Nephrology Nurses Week is marked during the second full week of September (this year from September 10-16) and honors nurses who specialize in the care and functions of the kidneys. For Nephrology Nurses Week, Faith Lynch DNP, RN, CNN and a national director of the American Nephrology Nurses Association (ANNA) talked with Minority Nurse about a nephrology nursing career path.
What issues are front and center for nurses in this specialty today? In nephrology nursing, the issues that are front and center are the lack of nephrology nurses going into the specialty. It is a very undiscussed specialty in nursing school which does a disservice to the patients in need. In nephrology nursing, especially dialysis, we are performing an invasive procedure that is life sustaining for patients with end-stage kidney disease. It is the only procedure that a physician orders and a nurse carries out. Bringing awareness to the nephrology nursing specialty is a huge priority for the American Nephrology Nurses Association.
How has technology changed nephrology nursing and approaches to treatment? Technology and innovation are changing nephrology nursing practice and approaches to treatment in so many ways. Dialysis machines are getting smaller and more compact instead of being large and bulky. You can monitor your patients with different technology to allow for better treatments and you are able to spot complications before they occur with the technology coming out.
What medical advances are most exciting and promising for nurses to see? I feel that nephrology nurses love the innovation that keeps coming out with all of these new devices. Dialysis is the same process as it was 40 years ago, but the devices are allowing nurses to use a more individualized patient-centered care approach. Safety on the machines has come a long way, which is great for nurses but most importantly the patients. A new smart patch that uses remote patient monitoring for patients with chronic kidney disease and end-stage kidney disease can read hemoglobin and hematocrit as well as potassium. This can be a game changer for the population we serve.
Why is nephrology nursing such a great career option? Nephrology nursing is such a great career option. It has brought me so much opportunity for growth in my career as well as challenges. Nurses do not realize that nephrology nursing is a broad term as there are so many different things you can do–you can work in dialysis (acute or chronic setting), a nephrology practice, transplant, education, administration, pediatrics, and more. You never get bored and feel complacent.
It is a nursing specialty that is unlike many as you develop such different relationships with your patients. It is the one thing that we, as nephrology nurses, cherish most. You make a difference in these patients’ lives as they see you more than they see their own families sometimes. It truly is the “work of heart.”
Please tell me about your role now and how your career brought you to this place.
My current role is as the Clinical Nurse Specialist and ARNP for Renal, Dialysis, and Transplant at the University of Washington Medical Center. Although I am involved in several committees and projects, my primary focus is on the inpatient kidney replacement therapy program. We have an in-house team that consists of over 100 unit-based RNs trained in HD, SLED, PD & CRRT who perform approximately 6,000 procedures a year on one campus with support from the dialysis technician team. My role includes staff training, patient education, regulatory compliance, evidence-based practice, quality improvement, and research. I also am consulted regarding evidence-based practice and care planning.
Following my passion and having the support of mentors in finding my way was invaluable. I started working as a nurse technician on the dialysis and transplant unit while I was in nursing school. When I graduated from nursing school, I was hired as a staff nurse. I had mentors who believed in me as I gained knowledge and confidence. I was able to become a charge nurse, dialysis nurse, and eventually assistant nurse manager. After being an assistant manager for several years, I realized that the parts of my role I enjoyed most were providing education, mentoring, clinical care, and improving systems. At the time I was applying for Master of Nursing programs, I was encouraged by one of the nursing professors to apply for the dual acute care nurse practitioner and advanced practice specialist tracks so that I could have the most flexibility in my future career path. I have been fortunate to find a role where I can still provide patient care directly and impact care at the system level.
Like many nursing students, I was fascinated with labor and delivery and pediatrics. There were no openings there so my first job as a nurse technician was on a dialysis and liver/kidney transplant unit. I had little exposure to nephrology in nursing school but once I started working with this population, I found a new passion. Instead of individuals bringing home a newborn, I was helping individuals bring home a new organ that they were learning to care for and helping them create a new life after transplant. It was inspiring, fast paced, and still a growing field. As I learned more about kidney disease, I also realized that the diseases that contribute to kidney disease, like diabetes and hypertension, run in my family and are prevalent in the community. This added another level of connection to kidney care as a way to advocate and provide the best care possible to other individuals who have these diseases in their families.
