Advanced practice nurses in ESRD: varied roles and a cost analysis.

Area of Science:

• Nephrology
• Healthcare Management
• Nursing Practice

Background:

• Projected nephrologist shortages necessitate exploring physician extender roles in end-stage renal disease (ESRD) care.
• The integration of advanced practice nurses (APNs) within case management models for ESRD patients in dialysis and transplant settings is not well-established.
• The cost-effectiveness of APNs in dialysis units remains largely unexplored.

Purpose of the Study:

• To describe the roles and experiences of APNs in ESRD dialysis and transplant programs.
• To evaluate the cost-effectiveness of employing APNs in chronic dialysis units.
• To highlight the adaptability of the case management model with APN integration for ESRD care.

Main Methods:

• A descriptive report of APN roles in outpatient and inpatient ESRD settings.
• A time log survey of dialysis APNs to document job responsibilities.
• A cost analysis of employing nurse practitioners in dialysis programs.

Main Results:

• APNs demonstrated varied roles across outpatient and inpatient settings within ESRD programs.
• A time log survey indicated that 93% of dialysis APNs' time is dedicated to direct patient care.
• Cost analysis suggested that employing a nurse practitioner is cost-effective for dialysis programs with 85 or more chronic dialysis patients.

Conclusions:

• APNs can be flexibly incorporated into the case management model for ESRD patients.
• The employment of APNs in dialysis units is cost-effective under specific patient volume conditions.
• Further research is required to fully understand the impact of APNs in ESRD programs.