Tucked within the Intensive Care Unit at Memorial Sloan Kettering Cancer Center are two small treatment rooms run by a powerhouse team of certified dialysis nurses doing extraordinary work. Elizabeth Kong CN IV, Mariea Casas CNIV, and Marjorie Guanco CNII are highly accomplished, well-respected, compassionate professionals. These three nurses provide an average of fifty hemodialysis treatments monthly to inpatients in our 524-bed hospital. They also play an integral role in training and supporting the critical care nurses who provide Continuous Kidney Replacement Therapy (CKRT) in our 20-bed Intensive Care Unit. Their actions have demonstrated how they embody MSK's nursing values of compassion, advocacy, relationship-based care, and excellence to carry out Dialysis operations seamlessly and effectively consistently. 

Nurses throughout the inpatient units who send patients for dialysis treatment have seen the impact of their compassionate care. They are essential in these patients' treatment journey, seeing them three times a week. As a result, their patients know exactly when to expect their calls and who will be providing the treatment based on the time of the call. The relationships they form with their patients are unique, and they often earn praise from patients and their loved ones, citing their excellent specialized care and attention to the patient's comfort and emotional needs.

This small team of highly accomplished nurses, Elizabeth, Mariea and Marjorie are widely respected by their nursing and physician colleagues. The Chief of the Renal Service, stated, "We have called our nurses in to dialyze patients after hours, often in the middle of the night. They have never complained about this and are more than happy to come in." He recounted an instance when the nurse on-call overnight had difficulty safely commuting to work due to extreme weather conditions. Her colleague, who had a shorter and safer journey, voluntarily came in on her night off without being asked. This is just one of many examples of how they collaborate and care for their nursing colleagues. 

The dialysis nurses demonstrate their commitment to quality and safety every day. According to the Centers for Disease Control and Prevention, approximately 37,000 people suffer from bloodstream infections related to their dialysis treatment. Our nurses are proactive in preventing the risk of infection and demonstrating compliance with the plethora of rules determined by governing regulatory agencies. They have worked to address the issue quickly when finding or confronted with a vulnerability—they were faced with the challenge of ensuring the best process for maintaining and disinfecting complicated pieces of equipment that are vectors for pathogens. They led an initiative with our Environmental Service team to streamline the disinfection process needed for the drains that remove dialysis waste for all 22 ICU beds. This initiative involved the challenging feat of in-servicing all the nurses and EVS staff who work in the ICU, doing so with minimal to no interruption in patients' treatments. As a result of their diligence, they have protected patients from infections. The dialysis nurses also spearhead initiatives to incorporate evidence-based practice by synthesizing and updating hospital policies related to hemodialysis and Continuous Kidney Replacement Therapy (CKRT). They have had a role in every step of the process, from preventing infections from invasive catheters to providing directions for procedures and working with Nursing Informatics to document all nursing interventions appropriately.  

In addition to their hard work and their commitment to this unique niche of patients, both Mariea and Elizabeth received their third nursing certification as certified dialysis nurses.  The Dialysis nurses play an essential role in training and education for every ICU nurse to perform CKRT and presenting a didactic course for ICU fellows and APPs. Marjorie, Elizabeth, and Mariea provide didactic courses and hands-on training for the ICU nurses. They also play an integral role in ensuring staff maintains competency after completing orientation. The ICU nurses also seek out their expertise and assistance when troubleshooting problems. This expertise was especially crucial at the start of the pandemic when many patients critically ill with COVID-19 required dialysis in the ICU. In fact, their poster, "Strategic Implementation for Providing Kidney Replacement Therapy during COVID-19," was accepted by the Oncology Nursing Society (ONS) 47th Annual Congress. 

They have demonstrated that their concerns extend beyond the walls of the hospital. The dialysis nurses proactively work to reduce the environmental impact of medical care. They successfully implemented the recycling of dialysate jugs, coordinated the installation of light dimmers in the dialysis storage and dirty utility rooms, and motion water sensor faucets to reduce water waste. The dialysis team helped ensure that equipment being retired was brought to Bio Med and Supply Chain / Sourcing and resold instead of being disposed of, avoiding waste and bringing funds back to MSK. 

The Dialysis Nurses are a small but mighty team. They continuously demonstrate their commitment to best practice by proactively researching and implementing processes designed to prevent transmission of bloodborne pathogens among patients. They provided input to ensure this standard requirement was implemented safely and with minimal interruption in patient treatment schedules. They have improved our hospital's documentation structure to ensure that the treatment provided is clearly understood and communicated to all the care teams. They are true role models who exemplify the excellence our institution values.