DNP | Nurse Leadership Special Issue February 2023

In This

4 Meeting Today’s Nurse Leadership Challenges

By Louis Pilla

8 Aligning Nursing Education to Reflect a Broad Approach: Will the DNP Be the New NP Requirement?

By Julia Quinn-Szcesuil

12 Myths and Facts of the DNP

By Michele Wojciechowski

16 A Look Ahead for Nursing in 2023: Q&A with Kathleen Belmonte, Chief Nursing Officer & SVP of Nursing & Clinical Services at Fresenius Medical Care North America

By Reneé Hewitt

Editor’s Notebook

Change is constant in healthcare. Change can be externally driven, such as the COVID-19 pandemic. Or may stem from internal efforts, such as improving patient satisfaction, staffing shortages, opportunities for the nursing team’s personal growth and development, preventing burnout among staff, and work-life balance challenges, just to name a few.

If change is the one constant in nursing, then change management becomes significant to nurse leaders. Nurse leaders must focus on managing change to achieve desired patient outcomes and promote the success of their staff.

Some nurse leaders have natural leadership traits, while others develop change management skills. And that’s where the DNP comes into play.

The doctor of nursing practice (DNP) degree focuses on executive leadership and prepares nurses for leadership roles within the healthcare system. DNP-prepared leaders possess the needed traits to become agents of change within complex healthcare environments.

Our nation’s healthcare system needs nurses with more education and preparation to lead the future of patient care using data and research, address nursing challenges, and transform the healthcare landscape.

This month, Minority Nurse focuses on the DNP and nurse leadership.

• If nurse leadership was difficult before the pandemic, COVID has brought new challenges. Lou Pilla dives into meeting today’s nurse leadership challenges.

• Initiatives to increase nursing education and training continue to evolve as the nursing industry and approach to patient care change over time. Julia Quinn-Szcesuil explores aligning nursing education to reflect a broad approach and if the DNP will be the new NP requirement.

• Many nurses need help understanding what the DNP is. Michele Wojciechowski dispels some common myths and shares important facts about the DNP.

• The nursing industry has undergone significant challenges in the last few years. Reneé Hewitt chats with Kathleen Belmonte, the Chief Nursing Officer & SVP of Nursing & Clinical Services at Fresenius Medical Care North America, about what’s to come for the nursing profession in 2023.

“You can’t build an adaptable organization without adaptable people — and individuals change only when they have to, or when they want to.” –American Management Consultant

Gary Hemel

-Reneé

Meeting Today’s Nurse Leadership Challenges

By Louis Pilla

If nurse leadership was difficult before the pandemic, COVID has brought with it its own challenges. Today’s top challenges nurse leaders face involve caring for staff’s emotional health and wellbeing; dealing with staff retention, furloughs, and layoffs; and coping with a traveling/ contingent workforce.

So say the October 2022 iteration results of the American Organization for Nursing Leadership (AONL) Foundation Longitudinal Nursing Leadership Insight Study. The results are the latest statistics from four studies conducted between July 2020 and August 2022.

In addition, the survey explored questions such as workplace bullying and violence, preparedness for a future pandemic, and nurse leaders leaving their roles.

AONL fielded the survey in August to nurse leaders at all levels across the care continuum. Most respondents worked in urban acute-care hospitals. According to the survey report, some 73% were

either vice presidents, chief nursing officers/chief nursing executives, directors, or managers.

Specifically, 58% of respondents said emotional health and well-being were their greatest challenges; 56% pointed to staff retention, furloughs, and layoffs, and 36% indicated travelers/contingent workforce.

These findings were not a surprise but instead “were the validation of what we knew was happening in the healthcare environment,” says Simmy King, DNP, MS, MBA, RN-BC, NE-BC, FAAN, AONL treasurer and chief nursing informatics and education officer at Children’s National Hospital in Washington, DC.

Responding to Challenges

Nurse leaders said they had the most difficultly responding to financial resource availability and travelers/contingent workforce issues. Nurse leaders, notes King, have been “trying to find that fine balance between what financial resources we do have available

to be able to operationalize and the increased costs of actual operations.”

King notes that helping a traveling or contingent workforce fully assimilate into a healthcare environment could pose challenges. “Realistically, you try to develop a good onboarding experience for them and resource them,” she says.

