Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

By Jeffrey E. Keller, MD, FAACP

Border detention facilities that house immigrants have been in the news recently because of their policy of not providing influenza vaccinations to their detainees, sparking high-profile protests. Why would an immigration detention facility, tasked among other things with providing comprehensive medical care to its detainees, refuse to provide them with flu vaccines?

To answer this question, it might be instructive to ask how influenza vaccinations are handled at other prisons and jails in the U.S. It depends on what type of facility you are in and how long you will be there. All prison systems I know of offer influenza vaccinations to their inmates. On the other hand, most jails (short-term detention facilities) do not have a routine flu vaccination program, though there are exceptions.

Vaccinations in Prisons

Inmates are sentenced to prison for a minimum of one year and usually longer. As a result, prison populations are stable. Almost all of the inmates in a particular prison now will still be there next year. Also, prisons are tasked with providing comprehensive medical care to their inmates. This includes influenza vaccinations, but also other recommended vaccinations and boosters. Of course, just like in the community at large, not all inmates want to be vaccinated. The percentage of prison inmates who get vaccinated depends on how vigorously the prison pushes the program.

If a prison advertises the availability of the flu vaccine and actively encourages its inmates to be vaccinated, the acceptance rate can be greater than 50% (compared to about 33% of adults in the community who get vaccinated). Most prisons have a “big push” campaign to encourage flu vaccines once a year in the fall. However, if a prison does not advertise the availability of the flu vaccine, the percentage of inmates vaccinated can be very low. It makes economic sense for prisons to actively encourage their inmates to be vaccinated. Every dollar spent on influenza vaccinations will save more than a dollar down the road trying to deal with influenza outbreaks.

Vaccinations in Jail

Influenza programs in jails are different for several reasons. The first issue is that the inmate population in a jail is not stable. The average length of stay in the average jail in the U.S. is around 2-3 weeks and many are released within days. If a jail offers influenza vaccinations in October, most of the inmates vaccinated will be gone by November. The jail will now be filled with new, unvaccinated inmates. If you vaccinate the November inmates, most (again) will be gone by December. So, to be effective, influenza programs in a jail must last the length of the influenza season — making jail influenza programs more difficult and expensive to administer than a prison program.

As an example, remember that one must order influenza vaccines well in advance. In order to have influenza vaccines ready in the fall, a prison or a jail has to order them at least six months earlier. A prison will know how many influenza doses it will need based on its population and previous acceptance rate. But how many doses will a jail need with inmates coming and going over the course of an entire flu season? That can be hard to get right in a jail! It is expensive and maddening to order too many vaccines only to throw the unused doses away at the end of the flu season.

Also, jails vary greatly by size and sophistication of the medical services they provide. There are many small jails in the U.S. (think 10 beds) where no medical personnel ever come to the jail for routine medical care. If their inmates need medical attention, the deputies have to load them into a van and take them to a clinic or ER in the community. Such a jail is unlikely to offer influenza vaccinations to their inmates. On the other hand, bigger jails (say, more than 1,000 beds) with a full-time medical staff may indeed have an influenza vaccination program.

“Kicking the Can Down the Road”

The most successful jail influenza programs that I have seen are done in cooperation with the local health department. The health department is tasked with providing vaccinations to the community at large, which includes jail inmates. When asked, health departments often will come to the local jail once a month to provide influenza vaccinations to any inmate who requests one. (This is also a good way to provide screening for sexually transmitted diseases in asymptomatic inmates.) Even small jails can approach their local health department about providing immunizations to inmates, though few do.

Customs and Border Patrol reportedly defended its policy of not providing influenza vaccinations during border detention by saying that immigrants are only there for a few days and are expected to get the flu vaccine later, when they are moved to a long-term facility. Where I grew up, this was called “kicking the can down the road.” To my mind, deferring vaccinations until later makes little medical or financial sense. Since none of these detainees is going to be released, and since you are going to vaccinate them later anyway (as reported), why not do it as part of their initial medical screening?

Jeffrey E. Keller, MD, FACEP, is a board-certified emergency physician with 25 years of experience before moving full time into his “true calling” of correctional medicine. He now works exclusively in jails and prisons, and blogs about correctional medicine at JailMedicine.com.

This post was originally published in MedPage Today.

