Nephrology nursing: A view from the other end of the dialysis needle

Editor’s Note: This special section, called Kidney Care 101, is part of a series in NN&I for the health care professionals entering the renal industry. Whether you are an administrator, social worker, nurse, patient, dietitian, technician, or nephrologist, this series of articles will help you get comfortable with how things come together in a dialysis unit. A special section will also be devoted to transplant care.

Once the series is completed, NN&I will offer the complete series of articles as an eBook, available on our website, NephrologyNews.com. Along the way, we encourage NN&I readers to share their own advice on how things work in renal care.

–– Mark E. Neumann

Executive Editor

mneumann@nephrologynews.com

The dialysis nurse

I started my nursing career as a new graduate working night shift on a surgical/oncology/pediatric unit in a 100-bed hospital in Seattle, Wash. Within a year I was able to move to the day shift and take a position as a float nurse. However, a year later, my husband and I decided we had enough of “big city” life and we returned to our home state of Montana. I was hired as one of the first float nurses at St. Peter’s Hospital in Helena.

I eventually moved into the house coordinator position, which called for me to walk an average of about 15 miles during an 8-hour shift. I was literally wearing out my feet and ankles. This meant I was faced with either ending my nursing career or changing to a position that did not involve as much walking. One day a co-worker called me and said “Alice, there is a job in dialysis. You need to apply!” It was the perfect solution. Dialysis care at the hospital was a small unit, required very little walking, and had nifty stools to scoot around on. My feet and ankles could get a well-deserved rest.

More articles on nephrology nursing

Reducing dialysis nurse burnout

The dilemma of dialysis nurse retention

Nursing and kidney research: The Wearable Artificial Kidney trial

ANNA keynote tells nephrology nurses to ‘put profession first’ in obtaining higher education

Communication key for nurses in the dialysis patient handoff

The emotional connection in the patient-caregiver relationship

Nursing and kidney research: The Wearable Artificial Kidney trial

Study shows role management style plays in nurse retention

Nephrology nursing and the wearable artificial kidney

My new direction

Nephrology was an eye-opener for me. As a float nurse, I didn’t see any patient two days in a row. Now I was seeing the same people three days a week for four to five hours at a time. The defined professional boundaries between nurse and patients that had been drilled into my head in nursing school suddenly became quite blurred. These people knew my husband’s name, my children’s names, my cat’s names and I knew about their families, friends and pets, too. I had patients give me handmade baby afghans and quilts when my daughter was born. I was the patients’ nurse first and friend second.

I like most of the people I see three times per week; I love a few, and there are some individuals I don’t like at all. Luckily the people I don’t like are greatly outnumbered by the ones I do. But it is not all about holding hands. The job can be frustrating. I have treated patients with phosphorous levels above 9 mg/dL who look me in the eye and say, “I always take my binders,” and patients with blood pressures of high over higher who say, “I took my blood pressure meds this morning,” while their pharmacies tell me they haven’t filled their prescriptions for months. I had to learn early in my nephrology career that I could educate, encourage, and support the people I cared for but ultimately it was up to them to make good decisions or make poor ones. How they lived their lives was not a personal reflection on me as a nurse.

Dealing with end-of-life

I have to remind myself of this when I see patients die of heart failure due to years of not controlling their fluid intake, despite warnings of what a 6+ kg weight gain does to the heart.

Nephrology nurses work with patients who have many co-morbid conditions, and if it weren't’t for dialysis, these patients would not be alive. Sometimes I feel death is my constant companion, so I have had to come to an uneasy understanding with the Grim Reaper. I have sat at the chair side of patients who have decided this was their last treatment, and would be leaving our unit and going home with hospice. Saying goodbye with my head resting on the chair’s arm table and crying my eyes out was not easy. Nephrology nurses must navigate through the graveyards of our profession in their own way. For me, knowing the patient is ready and seeing the serenity in his or her eyes (my colleagues know what I am talking about) gives me comfort.

Until I started as a nephrology nurse I was a “Jill of all Trades” when it came to nursing. I felt comfortable working on the medical, surgical, post-partum, newborn, ICU, radiology, emergency, pediatric, and psychology units but I was not an “expert” at any one thing. As a nephrology nurse I have had the privilege of becoming an “expert.” Since I now work in a small hospital-based unit, I take care of acute hemodialysis, chronic outpatient hemodialysis, peritoneal dialysis, and soon home hemodialysis patients. I enjoy learning how to help make life better for people with CKD.

Expand your knowledge

Outpatient chronic hemodialysis can easily become mundane. If a nurse doesn’t constantly try to keep up-to-date with new information or stay actively involved and committed to the profession, he or she risks burning out. From 2009 to 2011, I worked as an adjunct professor for Carroll College’s nursing program in Helena and was the clinical instructor for junior and senior nursing students on a surgical unit. I constantly stressed to them that they keep learning, keep asking “Why?” and then figure out “Why?” It is my belief that whatever area of nursing you find yourself in, join the professional nursing organization for that specialty, network with your colleagues, and never forget the people you are caring for are someone’s mother, father, sister, or brother.

When asked why they picked this profession, many nurses say, “Because I want to help people.” But to truly help, a nurse has to stay current and engaged. At one point in my career, I had the honor of precepting a former student for her capstone rotation in dialysis. When she graduated, she was hired as a dialysis nurse in our unit. I asked her, “What keeps you here in dialysis?” She said “There is so much to learn and the kidneys are fascinating; I didn’t realize how much there was to them until I started studying for my certification.” She then added, “And the staff here are so great.”

Those are exactly the same things that keep me in nephrology: the kidneys are fascinating and I do work with a great group of nurses. I have an excellent manager who encourages me to expand my professional horizons, co-workers who are supportive, and a nephrologist who seeks out and respects my professional opinion. Plus, there are always those patients and families I can laugh with, cry with, and most of all, just be with.

From that side of the needle, it makes it a rewarding profession. -by Alice Luehr