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Podcast: Retaining Nephrology Nurses

According to Mandy Hale, vice president of nursing for DaVita, “It’s really important for us as dialysis organizations to be very innovative and very laser focused on retaining our nurses, engaging them and attracting more nurses to the field of dialysis and nephrology.” Listen to this podcast, in which Christy Diehl, senior director in People Services for DaVita, interviews Mandy on why it is important to retain nephrology nurses. They also discuss how to retain these nurses and attract new ones through different types of support and training specific to nephrology.

Podcast Transcript:

Christy Diehl: 00:30 Hi, this is Christy Diehl and I am a senior director in People Services. Thanks for joining us today. I have the privilege of being joined by Mandy Hale, our VP of nursing, and I will pass it to her to share a little bit more about herself.

Mandy Hale: 00:45 Well, thank you, Christy. Hi, I am Mandy Hale and as Christy said, I’m really privileged to serve in the role as vice president of nursing here at DaVita. I have actually had an exciting career both in health care and nephrology and at DaVita over the past about 19 years to be real specific. I actually joined DaVita as a patient care technician many years ago while I was in nursing school. And since that time, I have worked as a nurse and charge nurse, a clinical coordinator where I managed patient outcomes for my dialysis facility. And I’ve had the opportunity to work in several different operational roles as well. During this time, I’ve also been able to not only work in our in-center hemodialysis facilities, but also work in the hospital setting where we provide dialysis treatments as well. So that’s a little bit about me and my background.

Christy Diehl: 01:44 Thanks, Mandy. So today we’re going to talk a little bit more about how to retain new nephrology nurses, and as someone who’s been a nephrology nurse for almost 20 years, we’ll start with just what’s your perspective on why this matters?

Mandy Hale: 02:02 Well, Christy, I’ll let you know we’re kind of in a perfect storm really of what could turn out to be a pretty significant nursing shortage. And that’s because there’s a high percentage of upcoming nurse retirement as the baby boomer generation starts to see more and more retirement. Simultaneously, we also have an increasing volume of Americans who will need and utilize health care services. And during this time, health care organizations here in the U.S. are experiencing poor retention of the nurses who they employ. So all of these things together are going to present some challenges for us in the health care system and actually already are in many places. And it’s important to note that for us, the dialysis setting is not going to be immune to this nursing shortage and the talent as presented. So it’s really important for us as dialysis organizations to be very innovative and very laser focused on retaining our nurses, engaging them and attracting more nurses to the field of dialysis and nephrology.

Mandy Hale: 03:15 I think more importantly or as importantly at least is this importance of patient care and the continuity in that care that occurs when nurses remain with their employers and for us in dialysis for a long period of time. There’s just a whole bunch of nursing knowledge and ability to provide really high quality care that comes along with nurse retention and so for our patients being cared for by an experienced nurse is really important.

Christy Diehl: 03:56 Yeah. You know, thanks, Mandy. One thing you mentioned really was just the broad challenge facing the health care industry with the increasing nursing shortage and that the dialysis setting won’t be immune. So digging in a little bit more, what is the breadth of this issue specifically for those in the dialysis setting?

Mandy Hale: 04:19 Sure. Well it is pretty significant. There’s almost half a million individuals in the U.S. who have end stage renal disease and received life sustaining care such as dialysis treatment.

Mandy Hale: 04:33 There’s actually over 6,000 dialysis facilities in the United States and this population of Americans who have end stage renal disease and do require dialysis, it’s projected to continually increase. So the patients that are impacted, these patients who are receiving dialysis treatment, really require the care of trained and competent nurses.

Christy Diehl: 04:58 So do nephrology nurses require additional training compared to those in other specialties or industries?

Mandy Hale: 05:06 The answer to that is yes. So the Centers for Medicare and Medicaid Services, which we often just abbreviate as CMS, require that nurses must have at least one year of registered nursing experience before they can staff in dialysis facilities without another nurse present. So we call that staffing independently. Once the nurse has obtained this one year of nursing experience, the nurse can work in a dialysis facility without the need for a more experienced nurse to be present alongside him or her. And during this one year period, a lot of training and things like that occur and the nurses can provide care. But again, in order to have that ability to practice independently, that does take an extra year.

Christy Diehl: 05:53 Great. You’ve obviously touched on the importance of retaining these nurses and that they take an extra training, right, especially within nephrology. And so for nurses who are new to nephrology, what are they searching for and how do we support them?

Mandy Hale: 06:12 Well, nurses new to nephrology have clearly established wants and needs, I believe. They desire things like additional support as they transition from learning and training about how to give dialysis care as they make that transition into practice. They also seek healthy and supportive professional environments. And additionally, they benefit from good preceptors who provide opportunities for clinical experience for them and they really rely on these preceptors or for trainers who are providing them with the education to perform their skills and deliver care.

Mandy Hale: 06:50 I personally believe that good preceptors are critical to help not only teach skills but really instill faith and hope in our new nurses here in the world of nephrology. Just in general, nurses will remain in positions where they experience rewards and recognition for their work. So I really feel that is a critical piece of support as well. And then it’s important to allow nurses, once they start to gain experience, allow them to practice with a lot of autonomy and provide all sorts of opportunities for career mobility and those sorts of things. However, everything starts with that nurturing care and training as our nurses kind of move from new or not as a dialysis nurses into independent practitioners.

Christy Diehl: 07:43 Thanks, Mandy. You highlighted a lot of key transitions and steps that are important and as someone who has personally probably gone through a lot of those in your professional nursing career, how can all of those wants and needs be combined into a program to support new nurses?

