Scope of Practice for Nephrology Nursing

Excerpt from Gomez, N. (2017). Nephrology nursing scope and standards from practice. American Nephrology Nurses Association.

Definition of Nephrology Nursing

Nephrology nursing is a specialty practice addressing the protection, promotion, and optimization of health abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities and populations affected by kidney disease.

Scope of Practice for Nephrology Nursing

The scope of practice for nephrology nursing describes, for the public and the profession, the nature of this specialty’s nursing practice. The specialty’s scope is derived from the scope of nursing practice as defined by the American Nurses Association (ANA) (2015) and builds on the previous versions published by the American Nephrology Nurses Association (ANNA).

Nephrology nursing encompasses the primary, secondary, and tertiary care of individuals with potential and progressive chronic kidney disease (CKD), end-stage renal disease (ESRD), acute kidney injury (AKI), and other healthcare conditions requiring nephrologic intervention. Nephrology nursing practice spans the continuum of care for patients with kidney disease. Nephrology nurses provide care to neonatal, pediatric, adult, and older adults in all racial/ethnic groups. The nursing care can be complex, as these patient populations may have various comorbid conditions, including cardiovascular disease, diabetes, hypertension, infectious disease, and/or mineral and bone disease. In addition, many face psychosocial issues, such as depression and anxiety.

To provide clearer understanding, the term kidney replacement therapies (KRT) is now being used in the nephrology community in place of the term renal replacement therapies (RRT). These terms identify all therapies used to treat kidney disease, including dialysis, transplantation, and palliative care. Throughout this publication, the terms healthcare consumer and patient will be used interchangeably. Healthcare consumer is defined as the patient, person, client, family, group, community, or population who is the focus of attention and to whom the registered nurse is providing services as sanctioned by the state regulatory bodies (ANA, 2015b). The term family relates to the family of origin or significant others as identified by the patient.

The ANNA work group authoring this edition determined to continue the usage of interdisciplinary as reflected in the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage (CfCs) (CMS, 2008), rather than move to the more contemporary term, interprofessional. The interdisciplinary team is composed of a diverse group of healthcare professionals. The members are recognized for their expertise and individual roles. Issues may be referred for collaboration to professionals within or outside one’s own profession as warranted. Interdisciplinary collaboration within the nephrology community may impact professional practice boundaries in the effort to improve the health of the population living with CKD, reduce healthcare costs, and enhance the quality of healthcare delivery.

Overview of the Scope of Practice for Nephrology Nursing

The recognition of kidney disease, acute and chronic, as a major health problem, has led to the development of nephrology nursing as a specialty. The practice of nephrology nursing encompasses the roles of direct caregiver, educator, coordinator, consultant, administrator, and researcher. The practice extends to all care delivery settings in which patients are at risk for developing or are experiencing chronic kidney disease (CKD) stages 1 through 5, and receive health care, education, and counseling for kidney disease prevention, diagnosis, progression, and treatment.

Optimal individual physical and cognitive function and family support throughout all phases of disease management are the primary goals of nephrology nursing. The nephrology nurse achieves these primary goals by diagnosing and treating human responses exhibited by individuals and families with kidney disease or who are at risk for developing CKD. These human responses include, but are not limited to, physical symptoms, functional limitations, psychosocial disruptions, and knowledge needs.

Treatment of these responses involves health promotion and disease prevention counseling, health maintenance education, psychosocial support to build or sustain coping capacity, education to encourage active participation in decision making and self-care, restorative physical care to manage disease and treatment-related symptoms, and the delivery of kidney-replacement therapies, including transplantation.

The focus of the nephrology nurse is the patient, an entity that can include individuals, families, groups, and communities. Nephrology nurses manage care to meet the individualized needs of the patient with kidney disease to maximize independence and quality of life.

Nephrology nursing practice occurs throughout the patient’s life span, along a continuum of care and across delivery settings. Care requirements extend beyond kidney disease to address acute and/or chronic causative disease processes, as well as subsequent comorbid complications. The nature of this nursing care spans the spectrum from preventive and acute through replacement therapies and rehabilitation, as well as palliative, supportive care. Nephrology nursing may be provided in a variety of settings that include, but are not limited to, inpatient, outpatient, freestanding clinics, and home care.

All nephrology nurses are legally, ethically, and morally responsible for practicing in accordance with recognized standards of professional nursing practice and professional performance, the recognized professional code of ethics, and specialty certification.

The Model of Professional Nursing Practice Regulation (2015), illustrates the scope and standards and provides the foundation for our practice (ANA, 2015). The apex of the model of professional responsibility is achieved with the individual nephrology nurse’s assumption of personal accountability for continuing education and professional experience over and above the basic requirements.

Note: The Nephrology Nursing Scope of Practice is excerpted from the 8th Edition of the Nephrology Nursing Scope and Standards of Practice (2017). Click here for more information regarding this publication.