The Problem of Pain: Prescribing Opioids to Addicted Populations

The Problem of Pain: Prescribing Opioids to Addicted Populations

Between 2006 and 2012, more than 32 million prescription pain pills circulated through Berkshire County, Massachusetts, a rural area of about 130,000 people.

Patients recovering from opioid addiction are seen at the local emergency department every day, according to Martha Roberts, a critical care Nurse Practitioner (NP) and Georgetown University School of Nursing & Health Studies alumna. Roberts works in Berkshire’s emergency department, which sees 50,000 patients per year — more than a third of the county’s population.

“It’s challenging,” she said. “It’s also an opportunity to help those patients in a way that may improve their outcomes.”

Patients in addiction recovery aren’t exempt from the need for pain relief in the case of acute injuries, surgical operations, or chronic pain. Providers like Roberts are tasked with finding and offering alternatives to opioids.

How can clinicians balance the weight of ethical responsibility with a patient’s need for immediate relief?

Opioid Dependence and Addiction in the United States

About 21% to 29% of individuals who are prescribed opioids misuse them, and 8% to 12% of them develop an addiction, according to the National Institutes of Health. Though only a small percentage of patients are likely to develop an addiction, there is still a chance of dependence, which is characterized by a physical reliance on the medication that, if unaddressed, can lead to addiction.

Even if the patient is not demonstrating symptoms of addiction, providers look for specific signs of dependence, according to Dr. Jill Ogg-Gress, assistant Family Nurse Practitioner (FNP) program director at Georgetown University.

“Opiate medications have side effects of dependence,” said Ogg-Gress, who works as a board-certified emergency NP in several Iowa and Nebraska emergency rooms. “If a provider recognizes that a patient is experiencing dependence, or if a patient demonstrates behaviors of dependence, it should be recommended to the patient they should talk to their primary care provider or the prescriber of the opioids.”

Signs of opioid dependence
  • Taking painkillers more frequently than prescribed
  • Taking higher doses than prescribed
  • Seeking a euphoric effect to counter physical pain
  • Experiencing excessive sleepiness or irritability

Taking these signs into account, providers can evaluate patients’ needs on an individual level to assess the magnitude of pain. If the patient is likely to develop a dependence, the providers may need to help them find an alternative treatment plan that is effective and sustainable.

Ruling out opioids altogether isn’t a realistic approach, Roberts said.

“There are still some painful injuries that will benefit from short-term opioid use,” she said.

Her key to implementing an effective treatment plan is working with the patient to assess their needs and openness to non-opioid pain medication.

Commonly Used Alternatives to Opioids

Opioids are a class of drugs that can be prescribed for pain relief but are highly addictive and illegal for consumption when not prescribed by a health care provider.

Individuals recovering from drug addiction might encounter injuries or surgical operations that require management of immediate acute pain or chronic pain in the long term. Providers can evaluate a patient’s needs when creating a treatment plan to manage that pain.

Pharmacological alternatives to opioids

Analgesics: Some of the most common painkillers can be obtained over the counter in small doses or prescribed in high doses by a health care provider. Roberts and Ogg-Gress agreed that these are the most common alternatives to opioid prescriptions.

Acetaminophen can be used for pain relief and fever reduction, but it does not reduce inflammation. It’s one of the most common pain relievers among Americans, used by roughly 23% of adults each week.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can treat acute pain and inflammation. A 2018 report found that NSAIDs make up 5% to 10% of all medications prescribed each year.

Gabapentinoids: This class of drugs includes gabapentin and pregabalin and has been historically used for seizure prevention. It is available by prescription to address pain but only in circumstances set by the Food and Drug Administration. While these painkillers can be an alternative to opioids, Roberts said they are not her intervention of choice because studies show there are other, more effective alternatives.

When medication isn’t appropriate or preferable, many non-pharmacological options exist to relieve pain and suffering.

“There are a lot of other nonpharmacological therapies that are available, if people are willing to try it,” Ogg-Gress said. “Providers need to educate patients regarding these pain therapies instead of the common thought of, ‘Here, take a pill, swallow it, and you’ll feel better.'”