According to King, in some larger healthcare systems, “they have looked at more creative strategies like developing their own internal travel agency” where a nurse could move within the system. “It’s a creative way to look at different strategies to address the workforce challenges.”

Dealing with Bullying and Violence

On top of these challenges, nurse leaders in the AONL Foundation study said workplace violence and bullying were widespread. Some 83% of CNOs reported having witnessed workplace violence, and 72% reported having

seen workplace bullying and incivility.

This workplace violence is “something that’s been top of mind for nurse leaders and healthcare systems for a long time,” says King. The past few years, she notes, have posed challenges for individuals, and “there’s a lot of trauma that we all need to heal from.” Healing will involve addressing the root causes of the trauma, and she notes, as well as “being very adamant about having no tolerance for those types of behavior.”

Working with the Emergency Nurses Association, AONL has issued guiding principles on mitigating workplace violence, and a toolkit, notes King. Those guiding principles include using evidence-based strategies to address all aspects of workplace violence; promoting a culture of safety; and creating a culture of nonviolence through intention, commitment, and collaboration from everyone in the organization.

Copyright: AONL Foundation Longitudinal Nursing Leadership Insight Study.

Future Pandemic

When asked whether their teams were better prepared for a future pandemic, the results were less than optimal. Since the initial July 2020 survey, the trend decreased by 20 percent, with 65% of respondents answering yes in August 2022 compared with 85% in July 2020.

“Right now, I think we’re facing the uncertainty of the future healthcare pipeline,” says King. Virtually all roles in healthcare, not just nursing, are facing shortages, she notes. “We have to see what we can do to ensure the consistency of being able to fill those roles

in healthcare wholistically and not just singularly in one particular role,” she says.

Leaders Leaving

On a somewhat alarming note, some 13% of nurse leaders said they intended to leave their position within the next six months. Moreover, 25% said they are considering leaving, which “indicates organizational dissatisfaction on some level,” the survey report notes. Better work-life balance tops the list of reasons why leaders want to leave.

Drilling down into the data, some respondents were close to or considering retirement,

notes King. But, in addition, “we do recognize the role itself is challenging, and they’re looking for opportunities to have more balance in their work, to have an opportunity to look at their work through a different lens,” says King.

To help nurse leaders, the AONL Nursing Leadership Workforce Compendium identifies best practices and innovations to support and empower them in attaining, retaining, and sustaining environments where they want to work and feel like they belong.

“Nurse leaders also need attention paid to their healing and their wellness in the

same respect that they’re going to provide that in their leadership role for others,” says King.

Louis Pilla is a seasoned publishing expert with over 20 years of experience providing content and digital products to healthcare audiences.

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Aligning Nursing Education to Reflect a Broad Approach

Will the DNP Be the New NP Requirement?

By Julia Quinn-Szcesuil

Initiatives to increase nursing education and training continue to evolve as the nursing industry and approach to patient care change over time. From the push to have nurses earn a BSN to current deliberations about requiring a doctorally prepared advanced nursing workforce, nursing education remains at the industry forefront. Currently, nurse practitioners (NPs), who now earn the NP credential with a master of science in nursing (MSN), might need a doctor of nursing practice (DNP) to be considered qualified as an NP.

Why a DNP?

While the switch would standardize the skills for NPs, if the industry moves to require a DNP for NP practice, nurses who want to pursue an MSN without the NP path will still be able to do so. Although the master of science degree in nursing will not be eliminated, the charge for NPs to earn a DNP addresses changes in the nursing industry and the broader healthcare system. As the increasingly complex approach to high-quality patient care requires in-depth knowledge and practice, the time requirements for preparing NPs increased.

Dr. Joan Stanley, the chief academic officer of the American Association of Colleges of Nursing (AACN) (AACN), says the move to DNP was first introduced decades ago.

“Since 2003, AACN has convened a series of task forces which all recommend that nursing, particularly programs preparing advanced practice registered nurses, should

raise the level of education to include a greater focus on quality improvement, system thinking, and the social determinants of health as well as additional time and opportunities for nurses to integrate these competencies into their practice,” she says. “This additional knowledge is needed to address the gaps and needs in the healthcare system and to prepare NPs and other APRNs for their full scope of practice.”

