Nephrology Nursing

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Nephrology refers to the branch of internal medicine concerned with the study and treatment of the full spectrum of diseases that can afflict the kidneys. Certified nephrology nurses are skilled medical professionals who apply their specialized knowledge of kidney disease and related systems to the care of kidney disease patients and at-risk patients in a variety of medical settings. Working to both prevent disease and provide continuing support to patients and their families, nephrology nurses provide care through all points of kidney disease progression.

The incidence of chronic kidney disease (CKD) in the United States has doubled in each of the last two decades, according to data published by the American Nephrology Nurses’ Association (ANNA). ANNA also reports that approximately 27 million adults in the U.S. suffer from CKD and that millions more are at risk. Due to the endemic nature of kidney disease in modern America, nurses who specialize in nephrology have a number of opportunities to pursue administrative as well leadership positions in community advocacy, as well as direct patient care.

Education and Experience Pathways to Nephrology Nursing

Nurses seeking to administer nephrology care as clinical nurse specialists or nurse practitioners will hold an existing MSN or DNP and pursue nephrology as a subspecialty under their primary patient population focus. Advanced practice registered nurses seeking experience in nephrology can continue to deepen their knowledge of this disease focus by attending conferences, symposiums, and pursuing continuing education.

Nephrology nursing grants the opportunity to provide care to diverse patient populations in many kinds of inpatient and outpatient settings. According to ANNA, advanced practice nephrology nurses provide optimum care when they are trained or gain experience in a sub-specialty relating to nephrology, with a focus on a particular patient population.

A nephrology nurse’s specialization also relates to the mode of therapy or intervention, including:

  • Hemodialysis – traditional extracorporeal removal of waste products from the bloodstream.
  • Peritoneal dialysis – the passing of waste products through the abdominal cavity membrane through a permanent peritoneum tube.
  • Transplantation
  • Continuous renal replacement therapy
  • Conservative Management

National Nurse Nephrology Certification

The Nephrology Nursing Certification Commission (NNCC) is the established certifying body in the United States that creates national criteria and administers certification examinations, in conjunction with the American Board of Nursing Specialties (ABNS) and the Accreditation Board for Nursing Specialty Nursing Certification (ABSNC).

The NNNC has established the following criteria for certification within the three major specializations within advanced practice nursing in nephrology:

CNN- Certified Nephrology Nurse

  1. The applicant must be an unrestricted, licensed and registered nurse in the U.S. or U.S. territories.
  2. The applicant must have at least two years of nephrology nursing experience in a clinical staff, administrative, teaching, or research capacity, within three years of submitting the application (50% of nursing experience should be in nephrology).
  3. The applicant must possess at least a BA in Nursing.
  4. The applicant must complete thirty hours of approved continuing education credit in nephrology nursing.

CDN- Certified Dialysis Nurse

  1. The applicant must be an unrestricted, licensed and registered nurse in the U.S. or U.S. territories.
  2. The applicant must complete, at minimum, 2000 hours of nephrology nursing care for dialysis patients within the two years prior to submitting the application.
  3. The applicant must complete at least fifteen hours of approved continuing education credit in nephrology nursing.

CNN-NP- Certified Nephrology Nurse – Nurse Practitioner

  1. The applicant must be an unrestricted, licensed and registered nurse in the U.S. or U.S. territories.
  2. The applicant must complete, at minimum, 2000 hours of nephrology nursing care within the two years prior to submitting the application.
  3. The applicant must complete at least fifteen hours of approved continuing education credit in nephrology nursing.

Approved Nephrology Continuing Education Entities Include:

  • Entities approved by the American Nurses’ Credentialing Center – Commission on Accreditation (ANCC – COA), for example, The American Nephrology Nurses’ Association (ANNA).
  • The American Association of Critical-Care Nurses (AACN).
  • The Council of Continuing Education
  • California, Florida, Iowa, Kansas, or Ohio State Boards of Nursing

Nephrology Nurse Career Opportunities

Certified Nephrology Nurses enjoy a broad range of career opportunities according to the ANNA, including:

  • Advanced Practice Registered Nursing – These include clinical nurse specialists (CNS) and nurse practitioners (NP). Advanced practice registered nurses oversee patient care for kidney disease in a variety of inpatient and outpatient settings. Roles include working as clinicians, educators, researchers and consultants.
  • Case Management – As the health care system becomes more complex, nephrology patients require the advocacy and expertise of certified nephrology nurse case managers to monitor the quality, effectiveness, and cost of patient care.
  • Corporate/Government Settings – Manufacturing and distributing dialysis equipment and attendant pharmaceuticals are big business and corporations require the expertise of nephrology nurses to assist in designing, marketing, and distributing products. Nephrology nurses will also find many opportunities to serve in government-run dialysis programs at state and federal levels.
  • Pediatric Nephrology – Pediatric care of kidney disorders is a rapidly growing and immensely rewarding subspecialty of nephrology care.

Nephrology Nursing Professional Organizations

Professional organizations serving the nephrology nursing community are focused on establishing standards within the specialty and advocating for nephrology nurse issues in the larger political sphere. The epidemic of kidney disease impacts many vulnerable patient communities and age groups, and nephrology associations are particularly effective in vocalizing patient, community, and over-arching healthcare system issues. The most prominent of these professional organizations include:

Nephrology Nurse Salaries

Nephrology nurses practice at all levels of the nursing profession, from generalists dispensing patient care to advanced practice nursing leaders and educators. Nephrology nurses who pursue advanced practice certification as either a nurse practitioner or a clinical nurse specialist can expect to dramatically increase their earning potential.

According to the 2011 American Academy of Nurse Practitioners National NP Compensation Survey, Certified nephrology nurses working as nurse practitioners earn the following average salaries based on setting:

  • Adult Care $98,160
  • Gerontology  $97,990
  • Neonatal $124,540
  • Pediatrics $92,250

According to a survey conducted by the U.S. Department of Health and Human Services, nephrology nurses who practice as clinical nurse specialists (CSNs) earned an average of $83,787, inclusive of all other CSN subspecialties. What’s more, this survey also notes that CNSs were very satisfied with their principal positions, with over 91% being moderately or extremely satisfied.

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