New NP going into nephrology

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Hello, so I just got offered a position at an educational institution seeing patients for outpatient dialysis. I graduated in June 2017 and this will be my first job. The nephrologist said he would train me for 3-6months and go from there depending on my comfort level. I'm still filling out paperwork and doing background check, so I won't start for another month or two. I plan to just review all things renal in the meantime. Can anyone tell me what their day is like as a nephrology NP? Do you have any suggestions/advice/tips regarding this specialty as well as starting out as a new NP? Thank you so much.

Specializes in Nephrology, Cardiology, ER, ICU.
So did you take the nephrology job? If so do you like it? I am a new FNP grad and trying to decide between a GI job and a nephrology job.

I answered on your thread. Check out some of my posts - I'll be glad to answer any questions.

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Hi here is an update. So I took the nephrology position and I am currently 6-7 months in. So far it's been a good learning experience. Lately I have been missing the acute care/hospital setting but I plan to stick with this and take the cnn-np cert in dec when I have enough hours. Rounding at the dialysis centers is just as traumaRUs described it in the earlier post. if any of that sounds interesting, nephrology may be a good option. I do like the fact that I am not in an office all day and I get to drive to the different centers. A neat thing I got to learn was to write/order chronic dialysis prescriptions. in addition to rounding, I also see some patients in outpatient clinic, majority of them for CKD 1-5. Some other interesting ones that I am still learning about are lupus nephritis, hypo/hypernatremias, s/p kidney transplants.

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I answered on your thread. Check out some of my posts - I'll be glad to answer any questions.

Hi traumaRUs, I tried to send PM but it won't let me since I haven't created the minimum amount of topics

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Specializes in Nephrology, Cardiology, ER, ICU.
Hi traumaRUs, I tried to send PM but it won't let me since I haven't created the minimum amount of topics

I sent you a PM - you will be able to respond since I'm staff. Ask away

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Hi here is an update. So I took the nephrology position and I am currently 6-7 months in. So far it's been a good learning experience. Lately I have been missing the acute care/hospital setting but I plan to stick with this and take the cnn-np cert in dec when I have enough hours. Rounding at the dialysis centers is just as traumaRUs described it in the earlier post. if any of that sounds interesting, nephrology may be a good option. I do like the fact that I am not in an office all day and I get to drive to the different centers. A neat thing I got to learn was to write/order chronic dialysis prescriptions. in addition to rounding, I also see some patients in outpatient clinic, majority of them for CKD 1-5. Some other interesting ones that I am still learning about are lupus nephritis, hypo/hypernatremias, s/p kidney transplants.

I am interested in this field after graduating. How was the training? Did you feel prepared to see patients on your own? What are your hours like? Are the pay and benefits good for a new grad? Sorry for so many questions.

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Specializes in Nephrology, Cardiology, ER, ICU.
I am interested in this field after graduating. How was the training? Did you feel prepared to see patients on your own? What are your hours like? Are the pay and benefits good for a new grad? Sorry for so many questions.

I've been in nephrology since graduating in 2006 with a brief hiatus to heart failure (for a miserable 6 months). I had no RN exp in nephrology but did have a solid 10 years in level 1 ED, 2 years in adult ICU and 1 year in peds ICU. When I interviewed they liked the idea I could think on my feet and know sick from not sick. I rec'd 5 months of training which included time with an MD, classroom lectures and time with a very experienced NP. This was pretty much the time it took to get credentialed too.

The practice I work with is fantastic. They have 20 MDs, 6 FNPs, 2 CNSs that all do dialysis rounding. We cover a huge portion of the state so travel from unit to unit seeing chronic hemodialysis pts. The benefits are unheard of in my area. Now, with 12 years exp, I have 8 weeks of PTO, a bonus structure, flexible schedule (some days are longer then others) and the respect of the MDs I work with. This practice appreciates us and shows it with continuous reviews, excellent pay as well as great benefits.

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I accepted a position with a nephrology. I will be transitioning from oncology to nephrology. I start in 1 week. Any advice, tips, etc. Would help. I will be rounding amongst 4 outpatient dialysis centers 3 days a week and in clinic 2 days a week.

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I recently accepted a position with a nephrology group I will be transitioning from oncology to nephrology. I start in 1 week. Any advice, tips, etc. Would help. I will be rounding amongst 4 outpatient dialysis centers 3 days a week and in clinic 2 days a week.

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Congrats on the new position cheights!

