Each year, St. Joseph’s Hospital in Atlanta awards scholarships to nurses who show exemplary performance in their specialty. In 2012, winners Kalpna Duvvuri and Lisa Waugh came from the hospital’s acute inpatient dialysis unit.
Dr. Gregory Knowlton, chairman of nephrology at St. Joseph’s Hospital, was not surprised. Although it’s small, the unit is indispensable and impressive, he said.
“Dialysis nurses see some of the sickest patients in the hospital, and they must constantly learn new things,” Knowlton said. “Not only does the technology keep changing, but they must blend that knowledge with knowing how to care for patients who have heart conditions or who are undergoing chemotherapy or have other conditions. I believe we have some of the most elite dialysis nurses in the country.”
Knowlton credits the hospital’s four-time Magnet designation, with its shared-governance model, for developing expert nurses like Duvvuri and Waugh.
“Our nurses are responsibility junkies and leaders,” he said. “If they see a problem, they fix it. When you’re sick, you want one of these nurses taking care of you.”
The Seymour P. Weinberg Memorial Scholarships come with $2,000 for each recipient to use for professional development. The nurses were cited for their clinical ability, leadership and for instituting new processes to improve patient care.
Duvvuri, RN, BSN, CDN, is an assistant nurse manager who has spent 15 years at St. Joseph’s and 18 years in dialysis. She describes her eight to 10 nurses as a close-knit team.
“We depend on each other, and we encourage everyone to be certified. We use the Magnet Synergy Model to achieve positive outcomes,” Duvurri said. “These are complicated patients, so we match the nursing expertise to the patient. Some nurses speak foreign languages, some have ICU backgrounds, and others are terrific at educating and comforting new dialysis patients.”
After graduating from nursing school, Duvvuri’s first patient required dialysis.
“Kidney disease affects all the organs, and his problems were complicated. I just wanted to help him physically and emotionally,” she said. “Since all of our patients are different, the treatments we give are customized. We look at the labs, assess the patient and work with the doctor to design a plan. If the patient is in ICU, we go to them.”
Duvvuri likes the autonomy, challenge and time she gets to spend with her patients. “The process takes three to four hours, so just sitting with them and answering their questions or calming their fears makes a huge difference.”
Nephrology nursing is a growing field because of the increase in kidney disease.
“I’ve been doing this long enough that I’m comfortable with patients and confident that I’m giving compassionate care, but we’re guided by evidence-based practice,” she said.
At Duvvuri’s suggestion, the department recently switched from heparin to saline for flushing catheters, knowing it would be safer for patients.
Reducing bloodstream infection
Waugh, BSN, CDN, said it was a proud moment for the unit to be recognized at an awards ceremony for the scholarships.
“We often feel like an island unto ourselves, but these awards told people that we are doing new things, being innovative and changing patient outcomes,” she said.
When she was younger, Waugh wanted to work in labor and delivery. But after spending six weeks with a nephrology preceptor, she fell in love with the specialty and has been a dialysis nurse at St. Joseph’s for 17 years.
“It’s one of the most challenging nursing fields because we deal with the sickest of the sick, and it’s always changing,” she said.
Waugh can remember when the field wasn’t such an exact science and nurses had to manipulate the early dialysis machine. “It was harder on the patient and they were often unstable.”
Over the years, the machines and processes have improved and patients suffer fewer side effects such as nausea or chills. They also live longer.
“When I started, someone on dialysis lived about five years. Now we are seeing patients live 30 years and I believe they are more comfortable,” Waugh said.
That’s due, in part, to expert nurses who can anticipate and prevent problems in various patients.
“Spending time with patients and learning their needs is big-picture nursing,” she said. “When patients go on dialysis, they’ll need treatment three times a week for the rest of their lives. Part of our job is to help them deal with the clinical, emotional, personal and economic factors involved with that diagnosis.”
Waugh is also proud of her work to reduce bloodstream infections in patients who have a dialysis catheter. Citing new evidence-based research, she advocated using an antibiotic ointment at the site of dressing changes.
“A lot of hospitals had cut this intervention out but I proposed it to our infection control and nephrology departments, and we started doing it in September 2011. Since then, we’ve had no infections in any of our dialysis patients with catheters,” she said.
Waugh has since enrolled in an acute care nurse practitioner program at Emory University and works in St. Joseph’s emergency department to broaden her experience.
“With nurses playing a bigger role than ever in health care, it seemed like a good time to get my NP degree,” she said. “But my goal is to use my specialty knowledge either in an ICU or working for a nephrologist. I love this specialty and look forward to bringing new knowledge back to my patients.”
