How to Become a Dialysis Nurse

In this guide, we’ll explain what a dialysis nurse does, how to become one, how much they make, and more!

Dialysis nurses are part of the larger specialty known as nephrology nursing. A dialysis nurse provides care to patients with acute and chronic kidney failure. Dialysis or hemodialysis will be required for these patients in order to eliminate waste from their bodies. 

Dialysis nurses are responsible for monitoring patients throughout their dialysis treatment and reporting any changes to the medical team. Despite primarily working with dialysis patients, they specialize in patients with all kidney-related medical problems. 

Dialysis nurse duties include:

• Educating patients, families, and caregivers about their disease and treatment plan
• Overseeing the dialysis treatment from start to finish, including priming the dialyzer and bloodlines
• Recording patients’ medical information and vital signs
• Managing multiple dialysis patients throughout treatment
• Identifying irregular dialysis reactions and notifying appropriate medical team members
• Providing pre-and post-procedure care to patients within the Hemodialysis Unit
• Preparing and updating nursing care plans
• Helping patients follow up with their transplant centers
• Developing a training plan for each patient
• Evaluating the patient's ability to perform their dialysis treatment
• Letting the medical team know about any changes to the patients’ conditions
• Collecting bloodwork and other laboratory tests as ordered
• Following up with patients after dialysis
• Scheduling dialysis treatments
• Working with the Dialysis Technicians to ensure that dialysis machines and equipment are set up correctly
• Evaluating patients’ reactions to dialysis treatment and medications
• Administering medications during treatment

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According to the U.S. Bureau of Labor Statistics (BLS), the median salary for a registered nurse in 2022 is $81,220 per year or $39.05 per hour, but conditions in your area may vary.

The BLS does not differentiate between different specialties of nursing, but Glassdoor.com states an annual average salary of $128,518. Payscale.com reports an annual average salary of $80,430 or $36.53/hr. 

Specifically, Dialysis Nurses can earn a higher annual salary with increased years of experience.

• Less than 1 year of experience earn an average hourly wage of $32.74
• 1-4 years of experience earn an average hourly wage of $34.54
• 5-9 years of experience earns an average hourly wage of $36.96
• 10-19 years of experience earns an average hourly wage of $39.04
• 20 years and higher of experience earns an average hourly wage of $40

Currently, the highest-paying states for Dialysis Nurses, according to ZipRecruiter.com are as follows:

• New York - $104,838
• California - $103,446
• Vermont - $94,543
• Maine - $93,926
• Massachusetts - $93,181

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To become a dialysis nurse, you’ll need to complete the following steps:

1. Attend Nursing School

   You’ll need to earn either an ADN or a BSN from an accredited nursing program in order to take the first steps to become a registered nurse. ADN-prepared nurses may want to take the additional step of completing their BSN degree.

2. Pass the NCLEX-RN

   Become a Registered Nurse by passing the NCLEX examination.

3. Gain Experience at the Bedside

   Prior to becoming a dialysis nurse, you'll likely need to have a minimum of two years of medical-surgical experience, preferably nephrology nursing. New graduates are rarely hired directly into a dialysis nursing position.

4. Earn Your Certification

   The Nephrology Nursing Certification Commission offers two certifications for Dialysis/Nephrology Nurses.

   Certified Dialysis Nurse (CDN)

   Certified Nephrology Nurse (CNN)

Like any nursing position, there are pros and cons to becoming a dialysis nurse. It’s important to consider everything before taking a position as a dialysis nurse. 

Pros

• High demand/job opportunities
• Mentally challenging and stimulating
• Make personal connections with patients
• Variety of work locations
• Job security 

Cons

• Long hours
• High burnout
• Critically sick patients
• Ongoing continuing education
• Physically demanding
• Exposed to blood and other pathogens
• On-call hours

Specialty nursing requires a unique combination of skills. Dialysis nursing requires skills that may not be needed in the OR. For that reason, dialysis nurses should have a minimum of two years of medical-surgical nursing with exposure to kidney and/or dialysis patients. Specific skills include, 

• Strong IV and phlebotomy skills
• Critical thinking
• Open communication
• Strong attention to detail

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Most dialysis nurses will find that their days are similar from shift to shift. However, there can be some variability especially if you work in-patient versus out-patient dialysis. A position as an out-patient dialysis nurse is more common, so let’s review what a day looks like for you.

