Key Responsibilities and Required Skills for Acute Dialysis Nurse

🎯 Role Definition

The Acute Dialysis Nurse works within the inpatient hospital or acute care environment, specialising in the delivery of renal replacement therapies to critically ill patients with acute kidney injury (AKI), end‑stage renal disease (ESRD), or multi‑organ dysfunction. This advanced nursing role involves initiating and managing dialysis modalities, monitoring and responding to patients’ rapidly changing conditions, supervising support staff, documenting and reporting care, collaborating with nephrologists and hospital teams, ensuring equipment integrity, and contributing to continuous improvement in dialysis services. You will act as a clinical resource, mentor junior staff, and support the hospital’s mission to deliver safe, effective, patient‑centred renal care.

📈 Career Progression

Typical Career Path

Entry Point From:

Registered Nurse (RN) with acute care or ICU/CCU experience
Nephrology Dialysis Nurse in outpatient or satellite dialysis unit
Critical‐care Nurse transitioning into renal replacement therapies

Advancement To:

Senior Acute Dialysis Nurse or Lead Dialysis Clinician
Dialysis Program Coordinator or Inpatient Renal Services Manager
Advanced Practice Nurse (APN) or Clinical Nurse Specialist in Nephrology

Lateral Moves:

Home Hemodialysis Trainer or Peritoneal Dialysis Educator
Renal Transplant Nurse Specialist
Dialysis Quality Improvement or Equipment Specialist

Core Responsibilities

Primary Functions

Initiate, monitor and terminate acute hemodialysis, ultrafiltration, continuous renal replacement therapy (CRRT) and apheresis treatments in the inpatient hospital environment following physician orders, hospital protocols and renal service standards.
Conduct comprehensive patient assessments including history, current status, fluid/electrolyte balance, vascular access evaluation, hemodynamic monitoring and risk stratification prior to dialysis start and adapt treatment plans accordingly.
Monitor patients throughout acute dialysis sessions: vital signs, ultrafiltration, hemodynamic stability, anticoagulation status, machine parameters, alarms, and intervene promptly for complications such as hypotension, clotting, air‐embolism or circuit failure.
Set up dialysis machines and water treatment systems, perform pre‑treatment safety checks, priming of dialyzer and bloodlines, check calibrations, conductivity, and ensure machine readiness for acute inpatient therapy.
Administer medications and transfusions during dialysis when indicated: manage anticoagulants, monitor clotting times, adjust based on patient response, and document reaction and effectiveness.
Collaborate with nephrologists, intensivists, ICU teams, vascular access surgeons and dialysis technical staff to coordinate patient care, adjust plans based on multi‐organ involvement and ensure comprehensive renal support.
Document acute dialysis treatment information thoroughly in patient records including pre‑, intra‑ and post‑treatment data, machine settings, patient responses, complications and plan adjustments as per hospital and renal service requirements.
Supervise and direct patient care technicians (PCTs), dialysis technicians and support staff in the acute dialysis setting, ensuring tasks delegated are within protocol and staff are competent for assigned responsibilities.
Maintain and troubleshoot dialysis equipment daily: perform machine disinfection, check water systems, replace filters, report malfunctions and follow maintenance protocols to ensure safe functioning.
Provide patient education and engage families: explain acute dialysis process, vascular access care, fluid restrictions, diet considerations, home follow‑up and what to expect during change in condition.
Participate in on‑call rotation, flexible scheduling including nights, weekends and holidays, respond to hospital dialysis emergencies and rapid transfers between wards or hospital sites as needed.
Evaluate and adapt acute dialysis treatments for patients with multi‑organ failure, hemodynamic instability, sepsis or other comorbid conditions, and apply critical care judgement in modality selection and ultrafiltration target adjustments.
Serve as an informer and consultant to hospital staff outside the dialysis unit (ICU, Med/Surg) providing guidance on renal replacement therapy, apheresis, ultrafiltration and safe handling of dialysis protocols in inpatient settings.
Lead quality assurance and performance improvement activities for acute dialysis services: collect and review treatment data, track complications, audit vascular access outcomes, participate in root‑cause analysis and recommend improvement plans.
Ensure compliance with inpatient renal service contracts, federal/state regulations (e.g., CMS, AAMI, JCAHO), hospital policies, and dialysis standards for safety, infection prevention and patient rights.
Assist with vascular access management pre‑ and post‑procedure, monitor access function, document complications, liaise with surgeons/interventional radiology and educate staff and patients in access care.
Coordinate transition of care for patients moving from ICU or Med/Surg to outpatient dialysis or home dialysis programs: ensure handover communication, produce summary documentation and support safe discharge or transfer.
Maintain patient safety and comfort during acute dialysis: assess for sensory impairments, positioning needs, hypotension risk, mobility limitations, and provide psychosocial support and reassurance.
Perform and lead staff education, orientation and competency training for acute dialysis protocols, new modalities, machine operation and emergent procedures.
Contribute to the renal services team strategic planning, equipment evaluation, budgeting of acute dialysis resources, staffing models and service expansion in alignment with hospital needs.

