What training is recommended for dialysis staff as a healthcare provider?

Training Recommendations for Dialysis Staff

All healthcare professionals involved in dialysis care should receive early and comprehensive core training in all kidney replacement therapy (KRT) options, including both home and in-center dialysis modalities, with continuous maintenance training necessary for nephrologists and nurses. 1

Core Training Requirements

Comprehensive Modality Education

• Staff must receive training in ALL dialysis modalities (peritoneal dialysis, home hemodialysis, and in-center hemodialysis), not just the modality their center primarily uses 1
• Training should include direct patient contact during fellowship training for physicians, as this builds confidence and reduces bias regarding patient eligibility for different modalities 1
• Educators must have a clear grasp of both home and in-center modalities to provide consistent, unbiased patient education 1

Competency-Based Framework

• Training must be underpinned by a system of competencies and responsibilities that differ based on local resources and healthcare systems 1
• Include safety training and retention support as core components 1
• The full multidisciplinary team should contribute to staff education to provide a unified message that builds individual confidence 1

Specialized Training Roles

Home Dialysis Specialists

• Home dialysis specialists require recognition of their specific skill set: modality expertise combined with complex case management in the home setting 1
• Rotating these specialists with other subspecialty experts risks diluting expertise, though may be necessary in smaller or resource-limited settings 1

Dedicated Educators and Navigators

• Specific home-dialysis educators and navigation specialists are essential for increased uptake of home therapies 1
• These professionals provide patient education that supports informed modality choice 1
• All dialysis nurses and care professionals should receive specific training so that patient education becomes part of routine care delivery 1

Training Content Areas

Patient Education Skills

• Staff must be trained to provide iterative, culturally sensitive, and consistent education across different team members 1
• Training should cover multiple education delivery methods: one-to-one sessions, group education, video-based materials, and peer support facilitation 1
• Staff need skills in addressing patient fears and anxieties, particularly regarding self-cannulation for home hemodialysis 1

Clinical Competencies

• Standardization of processes and procedures including patient education, access creation, and treatment of common complications 1
• Training in modality transitions, which are common and can be distressing for patients 1
• Skills in shared decision-making and supporting patient autonomy 1

Technical Skills Enhancement

• Simulation-based training can be valuable, particularly for procedures like arteriovenous fistula puncture 2
• Just-in-time training programs can prepare additional staff for disaster preparedness and staffing shortages 3
• Standardized education packages based on best available evidence and modern educational practices should be utilized 4

Implementation Strategies

Continuous Education

• Continuous maintenance training is necessary for both nephrologists and nurses, not just initial training 1
• Training programs should evaluate their current state, identify unique barriers, and work to overcome them 5

Program Development Support

• Smaller centers may need additional support over time, as meta-analyses suggest mortality benefits with larger centers 1
• Mentorship and support by local/regional expertise should be part of program development 1
• Local quality-improvement initiatives may be more successful than top-down approaches 1

Critical Pitfalls to Avoid

• Do not allow staff to develop bias toward specific modalities by limiting their training exposure 1
• Avoid rotating home dialysis specialists too frequently, as this dilutes specialized expertise 1
• Do not provide inconsistent messaging across team members, as this undermines patient confidence 1
• Ensure adequate resources and staff requirements are in place before program expansion 1