What Is Dialysis Nursing? The Ultimate Guide to Nephrology
According to the American Nephrology Nurses Association (ANNA), nephrology has been a recognized specialty for over forty-five years. In fact, in 1973, the federal government funded kidney disease treatments, including hemodialysis, peritoneal dialysis, and kidney transplantation, through the Social Security program, thereby making end-stage kidney disease (ESKD) the only recognized disability caused by disease. In turn, this determination has made kidney disease treatments more widely available and has increased the need for nephrology or dialysis nurses in many healthcare settings.
Are you interested in becoming a dialysis nurse? Read on to learn all there is to know about this nursing specialty, including work settings, duties, certifications, salary, and even how to land high-paying dialysis nursing jobs!
What Does Dialysis Mean in Medical Terms?
According to the National Kidney Foundation, the definition of dialysis is “a treatment that does some of the things done by healthy kidneys.” It is usually needed by patients who have developed end-stage renal disease (ESRD), at which point patients have lost about 85 to 90 percent of kidney function and have a glomerular filtration rate (GFR) of below fifteen. Some of these patients may be eligible for kidney transplants. In other cases, patients may need dialysis for a short time to recover from acute kidney failure.
Dialysis mimics some of the functions of healthy kidneys, such as removing waste, salt, and extra water so that these don’t build up in the body, maintaining safe levels of certain chemicals in your blood, including potassium, sodium, and bicarbonate, and controlling blood pressure.
According to ANNA, nephrology nurses, also referred to as dialysis nurses, work in a variety of inpatient and outpatient settings, including the following:
- Dialysis clinics
- Home settings
- Long-term care facilities
- Transitional care units
- Healthcare provider practices
- Transplant programs
What Does PD Stand For?
The abbreviation PD stands for peritoneal dialysis, the less common of the two types of dialysis. In the more common form of dialysis, hemodialysis, clinicians connect an artificial kidney called a hemodialyzer to patients’ blood vessels through minor surgeries on their arms or legs. Doctors create access by joining an artery to a vein under a patient’s skin, creating a larger blood vessel called a fistula. Otherwise, doctors may use a graft, a soft plastic tube used to join an artery and a vein. Less frequently, doctors create access through a catheter to a large vein in a patient’s neck.
Peritoneal dialysis also filters the blood of dialysis patients, but it does it differently. In PD, a cleansing fluid called dialysate flows into part of a patient’s abdomen through a catheter, which also must be placed by a physician through surgery. The peritoneum or lining of the abdomen filters the blood and removes waste products. After a specified time, the fluid with the waste products flows back out and is discarded.
Another aspect that sets PD apart from regular hemodialysis is that it can be carried out at home, at work, or during trips. However, this option is not available for everyone with kidney failure. Patients need to be independent and have manual dexterity or have a reliable caregiver who can assist with the procedure.
What Is a Dialysis Unit in a Hospital?
A nephrology or dialysis unit at a hospital provides all the necessary healthcare services for managing patients with acute kidney failure or ESRD, including the placement of vascular access for therapeutic hemodialysis, hemoperfusion, plasmapheresis, and hemofiltration.
These treatments may be carried out in dialysis units, intensive care units (ICUs), transplant centers, or even patients’ rooms. Patient treatment and care are carried out by a diverse healthcare team, including the following professionals:
- Transplant surgeons
- Dialysis nurses
- Social workers
- Clinical nurse specialists
- Nurse practitioners
Patients are assigned a dialysis nurse who provides treatment and education and answers any questions patients might have. They will also be examined by a doctor and visited by a dietician and social worker.
What Does a Dialysis Nurse Do?
In general terms, a nephrology nurse, also called a renal or dialysis nurse, plans, organizes, implements, and evaluates patient care for patients with kidney failure of all ages.
A dialysis registered nurse (RN) provides direct nursing care for patients but also coordinates and delegates care, working in conjunction with patients, family members, and the rest of the healthcare team.
What Is the Specific Role of a Dialysis Nurse?