What do you especially enjoy about your specialty?
I enjoy that there are several nephrology subspecialties such as chronic kidney disease, vascular access, outpatient dialysis, home dialysis, acute dialysis, and transplant. I have been able to continue working with the kidney community throughout my career and do different kinds of nursing – bedside, clinic, administrative, research. I have the privilege of working with individuals living with kidney disease over time and can support them through different stages of their health. Kidney care is very interdisciplinary, and I enjoy collaborating with colleagues in nutrition, pharmacy, social work, and nephrology. I have also worked on committees with patient advisors which has been so fulfilling professionally and personally. Professionally, I believe the systems that we create with patient advisors are more individualized and patient centered. Personally, I have learned so much about the strength of community, the power of hope, and how essential support systems are.
Please describe some of the activities you do within a week, i.e., patient care, medical records, family interactions, working with your team.
Every day and week vary some. I provide dialysis education to ICU and medical surgical nurses, meet with patients who are having issues with their vascular access or need dialysis modality education, am consulted on potential safety issues and perform chart audits, work with interdisciplinary committees on preventing catheter-associated bloodstream infections and urinary tract infections, consult on research or quality improvement projects, plan for continuing education, cover breaks for dialysis nurses performing intraoperative hemodialysis, and guest lecture at the school of nursing. Some days I am in meetings about developing care pathways with transplant surgery, updating the electronic medical record, discussing supply chain new equipment, or in a patient plan of care conference. With any system or product that impacts kidney care, the medical director, dialysis operations manager, and I are involved.
How do you keep up with all the industry changes around patient care and technology?
I attend ANNA’s National Symposium and Fall Meeting whenever I can. The quality of the presenters is excellent, and the content is evidence-based, relevant, and up to date. I also attend local nephrology conferences, attend online seminars, read the Nephrology Nursing Journal, attend Nephrology Grand Rounds, and subscribe to online nephrology list serves including the regional ESRD Network. The list serves provide highlights on a daily or weekly basis, and have different focus such as quality, new medications, treatments innovation, guidelines, and health policy. I also follow professional organizations on social media to get a sense of what are topics of discussion in the nephrology community.
If you are certified, how did you decide to pursue that additional credential and how has it helped your performance as a nurse and your overall career?
My first certification was the Certification in Nephrology Nursing (CNN) which I earned in 2001 because I knew I wanted to be a nephrology nurse long term. It also helped that I work in a Magnet institution which supports certification with professional development time and certification pay. I was starting to feel more comfortable with my nursing knowledge and skills and saw this as an opportunity to challenge myself and build confidence. I remember feeling so proud when I earned my CNN, and have continued to maintain it. My certification motivates me to stay current and engaged in my specialty. It also lets people know I am committed to nephrology care. I recently received my 20-year CNN pin and it is very special to me.
Can you talk a bit about how joining a professional organization like ANNA has helped your nursing career?
As a newer RN, I looked to ANNA to provide me with education and learning more about caring for people with kidney disease. As my career continued, I became involved in the chapter education planning committee and eventually chapter leadership. ANNA provided complimentary volunteer leadership education and tools to support me as a new leader. These skills carried over into my work as well as I became an assistant manager. When I was in graduate school and my husband was laid off, ANNA awarded me a career mobility scholarship that allowed me to finish my Master of Nursing. I have been able to present abstract posters at ANNA National Meetings and was published in the Nephrology Nursing Journal. I began volunteering on ANNA national committees and eventually became a director with the ANNA Board of Directors. Through ANNA, I met mentors and friends who have encouraged and mentored me over the years. There are so many potential benefits of engaging with a professional nursing organization, and I hope other nurses take advantage of all the benefits that membership offers. ANNA has made my nursing career and life fuller.
What else do you enjoy outside of your work?
Outside of work, I like to spend time with my husband of 26 years, our 24-year-old son, 21-year-old daughter, and our dog. We like to try foods from all over the world, visit national parks, take walks, visit museums, go to musicals, and play board games. My husband and I both have large extended families so we like to visit them when we can. At the end of the day, my introverted side takes over. I like to read, cook, work on puzzles and do crafts like knitting, making photo books, painting, and sewing. I also like to plant things and watch them grow.