Go Over Patient List

Most outpatient dialysis centers are free-standing clinics that may or may not be associated with a hospital or healthcare system. After arriving for your scheduled shift, you will go over the patient list for the day and determine what area of the clinic you will be working. 

Some clinics will have nurses take certain “chairs” or “bays” while others may be assigned specific patients. Depending on staffing, some will have nurses that do blood draws on the patients, others administer medications, while the remainder will access and deaccess the patient for dialysis. 

It’s important to discuss with the dialysis center the exact job functions of the nurse and how the team is broken up. 

Begin Dialysis

After determining your role for the day, you will start dialysis on your patients. Generally, patients are staggered throughout the day depending on the amount of time they are hooked up to the machines. 

After a patient is called back, you will review their orders and determine what labs need to be drawn, pre-medications given, and their dialysis bag concentrations. 

Once this all has been checked and completed, you will hook the patient up to the dialysis machine via their catheters. 

After the patient is connected, you are responsible for monitoring vital signs, particularly blood pressure, and administer any medications that are ordered throughout the process. 

You will also need to ensure that the machine is functioning properly and troubleshoot any problems that may arise. 

Repeat & Finish Out Shift

You will complete the same process for all of your patients throughout the shift. Once your shift is completed, you will need to ensure all documentation is completed and your stations are cleaned of supplies. 

Dialysis nurses are more limited in the places that they work because, generally, dialysis treatments and procedures occur in hospitals, outpatient clinics, or in a patient’s home. 

Typically, dialysis nurses can work in the following locations:

1. Hospitals
2. Outpatient clinics
3. Transplant center
4. Academia
5. Home healthcare agency
6. Nursing home
7. Hospice center
8. Hemodialysis center

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Dialysis nursing is one of the most in-demand specialty fields of nursing because of the high number of kidney failure patients in the United States.

• Approximately 35.5 million Americans have chronic kidney disease

• More than 726,000 have end-stage renal disease. More than 130,522 people start dialysis annually per Health and Human Services. 

Interestingly, dialysis nurse retention is an ongoing problem, especially at outpatient dialysis specialty centers. One of the main reasons is that they are typically underpaid as compared to other nursing specialties. Treating chronically ill patients can also be difficult for many nurses. 

According to the BLS, in 2022, there were 3,172,500 Registered Nurses in the United States. By 2032, there will be a need for an additional 177,400 nurses, which is an expected growth of 6%. With the aging population, this number is expected to be even higher.

Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee.

Each state has specific requirements, and it is important to check with the board of nursing prior to applying for license renewal.

If the RN license is part of a compact nursing license, the CEU requirement will be for the state of permanent residence. Furthermore, some states require CEUs related to child abuse, narcotics, and/or pain management. 

Obtaining a CNN or CDN certification will require specific continuing education hours. These hours can also be used for state-specific RN CEUs. 

A detailed look at Continuing Nurse Education hours can be found here.

• American Nurses Association (ANA)
• American Nephrology Nurses Association
• American Society of Nephrology
• American Association of Colleges of Nursing

• How much does a Dialysis Nurse make?

  • According to Payscale.com, Dialysis nurses earn an annual average salary of $80,430 or $36.53/hr.

• Is it hard being a Dialysis Nurse?

  • Working as a dialysis nurse can be difficult because treating chronically ill patients can lead to an increase in burnout. Typically, this specialty of nursing is not any more difficult than other nursing specialties.

• What is it like to be a Dialysis Nurse?

  • Dialysis nurses take care of patients who are receiving dialysis to treat end-stage kidney disease. They oversee dialysis from start to finish, including monitoring the patient, administering medication, and educating patients and their families. 

RN $70,000 - $90,000 Associate Bachelors Dialysis Bedside