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.
Neonatal Nurses Week kicks off this year on September 12 and will bring a week to spread awareness of neonatal nursing as a career and to call attention to the work these nurses do with the tiniest infants.
Sponsored by the National Association of Neonatal Nurses, this observation week shines a spotlight on nurses who work with pre-term and full-term infants who are facing various health challenges from low birth weight to genetically based health issues. According to NANN, nurses generally work with these infants until they are discharged from the hospital after birth, but that can span a months-long period of treatment. Some nurses in this area do continue to see patients until they reach toddlerhood.
Thanks to all the advances in neonatal care and treatment, babies born with problems such as low birth weight face much-improved survival rates than babies born even 15 years ago. And advances in neonatal intensive care units have seen great progress. Research in the Journal of Pediatrics and Neonatal Care shows how many different factors in the care setting can influence the health outcomes of infants. As nurses build awareness of everything from the importance of hand washing to the negative impacts of light and noise in the care environment, overall outcomes continue to get better.
Neonatal nurses are particularly attuned to their tiny patients and they have especially keen observation skills. Neonatal nurses continually monitor the infants’ vital signs, but they also use their own five senses to watch the infants for any changes in behavior or appearance for signs of pain or infection. With such tiny patients, every nursing process takes a more targeted approach including tasks such as central line or breathing and respiratory care so neonatal nurses develop specialized skills.
Working with families is significant part of the neonatal nurse’s day. Helping parent-baby bonds develop as is possible with infants who may be very ill requires careful approaches and often nothing the new parents have ever experienced. Neonatal nurses can help share their own observations for what works to help both parents and babies develop attachments in this critical time. They are also there to help support parents if they can feed babies on their own or even develop special feeding times if additional feeding support is being used.
Nurses in this specialty are devoted to their patients and advocate for them as they are unable to advocate for themselves. Neonatal nurses have sharp critical thinking skills that are necessary when conditions change or the infant is showing signs of distress. They should continue to develop their skills and deepen their knowledge and can do that through achieving certification with programs including the American Association of Critical Care Nurses CCRN-Neonatal program.
Nurses with a passion for dedicated nursing and for some of the most vulnerable patients will find neonatal nursing a meaningful career with opportunity for continual learning.
Pediatric hematology/oncology nurses work with the youngest patients and their families as they navigate through the difficult diagnosis of cancer or a blood disorder. From caring for the smallest children to adolescents and young adults, these nurses use their expert knowledge of evidence-based practice in the latest treatment and care of these diseases to help patients. Using equipment and treatments that are state-of-the-art, pediatric hematology/oncology nurses must stay current in the rapid developments in the field so they are able to provide the best nursing care possible.
As with other nursing specialties, pediatric hematology/oncology nursing requires nurses to have a nuanced approach to caring for patients who don’t always understand the scope of their sometimes painful treatments or who have to cope with symptoms or aftereffects of medications. But they also must work carefully with the families and loved ones of their young patients who also might be learning about cancer care or hematology conditions for the first time. There’s a lot of information to understand and process and so hematology/oncology nurses are excellent educators to help everyone involved have the information they need.
As nurses gain more hands-on experience in the field, they learn how to care for children, how to help them through any treatments, and how to bring some normalcy into their lives as is possible. A hematology/oncology nurse works with a compassionate family-centered approach to include all the loved ones who are with their patients and caring for them at home or staying with them in a hospital or facility.
Despite all the progress in cancer care and treatment, nurses know they will lose some patients. They need to have the support available to help with any loss, and many nurses say the work itself helps. Because they work with children, the boundless spirit of their patients keeps them going. Even children going through multiple hospitalizations want some of the fun of childhood and so they bring continual joy to their care giving team.
Nurses who are considering this specialty should first spend some time shadowing a pediatric hematology/oncology nurse and take some time to be on a unit where these nurses work. By spending time with nurses doing this work in real time, you’ll be able to see what a typical day is like. Pediatric hematology/oncology nurses should have a minimum of an associate’s degree, but a BSN is preferable because of the additional knowledge, critical thinking skills, and internship or externship opportunities available. And while spending time on a pediatric hematology/oncology unit is necessary, nurses may also want to work on a general pediatric unit with a pediatric nurse as well, to understand the differences in caring for a younger population.
And if you have pediatric hematology/oncology nurses in your life, today’s a great day to thank them for all they do for the lives of the young patients they work with.
This week kicks off Vascular Nurses Week, the annual September celebration of the vascular nursing specialty and the work of nurses in this area.
Vascular nurses work with patients who have different kinds of conditions or illnesses that impact the circulatory system. Because the vascular system is responsible for transporting blood and lymph fluids throughout the body, there’s a lot of ground for vascular nurses to cover. Vascular nurses understand how the veins and arteries in the body work and how the job of bringing fresh oxygen and blood to organs while also removing waste keeps the body functioning in optimal health.
