This is How I Became A Nephrology Nurse (Podcast)

Nephrology Nurses Week was September 11-17th and if you know a nephrology nurse, make sure you give them a hug, high-five or a fist bump! In the spirit of celebrating our nephro nurses, we welcomed Jennifer Payton to answer some important questions and to help us delve deeper into the specialty. She is a surveyor for the National Dialysis Accreditation Commission (NDAC), and she's also been a nephrology nurse for over 24 years. Her experience includes outpatient hemodialysis, home dialysis education administration, and she's been the author for the Nephrology Nursing Journal and the Contemporary Nephrology Nursing textbook. Jennifer has been a frequent presenter at American Nephrology Nurses Association (ANNA) Chapter and National meetings on various topics, and is the President-Elect for the ANNA.

^{This content used under license from "Ask Nurse Alice."}

Nurse Alice (01:47): Why nursing and how did you find yourself becoming a nephrology nurse? 

Jennifer (02:03): My “why” is education. I always wanted to be a nurse, but I also wanted to be that nurse that was teaching other people, and throughout nephrology I’ve been able to do that. I started out in dialysis, kind of by accident. I didn't know much about dialysis and I needed a new job because I had moved to a new location. I started looking for different opportunities and I found one in dialysis. So I went for an interview, they hired me, and 24 years later I'm still in nephrology. I started out as a dialysis nurse in an outpatient hemodialysis unit. I worked there for quite a while, and then went into management. I've managed outpatient dialysis units of varying sizes. I started out with a 13 chair unit where we’d dialyze 13 patients at once. Then I moved on to a 20 station unit. 

From there I’ve been a home program coordinator, where I taught patients how to do dialysis at home. I have worked as a nurse educator and have been able to train other nurses how to do dialysis. I’ve worked in pharmaceuticals and have been a legal nurse consultant for dialysis. I've just had many opportunities throughout the years, but all of them were related to education. And my current role, I was a surveyor, but I just got a promotion and I am the director of regulatory compliance. I'm on the operation side of an accreditation organization called NDAC: the National Dialysis Accreditation Commission, and what we do is go out and accredit dialysis facilities, making sure that patients are getting safe care.

Nurse Alice (04:07): Thank you so much for that introduction. When I say “nephrology nurse,” the first thing that comes to mind is dialysis. We know that kidney disease is one of the top 10 chronic medical conditions that we're dealing with here in the United States. Though nephrology is not just dialysis, what are those different lanes you can go down as a nephrology nurse?

Nephrology Specialties

Jennifer (05:07): First there’s dialysis. There’s dialysis in an outpatient setting or teaching patients how to do dialysis at home, either hemodialysis or peritoneal dialysis. If you wanted to work in a hospital, there’s what we call acute dialysis treatments. Patients who are in the hospital either are on dialysis and need to get their dialysis, or they have an acute kidney injury and are usually a much more acute situation so you need to have more skills and be ready for that patient to have many different lines and all the things you would see in an ICU or CCU situation. 

Besides dialysis, there are nurses that work in physicians’ offices that work with patients that are in the earlier stages of kidney disease before they go into dialysis. Advanced practice nurses, especially, are working in situations that are not necessarily in dialysis. They’re taking care of those patients in all those earlier stages of kidney disease. Then there are case managers who work in many different places such as a hospital. Many times hospitals have floors that are specific for nephrology patients that care for patients with kidney disease. There are many different avenues in nephrology. 

Nurse Alice (06:45): It sounds like there are so many different roles and settings in which you can be a nephrology nurse. Now let’s say I’m a newer nurse and I want to specialize in nephrology. What would be some of those first steps I should take?

Jennifer (07:10): If you wanted to start looking at nephrology, one of the ways to do that is by looking at some of the publications. There’s a Nephrology Nursing Journal that the American Nephrology Nurses Association (ANNA) has that comes out 6 times a year. So you could start looking at that to see some of the different things that nephrology nurses do and see if that interests you. You could become a member of the ANNA and go to meetings to meet other nephrology nurses and find out if this actually is something you’d like to do as you’re dipping your toe in the water. If you wanted to actually start working on a floor where they took care of nephrology patients, you could float. But there are kidney disease patients everywhere. So starting to learn a little bit more about those patients that have kidney failure and that part of their care is a great way to dip your toe into nephrology. 

Nurse Alice (08:28): I think that especially when you’re working in acute care, kidney disease is so prevalent. If you want to learn more about nephrology, I think you could do a lot of that in your current role where you are, regardless of what environment you’re in. Whether you’re on a regular med surg unit, stroke unit, heart failure unit. The kidneys are friends with the heart, so if there’s something going on with the heart, more than likely something is going on with the kidneys, and vice versa. As someone who specializes in cardiology, I’m always thinking of the heart, but I know that kidneys aren’t too far behind what’s going on. 

