Nephrology nursing is projected to grow an astounding 26% over the next decade, driven by the increase in chronic kidney disease and need for dialysis. This provides an opportunity for those interested in nursing who relish the idea of making a real difference in patients’ lives while contributing to advancements in an exciting and evolving area of health care.

For patients, going to dialysis several hours a day, three times a week for many years can be challenging. As the patient’s primary contact at the clinic, the nephrology nurse can make all of the difference in their experience and outcomes. Passionate about patient care, nephrology nurses employ a combination of compassion and proactive guidance to ensure the best outcomes and be sure patients continue their vital therapy and thrive. Providing so much value to patients’ lives can be incredibly rewarding. Nephrology nursing also provides a challenging career path by providing the opportunity to develop deep expertise in the evolving field of kidney care and the opportunity to fulfill nursing ambitions and goals.

Dialysis Patients and Their Nurses: A Unique Relationship

Nephrology nurses develop close and often lifelong relationships with patients, typically learning intimate details of their lives. They can draw on that information to motivate and help patients make life changes that work for them and allow them to achieve milestones, whether it’s making it to a family reunion, losing weight, or not missing dialysis treatments for six months or longer. For example, hearing a patient talk about a granddaughter’s upcoming wedding can provide the opportunity to say, “I know you want to dance at her wedding. Let’s figure out how you can get your weight under control so you can make that happen.” Patients often feel a sense of accomplishment for achieving a milestone they didn’t think was possible, and their nephrology nurses play a vital role in their patients’ successes.

Consider some of the ways nephrology nurses can make a difference:

  • Work with patients to create individual plans to get and stay healthy – Nephrology nurses work with patients to make lifestyle changes that work for them, whether it’s to lose weight, stop smoking, limit alcohol, or cope with emotional ups and downs. And they can tap into things that will motivate the patient. For example, a nephrology nurse might facilitate a friendship between the patient and another patient four chairs down who struggled with quitting smoking, and finally figured it out. That patient can share his or her success story and give tips to a patient who is currently trying to quit. Patients often try to emulate desirable behaviors. By connecting with patients on a personal level (e.g., tapping into a passion for a particular sports team) or introducing patients to others who have something in common (e.g., a career or personal goal) nephrology nurses pave the way for supportive relationships.
  • Inspire patients to take responsibility – Nephrology nurses can explain that it is important for patients to take responsibility for their own lives, decisions, and actions, while assuring them that clinic staff, friends, and family are always there for support and input. For example, a nephrology nurse can explain that all of the time spent in dialysis will be futile if the patient doesn’t take his or her blood pressure or other vital medications.
  • Help patients identify and set up support systems – At the clinic, the nurse and other staff provide strong support. Patients also need support outside of the clinic to help them stay healthy, yet may be reluctant to reach out and ask for help. The nephrology nurse can help patients identify family members, friends, and coworkers who can provide that system of support – and ideas for how to do so – noting that these people in the patient’s life want him or her to survive and thrive.
  • Teach patients about treatment options – Nephrology nurses can educate patients on the different treatment modalities – including in-center and at-home dialysis – and help them identify which option works best for their individual needs. When it is an option, at-home dialysis offers convenience and improved quality of life by allowing patients to have their treatment at home. At-home dialysis significantly improves outcomes – including survival and treatment adherence – and reduces costs.
  • Counseling patients on treatment access – Nurses also can play a big role in encouraging patients whenever possible to opt for a fistula, a safer method for vascular access to provide treatment. Because creation of a fistula involves a procedure and time to heal, some patients are fearful of moving forward and prefer to receive their care through a catheter. Nurses can explain why a fistula is the better and safer method, and support them through the process.

Nephrology nurses also enjoy working in a supportive team with health care workers in and outside the clinic – from dietitians to doctors – to ensure high-quality care and patient success.

Career Advancement Melding Patient Care and Expertise

In many areas of nursing, being a jack of all trades is requisite. This is not only exhausting, but also limits the ability to provide in-depth patient care, as well as the capacity to become expert in a particular area. The ever-expanding field of nephrology and ongoing introduction of state-of-the-art equipment fosters the nurse’s development of expertise in kidneys and their care. Nephrology requires nurses to use critical thinking and decision making based on that ever-expanding knowledge. While physicians make the major treatment decisions, nephrology nurses are the ones who most directly influence patient care by identifying issues that develop and proposing solutions. When medical complications arise, nephrology nurses must be on their toes, think fast, and devise a solution. It can be incredibly rewarding for nurses who are drawn to that type of work.

Nephrology nursing also provides multiple paths to professional growth. Nephrology nurses are passionate about outcomes and enjoy taking part in quality improvement efforts. For example, the Fresenius Kidney Care Clinical Advancement Program (CAP) matches nephrology nurses’ ambitions with opportunities. The four practice tier options range from remaining at chairside to choosing advanced practice nursing, such as becoming a case manager or home therapy advocacy manager. Some nurses choose a path outside of direct patient care because they want to make an impact on broader decisions about patient care and feel they can offer a bigger vision for solutions. Opportunities range from spearheading large-scale quality efforts and working externally with regional quality teams to becoming a specialist in transplant education or anemia.

Even those who prefer to remain in direct patient care have opportunities to be part of the quality improvement effort. For example, they can be responsible for ensuring the clinic achieves benchmarks for influenza vaccination. Nephrology nurses can own a quality effort within their clinic by spearheading an interdisciplinary team to identify metrics and design programs. Or they may choose to be involved in a quality project, such as providing training to other nurses and patients.

Nephrology nurses at high-quality dialysis centers often stay for years – even decades – as a result of being highly valued by patients and staff, challenged, and offered multiple career advancement opportunities. It speaks to the passion they have for caring for these patients, and the rewards for helping shape decisions that are made regarding the care of their patients and the field as a whole.

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Kathleen Belmonte

Kathleen Belmonte is vice president of clinical services at Fresenius Medical Care North America.

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