Nephrology nurses are a lifeline for patients who have kidney disease. This week’s National Nephrology Nurses Week helps bring attention to the specialty care nephrology nurses provide and the way they help their patients manage their disease and symptoms. Minority Nurse caught up with Phung Tran, MSN, MBA, RN, a member of the American Nephrology Nurses Association (ANNA) to find out more about a career in nephrology nursing and her own personal journey to becoming a nephrology nurse.
What does a career in nephrology nursing entail?
Nephrology nursing requires a strong set of communication and care management skills. Patient education is a crucial part of the nephrology nursing. Engaging patients to take an active role in their disease journey takes negotiating, active listening, and an empathetic approach to care. Taking the time to encourage patients to make small changes and to celebrate patients achieving set goals improve patient health outcomes. Planning, coordinating, and being proactive in care management allow for patients to live a productive and rewarding life. It provides patients the confidence to take control of their disease and not let the disease dictate their lives.
What training do you need?
Beyond the nursing school curriculum, there are specific training in the various modalities of kidney replacement therapies. Didactic and hands-on training focused on the disease process adds the specialty skill set for nephrology nursing. There are equipment and processes that demand proficiency in use and troubleshooting to enhance patient safety. Infection control and taking on the role of a patient educator and advocate provides another level of optimal patient care.
What attracted you to this area of nursing?
My husband is a chronic kidney disease patient. He was on hemodialysis for one year. His struggles and challenges motivated me to make an impact in this vulnerable patient population. The opportunity to engage and encourage patients to make small changes that lead to better health outcomes gives me great satisfaction in my professional contribution. I enjoy getting to know the patients and sharing in their journey. I am honored to hear their stories and how my care improves their quality of life to achieve their milestones.
What do you enjoy about this specialty?
I get to apply nursing care through conversations. It’s the open and honest dialogue of a life lived. Frank discussions of joys, struggles, and challenges allow patients to move beyond the disease. I enjoy the lighthearted and serious banter and negotiations that generate a bond of trust between a practitioner and patient.
How do you interact with patients?
Each encounter creates an opportunity to educate and learn. Using motivational interviewing skills, I actively listen without judgment to patient concerns and challenges. I seek to understand then ask the patient for viable options to meet their needs. I find generalized options and solutions often frustrate patients since they don’t meet the needs of the patients. Taking the time to get patients involved in their own care ensures follow through on the care plan.
Is there new technology that nephrology nurses use?
The ability to adapt and learn is what makes a nephrology nursing challenging and exciting. New equipment, processes, and procedures keep nephrology nursing evolving. The movement to give patients more flexibility in managing their treatment sparks innovations and initiatives.
Can you tell me a little bit about advancements in the field?
Professional advancements abound through various avenues of nephrology nursing. Mentorship and leadership development come from a strong and supportive professional association. The American Nephrology Nurses Association (ANNA) provides a collaborative group of nephrology nurses who strive to enhance the nephrology nursing profession. Networking opportunities to discover and explore jobs beyond clinical care exists in the ANNA collective.
What would you like nurses interested in this career path to know?
The learning curve is high. Give yourself patience and grace to learn from your struggles. As you find your stride, the reward comes from the incredible patient relationships and how your care impacts their quality of life. You can truly make a significant difference in patient lives.
Nephrology Nurses Week kicks off today and is a time to appreciate the dedication and expertise nephrology nurses bring to their roles.
Nephrology nurses have a distinct role in helping patients across the age spectrum who are dealing with issues concerning kidney function and health. Whether it’s a family history that predisposes someone to kidney disease, an older patient who is coping with a new diagnosis, a teen recovering from a kidney transplant, or a person with advanced end stage kidney disease, nephrology nurses specialize in all the ways to help patients.
Anyone interested in a career as a nephrology nurse can reference the American Nephrology Nurses Association for background information, career tips, certification information, and guidance. Nephrology nurses can flourish in any number of settings from corporate to home care to a coordinator of dialysis or transplant services. They have a broad knowledge of the entire body system and will know how kidney function will impact the rest of the body.
Often nephrology nurses will administer the frequent dialysis needed to keep a patient functioning. They might also counsel patients and their families who are preparing for a kidney transplant or recovering from one. Their expertise in helping both the patient learn about typical expected symptoms or results and in helping family members care for a patient will make a significant difference in physical and emotional recovery.
