The World Health Organization has declared 2020, the 200th anniversary of the birth of Florence Nightingale, the Year of the Nurse. Nurses are encouraged by the exposure this will bring to the profession, as it promises to highlight their many roles. Further, nephrology nurses are cautiously excited about the recent focus on kidney health and the role nephrology nurses will play in implementing the Advancing American Kidney Health (AAKH) initiative launched in 2019. This executive order places a focus on kidney health by increasing patient choice with a focus on home dialysis therapy options, kidney disease prevention, and strategies to increase the number of transplantable kidneys.
The goals of the executive order connect to an area that is among the “top to watch” in 2020 and moving forward—the lack of nephrology nurses qualified to practice as home dialysis therapy nurses. With the final rules for the ESRD Treatment Choices (ETC) Mandatory Model coming in 2020 and the resultant changes in kidney replacement therapy, growth in home therapy will be a priority for many dialysis facilities. Nephrology nurses are concerned that the kidney community and dialysis industry are currently unprepared for the increased number of patients who might choose home therapy.
There is no evidence base to support the “right size” for training. According to the Medicare Conditions for Coverage for ESRD Facilities (CMS-3818-F), a nurse is required to have 12 months of experience as a registered nurse plus 3 months of experience in the modality (i.e., hemodialysis or peritoneal dialysis), and some state ESRD regulations impose more stringent requirements. Frequently, home programs are small, with a single nurse responsible for providing patient training with little to no support from other experienced nurses.
The skills and training for patient education and care delivery for the in-center and home environments are not interchangeable. Nephrology nurses will require advanced training in home dialysis therapy. The basic level of training is not sufficient for the level of skills and competencies required of nurses who train patients and families in managing the complexities of home dialysis care. Home dialysis therapy requires that nephrology nurses and other health providers anticipate and prepare for any complications that may occur, to both smooth the course toward patient independence in home therapy and to prevent therapy failure.
We must invest in the time and resources needed to educate nephrology nurses so they have the proper skill set to train patients and their caregivers for home therapy, as well as prepare additional nurses to be competent in delivering home dialysis training and therapy management. In addition, nephrology nurse practitioners will require additional training and education to transition in-center patients to home therapies, provide adequate dialysis prescriptions, and troubleshoot complications.
There is concern that the kidney community and dialysis industry are currently unprepared for the increased number of patients who will transition to home therapy, and this may become a significant barrier to successfully achieving the home therapy goals of the executive order.
Suggested Reading
American Nephrology Nurses Association. (2019). Letter from the ANNA Board of Directors to the Centers for Medicare and Medicaid Services Regarding the Advancing American Kidney Health Initiative. Nephrology Nursing Journal 46; 5:477–481.
