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The Pandemic and the Nephrology Nursing Shortage

It’s estimated that by 2030, there will be a deficit of 900,000 nurses. This can be attributed in part to an increasing elderly population and a lack of nursing school capacity. GettyImages-1150911797

Though this shortage existed before the COVID-19 pandemic, the pandemic certainly has shined a spotlight on the shortage and its urgent need to be addressed.

Why is there a shortage? 

Nephrology nurses are not able to be replaced by other nurses. They are highly specialized and need to know how to operate and troubleshoot dialysis machines, manage vascular accesses and be able to spot subtle clinical changes in the patient. 

This high rate of specialization means that other nurses cannot substitute for them on short notice. The pandemic pushed nephrology nurses to their limit. As a result of acute kidney injury (AKI) caused by COVID-19, the demand for nephrology nurses skyrocketed. 

In addition to their current patient load and the need for acute dialysis services as a result of COVID, nephrology nurses also have to juggle those AKI patients who require dialysis after they’re discharged.

To manage this increased demand, the kidney care industry did the following:

  • The American Nephrology Nurses Association (ANNA) created a website that allowed nurses to find and volunteer their time in areas where the need was highest
  • Patient care technicians and nephrology fellows were used to assist with the management of dialysis machines
  • Nephrologists produced dialysate in-house to compensate for national shortages.


Despite these changes, the lack of nephrology nursing expertise left a glaring hole. 

How to retain nephrology nurses

It’s no secret that nephrology nurses are in short supply and stretched thin, which can quickly lead to burnout for the nurses on your staff. 

Thirty-three percent of newly licensed nurses leave the field within two years. This high turnover rate is especially problematic for nephrology because nurses take 3 to 9 months to gain competency. 

Some ways to increase nurse retention, according to authors of an editorial in the American Journal of Kidney Diseases include:

Provide a positive work environment: This can include prioritizing work-life balance, workplace safety and minimizing things like heavy lifting, exposure to chemicals or long hours.

Delegate: The writers of the editorial emphasize that nephrology nurses should be practicing at the top of their license with a limited burden from administrative tasks. 

Look at workplace safety: Workplace safety is a key driver in nursing satisfaction. Many nurses report working upwards of 12 hours per shift. Some nephrology nurses report working 16-18 hours per shift. 

In addition to these things, focusing on continuing education opportunities is another way to retain nephrology nursing staff. 

Moving forward

To reduce burnout and improve patient care, more nurses need to be available. Recruitment is key. To start, providers should partner with nursing schools and nurse leaders to educate younger nurses about kidney replacement therapies. 

“Bundling nephrology with required clinical experiences in acute and long-term care, and designing elective nephrology rotations would expose students to careers in the field. Dialysis organizations and nephrology practices should likewise partner with nursing schools as clinical sites for students to gain nephrology exposure. Such experiences should emphasize the dynamic nature of nephrology nursing—from caring for critically ill hospitalized patients to educating patients on home-dialysis therapies,” the authors state. 

Recruiting via nurse residency programs can also be useful. Read more about the shortage of nephrology nurses and what can be done to mitigate it here.

Day in the Life of a Vascular Access Coordinator