With the rapid treatment advances for complex health issues, many nephrology nurses become well-versed in the many conditions patients have and how those conditions can impact the kidneys and treatments for kidney disease. Because of this, they need excellent teamwork skills and critical thinking skills that will help them assess and prioritize care in crisis situations.
As with other specialties, obtaining certification improves your knowledge base, and it also helps you serve your patients to the best of your abilities. Certification is available for several areas of nephrology nursing including as a nephrology nurse, as a nephrology nurse practitioner, as a dialysis nurse, as a dialysis LPN, or even as a clinical hemodialysis technician.
Studying for and passing a certification exam is well within your reach, especially if you have been in the field for a while. You very likely already know a good deal of the information. But certification helps you stay up-to-date on the latest evidence-based practices, technology, and treatment, and also gives you a peek into the exciting developments in the industry.
As you gain more training, your employment becomes even more valuable to your organization. Certification also shows your dedication to your role. Taking the extra time to advance your learning shows the kind of attention to detail and commitment to high-quality care that employers want to see. When career advisers talk about showing your skills and your results, certification fits the bill.
Take this week to appreciate nephrology nurses and to find out more about the career if it sounds appealing to you.
One of the many specialties in the nursing filed is nephrology—working with kidney patients.
Shamekia Gullatte, RN, BSN, CPN, the Lead Post Kidney/Pancreas Transplant Coordinator at the University of Alabama at Birmingham, has served as a nurse with many different kidney patient populations, including working as a dialysis nurse, a pediatric nephrology nurse, and currently as a transplant coordinator.
What follows is an edited version of our communication.
As a nephrology nurse, what does your job entail? What do you do on a daily basis?
My current job entails educating and managing care of kidney transplant recipients. After working nine years in an outpatient pediatric nephrology setting, I decided two years ago that I want to care for patients who overcame chronic kidney disease and received a transplant. As a kidney transplant coordinator, I meet with newly transplanted patients while they are still in the hospital and provide education about their care. After the patient leaves the hospital, I continue to be a resource for the patient in the outpatient setting.
Why did you choose to work in nephrology? How long have your worked in the field? What prepared you to work in this kind of environment?
As a dialysis nurse, my first professional nephrology position, I became passionate about the disease processes in this patient population. Over the last 13 years, I have worked in various areas of nephrology. I was prepared to work in this environment because I worked 12 combined years as a dialysis nurse and pediatric nephrology nurse caring for children with chronic and acute kidney disease.
My parents laid the foundation for me to be a compassionate person and appreciate every aspect of life, which really are essential attributes of a nephrology nurse. Then I was awarded an excellent education at the prestigious Tuskegee University, where I obtained by Bachelors of Science in Nursing.
What are the biggest challenges of your job?
One of the biggest challenges of my job involves the lack of resources for patients. Some of our patients have limited financial resources and may have difficulties paying medications and sometimes have transportation issues. Although this is a challenge, UAB Transplant has a multidisciplinary team that includes amazing social workers who assist patients with these obstacles.
What are the greatest rewards?
The greatest reward in being a nephrology nurse in transplant is walking into a patient’s room to educate them on their new organ and saying, “Congratulations!” I certainly understand that some patients may have had a tough journey. For example, I can remember when one of my patients told me her story of when she was diagnosed with a rare disease, and she was getting prepared for transplant. This patient had been struggling from dialysis complications. Just to listen to her story leading up to kidney transplant was definitely a tear jerker, but now I was sharing a moment with her that she thought would never come.
I know that I was meant to be a nephrology nurse at UAB Hospital in post-transplant because I get this flutter of joy in my heart and soul every time I receive a new patient.
What would you say to someone considering this type of nursing work? What kind of training or background should s/he get?
To become a nephrology nurse, one would have to earn a degree in nursing and gain clinical experience in nephrology. To become a transplant coordinator at UAB, you have to get all of the above, but also have that little flutter of joy in your heart and soul when a patient receives a kidney transplant. UAB has performed more kidney transplants than any other transplant program in the nation since 1987, and we all take great pride in the care we provide our patients.
Being a nephrology nurse really takes more than just credentials. You have to be a person who is truly compassionate about your patient population, and someone who has a real love and desire for them. I love my patients, and appreciate the opportunity I have to care for them every day.
