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A perfect storm of external and internal factors has combined to worsen an already dire nursing shortage nationwide, particularly in the field of nephrology: a rapidly aging population and workforce, increased levels of burnout among nurses, and the overall impact of the Covid-19 pandemic. The situation has become a crisis for our nation’s healthcare community.
One key driver of this crisis has been payment policy that has not kept up with inflation. While the Centers for Medicare and Medicaid Services (CMS) has updated the payment rate for kidney care through End-Stage Renal Disease Prospective Payment System (ESRD PPS), the final rule’s three percent increase does not adequately solve the labor crisis facing the entire kidney care community.
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CMS could address this larger problem by adjusting the base rate to address previous inaccurate estimates in the forecast of the ESRD updates during the past several years. It is imperative that the Medicare rates recognize the dire situation to support quality care for individuals with kidney failure who require life-sustaining dialysis treatments.
But even with appropriate payment, there are also challenges in the nation’s registered nurse pipeline. A shortage of nurse educators across the country is also hampering efforts of nursing programs to recruit and retain more students. This is a major reason registered nurse (RN) programs turned away over 91,000 qualified applications last year. To get more students in the classroom—and, ultimately, more nurses in the workforce—there must be a concerted effort to support students and educators.
Congress can also help by increasing annual appropriations funding for the Title VIII Nursing Workforce Development Programs at the Health Resources and Services Administration (HRSA). This funding would help to help meet the nation’s demand for nursing services. These programs address all aspects of nursing education, practice, recruitment, and retention as well as ways to meet the needs of rural and underserved communities, where nursing care is critical to improving health.
Nurses already on the frontlines of care are too aware of the tremendous emotional strain on America’s healthcare providers generally and for our RNs in particular. Burnout across the spectrum of healthcare fields poses a very real threat to the future of the entire care system. According to one report, 54% of RNs and physicians, 60% of medical students and residents, and 61% of pharmacists all report symptoms of burnout.
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A 2021 Nephrology Nursing Journal study sought to investigate the mental health and wellbeing of nephrology nurses, specifically. Participants in the study reported high levels of burnout, anxiety, and fatigue. Without some smart policy fixes, the mass exodus from the nursing profession we are currently experiencing will only continue to intensify.
Fortunately, there is some movement in the policy sphere to address these issues. The National Academy of Medicine (NAM) recently released its National Plan for Health Workforce Well-Being. The plan calls for policy and systemic changes to drive collective action that will strengthen the well-being of the healthcare workforce and help restore the collective health of our nation. This plan addresses several priority areas that impact nephrology RNs, including:
- Supporting efforts to address mental health and erase the stigma attached to it;
- Institutionalizing well-being as a long-term value;
- Recruiting and retaining a diverse, inclusive workforce; and
- Addressing compliance, regulatory, and policy barriers that impede RNs’ ability to perform their daily work.
Perhaps most importantly, the plan advocates for maintaining positive work and learning environments that foster a climate of psychological safety, respect, and trust.
This plan is an important step in addressing the exceedingly short supply of and high demand for nephrology RNs, but it should not be where the conversation ends. While the ongoing nursing shortage is nothing new, it has been greatly exacerbated by the Covid-19 pandemic, particularly for nephrology RNs as the number of individuals requiring dialysis and kidney replacement therapy increased due to the impact of the virus.
Through education, monitoring, and assessment, nephrology RNS play a critical role in increasing and sustaining the number of individuals on home dialysis therapies. Yet, all too often, policy discussions and decisions related to nephrology RNs’ scope of practice—as well as what it will take to fill nursing vacancies in this critical field—are happening without the input of nephrology RNs. No significant kidney policy change can be successful without including nephrology RNs input at the formative stages of these conversations.
We believe there is a need to clarify the role of RNs in caring for patients with kidney disease across all nephrology settings. The fact is that RNs are required in the care of patients with kidney disease and most of the services they perform cannot be fulfilled by other licensed or unlicensed personnel.
The nephrology registered nursing workforce continues to confront today’s healthcare challenges and plan for the increased demand we will see in the future. However, this is not something we can do alone. It is critical for policymakers to work with nephology RNs to increase federal resources that will enable us to address burnout, decrease turnover rates, and build and support a stronger healthcare workforce nationwide.
Photo: ericsphotography, Getty Images
Angie Kurosaka, DNP, RN, CNN, CCM, NEA-BC, is the 2022–2023 President of the American Nephrology Nurses Association (ANNA) and Senior Vice President for Value Based Care Clinical Operations for U.S. Renal Care. ANNA is a member of Kidney Care Partners.
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