Mandy Hale: 08:05 Yeah, that’s a great question and as I’ve identified the transition from being a new nurse and not even new to nursing practice, but being new to nephrology, even, can be challenging. However, an effective foundation can be built to help our nurses in the world of dialysis and nephrology continually be able to advance their professional practice. And to me, pulling us all together with like very effective nurse development programs that are based on nursing framework and has historically demonstrated the ability to pull all of these critical elements together.

Mandy Hale: 09:00 I believe the position of nephrology care is continually increasing in complexity, so initial education and ongoing education for our nurses is really imperative to provide optimal patient care. So not only having an initial training program but also a clearly laid out plan for ongoing education as well.

Christy Diehl: 09:23 Great. What specific elements of nursing are imperative for nurses who are new to nephrology to be extensively trained on?

Mandy Hale: 09:33 Well, Christy, I’m glad you asked that question and the answer is not a brief one. There are quite a few just absolute imperative pieces of knowledge and expertise for nurses to obtain through training. So really nurses have to learn a lot of skills that are particular to nephrology and dialysis. These include things like really understanding the dialysis vascular accesses or the peritoneal dialysis access for home modalities. And we refer to these as a patient’s lifeline. So having this a very detailed understanding and be able to carefully provide care for our patients access is critical. Nurses has to be very well trained on patient safety and quality and also assessments and critical thinking skills so they can pull all the pieces of a puzzle together for a patient and really put together just a high quality plan of care.

Mandy Hale: 10:34 Also in nephrology, nurses have to be trained on and very skilled in interprofessional collaboration including physician relationships, dialysis facilities teams are just that they find their team. So nurses will work alongside of other nurses, patient care technicians, social workers, besides physicians assistants, et cetera. And each of those roles is very critical to the overall care delivery for patients. And so that type of collaboration and team building capabilities is really important.

Mandy Hale: 11:05 Also, our nurses are really the leader of the dialysis team and the floor that they’re running. So they have to be skilled in leading teams in conflict resolution and all of the things that go along with that. Additionally, I would say that our nurses really have to kind of understand the overall field of nephrology, not just the particular piece of dialysis that they’re working in because patient’s are going to really kind of move around to different and kind of the different pieces of care. For instance, for patients and for the dialysis facility, they’ve been under the care of a nephrologist most likely for chronic kidney disease. They may have been in a home modality or have had a transplant or be headed to one of those places. So our nurses really have to be well rounded in overall nephrology knowledge.

Christy Diehl: 11:58 Wow. You know that’s quite a list. I’m sure we could go and spend a lot more time on each of those and even build it out further. I’m curious, in addition to clinical training and what you kind of talked through, what else is critical in supporting new nephrology nurses?

Mandy Hale: 12:17 Well in DaVita, I think we kind of summed that up with one sentence and to me it is, be the kind of nurse you want to work with. So it’s really important that not only do we provide our nurses with the clinical knowledge and expertise when they’re new to us to be able to provide care to patients. But also, it’s important to me that we teach and support our nurses in caring for one another, also. There’s a lot of research that shows that nurses who are more satisfied and happier and work more collaboratively with other nurses provide better care. And so for me, I really consider that a twofer. If our nurses are kind to one another and care for one another and their entire care team, not even just limiting that to nursing, then we provide better care for our patients and everybody wins.

Christy Diehl: 13:07 Wow. Well, Mandy, I want to thank you for all of your insights on this very important topic. DaVita is lucky to have you leading the charge and supporting all of their new nephrology nurses as well as nurses in other care side staff moving forward. So thank you for all of the insights and your time today.

Mandy Hale: 13:35 Thank you as well! It was a pleasure to speak with you, Christy.

Amanda “Mandy” Hale, DNP, MSN, MBA, RN, CNN

Amanda “Mandy” Hale, DNP, MSN, MBA, RN, CNN

Mandy Hale, DNP, MSN, RN, chief nursing officer for DaVita, leads the nursing strategy at DaVita Kidney Care. She started with DaVita in 2001 as a patient care technician while completing nursing school, and after graduation, served as clinical coordinator, then facility administrator and then regional operations director. These responsibilities included all modalities and both chronic and acute dialysis. She has served as chairwoman of the Nurses & Technician Council for the National Kidney Foundation of Illinois and is currently on the board of directors. Mandy has delivered multiple clinical and operational presentations to groups in the kidney care industry. Mandy holds an associate’s in nursing degree from Kishwaukee College in Malta, Illinois, and a bachelor of science in nursing and a master of science in nursing degree from Lewis University in Romeoville, Illinois. Additionally, she earned her MBA from Lewis University. She obtained her doctorate of nursing practice degree from Bradley University in Peoria, Illinois and currently serves and adjunct faculty for the University.

Christy Diehl, MBA

Christy Diehl, MBA

Christy Diehl started at DaVita in 2011 and has held a variety in roles in operations, strategy, program management and technology development. As the senior director of the strategic programs team in People Services, she currently leads a team responsible for overseeing a portfolio of strategic initiatives focused on improving the overall experience, development, growth and retention of patient care technicians and nurses at DaVita. She has deep expertise in strategic decision making and planning, deploying and managing large scale operational improvements and projects. She holds a Bachelor of Science in Engineering from the University of Colorado and an MBA from UCLA Anderson School of Management. She has worked in a variety of industries including healthcare, technology and aerospace and defense.