this clinic. Looking out for yourself so you don't end up hurting someone else or yourself or ending up in court is not selfish, it's self preservation.

[Marisette, BSN, RN]

Hi. Your job is challenging. It sounds typical for a chronic care hemodialysis unit. I worked chronic hemodialysis for seven years, but worked dialysis total 27 years, inpatient, outpatient, home dialysis and management. People on dialysis are very sick and dialysis treatments don't always go smoothly. Dialysis nursing can be hard on the feet, back and can be stressful, another issue that may impact your decision. Take time to think about the work place and what issues are are bothering you and consider how you or your employer can work to improve the situation. Any chance your employer is willing to make changes to keep you?

A better position is a good reason to move from one job to another, better pay and benefits and so on. However, buyer beware. Moving from one job to another is not always the best decision. Starting new employment is risky. Like a box of chocolates, you don't always know what your gonna get. It takes several months, if not one year, to get comfortable in a new environment, not to mention obtaining the ability to perform the job with ease and competance. Consider, that much of nursing employment will involve stressful and challenging situations that may appear to be a license risk. I don't know the statistics, but I suspect the incidence of loosing a license related to nursing care is relatively low. Sometimes, patient's get very ill during dialysis treatment. Sometimes patient's code, but it's not necesarily do to nursing negligence and I believe the legal system know this.

I started a new job after many years of working in dialysis, mostly for the same employer. I can tell you, the grass is not always greener on the other side. Starting a new job has it's own issues. How good is your new employer's orientation? How welcoming are your coworkers to the "new kid" on the block. Why did the person who had the job before you leave? There are definitely some good aspects to my new job, but there is much my new employer failed to mention before my start date. I suspect some of the omission was purposeful, like the fact 4 nurses before me left the job (they lied), minimal training because a coworker went on FMLA, plans to restructure and re-define the roles and task a nurse would perform on the job and so on. Granted, my last job was no piece of cake, but I suspect my urge to take flight from a difficult work place, won. Now, I regret loosing wages, benefits, and some of the relationships I had with long time patient's and coworkers. Not to mention, my new employer has a ridiculous point system if employees request time off or call in sick (who knew).

If you can speak to management and ask for change, or change the way you approach things in the work place, it's sometime easier than moving to a new job with a promise a new employer may not be able to deliver. Of course, if the new employer offers are worth the risk, move on. If all logic and thoughts fail you, all you have is a gut feeling to go on.

Remember to ask direct specific questions before you accept your new employers offer. Consider getting things in writing like HR policies, and job descriptions that may be helpful if they decide not to live up to expectations. Ask to meet and speak to nurses working with your new employer. Any possibility of "shadowing" prior to accepting the job offer? Good luck with your decision.

[westieluv]

Thanks to all of you for taking time to reply. I have moved on, partly because of everything that I listed above and partly because this job exacerbated an old injury and my doctor told me that I needed to take care of myself and accept that I can no longer do this type of work.

I am blessed to be back at the company that I left earlier this year for the dialysis job. It is more money, working from home, and I got a promotion. I have a really nice supervisor and I already know and really like several of my co-workers. My reason for leaving had to do with benefits, not because I wanted to leave, and that problem is resolved now so I am happy to go back and I do not plan to leave again.

I did discuss the situation at the dialysis clinic with my supervisor there several times and her reply was basically, "Oh, well, it is what it is so suck it up and do it." The techs refused to follow company policy in the interest of getting people on and off and getting home earlier so they would test dialysate before the machine went through test, etc. and the other nurses would also defy policy and do things like ignore it if a machine was out of the required conductivity range, which can be extremely dangerous for a patient. I would not do this so I was told that I was being "anal". Basically a rotten and unsafe place to work and good riddance.

[Marisette, BSN, RN]

Thanks to all of you for taking time to reply. I have moved on, partly because of everything that I listed above and partly because this job exacerbated an old injury and my doctor told me that I needed to take care of myself and accept that I can no longer do this type of work.

I am blessed to be back at the company that I left earlier this year for the dialysis job. It is more money, working from home, and I got a promotion. I have a really nice supervisor and I already know and really like several of my co-workers. My reason for leaving had to do with benefits, not because I wanted to leave, and that problem is resolved now so I am happy to go back and I do not plan to leave again.

I did discuss the situation at the dialysis clinic with my supervisor there several times and her reply was basically, "Oh, well, it is what it is so suck it up and do it." The techs refused to follow company policy in the interest of getting people on and off and getting home earlier so they would test dialysate before the machine went through test, etc. and the other nurses would also defy policy and do things like ignore it if a machine was out of the required conductivity range, which can be extremely dangerous for a patient. I would not do this so I was told that I was being "anal". Basically a rotten and unsafe place to work and good riddance.

I'm so happy for you. It sounds like a move for the right reasons.