Nursing News

Nephrology Nurses Help with Clinical or At-Home Dialysis


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By Susan Kreimer, MS, contributor

Chronic kidney disease is on the rise, as are the number of patients requiring dialysis, particularly since there aren’t enough transplantable organs for everyone who qualifies. These factors have boosted the nation’s demand for nephrology nurses.

nephrology nursing
Susan Juarez, MS, ARNP, is the vice president of clinical education at DaVita Inc., a dialysis provider with more than 1,300 U.S. facilities.

“The shortage of organ donors for transplantation makes the need for dialysis nurses even more critical,” said Sheila K. Salls, RN, BSN, renal dialysis nurse manager at Faxton-St. Luke’s Healthcare, an inpatient and outpatient provider in central upstate New York.

As educators, nephrology nurses focus on diet, hypertension and diabetes – the nation’s leading cause of chronic kidney disease. They strive to prevent their patients’ health from deteriorating even further.

“There is a great deal of information, teaching and counseling involved with this particular group of patients,” Salls said. “We also connect patients to needed resources such as social workers and dietitians.”

Nephrology nurses are registered nurses or licensed practical nurses who specialize in managing patients with kidney failure.

All Medicare-certified facilities must employ an RN with dialysis experience. The RN oversees nursing services and home programs that train patients and caregivers in self-dialysis.

Advanced practice nurses, nurse practitioners and clinical specialists with graduate nursing degrees work with doctors in caring for kidney patients in medical offices and dialysis units.

Dialysis is necessary when patients reach end-stage renal failure, according to the National Kidney Foundation. Usually, this occurs by the time they lose about 85 to 90 percent of kidney function.

Like healthy kidneys, dialysis keeps the body in balance. It removes waste, salt and extra fluid to prevent buildup; maintains safe levels of potassium, sodium and bicarbonate; and helps control blood pressure.

Dialysis nurses face many of the same issues as colleagues in other nursing specialties. They grapple with the nursing shortage and chronically ill patients with multiple medical problems, said Susan Juarez, MS, ARNP, CNN, vice president of clinical education at DaVita Inc., a dialysis provider with more than 1,300 U. S. facilities.

One advantage to dialysis nursing, however, is the opportunity it provides to forge close relationships while providing care over a continuum. “Since we see our patients three times a week, they become part of our extended families,” Juarez said. “We are thrilled when our patients are successfully transplanted.”

Sometimes, however, the outcomes are much less favorable. Along with occasionally watching patients die, Shelley Curtis, RN, said she regrets not being able to motivate all of her patients. It also hurts “not having the time or resources to do the best job you want to do.”

Nonetheless, such disappointments are few and far between the positive moments that most nurses encounter in this specialty. Curtis emphasized that “Overall, it is incredibly inspiring to empower people with the knowledge and ability to care for themselves.”

Curtis, who lives in Portland, Oregon, works for a home dialysis program that instructs patients in managing their own treatments with the help of a family member or friend. Her husband, Jim Curtis, is vice president of clinical affairs at Home Dialysis Plus, Ltd., where she actively supports the development process.

Home dialysis programs have less turnover than dialysis units in which positions are available for both staff and travel nurses.

It takes between three and six months for a nurse to gain the expertise to care for kidney patients, and those with dialysis experience are very valuable to employers, Juarez said.

In 2008, the Centers for Medicare & Medicaid Services revised conditions of coverage for the first time since 1976. In its new requirements, the qualifications for home dialysis training nurses have increased. Nurses must have 12 months’ clinical experience and an additional three months in the type of dialysis they are training patients to perform.

“In the chronic setting, this is usually not an issue since there are other experienced nurses available,” Juarez said. “But in smaller rural settings, in order to start up a program, we must have a nurse who meets these qualifications.”

Juarez, who ventured into dialysis nursing in 1981, continues to be impressed by the determination of some kidney patients. Nothing seems to dampen their enthusiasm.

“With so many challenges, it is inspiring to see them lead relatively normal and productive lives,” she said. “While I miss direct patient care, in my current role as VP of clinical education, I feel I have the ability to affect the lives of many more patients by teaching our teammates how to give quality patient care.”

For more information, visit these Web sites:

National Kidney Foundation, www.kidney.org

Centers for Medicare & Medicaid Services, www.cms.hhs.gov/center/esrd.asp

DaVita Inc.,www.davita.com

American Nephrology Nurses’ Association, www.annanurse.org

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