The DNP offers particular benefits for nurses who are especially interested in a clinical component. “I truly believe that DNPs have the advantage of still having the ability to practice clinically,” says Danielle McCamey, DNP, CRNP, ACNP-BC, FCCP, assistant dean for clinical practice & relationships at Johns Hopkins School of Nursing, and founder, president, and CEO of DNPs of Color. “The understanding of systems/leadership and the basic scholarly knowledge of putting together

performance improvement, quality improvement, and evidence-based practice projects gives us a versatility to impact practice in a real-time sense.”

Aligning Degree Requirements

Several factors weigh into the initiative to see NPs achieve a standard DNP level of education, says Shannon Idzik, DNP, ANP-BC, FAANP, FAAN, professor and associate dean of the Doctor of Nursing Practice Program at the University of Maryland School of Nursing and the president-elect of the National Organization of Nurse Practitioner Faculties (NONPF).

Over time, she says, MSN credit requirements have grown faster and out of proportion to MS programs in other industries. Required credits for an NP could stretch to 45-50 for an MSN—far over the typical 30-35 credits for most master’s degrees. While this academic requirement was needed to help nurses gain all the necessary skills and knowledge for the roles they would fulfill, says Idzik, it also left nurses with degree credentials that didn’t reflect their extensive education. For example, some nursing specialties and nurse anesthesiology have already implemented the DNP requirement.

The additional credit creep was gradual and reflected the changing healthcare landscape.

“Healthcare is increasingly complex and complicated, and we were not able to put the content into the MS programs that were necessary for healthcare at that level,” Idzik says. Stanley agrees. “There is a growing body of research,

which shows that higher levels of nursing education are linked to better patient outcomes,” she says. “The transition to DNP education increases the knowledge, skills, and abilities needed to address the many gaps in patient care.”

As with all individual nursing paths, the journey to DNP will look different for each nurse. The initiative doesn’t require nurses to take a straight path from BSN to DNP, says Idzik, although that is an option.

According to Stanley, some BSN to DNP programs build options for students to perform RN work while starting their graduate coursework. Just as many nurses today take time between the BSN and the MSN NP to work in the field and gain hands-on experience, nurses may continue to make that choice. “The transition to the DNP for NP education should also provide additional time and opportunities for clinical practice in the NP role,” says Stanley.

Parallel Credibility

Parity with other healthcare leaders is another factor, though smaller, that informs this initiative. When nurses sit at a table with other leaders, many of whom have required doctoral credentials, there may be a credibility issue in some instances, Idzik says. Stanley says the DNP addresses that gap. “The transition, in addition to this expanded knowledge and experience, will give the NP the credential which more clearly recognizes their preparation and is recognized as a health professional leader,” says Stanley.

Danielle McCamey, DNP, CRNP, ACNP-BC, FCCP, assistant dean for clinical practice and relationships at Johns Hopkins School of Nursing, and founder, president, and CEO of DNPs of Color.

McCamey says as more nurses earn a DNP, a greater impact will evolve. “DNP degree education is structured around leadership and digging deeper in clinical knowledge and understanding,” she says. “The nursing industry will benefit from a body of clinicians that can assess systems, policies/structures, and have the skill set to make changes that improve quality and performance so that care is aligned with an evidence-based practice that directly impacts care and outcomes.”

Clinical Focus Remains

Master’s level programs were traditionally relatively clinically focused, says Idzik, and a DNP curriculum raises that clinical training to a level that allows nurses to go deeper into skills that take in population health, data and informatics, and social determinants of health. Some nurses will use those broadened skills to work on national policy change or their gained leadership skills to advocate for nurses and patients in their workplace. Idzik says others will choose to use them for one-on-one patient care.

“The DNP lets nurses move the focus from the patient in front of you to the entire population,” says Idzik. “It is more of a systems level of looking at a patient population.” So for a patient being seen for asthma, nurses will broaden the scope to consider the impacts of housing, environmental exposure, or access to care.

“My DNP degree introduced me to a different level of networking and access to other doctorally prepared nurses to begin collaborating and creating transformative changes in nursing,” says McCamey. “Having access to these

professionals and also creating ways to elevate others is probably my biggest benefit.”

Nurses are needed to lead healthcare, says Stanley. “Nursing as a profession needs to raise the benchmark for education, accountability, and in practice,” she says, “and step up and take the lead in the healthcare system.”

Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts

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Myths and Facts of the DNP

By Michele Wojciechowski

Many need help understanding what this terminal degree is, means or offers for nurses. So we’re here to set the record straight.

According to the American Association of Colleges of Nursing (AACN), Doctor of Nursing Practice degrees, more commonly referred to as DNPs, were officially accepted into the field on October 25, 2004. This was when the AACN member schools voted—and thus endorsed—the Position Statement on the Practice Doctorate in Nursing.

While it’s been 17 years since that happened, some still don’t understand what it is. So, we will present some Myths and Facts about the DNP.

Myth: DNPs can only work in hospitals or medical centers. Facts: Not true, say our sources. “DNPs can work in a variety of places, including outpatient settings, policy think tanks, academic institutions, public health, and healthcare startups,” says Imelda Reyes, DNP, MPH, FNP-BC, FAANP, Associate Dean for Advanced Education, University of Nevada, Las Vegas School of Nursing.

Jennifer Plescia, DNP APN, RN, FNP, ENP, RNC, who works in an Emergency Department and is the owner of IVs by the Seas, says, “Essentially, DNPs can work in any clinical setting such as the hospital, urgent care, med spas, primary care offices, or even mobile at home services.”

But wait, there’s more. Beth A. Brooks, PhD, RN, FACHE, Vivian Clinical Advisor, On the Horizon in Healthcare video blog and podcast adds

“settings such as private, public, profit, non-for-profit hospital and healthcare systems, home care, hospice/palliative care, government agencies, corporations (e.g., insurance, compliance, staffing, consulting agencies, pharmaceutical companies). They can also be self-employed and/or CEOs of startup companies.”

Myth: The DNP degree is just a watered-down PhD for nurses.

Facts: “The DNP degree is far from a watered-down PhD. Most people do not know this, but to be eligible for a DNP program, you must have a minimum of 3-5 years of bedside nursing experience,” explains Plescia.

“I can honestly say that the DNP program was the hardest thing I have ever done—and I gave birth twice! The DNP program not only includes an educational component but also requires hands-on clinical training and a capstone project. DNP capstones are projects that address clinical concerns in the field, and it is up to the student to implement a process to make a change. This project must be submitted to the IRB for approval and then implemented, analyzed for effectiveness, and evaluated by a panel of your peers—similar to that of a PhD dissertation.

“A DNP is a clinical degree, whereas a PhD is not. A PhD program does not make you eligible for clinical practice, but is used more in academia.”

Wanda M. Williams, PhD, MSN, RN, WHNP-BC, CNE, Program Director for the DNP program, UNCG School of Nursing, also says this myth isn’t true. “The degrees and

programs are unique. The PhD in Nursing is a research doctoral degree, and the DNP is a practice doctoral degree. The PhD program prepares nurse scientists to conduct nursing research and lead research teams, develop theory and contribute to the body of knowledge of nursing and the health sciences, and disseminate research findings through scholarly publications, presentations, and teaching.

“The DNP program prepares nurses for careers in clinical and non-clinical areas, but with a focus on improving patients’ health outcomes. Clinical areas are direct, hands-on patient care, while non-clinical can be in leadership, administration, or policy positions.”

Myth: DNPs aren’t medical doctors, so what’s the point of the degree?

Facts: “DNPs are not trying to be medical doctors or physicians. We are a distinct discipline that brings a muchneeded lens to the healthcare scene,” says Reyes. “It is often said that nurses bring a holistic approach to their care versus a disease-based approach, but with evolving times, I see that healthcare is changing, and we need to find a way to synergistically exist.”

Myth: The DNP is just a degree to fill in gaps that other advanced degrees can’t provide. Facts: “The physician is no longer the only doctor on the healthcare team. Many clinical disciplines have elevated the educational requirements to practice to the doctoral level. For example, other

practice-focused clinical doctorates in health care include the Doctor of Physical Therapy (DPT), Doctor of Occupational Therapy (DOT), Doctor of Pharmacy (PharmD), Doctor of Social Work (DSW), Psychology Doctorate (PsyD), Doctor of Audiology (DAud) to name a few,” says Brooks. “The Doctor of Nursing Practice is a relatively new degree; it’s only existed since the early 2000s. In all of these clinical disciplines, the knowledge gained at each level of education builds on previous learning, broadens the students’ knowledge base to prepare them for larger roles with different accountabilities, the scope of practice, and the outcomes influenced.”

