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The Home Dialysis Registered Nurse (RN) is responsible for providing comprehensive, patient-centered care to individuals performing home hemodialysis (HHD) and/or peritoneal dialysis (PD). The Home Dialysis RN conducts detailed assessments, develops individualized care plans, trains patients and caregivers, and ensures safe, effective, and compliant home dialysis care in accordance with CMS Conditions for Coverage (42 CFR 494), Joint Commission standards, and organizational policies.

The Home Dialysis RN functions as a key member of the interdisciplinary dialysis team, coordinating care, monitoring patient outcomes, and supporting patients in becoming confident, independent home dialysis operators. The role includes participation in quality improvement initiatives and taking on-call responsibilities to support after-hours patient needs.

A. Clinical Assessment & Monitoring

+ Completes comprehensive nursing assessments per CMS timeframes: initial (30 days/13 treatments), monthly, quarterly, annual, and upon changes in condition.

+ Evaluates patient physical, psychosocial, cognitive, environmental, and functional readiness for home dialysis.

+ Provides monthly face-to-face evaluations of all home dialysis patients as required by CMS.

+ Monitors home treatment logs, laboratory values, treatment adherence, vital signs, and access status, ensuring abnormalities are addressed promptly.

+ Performs direct clinical care as needed, including HHD or PD procedures in the clinic setting.

B. Care Planning & Interdisciplinary Coordination

+ Collaborates with the interdisciplinary team (IDT) to develop and update individualized plans of care in compliance with CMS §494.90.

+ Evaluates patient progress toward care plan goals and modifies care strategies accordingly.

+ Participates in required IDT meetings and communicates patient needs to the nephrologist and care team.

C. Home Dialysis Training & Competency Evaluation

+ Develops individualized HHD or PD training plans for patients and caregivers based on clinical needs, learning styles, and home environment considerations.

+ Provides comprehensive training on:

+ Treatment setup and termination

+ Equipment operation and troubleshooting

+ Infection prevention and aseptic technique

+ Emergency procedures

+ Access care and complication management

+ Documents all training hours, skills check-offs, and competency validations in accordance with CMS V-tag requirements.

+ Conducts home environment assessments and home visits as required to promote safe treatment practices.

D. On-Call Responsibilities & Emergency Preparedness

+ Takes call on a rotating basis to provide after-hours clinical support, troubleshooting, and emergency guidance to home patients.

+ Educates patients on emergency preparedness topics required by CMS §494.62, including power outages, access complications, equipment issues, and natural disasters.

E. Quality Improvement, Safety & Compliance

+ Ensures all documentation is timely, accurate, and compliant with CMS, Joint Commission, and organizational standards.

+ Participates in the facility Quality Assurance and Performance Improvement (QAPI) program, contributing data on home dialysis outcomes, infection rates, technique failures, and patient satisfaction.

+ Implements and reinforces infection prevention protocols, participating in surveillance, reporting, and patient education.

+ Identifies adverse events, near misses, and safety hazards, reporting them through appropriate channels.

F. Leadership, Delegation & Professional Practice

+ May serve as Charge Nurse, coordinating workflow, overseeing daily operations of the home program, and delegating tasks appropriately.

+ Serves as a clinical resource for staff, providing mentorship in cannulation, dialysis assessment, and home therapy troubleshooting.

QUALIFICATIONS Education

+ Graduate of an accredited school of professional nursing.

+ Preferred: Minimum six months dialysis or acute care nursing experience; home dialysis experience strongly preferred.

CMS Required Experience

+ Must meet CMS home training qualification minimums:

+ At least 12 months as an RN

+ At least 3 months of clinical dialysis experience (HHD or PD)

LICENSURE & CERTIFICATION

+ Current Montana RN license required.

+ Current BLS certification required.

+ Nephrology certification (CNN or CDN) preferred.

KNOWLEDGE, SKILLS & ABILITIES

+ Proficiency in dialysis theory, principles, and practice, including HHD and PD.

+ Ability to train patients and caregivers with patience, clarity, and adaptability.

+ Ability to prioritize multiple tasks, manage time effectively, and work independently.

+ Flexible and able to adapt to changing technology, schedules, and patient needs.

+ Ability to operate medical equipment, fax machine, copier, telephone, and computer.

+ Competent in operating dialysis equipment, PD cyclers, water treatment components, telehealth systems, and standard office equipment.

WORKING CONDITIONS

+ Exposure to body fluids, strong odors, cleaning chemicals, and varied environments (clinic and patient homes).

+ Regular lifting, bending, standing, and equipment transport may be required.

+ Must maintain a valid driver’s license (and personal auto insurance, if driving personal vehicle) when home visits are required.

CORE EXPECTATIONS

+ Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA) requirements at all times.

+ Demonstrates commitment to patient safety, service excellence, and quality care.

+ Actively supports a respectful, collaborative, and inclusive work environment.

Aptitudes:

+ Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and/or customers.

+ Possesses positive interpersonal and communication skills necessary for effective, non-judgmental, and empathetic patient care and customer relations.

+ Open to feedback and a quickly changing environment, which requires flexibility in scheduling, equipment, and department assignments.

+ Tolerance for body secretions, strong odors, potential exposure to disease, various body fluids, and varied environmental conditions including exposure to chemicals used for cleaning.

+ Demonstrates clinical judgment within RN scope, consistent with Montana Board of Nursing regulations.

+ Maintains professional behavior, effective communication, and a collaborative “How can I help?” approach with colleagues, patients, and families.

+ Strong assessment, clinical judgment, and critical thinking skills.