Non-pharmacological alternatives to opioids
  • Localized numbing
  • Ice
  • Massage
  • Exercise
  • Physical therapy
  • Acupuncture
  • Relaxation

Supporting Patients in Recovery

Every patient deserves time and attention to explain their case and their needs to a provider who is listening thoughtfully. Providers treating addicted populations must keep a constant eye out for identifying drug seeking behaviors, without stereotyping or wrongly assuming a patient’s motives. A 2016 report published by the National Institutes of Health described several types of drug-seeking behaviors:

Common Drug-Seeking Behaviors
Requests and complaints
  • Describing a need for a controlled substance
  • Asking for specific opioids by brand name
  • Requesting to have a dose increased
  • Citing multiple allergies to alternative pain therapies
Inappropriate self-medicating
  • Taking more doses than recommended by the provider
  • Hoarding a controlled substance
  • Using a medication despite not being in pain
  • Injecting an oral formula instead of consuming orally
Inappropriate use of general practice
  • Visiting multiple providers for controlled substances
  • Calling clinics when providers who prescribe controlled substances are on call
  • Frequent unscheduled visits, especially for early refills
  • Consistently disruptive behavior
Patterns of resistance
  • Hesitancy to consider alternative pain treatments
  • Declining to sign controlled substances agreement
  • Resisting diagnostic workup or consultation
  • Being more interested in the medication than solving the medical problem
Illegal activity
  • Obtaining controlled drugs from family members or illicit sources
  • Using aliases or forging prescriptions
  • Pattern of lost or stolen prescriptions

Clinicians who have identified these behaviors can use electronic medical records and crossover notes from other providers to see how many times a patient has sought medication for the same problem.

“People are here for assistance, but they’re not taking personal responsibility,” Roberts said. Engaging with patients to help them understand treatment plans can build a sense of agency over their own care.

Roberts said providers can help patients identify ways to care for themselves before writing a prescription for opioids. She recommended a gradual approach to trying different types of treatment:

A Step-Wise Approach for Pain Management

  1. Get to know the patient
  2. Use analgesics to address pain symptoms
  3. Use non-pharmacological treatments as intervention for side effects
  4. Encourage patient to stop smoking and drinking alcohol
  5. Eliminate foods that irritate the stomach or digestive system
  6. Reflect on previous steps: Did you really exhaust everything?
  7. Consider opioids as a last resort, and only enough to support immediate pain relief

Nurse Practitioners who work with a multidisciplinary team are uniquely positioned to provide holistic care. Clinicians serving communities with large addicted populations have to be familiar with law enforcement, social work organizations and, in the case of making a referral outside the clinic or emergency department, recovery programs and child protective services.

Roberts also acknowledged that providers working in communities fraught with addiction are at a high risk for fatigue. “If you have three back pain patients in a row, you’re going to be pretty burned out within two hours of working your shift, so you really, truly have to look at each case individually,” she said.

Taking time to self-reflect on personal motivations for treating patients can help remind providers of why caring for others is important to them.

“It’s hard to walk in and do a good job if you’re upset about the work you’re doing,” Roberts said. “Make sure you can do this without letting your own bias get in the way.”

Please note that this article is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided.

Citation for this content: [email protected], the online DNP program from the School of Nursing & Health Studies

“It’s a beautiful thing to witness…” A Talk with the Director of the VNSNY Gender Affirmation Program

“It’s a beautiful thing to witness…” A Talk with the Director of the VNSNY Gender Affirmation Program

In early 2016, Mt. Sinai Hospital* approached the Visiting Nurse Service of New York (VNSNY) to propose that VNSNY offer home care services to post-operative transgender patients. This was the genesis of VNSNY’s Gender Affirmation Program (known as GAP), which to date has provided home care to over 400 transgender patients.
*a strategic partner of VNSNY

DailyNurse recently interviewed Shannon Whittington, RN MSN PCC C-LGBT Health, the Clinical Director of GAP at VNSNY. We asked her about the nature of gender affirmation treatment, the home nursing care that VNSNY provides, and the outstanding LGBT-friendly services that VNSNY offers to patients across the Tri-State New York area.

 Shannon Whittington, the Clinical Director of the Gender Affirmation Program at VNSNY
Shannon Whittington, the Clinical Director of the Gender Affirmation Program at VNSNY

DailyNurse: What is gender affirmation surgery (GAS)?

SW: A surgical procedure that creates or removes body parts that align with the patients’ gender expression. E.g. vaginoplasty, phalloplasty, metoidioplasty, facial feminization, breast augmentation/masculinization.

