Nurse specialties in high demand fluctuate from time to time. Nephrology is one nursing specialty that may not get the attention it deserves, but maybe it should.

Experts in the field of kidney disease and dialysis shed light on why demand for nephrology nurses is growing.

In the U.S., it’s estimated that 37 million people have chronic kidney disease, according to the Kidney Foundation. A leading contributor of kidney disease is diabetes, which affects millions Americans.

Nursing Shortage Affects Nephrology

The national nursing shortage is felt throughout the nursing profession, and it includes specialties like nephrology, says Charlotte Thomas-Hawkins, PhD, RN, FAAN, Chairperson of the American Nephrology Nurses Association Education Task Force for the Nursing Shortage. She also serves as Associate Professor and Interim Associate Dean with Rutgers University School of Nursing, in Newark, NJ.

“It’s hard to get a handle on the exact nature of the shortage on nephrology nurses because we need to reach out to the major dialysis providers to better understand the amount of nurses they have and what their demand looks like,” said Thomas-Hawkins.

What we do know is nursing students are only slightly exposed to kidney disease, and for many of them, a career in nephrology is not on their radar, compared to ob-gyn, pediatrics, and cardiology, said Glenda Payne, MS, RN, CNN, Co-Founder and Chief Compliance Officer with the National Dialysis Accreditation Commission — and past president of ANNA.

“There is generally little to no exposure of student nurses to nephrology — maybe as little as one or two lectures on the kidney, so the graduate nurse has little knowledge of the myriad of opportunities nephrology nursing represents,” said Payne.

As for the national nursing shortage, we already know baby boomer nurses are retiring in record numbers, and Thomas-Hawkins said it’s predicted that within 10 years, the youngest baby boomer nurse will be 70 years old.

“It’s expected we will have a [continued] national shortage because of the retirement of aging nurses … a million nurses will leave the workforce in the next 10 years,” she said, adding that it’s largely unknown how to replenish such record numbers of highly skilled nurses, because baby boomers outpace nurse graduates.

“As a professor in a school of nursing, the challenge is we don’t have the capacity to graduate the number of nurses we need. We don’t have enough nursing faculty in our nursing programs.”

Strained by COVID-19

Approximately 14% to 30% of COVID-19 patients experienced loss of kidney function and a significant number required dialysis, according to data from the Kidney Foundation. In places like New York City, up to 40% of COVID-19 patients experienced kidney failure.

Because COVID-19 affects the kidneys, and a significant number of patients develop acute kidney injury, nephrology nurses have had to monitor COVID-19 patients undergoing dialysis in four-hour timeslots, in the patient’s room, Payne said.

Plus, she noted that some hospitals experienced a shortage of dialysis machines when increased numbers of COVID-19 patients developed AKI and needed dialysis. Because of increasing demands for dialysis treatments, nurses were required to shorten the treatments for patients with AKI. Typically, these patients would require several days of a slower type of dialysis treatment, but that was reduced to just 12 hours, Payne said.

Workload and stress for these nurses has gone up, because of the prolonged direct patient contact.

“There’s a huge increase in the nephrology nurse workload in acute care, as well as potential for an increase in the chronic patient numbers as some of those AKI patients will be discharged from hospitals and still need dialysis,” Payne said.

Highlight Job Satisfaction

A 2018 ANNA national work environment study by Beth T. Ulrich, EdD, RN, FACHE, FAAN, and Tamara M. Kear, PhD, RN, CNS, CNN, reported a high degree of job satisfaction among nephrology nurses.

“Most nurses surveyed (94%) indicated they are satisfied with their nursing career, and 91% said they definitely or probably would recommend pursuing a nursing career to qualified individuals. The majority would also recommend nephrology nursing,” according to the study.

Nephology nurses report a high degree of independence, something Payne said contributes to job satisfaction.

“Nephrology nurses have had the luxury of being autonomous for a long time, partly because of the technology used to treat patients,” said Payne. “And now that physicians are rarely there [during dialysis] it’s the nurses who routinely assess the patients and also interface with all other disciplines, like nutritionists, physicians, and nurse practitioners.”

Plus, as more in-home patient care positions become available, Payne said it’s yet another environment where nurses can enjoy autonomy, Payne said.

Nurses that provide in-home, long-term patient care over several years learn to understand patient needs on a deeper level, which contributes to overall job satisfaction, Payne said. And there’s a growing need for it.

“Only 12% of patients who require dialysis are on home therapy, and we have a real need for home therapies,” said Payne.

In countries outside the U.S., studies indicate that providing some form in-home care is gaining in popularity, even though the U.S. lags behind. And a metanalysis of studies specific to the U.S., suggests home hemodialysis can improve quality of life, mortality, and patient outcomes.

Besides highlighting the field’s job autonomy and overall job satisfaction, recruiters can entice nurses to the field with cutting edge opportunities such as innovative treatment projects, Payne said.

The Kidney Innovation Accelerator (or KidneyX) project is an example. “It’s a government collaboration project that recently won a $10M prize, an innovation we’re hoping will change kidney replacement therapy,” Payne said.

The KidneyX project seeks to develop innovative therapies for prevention, diagnosis, and treatment of kidney disease.