Secondary Functions

Support ad‑hoc data requests and exploratory analyses of acute dialysis outcomes, treatment metrics, patient‑flow, modality utilisation and staffing efficiency.
Contribute to the organisation’s acute renal replacement therapy strategy and roadmap, including integration with ICU, hospital services, and outpatient dialysis continuum.
Collaborate with other business units and clinical teams to translate acute dialysis requirements into hospital operational workflows, resource management and equipment upgrade plans.

Required Skills & Competencies

Hard Skills (Technical)

Current Registered Nurse (RN) licensure in jurisdiction and relevant dialysis nursing credential (e.g., Certified Nephrology Nurse – CNN or Certified Dialysis Nurse – CDN).
Knowledge and proficiency in hemodialysis, continuous renal replacement therapy (CRRT), ultrafiltration, apheresis and inpatient renal replacement modalities.
Ability to perform machine set‑up, priming, safety checks, vessel monitoring, calibration and troubleshoot dialysis equipment/systems.
Strong assessment and critical‑care nursing skills: interpreting lab reports, hemodynamic data, recognising complications and adjusting plans.
Proficiency with electronic health record (EHR) documentation, data entry, treatment logs and regulatory compliance tracking.
Experience administering medications, transfusions, monitoring adverse reactions within dialysis setting and following hospital pharmacy protocols.
Understanding of vascular access management, cannulation support, and monitoring of fistula/graft/tunneled catheter function.
Familiarity with infection control standards, water‑treatment systems, dialysis machine disinfection and dialysis safety standards (AAMI, CMS).
Ability to lead quality improvement initiatives: collect renal service data, audit outcomes, implement corrective actions and track metrics.
Capability to train, instruct and mentor dialysis staff and other hospital teams in acute dialysis modalities and protocols.

Soft Skills

Excellent interpersonal and communication skills: collaborating with nephrologists, ICU staff, technicians, patients and families with clarity, empathy and professionalism.
Strong organisational and time‑management abilities: managing multiple acute dialysis patients, changing acuity levels, equipment set‑ups, and documentation under pressure.
Critical thinking and judgment: recognising patient deterioration, intervening promptly, adjusting modalities and escalating appropriately.
Team‑oriented mindset: working effectively within multidisciplinary renal, ICU and hospital teams to deliver integrated care.
Adaptability and resilience: functioning reliably in high‑acuity inpatient settings, with shift changes, on‑call duties and emergent nursing demands.
Compassion and patient‑centred approach: supporting patients with serious renal conditions, navigating distress, educating families and promoting dignity.
Leadership and mentoring: guiding dialysis technicians, orienting new nurses, leading training sessions and advocating for best practices.
Ethical practice and accountability: upholding patient safety, confidentiality, hospital policies, regulatory compliance and professional standards.
Reflective practice and continuous learning: staying current with advances in nephrology, dialysis technologies, clinical guidelines and quality improvement methods.
Initiative and resourcefulness: identifying opportunities for service improvement, proposing process changes, supporting equipment upgrades and driving performance enhancements.

Education & Experience

Educational Background

Minimum Education:
Associate or Bachelor of Science in Nursing (ADN/BSN) from an accredited nursing program, current Registered Nurse (RN) licensure, BLS certification.

Preferred Education:
Bachelor of Science in Nursing (BSN) or higher, dialysis nursing certification (CNN, CDN) or nephrology nursing credential, and advanced critical‑care training.

Relevant Fields of Study:

Nursing with focus on critical care or nephrology
Dialysis/Nephrology Nursing
Critical Care Nursing or Acute Care Nursing

Experience Requirements

Typical Experience Range:
1–2 years of registered nursing experience in inpatient acute care, preferably with exposure to dialysis or critical‑care units.

Preferred:
3+ years of inpatient dialysis nursing or acute renal replacement therapy experience, including hemodialysis, CRRT or apheresis in hospital/ICU settings.