To understand what a dialysis nurse does, it is important to understand why the role of a dialysis technician and nurse is so important.
Over the past few years, nursing, which was always held in high regard, has become highly specialized. Among all the different types of nurses, the dialysis nurse has emerged as an unsung and often invisible, but vital, position. There are at least four reasons this is the case.
All of that adds up to the dialysis nurse providing a vital health service that directly affects the quality of life of the patient, regardless of the status of their disease. For example, imagine two patients: One with acute kidney disease and one with chronic kidney disease.
Patient #1: For this patient, dialysis is an immediate lifesaver because not receiving the treatment will lead to more severe illness and eventually, death. This patient’s treatment accomplishes more than improving their quality of life. For many with acute kidney disease, dialysis might be the reason they are alive at all.
Patient #2: For the patient with chronic kidney disease, dialysis lets them enjoy a quality of life that is as close to normal as is possible, given their health. Dialysis treatment might mean the patient gets a few more years to live, can eat a more normal diet, travel, work or wait for another treatment or cure for their health issue to be discovered.
So, what are the qualities of a great dialysis nurse?
A great dialysis technician will have the same qualities as a great general nurse or a nurse in another specialty, but will also have a few extra skills and characteristics:
Kidney disease education and knowledge: A hemodialysis nurse must know the type of disease or kidney issue a patient is dealing with. This knowledge will be gained by experience and training as well as coordinating with other medical professionals.
Technologically astute: The machinery and equipment in a dialysis operation are sophisticated and often technologically complex and require a highly skilled dialysis technician. Someone who is afraid of their smartphone may want to reconsider if they want to become a dialysis nurse.
Extremely detail oriented: Administering dialysis requires strict adherence to the process. This includes prepping the patient, maintaining the machines, documenting actions taken or problems, monitoring the patient, and troubleshooting the machines. Not paying attention can lead to a patient becoming ill and even dying.
A good teacher: A dialysis nurse has to educate the patients. They have to educate junior employees. They teach staff and patients about the patient’s disease, how to care for the patient after dialysis, how to administer and troubleshoot the dialysis machines, and what warning signs to look out for when the dialysis machine is in use.
A superb multi-tasker: As mentioned above, a dialysis nurse serves the same role as a general nurse, but also is an expert at dialysis delivery. They also will have multiple patients they treat, sometimes more than one at once. Managing patients, equipment needs, paperwork, etc., requires an expert juggler.
Each of these characteristics and attributes factors into what a dialysis nurse does on a daily basis.
A typical day: There was a time when a nurse was a singular profession: The nurse helped patients recover or recuperate from injury or illness. Performing either included feeding them, changing bandages, cleaning them, and administering medication. Nurses also aided doctors and executed physician orders.
As medical advances were made, the art of nursing became more sophisticated and specialized. Nurses focused on specific types of healthcare delivery, including but not limited to emergency, care, surgical support, acute care, pediatrics, neo-natal, and dialysis.
A dialysis nurse helps patients through various types of dialysis procedures. They are also sometimes referred to as a “nephrology nurse” or a “renal nurse.” The patients they work with have some form of kidney disease or recently had a kidney transplant.
On a daily basis, a dialysis nurse’s duties will include, but are not limited to:
Why is dialysis so vital? Kidneys filter waste and excess fluid from the body. When they are not working properly, there are a number of symptoms and side effects that can severely harm a patient and if untreated, will eventually lead to death.
When a person’s kidneys are not functioning properly, they need renal dialysis, which cleans the blood via a machine. This allows the body to function without becoming toxic even if the kidneys are not fully functioning or not functioning properly.
Kidney disease does not discriminate and can affect any person at any age. It can also be adversely affected by a number of issues, including, but not limited to infectious disease, injury, hereditary disease, drug and alcohol damage, and even just old age. Because of this, a dialysis nurse needs to be able to work with children, teens, adults, and the elderly and must have a broad scope of knowledge of both the types of issues that can affect a kidney and the various treatments up to and beyond dialysis.
Within renal dialysis, there are 3 types: chronic, acute, and peritoneal
Chronic dialysis: These types of patients have ongoing kidney health issues and require dialysis often as their kidneys are not capable of adequately filtering out toxins. They typically need hemodialysis treatment 2 to 3 times a week. These are often scheduled at the same time each week and patients incorporate that schedule into their normal routine.
Because chronic dialysis is so regimented, patients usually get their dialysis done during normal work hours during a Monday through Friday workweek. This means there generally are very few weekend requirements for a chronic dialysis nurse. Nurses also usually care for the same patients, which allows them to build a relationship with the patient and their families.
A disadvantage of a dialysis nursing schedule is that everyone who is scheduled for dialysis during a particular day must receive their dialysis. If there are delays to the schedule, the nurse usually is required to see the schedule through. Often, a renal dialysis nurse can have multiple renal dialysis patients receiving treatment at the same time.
