Fresenius Medical Care Employer Reviews

Tanika – June 13, 2013

This is Wordy but....worth the read! Glad to see a CM comment that truly understands what RNs do on the front lines in the facility!! Can't believe any CM with morals would want to stay with this company. I could never be a CM with this company.....they work people like dogs and don't care about their patients....Do Unto Others! Keep this in mind as you are reading this to set the tone: Our unit has 90ish some patients total with no charge RN, high acuity of patients...a lot of w/c patients w/lots of co-morbids. 24 stations (first mistake....a large unit=poor, rushed care), two full shifts, M-Sat clinic, starting time 6 am to 3:30 to 4 pm. Sometimes if we are "down in patients" our CM makes us decide which RN goes home first....regardless of the outstanding work there is to do. There is always work left for the next day, so the RN starting out the next day is already behind the 8-ball because she not only has to finish up the work from the previous day but try to address the issues on her shift also. Two RNs work daily on the floor. We do a third check on all the patients (i.e. goals, Rx, bath, etc.), pass meds, pass protein supplements because they won't let the PCTs administer them, address acute problems with pts (and this may be quick or time-consuming), then sit down at ecube to check orders, lab alerts, update med checks and this is done monthly (in which our Medical Director always complains aren't done, but we can only be as good as the pts compliance with this in bringing their meds in.) Also, we have quite a few nursing home pts and it takes time to review their MARs and make changes to ecube. We monitor PT/INRs, Dilantin/Dig levels, Vanco troughs, Gent troughs, and any other levels they want monitored (we do the PT/INRS, Dig/Dilantin levels as a courtesy! The cardiologist/neurologist will do it but we just do it because we're nice!..... isn't that nice...like we don't have ENOUGH TO DO!) ( I really think the Medical Director doesn't get the drift of all we do either.) Then there are about 17 CIAs to work on for the month (with 3 RNs because one RN quit) in addition to a copious amount of foot checks because this is a large unit and 90% are diabetic. This is only "some" of the paperwork that we have to do! Also, 5-6 chart audits per month. We also do monthly medical justifications paperwork, access flow monitoring paperwork with appts scheduled at our access center for acute problems with access or poor access flow outcomes, in addition to completing the referral paperwork for that and faxing it. New patient education which we are to sign off saying we discussed cath care, infection control, emergency take-off, diet, etc with the patient which gets done haphazard because we don't have time. We also do scheduling for CTs having to do pre-authorizations at times with those. With no charge RN, we have to check on hospital discharges daily and obtain new orders from physicians or when the patient comes back they can't be put on the machine, sign consents with new admits and get them settled in. Schedule pts for blood transfusions at the local hospital (we have a few that are chronic bleeders.) Plus, get antibiotics hung at the correct time on the patients during their course of treatment during all the chaos and interruptions. We also pass Midodrine if it is ordered on patients mid-treatment, so we have to remember that also. Also, if a PCT yells at you which happens a lot if you don't have experienced staff, we have to be at their whim. They also yell out at you during changeover to "call the taxi, call the nursing home", etc. for the pt to be picked up. (They are stressed out too!) We have to correct problems with validation from the day before which sometimes aren't an "easy fix" and take some thought. At the end of the day we have to reschedule pt labs that weren't obtained from the PCTs for some reason, peel off stickers from the tubes and re-label them, that is, if our Zebra printer is working. And in a large unit, around MB time, there can be at least a dozen pres/post BUNs to reschedule/re-label and this is an ongoing thing until near the end of the month. We are constantly rescheduling labs/re-labeling tubes for no shows or missed d/t hospitalizations. Also, keep logs updated daily (i.e. water, temp logs, infection blood culture logs, rounding tool, hospitalization log, missed treatment log, extra treatment log, med expiration log-monthly, etc.) In addition, assist the PCTs on the floor during changeover by setting up machines, washing chairs, taking the pts to the BR, weighing pts., assist patient d/t prolonged bleeding. All this and getting "nurse phone calls" ranging anywhere from "what time does my mom get off!" to "I am not coming in for dialysis today" to "I am from another local clinic and having problems what should I do?" to "I have an order to use an access, should I fax it or send it with the patient?" to "Could you fax HD orders with Hep B profile results to the hospital?" to I" want to discuss my mom's meds" to personal phone calls for the staff. We also do transplant referrals now because our social worker no longer does them. We also do potassium bath adjustments on every patient once monthly labs have been resulted as our medical director has established an algorithm for this and we also adjust biweekly per algorithm. Potassium bath adjustments are VERY, VERY time-consuming in itself on this many patients. It is VERY..... VERY difficult to get all of the paperwork done with everything that is required of the RN. All of this paperwork is very time consuming and with no charge RN what ends up happening is: First and foremost..... 1. The pts don't get the care they deserve! 2 .The quality of the paperwork and documentation is very poor because it is rushed, then our manager is critiquing it and asking why this, this and this wasn't done! 3. Poor morale, negativity, backbiting and high turnover because when the nurses sit down to actually do paperwork they must not "be busy" so they can take a patient to the BR that just happens to have to go. 4. Errors with orders, bath changes, antibiotic/trough order entrys, etc. because we get sooo many interruptions on the floor when we are trying to concentrate that it's not funny! I have to physically clock out and leave the building if I want an uninterrupted break, otherwise I get called to the floor all the time and never get an interrupted lunch! When is this company gonna wake up! Can't have a charge RN until we have at least 100 patients and maintain that amt for a while But instead of management understanding these things, they just push,,,,,push,,,,,,push...... and "it better be done and done with quality so you can get out the door!" Well, it will be done .....but NOT with quality! We definitely need to do Undercover Boss! I would love to just keep pushing work at the Undercover person and see how they handle it! TAP with FMS is destroying our quality, care and "patience" with the patients and each other! What a poor company to work for....this is NOT ULTRACARE......it doesn't promote staff teamwork or cohesiveness at all nor is it what I intended nursing to be! (Somehow rescheduling labs and peeling stickers off tubes is not what I intended nursing to be.....that must be what I missed under the "fine print" of the contract I signed)! I love being able to review labs, take time with new admits educate the patients, take time with them, etc. but with all the requirements/demands this company has placed on us, it is virtually impossible. And, also the demands from the Medical Director (i.e. potassium adjustments, CT pre-authorizations in which the medical director's secretary should be doing, etc!) And the problem is....the patients are the victims because they want to live and they have no-where else to go and the company knows this! The MD only rounds once/month which that is the CMS requirement. He/she could round more.....but WHY? that means more work for him/her! The company is pushing for GROWTH, because GROWTH=$$$$, but this is NOT a good thing when the staff has more than they can handle! It is not SAFE! As you can see by this list, there are ALOT of things the RNs should not be doing that would alleviate our time/stress....however, if we don't help the PCTs we get verbally yelled at on the floor and upper management always says we "need to help the PCTs"! #1....we need a charge nurse!!!!! A patient told me the other day that "this is a terrible place to be, everyone is always complaining!".....sad....is this ULTRACARE? and you know what.....this company doesn't care! When are we TRULY going to start putting the patient's first?! And you may say....well, you don't have to stay! I won't when I find something else but in the meantime I need a job! and I actually feel sorry for these patients! It is just sad when you feel that your patient's are not getting QUALITY care! :'(