Myth: DNPs are doctors’ assistants.

Facts: “We are a separate profession with very different training. An M.D. goes to medical school for four years, does a four- (or more) yearlong residency, and is then a physician who can take care of you. During residency, physicians often rely on nurses to help guide them along the way so they can practice independently in the future,” says Plescia.

“In contrast, DNPs have already had a similar ‘residency’ with their bedside experience that is required before obtaining the degree. Therefore, not only does the DNP have RN experience, but they also require hands-on clinical training. While the clinical training is not as long as that of a physician, it is this way because of the DNP’s previous clinical experience—they are already introduced to the field, and in most states, DNPs

are independent practice providers—meaning they do not need physician supervision.”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about nursing but comes close to fainting when she sees blood. She’s also the author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.

A Look Ahead for Nursing in 2023

Q&A with Kathleen Belmonte, Chief Nursing Officer & SVP of Nursing & Clinical Services at Fresenius Medical Care North America

by Reneé Hewitt

The nursing industry has undergone significant challenges in the last few years. Minority Nurse chatted with Kathleen Belmonte, the Chief Nursing Officer & SVP of Nursing & Clinical Services at Fresenius Medical Care North America, about what’s to come for the nursing profession in 2023, industry challenges posed by the COVID-19 pandemic— including staffing shortages in hospitals and dialysis centers, opportunities for personal growth and development and ways nursing leaders can help prevent burnout among their workforces.

leaving the nursing profession altogether, which means things will need to change for nurses to feel fulfilled and rewarded in their careers.

Ongoing investment in our nurses’ physical and mental well-being will help them to remain resilient and reduce stress and burnout. As leaders in the industry, we need to restore trust with our nurses by listening to their needs, giving them space to vocalize the change they want to see, and understanding what will meaningfully move the needle to ensure they stay in the field.

Also, strategic partnerships with universities will be essential in recruiting additional individuals into the field of nursing.

What are your expectations for nursing job growth in 2023?

How can healthcare leaders expand opportunities for personal growth and development for nurses?

Partnering to create a clearly defined career ladder enables continued improvement for everyone within the healthcare system and the organization. With a standardized career path, nurses clearly understand what steps are needed for advancement.

significant incentives as the risk, at the time, was quite high.

With the nationwide rollout of vaccines, we’re fortunate to see less urgency around these hot spots. Therefore the need to quickly activate a contingent of healthcare workers is less critical.

Kathleen Belmonte, the Chief Nursing Officer and SVP of Nursing & Clinical Services at Fresenius Medical Care North America.

What are your expectations for the nursing profession in 2023?

Nurses are the backbone of our healthcare delivery systems. While the pandemic magnified the cracks in that system, it also highlighted the pivotal role that nurses play in healthcare more broadly.

The nursing industry has undergone significant challenges in the last three years, and nurses feel overworked and stressed, driving high burnout and dissatisfaction with their roles. As a result, many nurses are considering

There is a serious concern as to whether the profession will attract enough nurses to care for populations in the future. We must continue to do everything we can to encourage more people to enter the healthcare field—specifically nursing.

I’m encouraged, however, by the visibility of the staffing shortage conversation across our industry because it is already resulting in meaningful change throughout the profession. As leaders grapple with solutions, we hope our nurses feel heard and listened to.

With proactive efforts like expanding nurse education programs, lowering financial barriers to receiving training, and operationalizing enhanced retention efforts, there is room to be optimistic that job growth will improve.

Fresenius honored 500 employees this year for their commitment to renal excellence in our inaugural CARE Awards, recognizing their incredible contributions and focus on our patients. The CARE Awards are important to recognize the outstanding individual work ethic the winners exhibited daily and show that everyone in the company—from management to support functions —deeply appreciates our frontline workers and understands the challenges they face every day.

How does increased funding from the Department of Labor impact nursing staff?

This funding is a critical step towards lowering the barrier of access for potential nurses to seek education and training to grow our pool of well-qualified nurses. Investment in the next generation of nurses will naturally support the development of a skilled workforce that our patients rely on.

Do you think there will continue to be a reliance on travel nursing and per diem staff?

