Nephrology nursing, a specialty that provides patients with kidney care, is an autonomous area of practice that occurs in many settings. The largest number of nephrology nurses work in freestanding hemodialysis clinics.
Kristin Larson, M.S.N., RN, AGNP-BC
National Secretary, American Nephrology Nurses Association (ANNA)
A typical day as a nephrology nurse includes preparing the patients for dialysis treatments, monitoring and assessing patients, providing information, teaching, and discharging patients home. Because of this level of responsibility, nephrology nurses have a solid understanding of physiology, fluid balance, hemodynamics, and psychosocial needs of persons requiring kidney care.
Kidney disease education
As forward-thinking advocates for their patients, nephrology nurses look beyond free-standing hemodialysis and educate patients to consider hemodialysis or peritoneal treatments in the home, or kidney transplantation.
This encouragement ties into the executive directive of 2019, Advancing American Kidney Health, which aims to improve kidney disease prevention, diagnoses, and treatment; promote home dialysis therapies as a management option; and increase the number of kidney transplants. The proposal requires that nephrology nurses play a more prominent role in the public platform by educating persons with and without kidney disease and, if needed, to prepare persons for in-home dialysis or transplantation.
Diabetes and hypertension
The epidemics of diabetes and hypertension are the leading cause of kidney disease and failure. The number of persons who will develop kidney issues because of these diseases is sobering and not expected to decrease as time goes forward.
Despite nephrology nurses educating patients in the early stages of kidney disease about behavior changes and preventative measures, if kidneys progress to complete failure, nephrology nurses are at the forefront of caring for the patients and their families. The family and immediate social support (or lack thereof) sets the starting point for education and advocacy. Successful nursing care engages the patient requiring kidney care where they are at that moment and is reinforced through a team of professionals dedicated to the patient. These nephrology nursing roles require highly skilled nurses that act in an autonomous manner.
The appeal for a new graduate nurse or experienced medical-surgical nurse to practice in a dialysis clinic would be the intense immersion in the process of dialysis, the mechanics of the equipment, and how the body responds to the treatment. Nephrology nurses react quickly to changes in the patient’s physiology during dialysis by altering the mechanics of the hemodialysis machine to keep their patient safe. Care of a person receiving hemodialysis will literally get your blood pumping, as well as your patient’s blood through their machine. The payoff for a successful hemodialysis treatment is sending the patient home to continue their life which would otherwise be shortened without this treatment and care. Because persons can receive dialysis treatments for years, lifelong relationships with patients and their nurses are created. No two persons receiving dialysis are the same, and no two working days are the same. Beyond the dialysis clinic, a nephrology nurse collaborates with nurses on the kidney transplant team, another role for nephrology nurses.
Together, the nephrology nurse and the kidney transplant team partner for success in the patient attempting kidney transplant by completing all the pre-transplant criteria and supporting transplant education. The patient will need an understanding of the elements required for placement on the transplant list, the possibility of a wait period for a kidney donor, and an acceptance of the new lifestyle that will be required for the success of the transplanted kidney. Along with the transplant team, nephrology nurses are the coach and anchor that reenforce education and hope.