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The Specialty of Nephrology Nursing
by ANNA President Sue Cary
Nurses
who work with patients with kidney disease so many times say they are a
“hemodialysis nurse,” a “peritoneal dialysis nurse,” or a “transplant
nurse.” Nephrology nurses are ONE specialty nursing group no matter
what area of the specialty they work in. Nephrology nurses work in a
variety of settings, including kidney replacement therapy, acute care,
education, pediatrics, research, chronic kidney disease (CKD) Stages
1-4, advanced practice, corporate, and government, just to name a few.
Nephrology nurses have the power to influence patients’ lives in
positive ways through health policy, education, and highly developed
nursing skills.
Arikan, Koksal, and Gokce (2007) analyzed job stress, burnout, and
satisfaction of nurses who work in dialysis nurses compared to nurses
who work in ICU. They choose nurses who work in the latter because
“they shared characteristics with dialysis nurses, namely caring for
patients similar in disease severity and using advanced medical
techniques and equipment” (p. 188). Nephrology nurses know how to
operate advanced medical equipment. More importantly they use skills of
assessment and knowledge of electrolyte imbalances, and blood pressure,
anemia, and bone care management. They have a working knowledge of many
disciplines, including cardiology, pulmonary, gerontology, neurology,
and psychology. The comparison of critical care nursing and nephrology
nursing gives a true picture of the extensive knowledge the nephrology
nurse must have to care for the patient with kidney disease whose every
body system is affected.
The specialty of nephrology nursing offers novice nurses a wide variety
of experiences and skills that help them develop in their careers.
Managing the care of the nephrology patient offers moments of quick
decisions, critical actions, and a true, trusting relationship between
patient and nurse. This nursing specialty has “stories of experience,
caring, compassion, leadership, and commitment” (Dingman, 2007, p. 13).
All of the above are selling points to recruit new graduate nurses into
the specialty of nephrology nursing.
The demand for nephrology nurses in all areas of the specialty will
continue to grow, with Stage 5 CKD growing at an annual rate of
approximately 3% (Gardner, Thomas-Hawkins, Fogg, & Lathum, 2007).
It is important to determine what would attract nurses to the specialty
of nephrology nursing. Gardner et al. (2007) conducted a study that
“examined the relationship between staff nurses’ perception of the work
environment and outcomes in dialysis facilities” (p. 280). Some
of their findings included “the need for organizational and unit level
strategies targeted at facilitating and supporting nurse autonomy and
control over nursing practice, improving nurse staffing, and fostering
collegial relationship between nurses and physicians in dialysis
facilities” (p. 280). To foster autonomy and collegial
relationships, it is imperative to teach novice nephrology nurses how
to assimilate all the information needed before calling the physician,
nurse practitioner, or clinical nurse specialist. For example, when the
nephrology nurse in a hemodialysis unit tells the physician, nurse
practitioner, or clinical nurse specialist that a patient continues to
have a drop in blood pressure toward the end of treatment, the nursing
assessment of the patient and patient data, such as the patient’s fluid
gains, cardiac ejection fraction, fluid removal goal, length of
treatment, blood pressure medications the patient is taking and when
the medications are taken, blood pressure history, and established dry
weight, are all important to communicate. The nephrology nurse’s
assessment is a vital piece of the care of the patient.
Nephrology nursing is an exciting career. As nephrology nurses, we need
to encourage the influx of nurses into our specialty. We also need to
encourage membership into the professional organization of the American
Nephrology Nurses’ Association (ANNA). With nephrology nurses’
expansion of autonomy and responsibility, there is a need for more
knowledge in order to feel competent in the position. ANNA can provide
education, practice standards, networking, and mentorship needs for
nephrology nurses. As we go forward celebrating the specialty of
nephrology nursing, let’s cherish and learn from the past and embrace
our future as one nursing specialty composed of nurses who care for
patients with kidney disease in many clinical settings.
Our world is not perfect, and sometimes nurses end up working long
hours or in fatigued conditions. Awareness of the results of fatigue on
patient care and knowledge of actions we can take to decrease the
effects of fatigue are necessary for nephrology nurses to practice
safely.
Sue Cary, MN, APRN, NP, CNN
ANNA President
References
Arikan,
F., Koksal, C., & Gokce, C. (2007). Work-related stress, burnout,
and job satisfaction of dialysis nurses in association with perceived
relations with professional contacts. Dialysis & Transplantation,
36(4), 182-190.
Dingman, S. (2007). Specialty nursing: A celebration for nephrology nurses. Nurses’ Lounge, 12-13.
Gardner, J.K., Thomas-Hawkins, C., Fogg, L., & Latham, C.E.
(2007). The relationships between nurses’ perceptions of the
hemodialysis unit work environment and nurse turnover, patient
satisfaction, and hospitalizations. Nephrology Nursing Journal, 34(3),
271-281.
Additional Reading
Callegari,
J., & Carter, M. (2008). A review of the nursing shortage in
America. Dialysis Times News & Views From RRI, 11(10), 1-3.
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Copyright 2008, American Nephrology Nurses' Association. Anthony J. Jannetti, Inc., publisher. An iNurse Web site.
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