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.
The compassionate work and care of all nurses deserves to be celebrated, and throughout the year, different branches of the nursing profession get the chance to spotlight their unique duties.
The need in this area is great. According to the National Kidney Foundation, one in seven adults has chronic kidney disease. Many people don’t realize they have a current disease and many of those who are at risk are also unaware.
Many sub-specialties exist within nephrology nursing, so nurses in this area have many choices. To advance their careers and gain more knowledge, nurses can become certified through the Nephrology Nursing Certification Commission in becoming a nephrology nurse nurse practitioner, a certified nephrology nurse, or a certified dialysis nurse (several technical certifications exist as well).
With a varied and diverse population, nephrology nurses work with all ages of patients from the youngest patients to the oldest. They can work in healthcare settings ranging from hospitals to home care, but may also choose to pursue research, policy work in government, or a position in academia.
Renal disease can impact anyone, so nurses become comfortable helping patients with prevention, with deciding on treatment options, and guiding them to administer self care and monitoring. And while many patients are relieved to know their kidney disease can be managed, sometimes the care options (like needing dialysis) are a daunting prospect when patients first hear it. They rely on the compassionate, professional, and expert nursing care to help understand and adapt to their diagnosis. Nephrology nurses must have broad knowledge and care for the whole body as kidney function impacts so many physical systems.
Many kidney patients have additional conditions making their care especially complex, so a nurse who wants to get into the nephrology field needs to be able to work comfortably on a team to understand the complexities of care.
In a public letter celebrating National Nephrology Nurses Week, Alice Hellebrand, MSN, RN, CNN, and 2017-2018 ANNA president, said, “Nephrology nurses use their vision, knowledge, and skills to take action and improve patient outcomes. They make a positive difference in the lives of patients and their families every day. Individuals with kidney failure rely on the skills, knowledge, and expertise of nephrology nurses to ensure the safety and effectiveness of their life-saving care.”
Thanks to all the nephrology nurses out there!
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