Advanced Practice in Dialysis

Onekidneynurse · Oct 25, 2009

Hello all,

I am a registered nurse with a BSN and within the next year or so I am really looking to continue my education. I am currently working in dialysis as an acute nephrology registered nurse and so far I love it. I love working with kidney patients and I want to continue to do so even as an advanced practice nurse. Are there any dialysis/renal/nephrology positions available for advanced practice nurses? If so what are they, and what would be the best master's program to pursue for these positions? Although I currently do dialysis, in the future I would love to especially work with renal transplant patients or maybe even work in home dialysis education/preparation programs. I am so unsure as to how to begin mapping/planning for advancement in this field any advice is appreciated. P.S I hope this post makes sense I am writing it after working a 10 hour shift on about 4 hours of sleep... Sorry and thanks again. :loveya:

As a travel HD nurse I have worked with many APN in chronic HD units. I can only say that I've been impressed with them. I would say that either the FNP or Adult NP route would be the best way to go. If you want to do transplant work then I'm sure you could go that way. I would go FNP to get the whole spectrum of possible patients. You would probably have to specify that renal is the route you want to specialize in during your advanced education. I would certainly put that goal into my application papers.

Most of the large dialyzers use APN's. I would make an appointment with your current nephrologist and the head of the transplant team to see if they might be willing to mentor you. That, IMHO, would show your university that you are serious about your choice. As many programs don't have a specific nephrology track you might have to do more work to get the education you desire. Being pro-active, I believe, can only increase your chances of being accepted, and completing a program successfully to your needs and wants.

Good luck, if I weren't so old :angryfire I'd be in program right now. I don't know where you are located but I'd always admired the U of Vanderbuilt in TN.

Trauma Columnist · Oct 26, 2009

Hi and welcome!

I'm an APN in a large (14 MD and 5 mid-level) practice in central IL. Much of what we do is geared towards what CMS will reimburse us for. At the present time (as I'm sure you know), an MD must visit the chronic hemo pts once a month and then the other three times a mid-level (PA, NP, CNS) can visit and that is how we get reimbursed. In the hospital, since a physician must visit each pt (in pt nephrology pts, not necessarily dialysis pts), we are there to help with pt flow and do the initial note and the physician follows us. However, we can't bill for this type of service.

I will be very honest - I never thought I would end up here. My nursing background is strictly level one trauma center and ICU and I had only seen CVVH done and that was many years ago - lol!

However, I got this job because they liked my ER background and the fact that I dealt with emergencies and difficult patients well. I have 200 chronic hemo pts - 130 at an inner-city HDU and 70 at a more upscale unit.

As to which direction you should go, I would definitely vote FNP all the way. I'm an adult health CNS back in school for a peds CNS. Being able to see the full age spectrum is priceless.

As to being "too old" - well I'm 51 and in school! And that ain't young! lol I figure that I will be working until I'm 70 and as an APN, I will have more options.

Good luck...

Onekidneynurse · Oct 27, 2009

Hi and welcome!
I'm an APN in a large (14 MD and 5 mid-level) practice in central IL. Much of what we do is geared towards what CMS will reimburse us for. At the present time (as I'm sure you know), an MD must visit the chronic hemo pts once a month and then the other three times a mid-level (PA, NP, CNS) can visit and that is how we get reimbursed. In the hospital, since a physician must visit each pt (in pt nephrology pts, not necessarily dialysis pts), we are there to help with pt flow and do the initial note and the physician follows us. However, we can't bill for this type of service.
I will be very honest - I never thought I would end up here. My nursing background is strictly level one trauma center and ICU and I had only seen CVVH done and that was many years ago - lol!
However, I got this job because they liked my ER background and the fact that I dealt with emergencies and difficult patients well. I have 200 chronic hemo pts - 130 at an inner-city HDU and 70 at a more upscale unit.
As to which direction you should go, I would definitely vote FNP all the way. I'm an adult health CNS back in school for a peds CNS. Being able to see the full age spectrum is priceless.
As to being "too old" - well I'm 51 and in school! And that ain't young! lol I figure that I will be working until I'm 70 and as an APN, I will have more options.
Good luck...

58 and love HD at the bedside.

Trauma Columnist · Oct 27, 2009

Lol Onekidneynurse!

jb2u, ASN, RN · Oct 30, 2009

nursetelly,

In my hospital we have an FNP that works for a nephrologist. Most of the nephrologists have a mid-level working with them; however, most are PAs. They make rounds on the patients, write orders/notes, and we call them for hd bath changes when we get the lab results back.

It would seem that FNP would be the way to go. What I would do is find nephrologists in YOUR area, see if they have websites and look to see if they have mid-levels listed. If they do, then what letters follow? You may see a pattern suggesting that there is a preference in your area for a certain credential, be it FNP, ACNP, or even PA. I am not saying you would need to follow this pattern, but it would help you make an informed decision. Also, since you are an HD nurse, talk to the nephrologists that come around. I would tell them my plans and ask them what credentials they would like to see in a NP.

I wish you all the best.

Regards,

Jay

Trauma Columnist · Oct 30, 2009

You are correct Jay - in our practice, we have NPs who are FNPs, we have PAs and we have me: CNS - lol.