Torchora
Back to Home

Key Responsibilities and Required Skills for Dialysis RN

💰 $60,000 - $95,000

NursingHealthcareNephrology

🎯 Role Definition

A Dialysis RN delivers direct nursing care to patients with acute and end-stage renal disease (ESRD) undergoing hemodialysis or peritoneal dialysis. This role includes operating and troubleshooting dialysis machines, assessing and cannulating vascular access, administering medications and dialysis-related therapies, monitoring hemodynamic stability, documenting care in the EMR, and coordinating care with nephrologists, vascular access teams, and interdisciplinary staff. The Dialysis RN upholds infection prevention protocols, ensures regulatory compliance (CMS, OSHA), and delivers patient and family education focused on self-management and home dialysis options.

📈 Career Progression

Typical Career Path

Entry Point From:

  • Dialysis Technician / Hemodialysis Tech (CCHT)
  • New graduate RN with acute care or med-surg clinical rotation experience
  • LPN/LVN transitioning to RN (after RN licensure)

Advancement To:

  • Charge Nurse / Lead Dialysis RN
  • Dialysis Clinic Manager or Operations Manager
  • Nephrology Nurse Educator / Clinical Nurse Specialist (Nephrology)
  • Advanced Practice Provider: Nurse Practitioner (Nephrology)

Lateral Moves:

  • Home Dialysis Nurse (PD/HD training)
  • Vascular Access Coordinator / Cannulation Specialist
  • Renal Transplant Coordinator

Core Responsibilities

Primary Functions

  • Provide comprehensive, evidence-based hemodialysis and peritoneal dialysis nursing care to adult and/or pediatric patients, including pre-, intra-, and post-dialysis assessment and interventions.
  • Safely operate, program, and troubleshoot hemodialysis machines (e.g., Fresenius, Baxter, Nipro) and related water treatment systems, following manufacturer and facility protocols.
  • Calculate and implement dialysis prescriptions as ordered by the nephrologist, including blood flow rates, dialysate composition, ultrafiltration goals, and treatment duration.
  • Perform and supervise vascular access care: assess AV fistula, AV graft, and central venous catheters for function and infection; perform venous and arterial needle cannulation using aseptic technique.
  • Monitor and interpret vital signs, cardiac rhythm, lab values (BUN, creatinine, potassium, calcium), and hemodynamic trends during dialysis; intervene for hypotension, cramps, disequilibrium, and access complications.
  • Administer medications related to dialysis care including IV iron, erythropoiesis-stimulating agents (ESA), anticoagulants (heparin), IV push medications, and emergency medications per protocol.
  • Provide emergency response and critical care stabilization during dialysis-related events (cardiac arrest, severe hypotension, air embolism), utilizing ACLS/BLS skills and facility emergency protocols.
  • Maintain accurate, timely clinical documentation in EHR systems (e.g., Epic, Cerner, Meditech) including treatment records, flowsheet entries, medication administration, and incident reports.
  • Educate patients and families on dialysis modalities, vascular access care, fluid and dietary restrictions, medication adherence, and signs/symptoms requiring urgent care; tailor education to health literacy and cultural needs.
  • Implement and enforce infection prevention and control measures specific to dialysis (vascular access asepsis, environmental disinfection, water quality monitoring, Hepatitis B protocols).
  • Conduct pre-dialysis assessments and triage acutely ill patients, coordinating admission to higher acuity settings (ED, ICU) when indicated.
  • Collaborate with nephrologists, social workers, dietitians, pharmacists, and vascular access teams to develop individualized care plans and optimize patient outcomes.
  • Perform vascular access cannulation training and competency validation for staff; mentor and precept new nurses and dialysis techs on cannulation and dialysis procedures.
  • Monitor and manage dialysis-related supplies and inventory (dialyzers, bloodlines, catheter kits), escalating shortages and supporting cost-effective utilization.
  • Participate in quality improvement initiatives, infection surveillance, and clinical audits to meet CMS, ESRD network, and facility benchmarking goals.
  • Complete and maintain required dialysis-specific documentation and regulatory paperwork (treatment logs, water quality records, adverse event reporting).
  • Provide home dialysis support by training patients and caregivers in peritoneal dialysis (PD) exchanges or home hemodialysis techniques, troubleshooting problems and coordinating home care resources.
  • Assess vascular access for hemodialysis adequacy and communicate access issues for timely referral to interventional radiology or vascular surgery.
  • Ensure compliance with occupational safety standards, ergonomics, and needle-stick prevention practices; participate in staff safety training and incident investigations.
  • Participate in monthly/monthly multidisciplinary case reviews, patient care conferences, and renal team rounds to address complex cases and continuity of care.
  • Maintain competency in new dialysis technologies, modalities (CRRT, SLED, nocturnal dialysis), and facility-specific protocols through ongoing in-service education.
  • Support scheduling and treatment flow: triage acute patients, prioritize treatments during high census, and adjust care plans to minimize skipped or shortened treatments.

