Do YOU Want to Be a Home Dialysis Training Nurse?
Have you read about how home dialysis offers people with kidney failure a greater sense of control and better physical health and emotional well-being? Have your colleagues told you how rewarding it is to work with people who take an active role in their care by doing home dialysis? Do you want to be part of the action? The ESRD Conditions for Coverage explains how you can make it happen.
First, if you're an RN and licensed in your practice state, you need at least 12 months of work experience as an RN with at least 3 months working with peritoneal and/or hemodialysis patients to independently teach patients.1 The Condition for Care at Home states that the clinic where training is provided must be Medicare certified for home training and support and must teach:
- Management of ESRD
- How to do the procedure
- What to report
- Resources and how to access them
- How to monitor and record health status
- Handling medical and non-medical emergencies
- Precautions for infection control
- Proper waste storage and disposal for that locale.2
The Condition for Patients' Rights specifies that you must give information in a way patients can understand, keeping in mind their learning style and any learning barriers.3
There's more. As a home training nurse, you must document in the patient's medical record when the patient and care partner (if applicable) finish training and demonstrate competency. And, you will have to receive and review the patient's treatment records at least every 2 months. As part of the clinic's interdisciplinary team, a home training nurse provides "support services" including:
- Monitoring the home through a first home visit and follow-up visits as needed
- Serving as the patient's "care coordinator" or working with that person
- Participating in the development, review, and revision of the plan of care
- Being available for consultation with the patient in-person at clinic visits and/or by phone, or email to meet his/her individual clinical needs
- Assuring that the home HD patient's water and dialysate quality have been tested and found to meet AAMI RD52:2004/Annex C standards
- Assuring that patients get all of the medically necessary equipment and supplies their doctor prescribes
- Identifying and arranging for back-up dialysis in medical and non-medical emergencies or when the patient or partner need respite4
Do you have the right personality type? Because home training nurses are expected to provide training and ongoing support, they often form close yet respectful professional relationships with their patients, understanding patients' right to self-determination while encouraging them to follow their treatment plan and/or honestly report why not. Home training nurses must be able to answer questions (sometimes more than once) and individualize their responses to fit with the patient's ability to understand, educating others who can help the patient as needed. They need to be inside and out-of-the box thinkers to troubleshoot common and not-so-common problems. If you meet these criteria, you may want to choose to be a home training nurse and make a world of difference in a patient's life by encouraging success in a treatment that allows a greater chance to live a full life on dialysis.
To learn more about the requirements for home dialysis, read the ESRD Interpretive Guidance on the Dialysis Survey & Certification site at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Dialysis.html.
- 42 CFR 494.140
- 42 CFR 494.140(a)
- 42 CFR 494.70(a)(2)
- 42CFR 494.140(b)