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