I recommend reading the Handbook of Dialysis by John T. Daugirdas, MD. It’s a good resource for hemodialysis and peritoneal dialysis. Also see previous comments by traumaRus. Just like any other specialty, it will take time to learn things. At least for me it took several months to really be comfortable seeing dialysis patients on my own.

To help in understand why we manage dialysis patients the we do is to first know the kidneys do. The kidneys have 5 main functions. 1. Filters fluid, electrolytes and toxins 2) Sodium and water balance by way of RAAS 3) Erythropoietin production 4) Helps activate vitamin d by 1 alpha hydroxylase 5) Acid base balance. When the kidneys fail, these functions stop working and complications develop such as 1) uremia 2) fluid overload, difficult to control BP 3) anemia of CKD 4) renal osteodystrophy and 5) metabolic acidosis. Thus renal replacement therapies such as HD, PD or kidney transplant help replace those functions to reduce complications. There are goals for each of these areas. Review guidelines by KDOQI/KDIGO https://www.kidney.org/professionals/guidelines/guidelines_commentaries

For outpatient clinic- I recommend reviewing CKD 1-5. This will be your bread and butter. I will attach a resource that I think is helpful: CKD.pdf and Practical Approach to CKD.pdf. I also recommend reading up on other renal conditions like cardiorenal syndrome, hepatorenal syndrome, hypo/hypernatremia, hypo/hyperkalemia, renal tubular acidosis, metabolic acidosis, hypercalcemia, IGA nephropathy, polycystic kidney disease, management of kidney transplant patients, persistent proteinuria, resistant HTN. Something I do in clinic is I always write out labs- electrolytes in fish diagram. I found this helpful when reviewing labs. You will get used to looking and reporting labs as NA, K, Cl, CO2, BUN, Scr, eGFR, Glucose, Ca, Phos, Alb. You will probably be doing a lot of BP management as well. Find out which BP guidelines your organizations follows like JNC7, JNC8, ANA/ACC, etc. Review your first line BP agents, second line and so on. Think ABCs (A) ACEI/ARBs (B) Beta Blockers (these are actually 3rd line agents, however it can be used if the patient is post MI, CHF and for resistant HTN) (C) Calcium channel blockers: Non DHPs and DHPs (D) Diuretics: Thiazides, Loops , MRAs, ENaC blockers. Then you have other agents such as centrally acting adrenergic agonists like methyldopa and clonidine, direct vasodilators like hydralazine which you will see often in our dialysis patients and resistant HTN. In some cases where you have patients on 4 meds maxed out and still with very high BP, consider work up for secondary HTN. The patients that are being referred to you will not have 1 or 2 blood pressure meds. They will be coming to you with 3 or 4 already on board. Consider risk/benefit ratio and keep in mind the importance of knowing when to treat and also knowing when not to treat.

Check if your employer provides Uptodate. I use this website and phone app often to look things up. Also recommend signing up to be a member of NKF. They give you a free book on kidney diseases called NKF Primer on Kidney Diseases.

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I forgot to mention that with CKD 1-5, the #1 cause is diabetes / diabetic nephropathy at about 45%. #2 cause is HTN / hypertensive nephrosclerosis at about 25%. That makes up about 70% of the cause for chronic kidney disease. The other 30% come from other causes like cardiorenal syndrome, ADPKD, glomerulnephritis, nephrotoxin use like chronic nsaids, iodine contrast and aminoglycosides, tubulointerstitial nephritis, ATN, acute on chronic, obstruction leading to hydronephrosis. Also review normal age related changes. Kidney function/eGFR typically decreases by 1cc/min each year after age 40 and let's say we all start off at 100cc/min. That will be important to note when you see older patients, for example in patients 80 years old and over, their kidney function may fall in the 50-60cc/min range, which is identified as CKD 3, however, they may not have CKD at all.

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Hi, it was nice reading all these threads. I recently completed my FNP program and was planning to take the board exams. I have been a dialysis nurse for 6 years now and work primarily in the Acute dialysis unit. Although sometimes I pick up shift in Chronic Unit but I like to work more in Acute dialysis unit. Anyway, my questions is can I take the AGNP (Adult-gerontology NP) board exam if I want to work as a nephrology NP. I will be seeing the adult patients and I have no plans of seeing pediatric nephrology patients. Can I take the AGNP Board exam?

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Specializes in Adult Primary Care.

If your education is FNP that is the boards you need to take.

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