Practice Issues in Nephrology Nursing

If change is constant, nephrology nurses represent their time. The American Nephrology Nurses Association (ANNA) first published its nursing standards in 1977. Although each state has nursing legislation, the Standards of Clinical Care for Nephrology Nursing define professional practice in the treatment of kidney disease. Health care has evolved so that, in 2005, the Nephrology Nurses Association amended the standards to make the profession an ultimate exercise in versatility.

Time

• Modern nephrology nurses manage patient needs and patient mortality at the same time.

  As of 2010, nurse practitioners provide assessment, planning, intervention and patient education over a continuum "...that may last days or decades," according to a 2010 article in Nephrology Nursing Journal. Nephrology nurses must balance the dynamics of patient illness with highly variable amounts of time to guide patients toward self-care, if possible. Nephrology nurses must continually oversee and and react to change. Historically, nurses were deployed at the "end renal stage," when the patient had reached the point of kidney failure. According to practitioners from the University of North Carolina - Chapel Hill (UNC-CH), nephrology nurses have been assigned a more prominent role in treating all four stages of Chronic Kidney Disease (CKD) with the same time frame.

Money

• The modern nephrology nurse is the consummate multitask master.

  In a funding-constrained medical system, nephrology nurse practitioners develop treatment plans with economics in mind. At the UNC's nephrology clinic, a nurse was hired to develop a treatment strategy that also decreased emergency department visits and hospital admissions, decreased time spent in hospital, and streamlined the admission and discharged process to maximize room availability. In other words, lower facility costs. At UNC, the Nephrology Nursing Initiative (NNI) crafted a new organizational structure in which six nephrology nurses were expected to communicate "...between all points of care for patients from the early stages of CKD through renal replacement therapy, including transplantation." Sometimes, UNC nephrology nurses must coordinate both inpatient and outpatient kidney dialysis programs.

Information

• Patient Data Management Systems make medical actions and reactions a key matter of electronic record.

  Nephrology nurses live in the time of Patient Data Management Systems (PDMS), which are warehouses of electronic records of treatment used to administer health. However, nurses must be computer literate in making records of their actions. In a study prepared for the America Society of Nephrology, Fretschner et. al concluded that "PDMS will be indispensable in the foreseeable future, because only with their help can we manage the vast amount of ICU data and use stored data in a meaningful way." Add data entry to tight times and budgets, all calibrated to optimize a patient's quality and length of life. That's the practice of nephrology nursing.