Burnout is common among dialysis nurses, and much of this is do to the nature of the specialty. But Francyne N. Rosenstock outlines some ways managers and clinics can minimize the problem.

“It is difficult for dialysis clinics to retain their staff nurses because they are often undervalued, overworked, and typically not paid as much as their counterparts in other specialties,” Francyne N. Rosenstock, vice president of Business Development and Marketing for Renal Reserve, wrote in her article “The dilemma of dialysis nurse retention.”  She discussed the issue further in the following Q&A.

Because the American Nephrology Nurses Association held its annual symposium this month, NN&I focused on nephrology nursing in May.

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NN&I:  Do you think burnout is more common among dialysis nurses, compared to other specialties?

Francyne Rosenstock: This is not a simple yes or no answer. I think nursing, in general, has a higher burnout rate than other disciplines in health care because nurses are on the front lines of patient care. They have a connection to their patients, especially patients who they are involved with over a long period of time. Outcomes, good or bad, affect them.

NN&I:  Why do you think burnout is so common among dialysis nurses?

Rosenstock: Dialysis nurses know that when it comes to dialysis, death is always lurking. So the question is “when” not “if” because dialysis is about delaying death, not curing the disease.

In other disciplines, nurses have hope for reversing a disease unlike dialysis nurses who know they will lose their patients eventually. This has to affect a nurse. Dialysis nurses are a special breed, compassionate and dedicated to their patients, but eventually, the gloom does contribute to burning out.

NN&I: Do you think less nurses are choosing to go into dialysis? If so, why do you think that is?

Rosenstock: Yes. It is not as “glamorous” a career as other disciplines such as ER, labor and delivery or ICU. It does not pay as well as other disciplines even though dialysis nurses are highly skilled.

It’s not a “happy” discipline because dialysis nurses are providing palliative care, not aiding in curing a patient.

NN&I: What role does management style play in nurse retention?

Rosenstock: Sometimes managers get promoted because they were great nurses. Unfortunately, they may not receive proper training in their new roles as managers, so they are not adept at supervising staff. This can lead to a high staff turnover, so they rely on travel nurses to fill the gap. Sadly, some managers do not respect travel staff and these clinics have bad reputations among travelers and their staffing agencies. This creates the perfect storm when it comes to patient care.

NN&I: Do you think pay is an issue for dialysis nurses?

Rosenstock: Yes, for nurses in general and specifically, dialysis nurses since dialysis reimbursements are being strangled by CMS. This is why staff nurses change disciplines or become travel nurses

NN&I: How do you feel about the term dialysis nurse vs nephrology nurse?

Rosenstock: The term dialysis nurse is limited to a function while the moniker nephrology nurse encompasses a discipline which better reflects the high skill level these nurses have.

NN&I: In your article you talk about using other staff members in different ways to free up nurses so they can do more direct care. Do you think the time spent performing direct care is related to a nurse’s job satisfaction? What kinds of duties would you say can be done by other staff members?

Rosenstock: Yes.

Nurses got into the profession for patient care, not to complete reports. Nurses like to help people. Scheduling, time-keeping, inventory, reviews and paperwork can usually be performed by those in other disciplines or an administrative professional. Of course, state regulations may be a factor in delegating some of these responsibilities.

NN&I: What would you say are the best practices for retaining nurses in a dialysis clinic?


Rosenstock: Retention is a problem in many industries, not just dialysis clinics. Like all industries, understanding that nurses have personal lives with demands is important.

Specific to clinics and acute settings, scheduling days off every three to four days, especially after being on call or floating, is important for rest, and to catch-up with family and friends.

Creating a team atmosphere is also important. A buddy system for new employees or travelers can help with transition. Acknowledging excellence in the form of a merit raise or an extra day of PTO demonstrates appreciation. Getting together outside of work, at company expense, can also build camaraderie. Building team spirit can minimize discontent.