Secondary Functions

  • Contribute to program-level quality metrics reporting (Kt/V, URR, vascular access rates, infection rates) and action plans to improve dialysis outcomes.
  • Assist with policy and protocol development for dialysis unit procedures, emergency response, and infection prevention.
  • Participate in community outreach and patient recruitment for home dialysis programs and transplant referral initiatives.
  • Support vascular access surveillance programs and documentation for access monitoring (intra-access pressures, dynamic assessments).
  • Help coordinate transportation, social supports, and referrals for patients with complex psychosocial needs impacting dialysis adherence.
  • Provide mentorship to new hires, prepare orientation materials, and lead competency validation sessions for dialysis staff.
  • Engage in performance improvement projects, root cause analyses, and corrective action plans in response to sentinel events.
  • Assist with vendor relationships and equipment maintenance scheduling to ensure uninterrupted dialysis operations.
  • Support clinical research initiatives and pursue training opportunities to remain current with nephrology best practices.

Required Skills & Competencies

Hard Skills (Technical)

  • Licensed Registered Nurse (RN) with active state license and dialysis-specific clinical experience.
  • Proficient operation and troubleshooting of hemodialysis machines and water treatment systems (Fresenius, Gambro/Baxter, Nipro).
  • Vascular access assessment and cannulation (AV fistula, AV graft, tunneled and non-tunneled catheters) with aseptic technique.
  • Knowledge of dialysis prescriptions, solute clearance concepts (Kt/V, URR), ultrafiltration management, and fluid removal strategies.
  • Medication administration expertise including IV iron, ESA, anticoagulants, and emergency drugs; familiarity with IV push protocols and syringe pump use.
  • EMR proficiency (Epic, Cerner, Meditech, or dialysis-specific platforms) and accurate flowsheet documentation.
  • Ability to interpret basic lab results (electrolytes, BUN/creatinine, hemoglobin) and translate into clinical action during dialysis.
  • Infection control practices specific to dialysis: Hepatitis B protocols, water quality monitoring, blood-borne pathogen prevention.
  • Competency in emergency response and basic critical care skills (BLS required; ACLS preferred).
  • Familiarity with dialysis quality metrics, CMS/ESRD network regulations, and clinical documentation requirements.

Soft Skills

  • Strong patient-centered communication and teaching skills; ability to explain complex renal concepts in plain language.
  • Clinical judgment and critical thinking to rapidly assess changes in patient condition and take appropriate action.
  • Empathy and cultural competency to support diverse patient populations living with chronic illness.
  • Teamwork and interdisciplinary collaboration with nephrologists, techs, social workers, and dietitians.
  • Time management and organizational skills to manage multiple treatments, documentation, and emergent issues.
  • Resilience and stress tolerance for fast-paced, high-acuity dialysis environments.
  • Attention to detail to maintain accurate treatment records, medication logs, and compliance documentation.
  • Leadership and mentoring ability for precepting and guiding less experienced staff.
  • Problem solving and adaptability when implementing new dialysis technologies or protocols.
  • Professionalism and ethical decision-making in handling patient confidentiality and sensitive health information.

Education & Experience

Educational Background

Minimum Education:

  • Associate Degree in Nursing (ADN) or Diploma in Nursing and active RN licensure.

Preferred Education:

  • Bachelor of Science in Nursing (BSN); specialty coursework or certificate in Nephrology or Dialysis Nursing preferred.

Relevant Fields of Study:

  • Nursing
  • Nephrology
  • Acute Care / Critical Care
  • Biology or Health Sciences

Experience Requirements

Typical Experience Range: 1–5 years as an RN; 1–3 years of direct hemodialysis or acute care nursing preferred.

Preferred:

  • 2+ years of dialysis-specific experience (outpatient hemodialysis, hospital dialysis, or home dialysis).
  • Certification(s) such as Certified Nephrology Nurse (CNN), Certified Dialysis Nurse (CDN), or CCHT familiarity is a plus.
  • Current BLS required; ACLS and IV therapy certification preferred.
  • Experience with home dialysis training (PD or home HD), CRRT/SLED in acute settings, or vascular access coordination strongly preferred.
Explore More Careers