Presidents Message

Sue Cary, MN, APRN, NP, CNN, ANNA

The Specialty of Nephrology Nursing

urses 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, ThomasHawkins, 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 patients 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 nurses 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, lets 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.

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.

NEPHROLOGY NURSING JOURNAL n May-June 2008

Vol. 35, No. 3

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