Nurses for a Healthier Tomorrow

NEPHROLOGY NURSE

Background:

Nephrology nurses use the nursing process to care for patients of all ages who are experiencing, or are at risk for, kidney disease. Nephrology has been recognized as a specialty for over 35 years. In 1973, treatment for end stage kidney disease (ESRD) by hemodialysis, peritoneal dialysis, or transplantation was funded by the federal government through the Social Security program making ESRD the only disease-caused disability and became more readily available. As a result, the role of the nephrology nurse grew in scope, practice boundaries broadened, and the number of nephrology nurses climbed steadily. Nephrology nursing involves both preventing disease and assessing the health needs of patients and families. Care spans the life cycle and involves patients who are experiencing the real or threatened impact of acute or chronic kidney disease; therefore nephrology nurses must be well-educated, highly skilled, and motivated. These nurses also deal with every organ system in the body, calling for a holistic approach to patient care that is both challenging and rewarding. Driven by technological and educational advances, nephrology nursing continues to be a dynamic field with a wide variety of career opportunities for nurses at all levels

Roles:

Nephrology nursing practice requires a common knowledge base to care for pediatric, adult, and geriatric patients with kidney disease. The roles of the nephrology nurse include the following:

Staff nurse, hospital or outpatient settings
Hemodialysis/peritoneal dialysis nurse
Vascular access coordinator
Nurse manager
Transplant coordinator
Organ recovery coordinator
Office nurse
Nurse practitioner
Clinical nurse specialist
Pharmaceutical representative
Nurse researcher
Quality management
Nurse educator
Corporate/sales
State or federal surveyor

Care may be extremely complex: patients may have numerous comorbid conditions including, but not limited to, cardiovascular disease, diabetes, hypertension, infectious disease, bone disease, or psychiatric conditions. In addition, many face psychosocial issues. The nurse’s role is to help patients manage their lives – succeed at school or work, socialize, maintain relationships, or enjoy hobbies – while effectively dealing with their health issues. It is important to note that not all patients with kidney disease require dialysis and/or transplant; the majority of the diseases that affect the kidneys are treatable and potentially able to be arrested or even cured. Some patients may elect conservative management and palliative care. In these cases, one of the nephrology nurse’s primary roles is to educate patients about their diseases, prognoses, and treatments.

Practice Settings:

Nephrology nurses practice in dialysis clinics, hospitals, physician practices, transplant programs, and many other inpatient and outpatient settings. They work in primary, secondary, and tertiary care facilities as well as in patients’ homes – wherever individuals experiencing or at risk for kidney disease receive health care. In inpatient settings, patients are often critically ill and care is fast-paced and challenging. In outpatient settings, the nephrology nurse is an integral member of a multidisciplinary team that cares for patients with complex needs. The nurse in this setting functions as advocate, educator, consultant, care coordinator, and direct caregiver and oversees long-term care of chronically ill patients. As such, the nephrology nurse can have a positive impact on the quality of patients’ lives. Other opportunities in nephrology nursing include:

Education
Management
Research
Case management
Advanced practice nursing
Corporate/government
Pediatric nephrology

Specialties:

To provide optimum care tailored to each patient’s needs, specialized areas of nephrology nursing have evolved, along with nurses’ knowledge and skills. These skills primarily relate to modalities of therapy which include:

Hemodialysis
Peritoneal dialysis
Transplantation
Continuous renal replacement therapy
Conservative management
Other extracorporeal therapies

Nephrology nursing practice overlaps the boundaries of other specialty areas. For example, transplant nurses now care for patients who receive multi-organ transplants.

Qualifications:

In addition to basic educational preparation to function as a registered professional nurse, nephrology nursing practice at the generalist level requires a specific knowledge base and demonstrated clinical expertise in kidney disease care beyond that acquired in a basic nursing program. At the advanced practice level, the nephrology nurse has a master’s degree in nursing as either a nurse practitioner or clinical nurse specialist. All nephrology nurses must have a common knowledge base relevant to all aspects of care for adult and pediatric kidney patients and their families. This knowledge base includes but is not limited to:

Anatomy, physiology, and pathophysiology
The nursing process as applied to nephrology nursing
Knowledge of the diagnosis and treatment for patients requiring any method of renal replacement therapy
Pharmacology and pharmacotherapy
Nutrition
Growth and development
Teaching/learning theory
Counseling/interviewing skills
Interdisciplinary team skills
Research processes
Rehabilitation principles
Palliative care and concepts related to death and dying

The nephrology nurse functions as a coordinator of patient care collaborating with other care providers and health team members to provide required care as effectively as possible. The nephrology nurse acts as a patient teacher and advocate, assisting the patient in seeking information, assuring the patient has the opportunity for informed consent for treatment decisions, and promoting the maximal level of patient-desired independence. The nephrology nurse may also function as a nurse manager to assure the delivery of appropriate care. The nephrology nurse actively participates in professional role development activities including continuing education, quality assessment and improvement, and the review and clinical application of research findings. The nephrology nurse develops ethically sound practice and confronts ethical challenges through application of the Standards of Nephrology Nursing Practice.

Continuing Education:

Nephrology nurses are registered nurses (RNs) with specialized education and experience in caring for patients who are experiencing, or are at risk for, kidney disease. Nephrology nurses continually update their education through a variety of programs, publications, and special activities. The American Nephrology Nurses’ Association offers an annual National Symposium and a Fall Meeting for Nephrology Nurse Managers, Advanced Practice Nurses, and Clinicians by providing in-depth education sessions for nurses at all practice levels. ANNA also sponsors legislative and leadership workshops; audio conferences; distance learning courses; and numerous chapter programs. To advance their education and earning power even further, many nephrology nurses seek certification through the Nephrology Nursing Certification Commission (www.nncc-exam.org). Certification in nephrology nursing recognizes an individual’s expertise in the specialty and demonstrates advanced knowledge and experience.

Associations:

American Nephrology Nurses’ Association (ANNA)
East Holly Avenue/Box 56
Pitman, New Jersey 08071-0056
Toll free: 888-600-2662
Phone: 856-256-2320
Fax: 856-589-7463
E-mail: anna@ajj.com
Web site: www.annanurse.org

ANNA’s mission is to advance nephrology nursing practice and positively influence outcomes for patients with kidney or other disease processes requiring replacement therapies through advocacy, scholarship, and excellence. The association was established in 1969 and has a membership of over 11,000 registered nurses and other health care professionals. ANNA serves members through a national structure separated into four regions. Within these regions are over 100 local chapters. Member services are provided through ANNA’s Web site, www.annanurse.org , publications, e-newsletter, and national/regional/local programs.

Publications:

Nephrology Nursing Journal
ANNA’s official journal; bimonthly

ANNA Update
ANNA’s official newsletter; bimonthly; member benefit

Core Curriculum for Nephrology Nursing, Fourth Edition

Contemporary Nephrology Nursing

Standards of Clinical Practice for Nephrology Nursing