Nephrology RNs Make a Difference
Beth Ulrich, EdD, RN, CHE, FAAN, Editor

Does it make a difference if a nephrology patient is cared for by a Registered Nurse (RN)?  Do we need to have RNs in dialysis units? In transplant units? In CKD clinics?  If you answer “yes” or “of course,” then the next question is “How do you know?”

Not Everyone Agrees
What may seem to RNs as an obvious answer apparently isn’t so obvious to everyone. When the most recent CMS ESRD Conditions of Coverage revisions were proposed, a number of individuals and organizations worked to have the provision removed that would require that an RN must be present at all times when patients are being treated in dialysis units. Sounds impossible, right? How can you dialyze patients safely with no RN in the unit? Apparently, some of our nephrology colleagues think that wouldn’t be a problem.
 
This is just one of the most recent in a long line of events that demonstrate that many people – including physicians, administrators/executives, other healthcare providers, and even some RNs themselves – do not understand what RNs do or the knowledge they possess nor the relationship between what RNs know and do and patient outcomes.

Relationships Between RNs and Patient Outcomes
Over the last decade,  Linda Aiken,  PhD, FAAN,  FRCN, RN, and colleagues at the University of  Pennsylvania have studied the relationships between RNs and patient outcomes in specific cohorts of  hospitalized patients. Their research has repeatedly shown that the presence of  RNs, the amount of RN time available, and the education levels of RNs are all  associated with patient mortality and morbidity. Other researchers have validated these  results and, in 2004, the Institute of  Medicine weighed in on the subject,  noting that nursing is “inseparably linked to patient safety.”
    
Establishing the Evidence Base
With this inpatient research as a base, the next step was to determine if the same relationships exist in nephrology and specifically in dialysis units. Not only is the patient population different, the setting is different as well. Dialysis most frequently occurs in outpatient units, sometimes located far away from an acute care facility – a distance that, on most days, isn’t a problem; but, on some days, a distance that could mean the difference between life and death – especially if there was no RN or not enough RNs in the unit.

The ANNA Board of Directors, recognizing what most RNs know intuitively and experientially – that RNs do make a difference — but understanding that this is not a universally accepted premise, funded a research project to investigate the relationships between RNs and adverse patient events in hemodialysis units. ANNA member Charlotte Thomas-Hawkins, PhD, RN, was named the lead investigator.  Dr. Thomas-Hawkins and colleagues recently completed the research and we are pleased to present the first article reporting results of the research in this issue of Nephrology Nursing Journal.  This research establishes an evidence-based foundation for the relationship between nephrology RNs and patient outcomes in hemodialysis units.
 
Nephrology RNs Do Make a Difference
There is a big difference between believing that nephrology RNs make a difference in patient outcomes and in having the evidence to back up our beliefs. Belief is “I think;” evidence is “I know.” But evidence is only persuasive and can only result in change if others know about it.  Every nephrology RN has a responsibility to educate others on the value RNs bring to nephrology patients and organizations and to demonstrate that value in practice. This latest ANNA research offers nephrology RNs and other stakeholders (especially nephrology patients) the evidence to expect and, indeed, to demand access to the care of nephrology RNs for all nephrology patients. ꆱ

Beth Ulrich, EdD, RN, FACHE, FAAN
Editor
E-mail: BethUlrich@aol.com