2023-05-23 14:30:52
One has been a dialysis nurse specialist for 10 years, the other is almost finished with her training. But both Anita de Vette (49) and Nomi Schreuder (31) are proud of their young profession.
After this interview, Anita de Vette will go to the National Career Fair to tell students about her work. There is no shortage of enthusiasm: she always wanted to become a nurse. “But when I had obtained my nursing A diploma, my wrist started to bother me. In the dialysis department my wrist was put under the least strain. Above all, the atmosphere was great: there were many patients from the Amsterdam Jordaan. That was of course laughter.”
Nomi Schreuder – just a few days back from the United States, where she did an internship – also quickly knew that nephrology was her heart. “When I unexpectedly ended up in hospital during my gap year, a nurse supported me at a frightening moment and helped me through it. I thought: I want to do this for others as well. What appeals to me in nephrology? The complexity. You have to be able to solve puzzles when someone is disrupted.”
Step extra
But both nurses wanted to be able to do more for patients. “When the profession of nurse specialist was on the rise, the two-year HBO master’s program seemed to me to be an excellent opportunity for more depth,” says De Vette. “You continue to do nursing work, but you get a piece of the medical domain.” Schreuder: “After I returned from traveling and working in Australia and Indonesia, I hoped to be able to work in nephrology again. Exactly then a vacancy became available for a position as a nurse in training to become a dialysis specialist in the Noordwest Hospital Group. I have been following the course since September 2021 and am almost done.”
pioneers
The fulfillment of the function is sometimes still pioneering work, De Vette and Schreuder brands. “I am the first nurse specialist in the hemodialysis department,” laughs Schreuder. “For the time being, I am mainly the first point of contact for patients and dialysis nurses. I also make visits: during the day we see about 80 patients a week in four shifts. Initially I did the visit together with the nephrologist, now independently with supervision.” Her duties partly overlap with De Vette’s activities. “I also do visits for the 130 chronic dialysis patients we see during the day. In this I rotate with the nephrologist; the variety keeps us sharp on each other.”
Acute and transplant care
But in the 10 years that De Vette has been working as a nurse specialist, her responsibilities have increased considerably. “I also receive acute patients, and sometimes the ambulance takes a stuffy patient directly to the ward. I also prescribe a lot more resources than when I first started. You grow in the process. I also teach nurses and supervise doctors in training to become specialists. Finally, I prepare the trajectory of people who receive a kidney transplant. I also consult with the Amsterdam UMC – where the transplants take place – about patients about which we have doubts.”
Low-threshold contact
In addition to their own tasks, an important part of the work consists of coordinating and working together. They both chair the multidisciplinary consultation. Schreuder: “I also chair the morning transfer. I am also the first point of contact for the family and I am trained to assess patients with an imminent acute dialysis indication.” De Vette adds: “In addition, we have a lot of low-threshold contact with the primary care: the general practitioner, home care and nursing home, but also the dietician, social work and sometimes other medical specialists. We really are the link between the nursing and medical domains.”
To trust
Of course there are limits to what the nurse specialist can do. “We take over tasks from the nephrologist, but we are mainly an addition. We do it together,” says De Vette. “If I see an abnormal blood count in another specialist field in a patient about which I have doubts, I may have a suspicion, but I will ask the nephrologist about it.” Schreuder: “I agree with that, with the addition that a successful collaboration is based on trust. It is important that the nephrologist trusts us to act within our authority and competence. And vice versa that we know our blind spots and can turn to the specialist in case of doubt or questions.”
Explanation
The collaboration with the nephrologists runs smoothly. De Vette: “But when I just started, I sometimes got a doctor from outside the department on the phone who said: I don’t do business with you. It was also difficult in the beginning to manage nurses who trained me. Now I have to explain our professional title sometimes. We are not specialized nurses, but nurse specialists with prescribing authority. After all, we follow refresher courses with the specialist together. But at the same time, we are not residents or medical specialists with a broad medical background, but nursing specialists with medical knowledge of a defined area.”
Complete picture
That is the unique added value of the nurse specialist, think Schreuder and De Vette. “The trick is to keep taking your nursing heart into your work,” says De Vette. “Because we can make a little more time for conversations and know more about someone’s background, we often see the complete picture. This is useful, for example, during a discussion about advanced care planning. Then we not only look at whether dialysis is still useful from a medical point of view, but also what fits with what someone still wants. For example, we notice that more people are opting for conservative treatment, now that the Home Kidney Team provides information to patients and their network about renal replacement treatments and forms of home dialysis from social work.”
stable factor
How do nurse specialists see the future? “Research shows that the use of a nurse specialist does indeed lead to more care for the same money and that we also contribute to further improvement of the quality of care,” says Anita de Vette proudly. Doctors can focus more on providing more complex care, while we are a stable factor in the department in these times of shortages.”
Strengthen further
However, there are still quality improvements to be made, notes Nomi Schreuder. “It is great that nurses now have the opportunity to grow in their position and specialism. That may result in less outflow. There are also many opportunities in the field of scientific nursing research in which we can play a role. In addition, many nurse specialists are still searching for their role. That is why Anita and I, together with a few colleagues, form the recently established board of nurse specialists in nephrology (VSN), a network within V&VN. By joining forces, we can learn from each other, exchange examples and further strengthen our profession.”
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