Background Nephrology registered nurses/advanced practice registered nurses use the nursing process to care for patients of all ages who require kidney caree. Nephrology has been recognized as a specialty for over 45 years. In 1973, treatment for end stage kidney disease (ESKD) by hemodialysis, peritoneal dialysis, or transplantation was funded by the federal government through the Social Security program, making ESKD 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. Nephrology 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 and practice settings for nurses at all education and skill levels. Roles Nephrology nursing practice requires a common knowledge base to care for pediatric, adult, and older adult patients with kidney disease. The roles of the nephrology nurse include the following: Staff nurse, acute or outpatient settings Home dialysis therapies nurse Hemodialysis/peritoneal dialysis nurse Vascular access coordinator/manager Nurse manager/administrator Transplant coordinator/manager Organ recovery coordinator Office/clinic nurse Nurse practitioner Clinical nurse leader Pharmaceutical representative Nurse researcher Quality improvement director/manager Infection prevention manager Patient safety manager Nurse educator Faculty member/professor/instructor Corporate/sales State or federal surveyor Case/care manager 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 mental health conditions. In addition, many patients requiring kidney care face psychosocial issues. The nurse's role is to help patients manage their lives - succeed at school or work, socialize, maintain relationships, and enjoy hobbies - while effectively addressing their health issues. It is important to note that not all patients with kidney disease require dialysis and/or transplant; most 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/supportive 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, home settings, long-term care facilities, transitional care units, healthcare provider practices, transplant programs, and many other inpatient and outpatient settings. They work in primary, secondary, and tertiary care facilities – wherever individuals experiencing or at risk for kidney disease receive health care. In acute care 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 interprofessional 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/leadership Research Case management Advanced practice nursing Corporate/government Pediatric nephrology Government affairs Informatics Infection prevention 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 Home dialysis therapies 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 graduate level and advanced level, the nephrology nurse has been master's and/or doctorally prepared in nursing with either a nurse practitioner or clinical nurse specialist role. All nephrology nurses must have a common knowledge base relevant to all aspects of care for adult and pediatric patients requiring kidney care and their families. This knowledge base includes but is not limited to: Anatomy, physiology, pathophysiology, and microbiology 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/interprofessional team skills Research processes Rehabilitation principles Palliative/supportive care and concepts related to end-of-life care 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 Scope and Standards of 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 (ANNA) offers an annual National Symposium in the spring and a Nephrology Nursing Practice. Management, and Leadership Conference in the fall, which provide in-depth educational sessions for nurses at all practice levels and in all nephrology subspecialties. ANNA recognizes the importance of continuing education by offering scholarships to support members in their pursuit of higher education. ANNA also provides ongoing educational opportunities through the ANNA Online Library as well as continuing education articles in the Nephrology Nursing Journal. 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.