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 Nephrology Nursing Standards of Practice and Standards of Care. 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. Certification 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.