Advanced practice nurses in nephrology

With the growing shortage of nephrologists and the increasing number of end-stage renal disease patients, collaborative practice arrangements between nephrologists and advanced practice nurses (APNs) are becoming more common. This report addresses both the credentials and scope of practice of nephrology APNs. Because the APN role in nephrology is multifaceted, role responsibilities in the nephrology office, chronic dialysis unit, and acute care setting are outlined. Nephrologists and APNs have overlapping scopes of practice, and practicing collaboratively allows each health care professional to use their strengths maximally. Barriers to practice and reimbursement issues are discussed. Documentation needed to enter into collaborative practice is delineated. This includes collaborative practice agreements, scope of practice statements, prescribing protocols, hospital credentialing, and dialysis facility credentialing. The goal of the collaborative practice model is to improve traditional patient care and delivery of services. The APN's role complements that of the nephrologist and offers a unique, holistic approach to the quality of patient care that is needed in the current health care environment.