Valesca Adams, RN, was a new mother and eager to switch to a unit with regular day hours when a friend told her about an opening on the dialysis unit. Adams landed the job at Texas Children's Hospital and quickly discovered that dialysis nursing offered much more than just normal hours.

She found that the rigorous demands of dialysis treatments allowed nurses to capitalize on their greatest strengths as caregivers -- teaching and compassion.

"When I first see patients they have a lot of anxiety, because they don't know what to expect," says Adams, a certified nephrology nurse (CNN). "We do a lot of patient education, and that fear goes away when they see that they can really trust me."

Diabetes Driving Demand

With the growing nationwide diabetes epidemic, the demand for dialysis nurses should increase, says Melissa Foster, RN, CNN, a case manager with the dialysis company Fresenius Medical Care in Tennessee. Diabetes is the leading cause of kidney failure in adults, and the incidence of diabetes increased 14 percent between 2003 and 2006, according to the American Diabetes Association. Patients may also need dialysis for hypertension, genetic diseases, cancer and other conditions.

The majority of dialysis nurses care for their patients through privately owned outpatient units, but opportunities exist to provide inpatient dialysis to acutely ill hospital patients as well. In addition, nurses can specialize in educating patients to perform their own dialysis at home. While certification is not usually required, it can be helpful, according to Foster.

Before opting for the outpatient setting, Foster worked for two years providing dialysis treatments to acute patients.

"Inpatient care is exciting, because you see a lot of different things, but it is also stressful because you are dealing with very ill people," she says. "It's very emotional, and you see a lot of death. You also have the factor of being on call."

Now, as the case manager of the Right Start program at Fresenius, Foster focuses on patient education. She works with new hemodialysis patients who come in to have their blood cleaned by a machine three times a week in sessions that last more than three hours each time. She teaches the patients how dialysis works, how to take care of their catheters or fistulas, and about diet restrictions.

"This allows me to do what I do best," Foster says. "[Patients] are scared, because they don't know what is happening to them, and I offer them knowledge that will decrease their anxiety."

Home Dialysis

Elaine DeVoe, RN, CNN, also focuses on patient education, but she trains patients on how to perform dialysis at home independently. DeVoe, a nurse with Fresenius Medical Care in New Jersey, works with patients who are learning either hemodialysis or peritoneal dialysis, a treatment that uses a stomach catheter to cleanse the body of toxins.

"It is rewarding to be able to get these patients home," DeVoe says. "It gives them a more flexible schedule and increased independence."

These patients must be trained to manage a rigorous program that can range from three treatments a week for several hours each cycle up to nightly treatments of 10 hours. DeVoe teaches patients how to troubleshoot problems, how to avoid having excess fluid in their bodies, how to take vital signs and the importance of taking their prescription drugs.

Many dialysis patients go on to lead independent lives for years, thus deepening their bonds with the nurses they see regularly. Foster admits that this bond can also make it more difficult to lose the patients, but the cost is well worth the benefit she imparts to them.

"I highly encourage nurses who are looking for a job shift to consider dialysis because of the relationship factor," she says. "Patients bring a lot of issues with them, and you deal with the patient on a personal level. You treat the patient physically, mentally and sometimes spiritually."