Nephrology Nurse Career Overview

What Is a Nephrology Nurse?

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 to do 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, and 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 an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) degree. After obtaining a 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 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 $94,480 per year, according to the U.S. Bureau of Labor Statistics (BLS). Salary can differ by location and experience, from the low-end average of $63,720 to the high-end of $132,680. Depending on your workplace, your employer may be able to offer higher or lower compensation:

• General Medical and Surgical Hospitals: $96,830
• Offices of Physicians: $83,110
• Outpatient Care Centers: $102,640
• Home Health Care Services: $87,430
• Nursing Care Facilities (Skilled Nursing Facilities): $79,280

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.

The top-paying areas for nephrology nurses include:

• San Francisco-Oakland-Hayward, CA: $174,370
• Vallejo-Fairfield, CA: $171,620
• San Jose-Sunnyvale-Santa Clara, CA: $170,780
• Napa, CA: $166,180
• Sacramento–Roseville–Arden-Arcade, CA: $154,510
• Santa Rosa, CA: $152,930
• Modesto, CA: $145,190
• Santa Cruz-Watsonville, CA: $140,880
• San Luis Obispo–Paso Robles–Arroyo Grande, CA: $140,560
• Stockton-Lodi, CA: $138,420

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 that 35.5 million Americans have chronic kidney disease (CKD) 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.

Additional Resources for Nephrology Nurses

To learn more about becoming a nephrology nurse, these websites offer additional resources:

• The American Nephrology Nurses’ Association (ANNA)
• Nephrology Nursing Journal
• American Society of Nephrology
• The American Society of Pediatric Nephrology
• The American Association of Critical Care Nurses