DN: Is this the same thing as “sex-change surgery?”

SW: It is the same thing but we don’t use the terms “sex-change surgery” anymore.

Gender Affirmation or Gender Confirming surgeries are the correct terms now.  Understanding that this is a linguistically fluid language, words and meanings are always changing and we need to be mindful of correct terminology.

DN: What are the components of the VNSNY Gender Affirmation Program?

SW: The program emphasizes home care following surgery from other providers. I train clinicians (nurses, social workers, physical therapists, home health aides, speech and occupational therapists) in cultural sensitivity as it particularly relates to transgender patients.  The training is extensive and they are also educated in how to teach the patients to care for their new or altered body parts (i.e. penis, vagina, breast, face)

DN: How did you come to specialize in the treatment of Gender Affirmation surgery patients?

SW: Fortunately, I was chosen for this project by my manager.  I had no idea what I was saying yes to but this has literally changed the trajectory of my career path.  I discovered a passion that I did not know I had!

DN: What sorts of clinical training do nurses in the program need to take care of GAS post-surgery patients? 

SW: They need to know what to assess for and what is normal and what is not.  They learn about vaginal dilation because the patients who undergo vaginoplasty must do this on a regular basis. Patients come home with VACs, JP drains, foleys and supra pubic catheters. Although the nurses are already familiar with these devices, they need to teach the patients how to manage them. The clinicians are also trained in social determinants of health for this cohort.

DN: What sorts of cultural issues do nurses need to learn about before tending to a GAS patient?

SW: We really need to understand that these patients, like all of our patients, are patients first who happen to be transgender. We must respect their chosen names, their pronouns and their gender expression. We focus on getting them better and integrated back into society. It’s a beautiful thing to witness and an honor to be associated in such a transitional journey.

DN: How does the Gender Affirmation Program reflect the larger VNSNY commitment to LGBT patients?

SW: It reflects our commitment to this population on an agency wide basis.  What is great is that we are now getting non-operative transgender patients who are seeking home care services for reasons other than gender affirming surgeries.  They feel safe here and seek care outside of gender affirming surgeries. 

We are initiating various ways to continue to be inclusive along the binary spectrum by hiring gender non-confirming and non-binary individuals. These individuals have a lot to offer and need to be the best expressions of themselves in their work environment just like the heteronormative society we all live in.

DN: And can you tell us something about the SAGE training in your organization?

SW: All divisions of the Visiting Nurse Service of New York have been awarded Platinum certification (the highest level possible) from SAGE, the world’s largest and oldest organization dedicated to improving the lives of LGBT older people.

More than 80 percent or more of VNSNY’s clinical and other staff have received SAGE Care LGBT cultural competency training, further establishing VNSNY as a preferred health care provider for New York City’s LGBT residents.

The SAGE training is designed to increase awareness among VNSNY clinical and administrative staff of cultural issues and sensitivities around sexual orientation and gender identification, so as to ensure a welcoming and respectful health care environment for all individuals within the LGBTQ community.

Among other things, the training stresses the importance of approaching each patient in a non-judgmental fashion and never making assumptions about anyone’s sexual orientation or family structure. We want every patient to feel they can be totally open about who they are with every member of our GAP team who walks through their door.

Guiding COPD Patients from Diagnosis to Treatment

Guiding COPD Patients from Diagnosis to Treatment

Helping patients to navigate what comes after a difficult diagnosis is a necessary part of our profession. In my many years working with patients facing progressive diseases, like chronic obstructive pulmonary disease (COPD), I have found that they often have questions, namely:

What do I do now?

That’s where we, as nurses and other health care providers, can offer answers. COPD is not currently curable; however, there is still hope for these patients. Lifestyle changes and medical advancements make it possible for patients to improve their ability to breathe and overall quality of life. The objective of treatment is to slow the progression of the disease and assist with managing its symptoms. As patients with COPD come to terms with their disease, here’s what I would recommend to guide them through the next steps of their journey, from diagnosis to treatment:

Work With Them to Create a Plan

After giving a diagnosis of COPD, educating patients on the disease and working with them on a personalized plan to start addressing their symptoms is an important first step. In fact, there are many lifestyle changes that patients can make every day to not only accommodate their new medical needs but also to help improve lung function. Committing to a diet of anti-inflammatory foods — like fatty fish or dark leafy greens — participating in regular low-impact physical activities and other techniques can help to reduce inflammation in the lungs that can exacerbate symptoms.