For my years as a newer nurse, I overlooked the Glomerular Filtration Rate because I didn’t really understand it. I wasn’t in an advanced practice role at the time and no one really talked to me about it, but I learned that looking at the GFR, you can really identify what stage of kidney disease someone is in. Can you quickly go over how many different stages of kidney disease there are and what the GFR means for our patients? 

Kidney Wellness

Jennifer (10:06): The GFR is the Glomerular Filtration Rate and that’s a number we want to be higher, closer to 100. The lower that number is, the higher stage of kidney failure you’re getting into: chronic kidney disease. So when someone gets down to a GFR of around 15 or lower, that's when we're starting to look at patients needing to start dialysis. But the patients that are in the 60s, 50s, 40s, those are all different stages that patients can be in. We just need to make sure that we’re looking at those and especially looking at them as they get into a stage two or a stage three, because we don’t want them to go down to stage four and five and end up on dialysis. 

We want to get those reasons why they have kidney failure under control. A lot of those reasons are things like diabetes and high blood pressure. We want to make sure we’re getting that diabetes under control or that hypertension under control. And, there are certain medications that patients can be put on for their hypertension that can protect the kidneys, so we want to make sure we’re looking at all those different stages because they can really make a difference in how quick a patient moves through those stages. 

Nurse Alice (11:31): Exactly, and you raised a good point though. When we say nephrology, many of us automatically jump to dialysis, but a nephrology nurse also helps focus on kidney wellness and identifying those other factors that can worsen the kidney. They work on prevention, helping a patient manage their diabetes, high blood pressure, healthy eating, getting on certain medications and also being mindful of what medications could be nephrotoxic. 

If you see the GFR is trending downward, there’s something going on. And whether you’re a newer nurse, or maybe you don’t feel as empowered because you’re not the ordering physician, APRN or the PA, but you know there’s an issue that needs attention, you can raise that attention to the primary provider so we can help this patient preserve their kidneys. Jennifer, you also mentioned being a part of your professional nursing organization. Could you tell us a little bit more about your experience exposure with them and what benefits are there for people who are looking to join a professional organization?

Professional Associations

Jennifer (13:32): I've been a member of the American Nephrology Nurses Association (ANNA) for over 20 years. I started when I was new to nephrology nursing. I've been a chapter officer, committee member, presenter for meetings and have been published in textbooks. The biggest thing I think you get from a professional association is leadership skills. I've been able to learn so much about leading groups and teams and that has helped me in my profession and my personal life. It's helped me communicate effectively with others. 

Then there's all the networking that you can do. You get to meet nurses from all different parts of the nephrology specialty and you get to meet them from all around the country. So you may be dealing with something in South Carolina that someone in California's dealing with and they don't even realize that both of you are dealing with this same situation, and you can learn ways to help better care for our patients. That’s another big benefit, is to find other people that you can talk about clinical issues with and the day to day things that we deal with as nurses. We also get to meet other people that do the same thing that we do. Some of the best friends I’ve made in my life are through ANNA, so it’s like a big family reunion. We have a meeting coming up in a few weeks and I can't wait to see all my nurse friends that are all over the country. 

Nurse Alice (15:26): There’s a common interest in kidney care and to make friends and network with people who have similar interests is amazing because you get to hear about different practices, how people are progressing in their profession and then just bouncing off ideas of other great leaders and leadership development. 

If you’ve not already joined a professional nursing organization, definitely look into doing that because that’s one of the great things about nursing organizations, they can really help develop you and advance your career because there are different opportunities. I’ve had some of the best leadership opportunities and training in my professional nursing organization that have helped me in my professional career. Jennifer, I know you mentioned that you have a conference coming up. Is there any information you can tell us about the conference in case those who are listening may want to come? The city, the date? 

Jennifer (16:37): It’s in San Diego on October 1st and goes for 3 days. It’s what we call our Fall conference. It has a very long, large name that I can’t think of right now but it’s a great opportunity. It specializes in topics for nurse practitioners, nurses in management and clinical practice as well. We have this meeting every Fall and another meeting in the Spring.

Nurse Alice (17:07): You’ll be around a lot of beautiful people and minds, learning a lot about nephrology, CEUs available I’m pretty sure of that, and just some great networking. With the pandemic easing up, it’ll be a great way to get back out and meet some friends, network and be around others who are supportive or have similar interests in what you’re doing. There’s a comradery in nursing that’s very important. 

Jennifer, thank you so much for joining us. We appreciate you and everything you’re doing. We’re going to continue to celebrate nephrology because your roles are so important. For the rest of us, especially in the acute care area and critical care, we all have a little nephrology nurse in us. We have the opportunity to help guide the plan of care for our patients and speak up. If you see something going on with that BUN, that creatinine, the GFR, you know that some medications might be nephrotoxic and the patient's teeter tottering with that GFR, speak up. Help our patients. There's just so much you can do and you can help protect the kidneys and the heart along the way. I had to throw that in there, I’m a cardiology nurse. But that’s why Jennifer and I get along so well. She’s kidneys, I’m heart and we are in sync!