Advanced practice nurses in ESRD: varied roles and a cost analysis.

The predicted shortage of nephrologists to care for end-stage renal disease (ESRD) patients has prompted examination of the potential roles for physician extenders, such as physician assistants and nurse practitioners or advanced practice nurses (APNs) in the care of these patients. Although the case management model is ideally suited for the care of ESRD patients, little is known about incorporating APNs within this model in either dialysis or transplant programs. Furthermore, the cost-effectiveness of APNs working in dialysis units has been unexplored. We report our experience with APNs working in our dialysis and transplant programs, providing a description of their varied roles in the outpatient and inpatient settings that emphasizes the flexibility of the case management model in the care of ESRD patients. A time log survey completed by dialysis APNs outlines a mode for job responsibilities and shows that 93% of their time is spent in direct patient care. The dialysis cost analysis reveals that employment of a nurse practitioner is cost effective if the dialysis program includes at least 85 chronic dialysis patients. Additional studies of the impact of APNs in ESRD programs is needed.