Nephrology nurses care for patients whose kidneys aren’t functioning at total capacity. They also care for people with acute kidney injuries or those at high risk of developing kidney problems. Nephrology nurses can treat any age from newborns to older adults, and can work in a variety of settings.
The majority of nephrology nurses working in dialysis centers perform dialysis: a procedure nephrology patients have done three times a week to filter their blood through a machine. However, nephrology nurses may also work in other areas, like a hospital unit, treating patients with kidney disease or pre- and post-transplant.
Where Do Nephrology Nurses Work?
Almost every health setting treats nephrology patients in some capacity, so nephrology nurses have a lot of choices when it comes to employment settings:
Assisted living facilities
Clinics
Dialysis centers
Home care
Hospitals
Long-term care
Nursing homes
Offices of physicians
Skilled nursing facilities
Urgent care
Peritoneal dialysis (dialysis through the abdominal cavity) can be done from home, and some nephrology nurses spend a lot of their time starting and completing in-home dialysis sessions.
Many hospitals have a dialysis unit where inpatients come on their scheduled dialysis days. Over the several hours it takes to complete dialysis, a patient’s nephrology nurse must monitor the patient’s vital signs, intravenous access, and electrolyte counts, as well as address a patient’s daily needs like toileting and meals.
In private offices, nephrology nurses will monitor high-risk patients: those who will likely develop kidney disease soon but do not yet need any medical intervention. In this role, nurses can educate patients on preventative measures and kidney health, with the goal of preventing further damage and prolonging kidney life. Whichever role a nephrology nurse chooses, they need to be able to pay attention to detail.
Some common kidney problems include:
Acute renal failure
Chronic kidney disease (CKD)
End-stage renal disease (ESRD)
Kidney cancer
Kidney stones
Polycystic kidney disease
Pyelonephritis
Renal cysts
Kidney function isn’t obvious by visual assessment, so nephrology nurses must work with their health team to monitor labs, urine, and patient symptoms to stay on top of patient status.
What Does a Nephrology Nurse Do?
One major role of a nephrology nurse may be in dialysis. While this is not the only nephrology nurse position, many choose this specialty within a specialty. During dialysis, a nephrology nurse connects sterile tubing to a fistula (a large two-channel IV) in a patient’s arm or chest. Over the course of three to five hours, the patient’s entire blood volume is filtered through a machine, which does what a kidney would normally do.
Nephrology nurses in dialysis and in other roles must be able to complete these tasks:
Central line management (like ports and PICCs)
Collaboration with physicians, nurse practitioners, patients, and families
Coordination of care with other departments
Emergency resuscitation
Head-to-toe assessment
Insertion and maintenance of foley catheters
IV insertion and management
Laboratory sample collection of blood and other bodily fluids
Medication adherence monitoring
Medication administration
Patient and family education
Patient hygiene
Patient transportation
Vital signs monitoring
Kidney function is closely linked with blood pressure, and together they can affect almost every system in the body. Maintaining kidney function is a vital responsibility of nephrology nurses, and they will need to collaborate with other members of the health team to identify and treat problems early.
How Do I Become a Nephrology Nurse?
A nephrology nurse candidate must first graduate from an accredited nursing program with a Bachelor of Science in Nursing (BSN). After obtaining this degree, nurses can work in health settings as graduate nurses (GNs). It’s not uncommon for health facilities to hire nurses as GNs and train them until they pass the NCLEX-RN, their state licensing exam. After they pass the NCLEX, GNs become registered nurses (RNs), and after their orientation period, can practice nursing independently.
After some experience, nephrology nurses can apply to earn specialty certification, or they can further their education with an advanced practice degree to become a nurse practitioner (NP). Nephrology nurses can become nurse practitioners by earning a Master of Science in Nursing (MSN). It’s possible to graduate with an MSN in two years, but it may take longer to complete this degree while working full-time.
Nephrology nurses and NPs can test for a Certified Nephrology Nurse (CNN) designation, offered through the Nephrology Nursing Certification Commission (NNCC). To be eligible for this certification, nurses must:
Hold a current RN license
Complete a minimum of 3,000 hours of experience in multiple areas of nephrology nursing within the three years prior to application
Have a BSN or MSN degree
Have completed thirty contact hours of approved continuing education credit in nephrology nursing within the last three years
For nurses who work in an outpatient hemodialysis facility, at least 750 hours of their 3,000 hours of experience must be in at least one of these settings:
Apheresis
CKD management NOT on kidney replacement therapy
Home hemodialysis
Home peritoneal dialysis
Inpatient acute kidney injury on kidney replacement therapy
Inpatient critical care on kidney replacement therapy
Kidney transplant
How Much Does a Nephrology Nurse Make Per Year?
Nephrology nurses’ annual salary is comparable to that of registered nurses. RNs make an average of $81,220 per year as of 2022, according to the U.S. Bureau of Labor Statistics (BLS). Salary can differ by location and experience, from the low-end average of $61,250 to the high-end of $129,400. Depending on your workplace, your employer may be able to offer higher or lower compensation:
General Medical and Surgical Hospitals: $90,600
Offices of Physicians: $79,810
Outpatient Care Centers: $97,200
Home Health Care Services: $82,920
Nursing Care Facilities (Skilled Nursing Facilities): $77,190
Salaries also vary depending on which state a nephrology nurse practices. The west coast generally pays nurses the best, but they also have a higher cost of living.
The west coast, New England states, and Alaska pay their nurses the best, but the cost of living in these areas can also be high. The lowest paying states are in the Midwest and some southeastern states.
Nephrology nurse practitioner salaries are higher than RNs’, with average annual earnings of $121,610, according to BLS data from 2022. The low-end average was $87,340, and the high-end was $165,240. Salary can also change based on employment type:
General Medical and Surgical Hospitals: $129,330
Offices of Physicians: $121,880
Offices of Other Health Practitioners:$112,660
Outpatient Care Centers: $134,030
Home Health Care Services: $148,960
The location of employment can affect nephrology nurse practitioners as well, with differences similar to RNs.
The top paying areas for nephrology nurses and nurse practitioners include:
San Jose-Sunnyvale-Santa Clara, CA
San Francisco-Oakland-Hayward, CA
Napa, CA
Vallejo-Fairfield, CA
New York-Newark-Jersey City, NY-NJ
Yuba City, CA
Sacramento-Roseville-Arden-Arcade, CA
Nephrology nurses with a specialty certification can earn more than nurses who are not certified. The more experience a nephrology nurse has, the more they can earn.
Are Nephrology Nurses in High Demand?
The Centers for Disease Control estimate 35.5 million Americans have chronic kidney disease, and that nine out of every 10 of those don’t know they have it. As CKD progresses, it becomes harder and harder to treat, and those with severe symptoms may need hospitalization, dialysis, and care from a nephrology nurse.
Nurses are in short supply all over the United States. The U.S. Department of Health and Human Services reports 24% of U.S. hospitals have reported critical staffing shortages. As a large volume of the U.S. population ages, nephrology nurse demand may continue to rise.
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