Table 4.

Strategies to improve nurse engagement in home dialysis programs

Home Dialysis Nurses
Advantages	Disadvantages
Schedule of 8 am to 5 pm	Less opportunities for growth into leadership, considering smaller market share of patients on home dialysis
No scheduled work on holidays or weekends	Call responsibilities for after-hours issues
1:1 care of patient, starting with evaluation, training, and then care at home	Lack of moonlighting opportunities
Role in education and training
Nurse to patient ratio (1:20 at UAB) may appear high, but ability to see patients at your own pace
Measures that helped our program in high retention of staff
Offer a 4-day work week
Offer flexibility in work and call schedule
Dedicated steps toward staff engagement, including team building efforts and quality incentives
Ongoing discussions, with success, with LDO to adjust nurse/patient ratios (overstaffing) to
Accommodate for training and growth
Achieve quality and safety measures
Train new hires
Cross-training of nurses in home hemodialysis and peritoneal dialysis
Proposals for a national level policy change
Consider incentives for nursing staff engaged in home modalities
Dedicated effort to offer leadership and growth opportunities to home dialysis nurses

UAB, University of Alabama at Birmingham; LDO, large dialysis organization.