Nurse Specialty Spotlight: Urology and Nephrology Nursing

Caring for, educating, and guiding vulnerable patients

“Nephrology nursing is my field and my passion,” says 40-year nephrology nurse veteran Celeste Jindra, RN, CNN. Jindra works within Cleveland Clinic’s Glickman Urological and Kidney Institute on the 9th floor of the Q Building at Cleveland Clinic main campus, where she specializes in infusions for kidney transplant patients, and more.

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Retiring this month, Jindra began her tenured nephrology nursing career working with dialysis patients. She then moved to the outpatient nephrology setting, where she cared for chronic kidney disease and hypertension patients. That position evolved to the infusion position she holds today caring for patients who are getting ready to start dialysis by giving infusions and monitoring anemia of chronic kidney disease, as well as patients who have been on dialysis and need ‘induction therapy,’ an anti-rejection IV medication given to patients following a kidney transplant. Jindra says she also often assists her colleagues in the urology recovery area, helping to discharge patients who have had kidney biopsies or other procedures.

Looking back on her nephrology nursing career, Jindra says what she will miss most about her work is her patients. She comments: “I know a lot about how kidney disease works, what signs to look for, how to maintain anemia, and more, but I love my patients and they are what I am going to miss most in retirement.”

A career with a variety of patient care options

Jindra says there are currently four nurses on her nephrology infusion team – and together, they provide roughly 12-15 infusions and injections per day. Jindra’s team is one of many nephrology/urology nursing teams at main campus. There are also gastrointestinal teams, intensive care teams, surgical teams, pre- and post-operative teams, research teams, other outpatient clinic teams, and more.

One of Jindra’s urology colleagues, Alfreda LaVette, RN, works in the hospital outpatient procedure specialty area, which is where outpatient kidney and prostate biopsies are performed, as well as procedures such as cystoscopies, placement/removal of dialysis catheters, and more. LaVette’s team includes a combination of approximately 10 nurses and medical assistants. LaVette has been in her position for 2 years, although she has 12 years of additional inpatient nursing experience at Cleveland Clinic.

“Outpatient urology is so different than inpatient settings,” LaVette says. “You still provide the same patient care, safety and quality, it’s just a different opportunity seeing and caring for patients who are not as emergently sick. It presents another side of patient/caregiver interaction as you can talk to them and get input from them on what they need and what their concerns are. I love doing special procedures.”

Helping patients through health hardships

LaVette says the specialty procedures area also runs a lot of patient diagnostic testing, which unfortunately, can return less than favorable results for patients so many of the patients she sees are nervous or scared.

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“As a nurse in this specialty, you play an important role in a big part of your patient’s life that is uncertain or unstable, so you focus a lot on helping people get through a rough patch,” she adds. “Urology nurses really need to be compassionate and empathetic, taking their time to de-escalate situations and keep patients well-informed. It’s a whole other side of nursing and it is extremely rewarding and very satisfying – your patients keep you going.”

Jindra agrees. She says what’s so unique to the nephrology specialty is providing patients with critical education and guiding them through all the stages of their disease – whether they are undergoing a transplant, recovery from a transplant, having another surgery, getting dialysis, or something else.

“Throughout my career, I’ve seen a lot of return patients and a lot of those at one time were very sick, but over the years I’ve witnessed them get better and that is just wonderful. To me, it’s really exciting to go through this journey with them, cheering them on and giving them the guidance and support they need,” she notes.

In one example, Jindra shared the story of a woman who is now 37 years old, but first became a patient of hers 17 years ago. She said when the patient first came to Cleveland Clinic, she required a kidney transplant, but unfortunately, experienced complications and ended up in the ICU for 8 weeks unable to walk or talk. Thankfully, the patient received a second transplant and is now doing very well.

“You see patients at their most vulnerable and all of it can be really overwhelming so as a nurse, being there for them is what it’s all about,” Jindra says.

Additionally, both Jindra and LaVette agree that to deliver urology and nephrology patients the best possible outcomes, collaboration and communication with the entire care team, especially physician partners, is pertinent. Both note that within their departments, there is a lot of multidisciplinary teamwork – from offering advice or asking questions to staying in constant communication.

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“We have a lot of teamwork and dedication here,” says LaVette. “We work together with the surgeons who are doing the procedures, we make sure we know what instruments they like and what techniques they use, and we are always communicating regarding patient scheduling, plans for recovery needs, and more.”

Becoming a urology or nephrology nurse

Jindra also serves as a preceptor for nursing students interested in learning more about the nephrology nursing specialty, which she says is inspiring.

To become a nephrology nurse, you must be a licensed practical nurse (LPN) or a registered nurse (RN) with an associate’s degree or a bachelor’s degree in nursing. Each license has a different scope of practice and education requirements must be met, as well as passing a board exam. Additionally, there are two designated certifications recognized by the Nephrology Nursing Certification Commission, including a certified dialysis nurse (CDN) and a certified nephrology nurse (CNN).

Urology nurses hold a registered nurse license, and a bachelor’s degree in nursing is highly preferred. Certification, while not required, is offered by the Certification Board for Urologic Nurses.

Happy Year of the Nurse to all nephrology and urology nurses!