The regular, workweek schedule also means the dialysis registered nurse will be expected to provide nursing administration support throughout the day. This can include contributing to healthcare plans, reviewing patient medications, adding to and reviewing RN notes, and checking vital data for each patient.
Acute dialysis: An acute kidney patient has an urgent and immediate need for renal care. Often, their treatment is part of emergency treatment. The urgent nature of the required dialysis often means that a nurse only has 1 or 2 patients at any given time.
Often, the acute dialysis nurse is the only nurse in their medical unit. They often will only deal with 2 patients throughout a shift, so can focus on those patients exclusively.
The flip side to being the only renal nurse in the unit is that the larger degree of autonomy also means very little support for troubleshooting or handling complex cases. Additionally, acute dialysis nurses are expected to be on-call, which can mean having to work extra hours after a normal 12-hour shift.
Peritoneal dialysis: This is longer-term dialysis treatment, often lasting overnight. Peritoneal dialysis nurses are expected to set up by afternoon or evening and to have completed the dialysis and removed the equipment by the following morning.
Peritoneal dialysis machines are easier to operate and troubleshoot. Patients receiving peritoneal dialysis are usually stabilized, which means emergencies are rare.
The downside is having to remove the dialysis bags and empty them. A peritoneal dialysis bag weighs about 15 pounds each, which has to be emptied in the proper disposal receptacle or toilet.
During a typical day, a dialysis registered nurse will check-up with the patient receiving dialysis and assess their state of mind and health. They will maintain and troubleshoot dialysis machines. When needed and with new patients, they will educate the patient regarding what is happening and what the patient should expect.
They will attach the machines to the patients and ensure the patient is as comfortable as possible while the dialysis is happening. This includes preparing and placing vascular access and/or a catheter.
During dialysis, a dialysis nurse will monitor the patient. They will check their vital signs and evaluate their condition regularly. A dialysis nurse will document the state of the patient as well as any changes.
When the dialysis is over, they will remove the machine from the patient. They will also monitor the patient and make sure they are able to function normally.
A dialysis nurse will usually administer dialysis treatment in a hospital setting, but not always. The following are a few settings that are extraneous to the hospital setting:
Home care: With home care dialysis, a nurse travels to the patient’s home and delivers the dialysis treatment. The dialysis machine typically remains at a patient’s home and the home health nurse must know how to operate, maintain and troubleshoot the machine and associated equipment on their own. They must also know how to handle equipment failures, including swapping out machinery if it is necessary.
A home care dialysis nurse also serves as a care coordinator. They function as part of a medical team and not only deliver their part of the health plan, but also make sure the general health of the patient is as expected. If they notice a deviation from the expected state of the patient, they have to address the health issue, including overseeing emergency responses.
The benefit of home care dialysis is that it affords the patient more independence. Generally, this means the patient’s condition is not acute or prone to need an emergency response.
Home care is also convenient for patients that cannot travel or drive or live in more rural areas. Home care dialysis nurses will usually have a roster of patients and will visit them throughout the week according to their dialysis schedule.
A downside to home care dialysis treatment is that the dialysis registered nurse is on their own if machinery or equipment breaks or if the patient experiences health issues.
Clinic: Some patients receive their dialysis in a clinic. When this is the case, the dialysis nurse may or may not also have patients in a nearby hospital. Clinics often function as “satellites” for a larger healthcare center, such as a hospital, and exist for the convenience of the patients.
While not as fully equipped as a hospital, most clinics can address all but the most acute emergencies or equipment issues. There usually will be one or two staff members or other nurses on hand whenever dialysis is being administered, which can help in organizing and managing patients, responding to patient health issues or emergencies and monitoring patients.
The downside to a clinic treatment environment is that it is not as equipped as a hospital to handle hybrid issues or emergencies.
Hospital: A hospital dialysis treatment environment is exactly what it sounds like. A dialysis nurse will have a full staff to address emergencies or troubleshoot equipment and will have access to additional equipment and machinery if the dialysis equipment or machinery has a malfunction.
The downside to working in a hospital include, but are not limited to:
From a work perspective, though, in addition to the dialysis technician salary, a major selling point for many is a huge and growing need. The same holds true for dialysis nurses. Virtually wherever a dialysis nurse lives there is a demand for their set of skills, which opens both permanent and travel nurse opportunities.
There are several reasons for this:
Salaries for dialysis nurses, including those working in dialysis travel nursing, vary, depending on the location of the job. A dialysis nurse that works in rural Wyoming will not make as much as a dialysis nurse that works in downtown New York City. Some states also have higher rates of pay for dialysis nurses than other states based on the average registered nurse salary.
For example, nurses in California (Entry: $64,400.00, Median: $100,000.00,) earn a lot more than nurses in Pennsylvania (Entry: 47,000.00, Median: $66,000.00.) Nurses in Pennsylvania, make more than nurses in Maine (Entry: 46,000.00, Median: $62,800.00,) and so on.
A dialysis nurse’s salary is also affected within each state. In New York State, for example, a dialysis nurse will make more working in New York City, less working in Albany, and less than that working in rural New York.