The responsibilities of a dialysis nurse vary depending on their level of education and work experience. A dialysis RN may have all the following duties:
- Overseeing the preparation of the delivery system, dialysate bath, and dialyzer
- Reviewing doctor’s orders for dialysis patients, collecting pre-treatment dialysis information, and reviewing patient records before dialysis
- Conducting pre-dialysis patient assessment by obtaining patient vital signs and assessing the patient's vascular access, laboratory results, and the patient's general health
- Verifying that patients are taking all prescribed medications and performing medication reconciliation
- Documenting findings of patient assessments and interventions and informing physicians of any significant change in the patient's condition and other relevant information
- Discussing patient concerns and answering questions
- Supervising dialysis technicians in the performance of dialysis from start to finish, monitoring patient reaction to treatment, and monitoring the performance of the dialysis machines
- Assessing, preparing, and cannulating a patient's vascular access
- Assessing the dialysis catheter exit site and applying a dressing on the patient’s vascular access
- Performing surveillance on dialysis access for early signs of failure or infection
- Reviewing patient's records for orders and administering dialysis-related intravenous or oral medications as prescribed or per protocol
- Conducting post-dialysis assessment and patient discharge
- Providing patient education regarding their medical condition
- Referring patients to other disciplines or services as needed, such as dieticians or social workers
- Performing other treatments and diagnostic tests such as blood sugar testing
- Overseeing disassembly and disinfection of dialysis equipment
- Performing regional heparinization, separating and storing blood samples, setting up oxygen, administering saline, and maintaining dialysis equipment
How to Become a Dialysis Nurse
Nurses at all levels of education can work in dialysis: certified nursing assistants (CNAs), licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs). In addition to state licensure, many jobs require a minimum of one year of work experience.
According to ANNA, nephrology nurses require specific knowledge and clinical experience in kidney disease beyond the scope of a basic nursing program. A dialysis nurse must have advanced knowledge in all of the following areas:
- Anatomy, physiology, microbiology, and pathophysiology
- The nursing process specifically applied to nephrology nursing
- Diagnosis and treatment for patients requiring renal replacement therapy
- Pharmacology and pharmacotherapy
- Growth and development
- Counseling and interviewing skills
- Interdisciplinary team skills
- End-of-life care
Dialysis Nurse Certification
As with many other nursing specialties, most jobs in dialysis nursing require nurses to have basic life support (BLS) certification and advanced cardiovascular life support (ACLS) certification, both of which can be obtained through the American Heart Association.
Furthermore, the Nephrology Nursing Certification Commission (NNCC) offers certifications for dialysis professionals at all levels of education: technicians, LPNs, RNs, and nurse practitioners (NPs).
- Technicians may apply for the Certified Clinical Hemodialysis Technician (CCHT) credential or the Certified Clinical Hemodialysis Technician - Advanced (CCHT-A) credential. The CCHT-A is for technicians with at least 5,000 hours and five years of experience.
- LPNs with at least 2,000 hours of experience with patients with kidney failure may obtain the CD-LPN credential.
- RNs with at least 2,000 hours of nephrology experience may apply for the Certified Dialysis Nurse (CDN) credential. RNs with 3,000 hours of experience in multiple areas of nephrology are eligible for the Certified Nephrology Nurse (CNN) credential.
- NPs with a minimum of 2,000 clinical hours in nephrology can apply for the Certified Nephrology Nurse - Nurse Practitioner (CNN-NP) certification.
How Long Does It Take to Become a Dialysis Nurse?
The length of training required to become a dialysis nurse depends on the type of nurse that potential nurses aspire to become.
- Becoming an LPN takes approximately one year—plus 2,000 hours of clinical experience to become certified as a dialysis LPN.
- Becoming an RN takes two to four years—plus 2,000 to 3,000 hours of clinical practice to become certified.
- Becoming an APRN takes about six years—plus 2,000 hours of hands-on nephrology experience to become certified in this area.
How Much Do Dialysis Nurses Make?
Many factors determine a dialysis nurse’s salary. However, the main factor is their level of education. Here are average salaries for nurses with different levels of education based on data from the US Bureau of Labor Statistics (BLS):
- Certified nursing assistants: $33,250
- Licensed practical nurses: $51,850
- Registered nurses: $82,750
- Advanced practice registered nurses: $118,040
What Is Dialysis Nursing Like?
The jobs of dialysis nurses may differ based on the facilities where they work, such as hospitals, dialysis clinics, long-term care facilities, patients’ homes, etc.