During the height of the pandemic, travel nursing was a critical solution for quickly and sufficiently staffing COVID “hot spot” regions. It required

As industry leaders face the surmounting staffing challenges, the payment structure and incentives that were put in place for travel nurses are no longer relevant, forcing the entire industry to rethink these structures.

One of nursing’s critical needs is to pay greater attention to nurses’ mental health. How can we ensure nurses are aware of the resources available to them? This is a very important question, as we are seeing the impacts of the pandemic’s first 1-2 years play out through high burnout and staffing shortages across the nation. However, we know the pandemic is not over, so how are we continuing to build resilience in our frontline healthcare workers?

At Fresenius, we have rolled out new benefits and healthcare options to show our care teams and nurses how much they mean to us. For example, we’ve emphasized developing wellness programs that support our nurses’ physical and emotional well-being.

Helping to achieve worklife balance and supporting a healthy person is very important, so we have invested in tools promoting wellness because we believe mental health is equally as important as physical health.

Ensuring there is space to be heard by leadership and

closing any gaps in communication are critical to creating a healthy working environment. We want to ensure they know that even though these programs are available, we are not stopping there – we are moving to make meaningful change that strikes at the root of their concerns.

What can nursing leaders do better to help prevent burnout among their workforce?

I’ve learned in my career that it is important to work hard, take time off, and periodically unplug. In addition to preventing burnout, it provides an opportunity to take care of yourself.

I encourage other nursing leaders to be fierce in protecting themselves from stress and burnout.

One of the trends we’re seeing is an increase in patient-wearable medical devices. What role do you see these devices having in patient care?

Empowering our patients to be independent and educating them on how to manage their diagnosis best and prevent the progression of their chronic kidney disease is a huge part of how our nurses provide care.

Unfortunately, being diagnosed with chronic kidney disease puts you at higher risk for comorbidities. For example, the leading causes of CKD are high blood pressure and diabetes, which account for 73% of new CKD diagnoses.

All these things together mean our patients are managing a lot. So, when it comes to wearable medical devices, having apps or monitors that allow them to easily track critical aspects of their treatment,

like exercise, diet, medication reminders, etc., helps give them more control and independence.

Regulations increased the flexibility of Medicare reimbursement for telehealth visits. Do you expect the integration of virtual visits to result in a higher level of in-home healthcare from skilled nurses and nurse practitioners? Absolutely. Especially in the dialysis industry, the adoption of in-home treatment has been on a steady rise for years.

In fact, for our patients specifically, home dialysis is an option that offers them more independence and improved clinical outcomes. The type of around-the-clock care that we provide our home patients relies, in part, on our ability to connect with them efficiently and seamlessly via telehealth and remote monitoring.

At Fresenius, we’re continuing to invest in education around home dialysis and home therapies for our patients, importantly our nurses and care teams so that they feel comfortable guiding patients and ensuring they feel fully cared for despite receiving treatment in the comfort of their homes rather than a clinic.

Our nurses and care teams are not only trained on the ins and outs of the treatment but also receive cultural competency training as part of their overall education when they join our clinics. This ensures that those who provide inhome visits are equipped to support patients from a specialized medical perspective and have the awareness and tools to support them no matter where they live or come from.

As an NP, where do you see the role of nurse practitioners going in 2023?

The U.S. News and World Report have named nurse practitioners the #1 best job on the Best Healthcare Jobs list for 2022.

Nurse practitioners have already become an integral part of the healthcare space, and in 2023, I expect this trend to continue. With a shortage of primary care doctors and nephrologists throughout the country, nurse practitioners can take on new skills and responsibilities to fill this gap.

As full practice authority is gaining ground in many states, do you expect to see a rise in the number of NP-led practices?

Nurse practitioners are leading the way in expanding access to care for patients in rural and underserved markets. Nurse practitioners are clinical leaders in many healthcare settings— and more patients are choosing NPs as their healthcare providers.

I expect to see more NP-led practices as access to healthcare is expanded—particularly in rural and underserved markets.

How did the pandemic impact patients who receive dialysis?

The pandemic forced the entire industry to rethink, re-evaluate, and innovate healthcare delivery to ensure patients could continue to access the care they need safely—and this was no different at Fresenius Medical Care North America, where I work.