The Society of Vascular Nursing is a great resource as a professional organization devoted to nurses in this specialty. Vascular nurses often work in outpatient settings or in hospitals to treat patients recovering from surgery, undergoing treatment, or maintaining their long-term health. They will see patients who have conditions as varied as blood cancers (such as lymphoma), cardiovascular disease, or varicose veins. With such a range of conditions, vascular nurses treat patients of all ages and from all backgrounds.
Some patients under the care of a vascular nurse will have minor symptoms (such as some varicose vein treatment) and others will require extensive treatment and rehabilitation (from heart surgery). Vascular nurses are in an excellent position to help patients learn how to recover from a procedure, how to manage on-going symptoms, and to offer evidence-backed education on lifestyle changes.
Whether they are monitoring a patient immediately after a procedure or continuing an on-going relationship with a long-term patient, vascular nurses will check in with patients to see how they are progressing, to ask about how their medication is making them feel and if they have any side-effects, and to find out about current or new symptoms. They may be tasked with giving direction on how to make important lifestyle changes to diet and exercise, or they might help patients who need to learn how to find methods to reduce stress that will work for them. Because some vascular-based conditions, such as hypertension, disproportionately impact traditionally underrepresented communities, nurses should be especially aware of patients who may be at an increased risk.
When thinking about lifestyle changes–whether that’s increasing exercise, following a low-fat or low-salt diet, or reducing stress–nurses will want to really listen to a patient to find out about their typical days and how they live. Changes that work for patients are the ones that consider their particular barriers to following what is instructed. A mom with three kids, a full-time job, and parents to look after may not be able to follow a routine that includes an hour of daily vigorous exercise and time for meditation. She might, however, be able to fit in short bursts of jumping jacks or marching in place–both of which can reduce stress and count as exercise–and longer planned sessions. For a grandfather who hosts lots of family get togethers, where traditional food is an essential part of the gathering, implementing a strict diet will be nearly impossible to follow. In this case, some recipe makeovers can help as can listening to the patient to figure out what other healthy choices could be included to help him balance any heavier choices.
Vascular nurses play a vital role in how their patients navigate the many conditions related to the vascular system. This annual awareness week helps spread awareness and celebrate the work these nurses do.
Diagnosis isn’t always straightforward as symptoms can mimic other conditions. Because some patients will have a delay in emptying the stomach as well as in the esophagus, small intestines, and colon, they can experience trouble swallowing and constipation as a range of symptoms. “The most common symptoms of Gastroparesis are abdominal pain, most of the time in the upper part of the abdomen, nausea, and vomiting.” says McArthur. “Other associated symptoms include feeling extremely full, especially after meals, and bloating (feeling like you need to loosen your pants).”
Nurses can be watchful for digestive troubles and, says McArthur, of the some patients who could have conditions that make gastroparesis more common. Surgical procedures including acid reflux surgeries or gastric bypass or medications like opioids or narcotics can slow down digestion. Patients with previous infections of COVID-19, Epstein-Barr Virus, or parvovirus or with diabetes or some autoimmune conditions could have symptoms that point to motility disorders in the gastrointestinal tract, says McArthur.
In these patients, nurses can be particularly alert to any digestive complaints. McArthur says watching for nausea, vomiting, bloating, abdominal pain, fullness, or lack of appetite can signal follow-up testing to help with a proper diagnosis. Those tests could include an upper endoscopy to look for any ulcers, infections, or mechanical obstructions. Patients may also have a gastric emptying study which, McArthur says, uses a specific caloric meal that the patient eats and is followed by nuclear radiology to time the emptying of the meal out of the stomach. If delayed emptying is noted, there is a positive diagnosis of gastroparesis.
Patients will also likely work with a healthcare team that might include a gastrointestinal registered dietician for the gastroparesis type diet which could be very different from the patient’s current diet. McArthur says there are other available therapies including anti-nausea/vomiting medications, prokinetic therapy (medications to speed up the motility of the gastrointestinal system), and likely laxative therapy. “Constipation treatments are often initiated as we know improving the emptying of the colon can help upper gastrointestinal symptoms,” she says. “Other options may include endoscopic therapies, surgical interventions, and/or consideration for gastric electrical stimulation techniques.”
Nurses, whether GI nurses or in another specialty, can play an active role in helping patients navigate through uncomfortable and disruptive symptoms and diagnosis. “Nurses can help patients with gastroparesis and/or motility conditions by showing compassion and empathy,” says McArthur. “Motility patients often need help coordinating testing, medications and other conditions they may be dealing with. Motility disorders are often misdiagnosed/undiagnosed and patients may have seen many different healthcare providers, so having trust in their care team is vital.”