Help Them Take the Steps to Quit Smoking

Smoking can cause significant damage in the lungs which only increases over time. One of the best things that patients can do if they’ve been diagnosed with chronic lung disease is to quit smoking if they currently smoke. It’s important to arm them with information and tools they need to successfully do so — whether it’s helping them to identify smoking triggers, create an exercise and diet regimen or connect to support groups or other resources. For example, at Lung Health Institute, we offer our patients access to programs like American Lung Association’s Freedom From Smoking® Plus, a flexible online smoking cessation program that can be completed in six weeks.

Have an Honest Conversation About What Treatment Is Right for Them

Every patient is different, and treatments will vary for each patient with COPD — depending on the severity of the disease and other factors, including age, fitness level or medical history. That’s why it’s critical to create an environment where patients are comfortable being completely honest about how they’re feeling both physically and mentally. That will ensure that we can provide them with the best course of action when it comes to their treatment.

Melissa Rubio, Ph.D., APRN, is a nurse practitioner and principal investigator for research at the Lung Health Institute, based at its Dallas clinic. Rubio also currently serves as a visiting professor at DeVry University’s Chamberlain College of Nursing in Downers Grove, Illinois. Prior to joining Lung Health Institute, Rubio worked at Pleasant Ridge Internal Medicine in Arlington, Texas, as a family nurse practitioner. Rubio holds a doctorate in philosophy from the University of Wisconsin-Milwaukee College of Nursing. She also earned a bachelor’s degree in nursing from the same school. She is a board-certified family nurse practitioner and a certified principal investigator. Rubio is also a member of the North Texas Nurse Practitioners and the Southern Nursing Research Society.

When it Comes to Population Health, the Answer is Motivation

When it Comes to Population Health, the Answer is Motivation

It was no great leap for Austin Regional Clinic to embrace the concept of population health, an approach that aims to improve the health of groups of people, particularly those with more medically complex conditions. Our medical group was founded on those principles back in 1980, when no one ever heard of the term. Over time, we became very good at population health and now we are often asked to present our “best practices.”

What’s the secret to our success? The long answer often includes a description of our IT investments. No doubt the advent of electronic medical records has made us better — instead of reacting to illness, we are beginning to use the data to predict illness, allowing us to shift resources to the sickest patients.

But it is the human element — the way each provider engages with the patient — that takes us from simply identifying the high-risk to making a difference in their lives. The technique we’ve honed is motivational interviewing.

Listen Versus Fix

The “front line” of our population health program is our nurse navigation team. Ten years ago, it consisted of four trained nurse navigators who primarily guided our Medical Home patients — individuals living with chronic conditions who rely on frequent care from various specialists. Today, this team has grown to 25 and now includes in-hospital nurse navigation as well as a Home Health Navigator.

While the roles within our team have expanded, our approach to patient interaction has not. Instead of telling our patients, we ask questions. We hire listeners, not fixers.

To a psychologist, motivational interviewing is a fundamental technique. It is less well known in most doctor and nurse cultures. Providers are taught to fix. Yet, we’ve found, that without first understanding the patients’ goals and then uncovering the obstacles that stand in the way of their goals, our sickest patients don’t feel compelled to change.

How does it work? Instead of telling patients to change, we guide them to express their own commitment out loud, which has been shown to improve patients’ ability to actually make a change.

‘Fishing with My Grandson’

When I asked one of my patients with a chronic breathing disorder about his goal, he replied, “I’d like to be able to fish with my grandson.” Later, at his appointment and others, I asked questions about what might be getting in the way of his goal. “I can’t breathe outside” or “I can’t leave the house without my breathing device.” We discussed the obstacles and set forth reasonable small goals to progress him forward. Each time he achieved a goal, he was motivated to set another.

My patient was aware of his barriers. With motivational interviewing, he became empowered to learn how to overcome them.

