Getting Creative to Address the Nursing Shortage in the Dialysis Unit

Dr. Sahar Fathallah-Shaykh is a pediatric nephrologist at Children’s of Alabama.

The pandemic hit the dialysis unit at Children’s of Alabama with a double whammy: increased census and staff shortages—particularly among nurses. “Similar to many other centers, we are searching for additional outstanding nurses” Children’s nephrologist Sahar Fathallah-Shaykh, M.D., said. Despite this deficit, the dialysis team is finding creative ways to give patients the attention they need while still prioritizing work-life balance for nurses.

Because of the nature of dialysis patients’ needs, it’s tough for the dialysis unit to compensate for staffing issues by limiting patient access. “We provide life-saving care, and patients have to get dialysis,” Fathallah-Shaykh said. “Otherwise, they cannot survive.” Children’s is also home to the only pediatric dialysis unit in the state. “The dialysis unit is not just a machine,” Fathallah-Shaykh said. “It’s not just a physician or just a nurse. It’s all of us working together. And if one is understaffed, that affects the whole dialysis unit.”

In addition, the unit provides dialysis to a significant number of infants and toddlers. While most dialysis patients wait about a year on average for a transplant, Fathallah-Shaykh says little infants or toddlers may have to wait until they’re big enough to be able to successfully receive a transplant. This can require them to be on dialysis longer.

Those patients also require dialysis four to five days a week, with one nurse assigned to a patient for three to four hours. “We have to be very careful to pay attention to details so we can do a good job,” Fathallah-Shaykh said.

The team has been working closely with the administration at Children’s to come up with alternatives. “It starts with recruiting more nurses and retaining nurses in their jobs,” Fathallah-Shaykh said. They also get help from nurses from other service areas, such as the intensive care unit, although they need significant training. “But they have some dialysis experience and have been a good help to us,” she said.

The team has also hired traveling nurses, but their availability is limited because they are in high demand nationwide. In some cases, physicians have stepped in to cover night calls. A newly hired nurse practitioner is also taking some of the pressure off and standardizing care.

For the long term, however, the unit is identifying ways to improve nurses’ work-life balance—the lack of which is one of the main reasons some healthcare professionals are changing careers. For example, dialysis nurses must be on-call at night for patients who require acute dialysis, so one change is to assign nurses to cover either acute dialysis on nights and weekends or chronic dialysis during the week to reduce the amount of on-call time overall. “We feel that dividing the acute dialysis from the chronic dialysis may help with a work-life balance and recruitment,” Fathallah-Shaykh said.

“We are very grateful for the nurses for everything they do,” she said. “Without them, these kids would not survive.”

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