Dear editor,

I would like to take this opportunity to respond to the interview “Reducing Dialysis Nurse Burnout” (May 31, 2016) by Rebecca Zumoff. Despite being a factual interview that emphasizes many valid points, I believe the article overlooks a very important factor related to nephrology nurse burnout. This overlooked issue is the work burden on nephrology nurses due to challenges in recruiting novice nurses into the specialty. I am a practicing nephrology nurse in the acute dialysis setting, an assistant professor of nursing, and a research consultant for a medium-sized healthcare system in the Philadelphia suburbs. In this consultant role, I work with all novice nurses hired across the health system through their participation in a mandatory yearlong Nurse Residency program. In nephrology nursing, we are lacking programs that recruit and support novice nurses and are competing against health care systems that have developed sophisticated educational and supportive programs. Such programs include:

  1. Externship programs that bring nursing students into the health care setting between the junior and senior years of college. Externships allow future graduate nurses the opportunity to gain exposure to the health care setting, a nurse manager, an interprofessional team, and various areas of practice. The nurse externs receive pay, mentorship, and education during this coordinated externship program. The nurse managers have the opportunity to observe the work ethic, dedication, and patient care skills of the nursing student. Nurse externs often apply to the health care system and unit upon graduation from college. It is a cost-effective recruitment tool.
  1. Upon graduation, many health care systems offer Nurse Residency programs for novice nurses. This program not only provides a highly structured orientation process, but also includes classes on self-care, patient safety, clinical skills, mentorship support, patient satisfaction, and evidence-based practice project guidance (to name a few of the benefits). Residency programs span from 6-12 months. Retention rates for new hires are improved and positive patient and nurse outcomes result.
  1. After completion of the Nurse Residency program, health care systems provide financial support for continuing professional education and development. Nurses are encouraged to grow and expand their knowledge, as the benefits to the health care system will be financially reaped.

It is difficult to attract new nurses to nephrology nursing when our specialty does not provide this level of support, education, and mentorship in a formal and established manner. Certainly, there are testimonials of mentorship and support programs in nephrology practice settings, but not at the level and caliber of health care systems that depend upon these systems to safely staff units and meet the satisfaction of nurses. Satisfaction of nurses results in retention. Lack of retention results in increased hiring costs and work burden on the unit staff. There are very few areas in the healthcare system today that do not hire novice nurses. The belief that a nurse needs a couple years of medical-surgical experience before selecting a specialty is antiquated.

Letters to the editor can be sent to Digital Media Editor Rebecca Zumoff at

We are losing novice nurses to positions in critical care, maternity, pediatrics, homecare, the OR, the ED, and other specialty settings. The competition to attract nurses has never been greater, as the nursing shortage is predicated to continue to grow at the same time we find the number of patients with kidney failure increasing. I suggest that we open our minds and nephrology practice setting doors to novice nurses and provide the programs that support and foster their development, modeled after well established nurse residency and externship programs. Until we decide to develop these programs and support our newly practicing nurses, we are not going to be competitive in the hiring market with increased hiring costs and nephrology nurse work burden.


Tamara Kear PhD, RN, CNS, CNN

Assistant Professor of Nursing

Villanova University