Numbers Reflect Success

A successful population health program is an investment in time and money, but the effort pays off. As last year showed, Austin Regional Clinic’s success has the numbers to back it up:

  • More than $3 million in 2018 shared savings, bringing the total to almost $25 million in the past eight years
  • An 80% screening rate for depression and fall risk, up from 38% just two years previous
  • 12% of diabetic patients moved to “good controlled” from “poor controlled”
  • 73% of our Medicare population is up to date on their colorectal screenings, up from 65% a few years before

Every year we set new population health goals, raising the bar just a bit. Admittedly, improving population health is a marathon, and we are only in the first leg of the race. Enhanced predictive analysis using artificial intelligence and machine learning will guide us to the patients for whom we can make the greatest impact on their health.

Our philosophy concerning our patients is unwavering — to not just consider each patient’s illness, but to see the person. To understand their values, their lives, and their support. To listen and to empower.

The most accurate predictive analysis cannot compel a patient to change — a patient’s will does that … and the dream to fish with a grandson.

Healthcare Heroes: Dialysis Nurses

Healthcare Heroes: Dialysis Nurses

In honor of “Nephrology Nurses Week,” September 8-14, 2019, Daily Nurse is highlighting two very special dialysis nurses.

At 25 years old, Jackson, KY resident Bridgette Chandler was living with her husband and raising two young children while enjoying a satisfying career as a nursing tech.

Bridgette’s life changed forever after she rushed to the emergency room with what she thought was a case of the flu. Instead of flu, doctors informed her, she was actually suffering from kidney failure. During the long wait for a transplant she underwent arduous four-hour dialysis treatments three times a week.

Despite finding that dialysis made her “a completely different kind of tired that sleep doesn’t fix,” in her determination to remain actively involved with her young family, Bridgette opted for at-home dialysis at the Fresenius Kidney Care clinic in Kentucky. With her home treatments, Bridgette managed to experience all of the special events that happen in a family, from games and recitals to the hubbub of birthdays and holiday seasons. She remarks, “For me, being able to take part in special moments with my family was most important and that’s why I chose home therapy. It gave me the opportunity to take back some of the control of my health.”

Five years later Bridgette found a donor and had her kidney transplant surgery. Even before the hospital had discharged her, she asked her doctor how long she had to wait before she could start school and become an RN. Now, Bridgette is working alongside her former nurses, treating home dialysis patients at the same clinic that treated her. “Because of my personal experience, my intention had always been to become a nephrology nurse” she says. “I stayed in touch with my nurses and doctors who made such a difference in my life. When a position became available in the clinic with those nurses and doctors, I jumped on it.”

Bridgette’s experience also creates a special bond with her patients: “helping patients find ways to make dialysis work for them has definitely been beneficial. I’ve had so many patients tell me they respected me so much more because I understand what they are going through. Many of my patients have even told me that I give them hope.  That is just as important to me as it is to them. That’s why I wanted to be a nurse.”

Anne Diroll was also destined to become a nephrology nurse.

A year after losing her father to a sudden heart attack, 15-year-old Anne was hospitalized for a week after being struck by a car.

During her time in the hospital, unable to walk, and suffering from a “huge hematoma,” she had plenty of time to think and look around. She saw—and deeply admired—the nurses who cared for her, and was inspired by fellow patients stories, learning of “tragedies and hardships in others’ lives that I had never experienced or been aware of at a young age, and [I] thought ‘this is a part of life that needs healing.’”

Anne began her nursing studies almost as soon as she was discharged from the hospital. Initially working as a pulmonary nurse, when she sought a new job, she “didn’t know anything about kidneys, except that they made urine. In my interview for a dialysis nurse position, my interviewer explained that the reason dialysis nurses exist is because [failing] kidneys don’t make urine, so I was able to understand that dialysis is to kidneys as ventilators are to lungs. I got the job and have been a nephrology nurse ever since.”

Today Anne manages a Fresenius Kidney Care clinic in California, overseeing the care of 50 patients.

The American Nephrology Nurses Association (ANNA) launched Nephrology Nurses Week in 2005 to give employers, patients and others the opportunity to thank nephrology nurses for their life-saving work. In addition, ANNA seeks to interest other nurses in the career opportunities available in nephrology.

About 30 million adults in the United States suffer from chronic kidney disease. The nephrology nurses who treat them make a positive difference in the lives of patients and their families every day. Caring for kidney patients requires nurses to be highly skilled, well educated, and motivated, and nephrology nurses cite the variety and challenges of the specialty as fueling their ongoing passion.

For more information nephrology nursing, the Nephrology Nurses Week celebration, and more, visit www.annanurse.org/

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