Sustaining the renal nursing workforce

Background The prevalence of kidney disease continues to increase, as does the acuity of kidney care. Patients with kidney failure are older, sicker and less mobile. Health systems are under more pressure to manage growing care needs and capacity constraints. This is likely to have an impact on nursing workforce experiences. Aims The aim of this research was to examine nephrology nursing in South Australia to understand the impact of increasing acuity and organisational factors that may support and sustain the workforce. Methods An exploratory semi-structured qualitative approach, facilitating eight focus groups with 36 nephrology nurses across six public metropolitan renal units was applied. Data were thematically analysed. Findings Three central themes relating to nursing culture, patient acuity and organisational factors that impact the nursing workforce were identified. Sub-themes identified were pride and passion, teamwork and collegiality, increasing patient acuity and the lack of clinical rationalisation in kidney care, the value of a 'flat' hierarchy, and vulnerability during the COVID-19 pandemic. Consequently, we identified a disconnect between institutional expectations and what the participants considered pragmatic reality. Participants reported sustained workplace pressure, a 'triage' approach to care, and a sense of work left undone. Conclusion Nephrology nurses experience a gap between 'supply and demand' on their time, resources and workload. These findings highlight the need for further exploration of the root causes and the development of new systems to provide quality, safe and rewarding care for patients and to reduce the risk of workforce moral distress and burnout.