Nurses save lives every day. In nephrology nursing, I like to say I give life every day. If you have ever had an interest in nephrology nursing, let’s look at a day in the life of a nephrology nurse.
Chronic kidney disease (CKD) affects more than 37 million Americans. Often referred to as a “silent killer,” this disease usually masks itself with vague or no symptoms, leaving 90% of people unaware their kidneys are steadily losing function over time. If left unmanaged, CKD can lead to end-stage kidney disease (ESKD), and a kidney transplant or dialysis is needed to sustain life.
Kidney health can be impacted by a multitude of other health issues. In fact, diabetes and hypertension are the two leading causes of ESKD. Because of this, my patients’ health care needs can be complex.
To meet the needs of our patients, nephrology nurses are trained to deliver dynamic, diverse, and holistic care that is both challenging and rewarding.
Nephrology Nursing – A Day in the Life
As a nephrology nurse, my practice can involve helping slow the progress of CKD and effectively managing ESKD. But no matter what stage or set along the kidney care journey I engage with a patient and their loved ones, I help assess their total health needs to help them live their highest quality of life.
Opening the dialysis center
5:00 a.m. If I’m the nurse in charge that day, I’m likely opening our outpatient dialysis center with the sunrise.
I flip on the lights to a row of dialysis chairs and machines lining the treatment floor, and my nurse’s station is placed in the middle for the best vantage point. From my station, I will be able to see each chair where a member of my community will soon sit: the cashier from the local grocery store, the mailman, the old music teacher from the elementary school down the street.
Until then, I’ll take advantage of the quiet hours and prepare for the day. I start by divvying up the task list between myself and a team of patient care technicians (PCTs) opening the center along with me.
For the next 12 hours, the dialysis center will function as its own little community within the broader community our center serves.
I see on the schedule that the first shift will have 20 patients. That means 20 dialysis delivery systems need to be configured with the correct prescription for each patient. That also means my care team and I will need to prepare to help 20 patients—each with different socioeconomic backgrounds, families, professions, and lived experiences—feel safe and cared for over the next several hours we get to spend with them.
As the PCTs continue preparing the dialysis delivery system, I validate that each one is configured correctly to ensure each patient receives the correct prescription, which is one of my key responsibilities as the nurse in charge.
Next up, I turn my attention to the PCT who is inspecting our water room.
Just like the local community outside of our center walls, clean water is a basic need for dialysis treatment. However, while city water is suitable for drinking purposes, more stringent standards must be met to make it safe for dialysis uses. Dialysis patients are exposed to many liters of water as part of their dialysis therapy, and it’s important the water is purified to exacting standards.
The specially trained PCT initiates several purification steps to remove toxins and potential contaminants. Next, the PCT performs safety tests to validate the water purification system is functioning within safe parameters. As the nurse in charge, my job is to review the results of the safety tests and validate the results meet the required standards.
Now that I’ve signed off on the water for today’s treatments, I can continue getting organized for the day. Typically, this means I’m reviewing notes from yesterday’s charge nurse, checking for new admissions, and identifying changes to physician orders.
This is my signal that it’s time for that second cup of coffee before I turn my attention back to my care team.
Managing the Care Team
DaVita dialysis centers nurture a team environment. That’s because providing life-sustaining care involves the entire care team, as well as the patient and their loved ones.
So while I enjoy a great deal of autonomy (within the scope of my practice) to make certain decisions about patient care, to be effective I must also collaborate and guide the care team in effectively administering that care.
In other words, with my autonomy comes great responsibility. It’s my job to set the tone for the treatment floor. How I show up each day impacts my team and my patients. That’s why part of my success as a nephrology nurse hinges on the relationship and trust I build with the entire care team.
Some of the most crucial relationships I foster are with the nephrologists (kidney doctors) who treat these patients. Because nephrologists aren’t required to be in dialysis centers at all times (as they care for patients who treat at a variety of locations in the community), I get to be their eyes and ears. For example, nephrologists trust me to inform them of a change in a patient’s condition that might help inform an updated dialysis prescription. Thus, my assessment and communication skills are vital.
When it comes to other members of our care team (PCTs, dieticians, and social workers), I use the “homeroom huddles” as an opportunity to establish open lines of communication that help our team get focused and organized for the day. Now that we’ve readied the center, it’s time to huddle up.
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5:50 a.m. This five- to 10-minute meeting comes after the quiet fades and right before the humming and beeping of the dialysis machines begin.
