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Thomas-Hawkins, Livaudais, and Belmonte do not report any relevant financial disclosures.
Tina Livaudais, RN, BSN, MBA,A great story about how she got involved in kidney care.
In 1995, she began her career as a patient-care technician at DaVita Kidney Care. She was named chief nursing officer in September 2021. The company has more than 200,000 clients.
“I always share details about my personal DaVita journey with current and potential nurses,” Livaudais, who lives in New Orleans, told Nephrology News & Issues. “I want each of them to know they can achieve the same level of career fulfillment,” she said.
Nursing workforce
Livaudais, head of a more than 18,000 nursing force, is concerned about finding new nurses.
- According to an analysis published in, more than 100,000 U.S. nurses will leave the workforce in 2021. This was mainly driven by nurses under 35 who are leaving hospital-based jobs. Health Affairs. According to the study, the nursing workforce experienced a 1.8% decrease between 2019 and 2021. This is the largest decline in four decades.
- The U.S. Bureau of Labor Statistics predicts that more than 275,000 more nurses will be required to provide patient care in the United States between 2020 and 2030.
- According to the 2020 National Council of State Boards of Nursing, the median age of registered nurses was 52 years. Over one-fifth of respondents indicated they intended to retire from the nursing profession in the next five years. This is according to the National Forum of State Nursing Workforce Centers’ national survey of the U.S. nurse workforce. The survey revealed that the trend was accelerated by the pandemic.
- A shortage of nurses educators means that many young people are unable to find schools that will accept them. According to the American Association of Colleges for Nursing, 80,407 qualified applicants from U.S. nursing schools were turned away by their programs in 2019 due insufficient faculty, clinical sites, classroom spaces, clinical preceptors, and budget constraints.
Shortage prior COVID-19
Walz and KearThe nursing shortage started long before stress and high patient mortality from COVID-19 made nephrology nurses consider whether it was time for them to leave the profession.
Kathleen Belmonte MS, RN-CS MBAFresenius Medical Care North America chief nursing officer, agreed.
“ … Pre-COVID-19, there was already a serious concern as to whether the profession was going to be able to attract enough nurses to care for populations, and that also includes the [end-stage renal disease]ESRD population [chronic kidney disease] CKD population, moving into the future,” Belmonte said in a podcast earlier this year. “ … [W]When we ask nurses how they feel, what they have experienced, they tell me that they feel stressed, tired, and burned out. And of course, when we hear our nurses telling us that they are burnt out, we are worried that a consequence of that may be nurses choosing to leave the field, leave the profession.”
Added Livaudais, “The larger health care community has been battling a critical shortage of clinicians for almost a decade which was exacerbated by COVID-19. Prior to 2020, the main concern had been replacing retiring talent. However, the pandemic drew attention to a shrinking workforce and forced it to work harder than ever. Inevitably, many nurses experienced burnout, and some left the field entirely.”
Sources say there is no quick solution to the shortage.
“The solutions are just hard,” Charlotte Thomas-Hawkins PhD, RN FAAN Associate dean of nursing sciences, associate professor, and director of Center for Healthcare Quality in Rutgers University School of Nursing. Nephrology News & Issues. “The research I did in nephrology … showed that dialysis units that have low RN staffing, as measured by patient-to-RN ratios, was predictive of negative nurse outcomes like burnout and intent to leave,” Thomas-Hawkins said. “The intent of nephrology nurses to leave their job is higher when they work in a unit that have persistently low RN staffing.
Charlotte Thomas-Hawkins PhD, RN FAANAssociate dean and associate professor of Nursing Science and Director of the Center for Health Services Research and Policy at Rutgers University School of Nursing said that new opportunities to redefine nursing could ease the shortage. Source: Rutgers University Department of Communications
“That isn’t a new finding,” Thomas-Hawkins said. “We know that is true in hospitals and other settings.”
Thomas-Hawkins stated it is clear that outcomes are better in dialysis units if RN staffing is higher.
“That was the problem with the COVID-19 pandemic,” Thomas-Hawkins said. “It exacerbated already existing problems with low RN staffing and a stressful work environment.”
Young nurses
Researchers acknowledge that nurses are having second thoughts about their job after the COVID-19 epidemic. Surprisingly, most of those who leave the nursing profession are not at retirement age. In the Health Affairs paper, entitled “A worrisome drop in the number of young nurses,” David I. Auerbach, MS, PhD, and colleagues found younger nurses – not an older generation that was retiring – were the source of the exodus from the profession.
“Just before the pandemic, the total workforce size decreased 1.8 [%]Through 2021, which was made up of a 4[%]Reduction in the number of RNs below 35 years of age, a 0.5[%]Reduced number of RNs from 35 to 49 [years], and 1[%]Reduced number of RNs who are older than 50 [years],” they wrote.
This will hinder growth in the profession as nurses tend to stay in the workforce for the long-term.
“A sustained reduction in the number of younger age RNs would raise ominous implications for the future workforce. Because RNs typically remain working in nursing over their career, a reduction of younger RNs in the workforce would exert an impact that is felt over a generation, in contrast to a modest reduction in long-run RN supply due to early retirement of the baby boomer RNs working into their 60s and 70s,” they wrote.
Favorable news
There are some positive developments for dialysis professionals looking for nurses. According to data released by AACN April 5, student enrollment in entry level baccalaureate nursing programmes increased by 3.3% by 2021, according to the AACN.
Belmonte collaborates with FMCNA in order to increase interest and enthusiasm for nephrology. This program recruits graduate nurses from colleges across the country. It involves a 12- to fifteen-month residency.
“Growing our own nursing talent gives us the opportunity to not only fill vacant nursing positions but also to mold novice nurses into future leaders within the organization,” Belmonte told Nephrology News & Issues. “Residents are supported holistically with a nurse mentor and the support of their cohort and leaders in the program. We are also expanding the scope of this program to include home therapies.
“It is a fantastic way to expose new graduates to nephrology nursing.”
Thomas-Hawkins sees the increased interest in nursing as an opportunity for nurses to explore other options. “I think there is a lot of opportunity in the area of chronic kidney disease for advanced practice nursing,” she told Nephrology News & Issues. “The new kidney care payment models and interest in value-based care “may help us redefine the nursing role.”
Livaudais answered a question about the future nursing in kidney care. She said that dialysis providers recognize the importance of nurses being appreciated and kept healthy.
“… [W]e are increasing wages, expanding training opportunities, which is vital when education opportunities are somewhat limited, building greater support for nurse well-being and new technology innovations to help drive recruitment efforts,” Livaudais said.
“Although the shortage won’t be solved overnight, we’re getting closer to identifying what nurses truly need and deserve.”
- For more information, please visit:
- Kathleen Belmonte MS, RN-CS MBAYou can reach us at [email protected].
- Tina Livaudais, RN, BSN, MBA,You can reach us at [email protected].
- Charlotte Thomas-Hawkins PhD, RN FAANYou can reach us at [email protected].
