Dialysis nurse retention is difficult for many clinics.

If you work in dialysis, it’s hard to deny there is a dearth of nurses across the board. The strain is apparent after a quick search on any national nurse recruitment agency website. Several years ago, there might have been a few dozen notices for staffing needs. That has changed significantly.

Our experience is that dialysis staff nurses are leaving their jobs. This occurs by attrition, relocation and, unfortunately, leaving dialysis for perceived greener pastures in other specialties. In some geographic areas, their absences are felt more acutely.

It’s not that dialysis nurses don’t like their work; it is because they are often undervalued, overworked, and typically not paid as much as their counterparts in other specialties.

There’s also another issue: Burnout that occurs when treating the chronically ill. Nurses want to help people. Other specialties offer them the opportunity to heal and hope. Dialysis is a tough assignment.

When dialysis facilities become short­ staffed, it forces them to use travel nurses to assuage the deficiency. Travel nurse billing rates are higher than what staff nurses are typically paid, but ancillary costs such as transportation, lodging, and meal stipends associated with their assignments cut into that travel nurse rate. So there is not as much of a difference in the net pay rate between a staff nurse and a travel nurse as many think. Travel nurses fre­quently count on overtime pay to make money.

There is a trend for some companies to keep costs in line by limiting guaranteed minimum hours and overtime hours. As a result of limiting the opportunity for the extra pay, travel nurses turn down some assignments for those that are more lucrative.

Steps to retain dialysis nurses

Finding ways to make the nurse staffing position more rewarding requires some creative thinking. Here are a few ideas, some of which have been implemented by dialysis companies. Others are “out of the box” approaches.

  1. Dialysis clinics can use their health care staff in different ways to free up time for nurses to do direct care. In lieu of having nurses as managers, registered dietitians (who are adept at adjusting medications because of their nutritional train­ ing) or social workers can be trained to manage clinics and should be considered as a feasible option. One national provider is already doing this.
  1. Allowing patient care technicians (PCT) to perform more of the duties registered nurses do would also free up their time to do more direct care. What PCTs are allowed to do varies by state, company, and facility, and their licensing. In 2010, The Centers for Medicare & Medicaid Services announced that PCTs must be nationally certified. PCTs can be certified by BONENT (Board of Nephrology Examiners Nursing and Technology), which offers a CHT (Certified Hemodialysis Technician). The NNCC (Nephrology Nursing Certification Commission) offers a CCHT (Certified Clinical Hemodialysis Technician). In addition, there is a trend among states to issue licenses to PCTs in addition to their certification. This could permit them to take on additional duties. Currently, the only states requiring PCT licensure are California, Kentucky, Maryland, Ohio, Oregon and Washington, but look for more states to join this bandwagon.
  1. MedPAC (the Medical Payment Advisory Commission) could suggest adding a separate payment rate for registered nurses who are working in remote areas and areas with low populations where there are nursing shortages. With the implementation of dialysis facilities’ cost report data audits, it will assure payments for registered nurses are, in fact, going to registered nurses.
  1. States that have the greatest needs and the largest nurs­ing shortages should become part of the Nurse Licensure Compact which permits a nurse to have a multi-state license that allows them to practice in both a home state and other compact states. Currently, there are 24 states that recognize compact licensure. Right now, Massachusetts, New York, New Jersey, Minnesota and Oklahoma have pending NLC legislation according to the National Council of State Boards of Nursing. Montana has already enacted this law and it will be implemented this month.
  1. Most dialysis provider’s have an exclusionary period for former employees to return as travelers, ranging from six months to 12 months. Decreasing the length of this exclusionary period would help make more nurses available for work.


Without an increase in base pay rates for staff and travel nurses, and rethinking some hard and fast practices, there will be no improvement in the dialysis nursing land­scape in the foreseeable future.


  1. MedPAC Report to the Congress: Medicare Payment Policy I March 2014
  2. The US Renal Data System (www.USRDS.org)
  3. National Council of State Boards of Nursing (www.NCSBN.org)