Throughout the pandemic, patients with chronic kidney disease (CKD) who rely on dialysis were at a much higher risk for morbidity and mortality

due to being immunocompromised and at increased risk for exposure in dialysis clinics.

As you may know, patients receiving life-sustaining dialysis in a clinic typically receive treatment 3-4 times a week for 2-3 hours. These clinics often have 4-6 beds each, all serving immunocompromised patients, typically with many comorbidities.

On the clinical side, we have and continue to implement many strict infection control policies and procedures, screening processes, and COVID-19 testing to limit the potential spread of the virus to our patients, as well as our nurses and staff.

Early in the pandemic, we ensured that we were prepared and had sufficient PPE for all our clinics and care staff. We even opened isolation clinics and shifts so patients who tested positive for COVID-19 could still receive the life-sustaining treatment they need while minimizing the risk of spreading to other patients.

What is the current demand for the specialty of nephrology and dialysis nurses, and how can we address this?

Across the nation, about 15% of U.S. adults have CKD— that’s around 37 million people. Many patients manage their disease through dialysis in clinics or at home. Still, that treatment requires a full team of specialized care providers, including nurses, who are educated on the complex nature of caring for this patient population.

Unfortunately, many nursing and university programs do not offer specialized dialysis education as part of their general training. I, for

instance, didn’t even know what nephrology nursing was when I was studying to become a nurse, and that trend remains consistent today.

As a solution, we’ve invested in developing university relations teams dedicated to growing strategic partnerships with universities so that we can expand access to nurses and, importantly, introduce prospective nurses to nephrology nursing earlier. These programs and other tuition and college reimbursement programs help us bring students to dialysis units and show them firsthand the great career opportunities available to them in this field.

We have also developed a nurse residency program so people can see the benefits of a career in dialysis nursing and nephrology nursing professional advancement pathways.

The rising demand for nursing staff to care for patients with more complex healthcare needs and a falling supply of nurses has contributed to the largest nursing shortage the U.S. has ever experienced. What do you see as nursing shortage solutions, especially in hospitals and dialysis centers?

It’s no secret that even before the pandemic, there was serious concern about whether the profession would attract new nurses to care for specialized patient populations, including those with end-stage renal disease and chronic kidney disease.

Though we’ve always prioritized support for our nurses at Fresenius with competitive compensation and benefits based on feedback from our staff, we’ve also rolled out new benefits and healthcare

options that emphasize wellness programs to support their physical and emotional wellbeing. These resources focus on building resilience, balancing work and life, and supporting a healthy person.

Additionally, investment in technology improvements and other clinical work process enhancements will help reduce workload and stress and make our nurses more effective and efficient in providing patient care.

Overall, healthcare and hospital systems leaders must refrain from implementing only reactive solutions. To make meaningful change, we must take a step back, make space for our nursing and care staff to be honest with leadership about their needs, and be willing to take a hard look internally at how we can operationalize those changes to improve outcomes.

This is the exact approach we’re taking at Fresenius Medical Care North America. Over the past year, we have been pursuing an assessment of more than 2,600 dialysis clinics across the U.S. to identify standout challenges among clusters of centers. So far, the reception among employees has been positive, with many affirming that the effort made them feel heard in a way they hadn’t been previously. This approach can impact the healthcare profession’s future, so it’s critical to understand what motivates healthcare staff in a world much different than it was three years ago and for companies to evolve their retention strategies accordingly.

Beyond staffing shortages, what other industry challenges did the pandemic pose to nursing, and how can we overcome these challenges?

Nurses are the backbone of the healthcare delivery system and have been heroes throughout the pandemic –they rise to the challenge daily. These nurses continue to provide expert clinical care under enormous pressure to sick and dying patients throughout the pandemic. Unfortunately, as a result, our nurses tell us they are feeling stressed, exhausted, and burnt out, and a consequence of nurse burnout is leaving the field.

One of the most apparent challenges of the pandemic was providing meaningful mental health support to our healthcare workers and all professions on the frontlines during the pandemic. We believe that mental health is equally important as physical health – so we have made more programs available to help our nurses and other staff to manage stress and find balance.

R eneé Hewitt is the editor and content strategist for Minority Nurse. When enjoying life unplugged from the digital world, you’ll find her on a trail taking wildlife photos or birdwatching.