Nurses who work in acute care settings treat patients who are critically ill. Therefore, this type of job is fast-paced and challenging. Nurses working in outpatient settings can significantly impact patients’ quality of life since they act as patients’ advocates, educators, consultants, care coordinators, and direct caregivers.
“Each location is going to differ pretty wildly as far as your workload is concerned. Generally speaking though, your acute dialysis units in the hospitals can run you ragged according to most every tech I’ve spoken to (staying hours past your scheduled time and obviously it’s a stressful environment). Your outpatient dialysis units are more of a mixed bunch and the workload varies more depending on what company you work for and what area of the country you’re in. If you get in a well run outpatient dialysis clinic, it’s a cakewalk.” Reddit – u/Guthwine_R
Furthermore, nursing care can be complex since patients may have multiple health conditions. The following are some of the comorbidities that dialysis patients may have:
- Cardiovascular disease
- Infectious disease
- Bone disease
- Mental health conditions
Is Dialysis Nursing Hard?
There is no better way to learn about the hard truths of nephrology nursing than through the experiences of nurses themselves. Here are some testimonials of dialysis nurses:
“It can be very routine. Very very routine. You do need top-notch nursing skills, because not only is it for dialysis it seems to be for everything else. For some people it’s their only medical care. You will spend a lot of time communicating with the doctors about the patient. You will use your nursing judgment a lot…You will be the primary nurse for several of the patients in the clinic. You will do monthly med reviews with them for their home medication. For your primary patients you’ll be their lead for transplant coordination. Lots of education to review with a patient. The pace is constant, Nonstop.” Reddit – u/Dominar_Rygel_XVII
“Sometimes you just have a day where everything that can go wrong goes wrong at the same exact time (machine failing self-tests or errors, an infiltration, etc). And the educator is there watching it all go down staring at you and judging just a few feet away.” Reddit – u/FreeLobsterRolls
Why Choose Dialysis Nursing
Just as dialysis nursing has its challenges, it also has its perks. Here are some reasons why dialysis nurses love their jobs:
“I literally just quit ICU to work in a dialysis clinic. Cannot tell you how much more I love the patients, improved mental health and not having to work nights. It's a lot of learning but once you get the hang of it, you will hopefully love it! I was bedside for 10 years and personally I am very happy I made the move.” Reddit – u/derpina6699
“We work for 10 hour days…The pay is excellent, the benefits are wonderful, and a six day clinic we’re closed every Sunday, and work four days a week. No evenings,We close for Christmas Thanksgiving and New Year’s…they take a half hour break in the morning and a half hour lunch in the afternoon. Every day. Dialysis nurses refuse to miss their breaks and lunches…” Reddit – u/Dominar_Rygel_XVII
What Makes a Good Dialysis Nurse? Tips for New Nurses
In addition to obtaining their nursing licenses and nephrology certifications, dialysis nurses should strive to achieve the following skills and qualities to be great at their jobs.
- Responsibility: To a great extent, patients’ health is in nurses’ hands. Therefore, slacking on the job or being careless can have devastating consequences for patients. Furthermore, nurses must be worthy of patients’ trust and protect patients’ privacy.
- Independence: Healthcare settings tend to be understaffed and hectic, and nurses tend to be overworked and inclined to experience burnout. Consequently, nurses who can work autonomously and carry their own weight are indispensable members of healthcare teams.
- Critical thinking: Patients with renal failure are in delicate health conditions. Moreover, they often have comorbidities on top of kidney failure. Thus, nephrology nurses must care for and treat patients with very complex conditions, which requires a high level of critical thinking skills.
- Effective communication: Nurses act as liaisons among healthcare team members, patients, and their families. Thus, excellent communication and interpersonal skills are indispensable.
Final Thoughts on Working as a Dialysis Nurse
As with all nursing specialties, dialysis nursing has its advantages and disadvantages. Ultimately, the best specialty for each nurse will depend on their personality traits as well as many other factors.
Whether you are a newly graduated nurse or an experienced nurse in need of a change, you should consider PRN nursing as a way to test out different facilities and nursing roles. Through Nursa’s per diem staffing app, you can browse available nursing jobs near you and request as many as you like. That way, you can obtain the hands-on experience you need to make an informed career choice.