The goal of the huddle is to connect with each other personally and prepare for the day ahead. As the nurse, I lead the huddle. I ensure the team has a chance to review the shift, flag new admissions, share new education or learnings, and discuss topics of care that may need to be addressed before the first patient walks through the door.
Nephrology Nursing First Shift
6:00 a.m. After we’ve welcomed our first shift of patients and their treatments begin, I’m observing the floor from my nurse’s station. I’m reviewing medications and readying to administer them, contacting nephrologists, if needed, and completing care plans. I’m keeping a close eye out for any signs a patient may need extra attention. This can look like a change in vital signs, consciousness, or in their overall health.
Also, I’m constantly assessing each of them. I’m mentally noting which patients have come in with too much fluid on, or which patients are hypertensive versus hypotensive. As I’m observing all this, I’m calculating how this will factor into their care for the day.
I’m observing not only the clinical elements of my patients but also their mood and energy level, which I’ve come to know quite well through the bonds we’ve formed. That’s what makes nephrology nursing so special and unique. As their nurse, I get to spend a lot of time with my patients because dialysis treatments happen several times a week for multiple hours each time. I have time to build trust and rapport with my patients, which can give me insights into their lives outside of our center that can help explain other aspects of their health.
Here’s a hypothetical scenario: A patient comes in with high blood sugar levels and is carrying extra fluid. This is unusual for this patient, but just last week he told me he would be attending his granddaughter’s birthday party. She’s turning seven. I know this because she excitedly told the entire center when she came with her mom to pick her grandpa up after his treatment.
Patients with ESKD have to follow strict, kidney-friendly diets, so it’s possible his high blood sugar and extra fluid could be the result of a little too much birthday cake over the weekend. I ask, and sure enough, that’s the likely culprit. Because this patient typically follows a kidney-friendly diet, walks around the block regularly, and is compliant with treatment and medication, there is little cause for concern. I adjust his care plan to take off the appropriate amount of fluid, check his nephrologist’s orders for how to handle his blood sugar, and make a note to contact our dietician who can check in with him to help ensure his regular eating habits are on track.
7 a.m. Finally, once all the patients have started their dialysis treatment, it’s time to start documenting the day. As a nephrology nurse, I’m responsible for signing off on treatment documentation every day.
Because of our patient’s complex health needs, documentation can be extensive. We keep tabs on nephrologists’ orders and protocols, care plans, assessments, hospitalizations, medical tests, notes and lab results—all of which factor into how the patient will be treated from shift to shift. This documentation serves as the record of what occurred during treatment, from the setup of the dialysis delivery system to the regular vital sign checks, medications, and treatment interventions.
Wrapping up the First Shift
11a.m. The machines begin to chime, and suddenly sleeping patients start to squirm in their chair, ready to have the tubes cleaning their blood unhooked – it’s the end of the first shift. As the patient care technicians begin taking patients off the machine one by one, I follow behind, assessing that the patient is stable for discharge. I use this short face-time to reinforce any education that was provided during treatment, provide special instructions about access care, inquire about any medication or health concerns and let them know I look forward to seeing them at their next chair time.
Repeating the Cycle and Closing the Center
I’ll repeat this routine two more times: at the start of the second shift and the third shift. But with each new shift comes dozens of new patients with vastly different care needs.
Between clinical needs, nurses also prioritize education with patients. This ranges from diet and exercise to various treatment options and dialysis access placement education. The chance to educate patients helps me, as their nurse, continue to build trust and provide the highest quality of care possible.
7 p.m. After all the patients have been treated, I’ll review the documentation for the day and close out the treatment record for each patient.
Nephrology nursing is not the fast-paced environment of the Emergency Room or ICU. At its core, being a nephrology nurse gives me time to connect and serve my highest purpose: taking great care of people who are sick.
Because my teammates, patients and I get so much time with each other, we form a little community inside each of our dialysis centers. We become like a family. We’re there for each other in good times and bad, and we take every opportunity to cheer each other on in life.
So finally, before turning off the lights, I’ll gather my teammates and thank them for another successful day of giving life.
Are you a nephrology nurse? Does your day look similar?
About the Author:
Lisa Hornborg, RN, has served DaVita Kidney Care patients and care teams in a variety of clinical leadership roles since 1996. Prior to joining DaVita, Lisa managed acute, home, and outpatient dialysis programs, as well as worked as an ICU nurse, at The Ohio State University Wexner Medical Center. Lisa received her nursing degree from Anderson University and her Bachelor of Business Administration from The Ohio State University.
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