Because a dialysis nurse has opted for a specialty, there is a base and then additional pay based on that specialty.
It is also important to remember that while some places may have a larger starting or median salary, those places also likely have an extremely high cost of living. When considering where to work, factoring in the cost of living can make a huge difference.
A dialysis nurse in New York City, for example, might have a larger average salary than someone working in rural Indiana. That New York City dialysis nurse, though, might also barely be able to afford rent and food or have to live over an hour away from work because of the cost of living in the New York metropolitan area. The nurse in Indiana might not make as much but may have more “bang for the buck” because of the cost of living impact.
The near-universal demand for dialysis nurses makes the “best places” topic subjective to the personal goals of the dialysis nurse.
For example, if they want to work in a dialysis clinic in a big city, there are ample jobs in New York City, Los Angeles, San Francisco, Chicago, Dallas, Orlando, etc. There is no metropolitan area that does not have a need for nurses in general and dialysis nurses in specific.
Likewise, if a dialysis nurse wants to work in a rural setting, other factors such as quality of life, where to raise a family, or expenses will likely play a larger role than picking a specific locale. Anywhere one goes, virtually, there is a need in rural areas for nurses.
The same holds true for the vast area between rural and urban. One can find dialysis hemodialysis technician jobs in the greater Philadelphia area, suburban southern Florida, New England, etc. No matter where one looks, there is a demand for nursing and dialysis nurses.
Another factor is the type of patients a dialysis nurse wants to administer dialysis to as part of their regular slate of clients. Someone who wants to work with geriatric patients, while the need is everywhere, should probably look in places known to have a lot of elderly patients, like Florida, Pennsylvania, New Hampshire, etc.
If a younger type of patient is desired, focusing on states with a younger average age is a good place to start. One will find, though that while there may be one type of patient in certain places, almost everywhere has a very diverse set of patients that qualify as “typical.”
Additionally, the range of salaries across the nation makes the discussion of great places to work as a dialysis nurse highly subjective. As mentioned above, any dialysis tech nurse will have to choose between higher salaries and higher cost of living versus a lower salary, but a more affordable cost of living.
The point is that because dialysis nurse jobs are in such demand, there are no specific areas that are bad to work as long as the location meets the personal goals of the dialysis nurse.
An undergraduate degree
Dialysis nurse education requirements start with a nursing degree (Licensed Practical Nurse (LPN) or Registered Nurse. The requirements for both are below:
LPN: A diploma from a certified LPN educational program at a community college or vocational school. This takes approximately one year of study and serves as the basis for many different nursing specialties.
Registered nurse: For Registered Nurse associates degrees, two years of study is required as well as a hospital-based diploma. For a Bachelor’s Degree as an RN, four years is required.
With either type of degree (or with a hospital-based diploma program,) at least one internship is required. Those wanting to be a dialysis nurse can usually find a clinical rotation with a dialysis department. Internship requirements are set by the institution granting the degree.
Official license and certification
Every state has different licensing processes for RNs, but the basic nursing license is the same throughout the country. One standard requirement is passing the NCLEX exam. In addition, many states have their own requirements.
For LPNs, state law drives requirements. Some states do not require LPNs to be licensed to start work. This is because, in those states, LPNs are limited in what medical tasks they can perform. For example, an LPN in a dialysis unit does not need a license if they function as a “technician.”
For RNs, certification through the Nephrology Nursing Certification Commission is an option. This certification comes in multiple forms:
In addition, LPNs may also take a dialysis technician training program and become certified as Clinical Hemodialysis Technicians with the same organization. A technician will do the prep work before dialysis, after-dialysis work and help the dialysis nurse administer the dialysis. They will also help with any paperwork associated with nephrology nursing and documentation needed in the patient notes.
Advanced practice dialysis nurse
This is an option after a nurse becomes a dialysis nurse. A nurse wishing for this designation will complete a nephrology nurse practitioner program or a nephrology clinical nurse specialist program. Both programs are graduate-level degrees and take up to three years to complete. The result of successful completion of these programs is a Master’s degree or a Doctor of Nursing Practice Degree.
In addition to any degree requirements, nurses pursuing the dialysis specialty will also have to complete practical training. This is very similar to internship position requirements for 2 and 4-year degrees. During this practical training, nurses will learn how to operate dialysis machines, how to troubleshoot them, patient techniques, and how to administer dialysis to patients.
APRNs will already be familiar with the practical administering of dialysis so their specialized training will be role-specific. This can be in direct patient care, education, consulting, or research.
Once a dialysis nurse has functioned in that capacity for a while, they might want to pursue other opportunities within the field. This can include a dialysis nurse manager career or becoming a nurse educator, case manager, or head nurse. APRNs often follow up their advanced degrees with executive, academic, or research positions.
Any person interested in either an LPN or RN position should look for programs affiliated with a hospital. This association generally leads to direct placement for internships and inside knowledge for available jobs. It also can lead to better prospects for placement if the degree holder ends up working in a state different than where they got their degree.