The changing landscape of the nephrology nursing care environment in the United States over the last 45 years.

The nephrology landscape has changed significantly over the last 45 years. We are providing more options for patients and utilizing safer and more advanced technology, and remain grounded in a desire to continue to improve. In a description of the nurse's role during hemodialysis in 1950, responsibilities included technical aspects of the treatment, infection prevention, patient assessment and monitoring, documentation, medication administration, fluid management, patient education, and providing comfort and encouragement (Coleman & Merrill, 1952). Although the manner in which these roles are carried out has changed with time, the skills remain important today. Additionally, despite the technological differences throughout the last several decades, nephrology nursing has remained focused on humanizing the process for people with complex care needs, preserving the patient's dignity, teaching, supporting, and involving the patient and family in their care (Hoffart, 1986b). Throughout our historical journey, it is apparent that nephrology nurses have always been responsible for a significant amount (or majority) of the care of patients with kidney disease and that nursing care is much more than delivering a treatment (Lynaugh & Fairman, 1989). Nephrology nursing is grounded in patient and family-centered care based on both physiological and psychosocial needs. Nephrology nurses have touched every aspect of the kidney care community shaping the service, government, and product sectors. Nephrology nursing has been vital from the initial development years and continues to be an undeniable force in improving nephrology care to a patient population with very complex patient needs. Many changes have taken place since the inception of the ESRD program in July 1973. Advances in technology, demonstration projects, research, and reimbursement changes have reshaped the landscape of our care delivery models. In the same way, our knowledge of kidney disease has progressed substantially, resulting in improved diagnosis and treatment in an effort to reduce complications and improve outcomes for patients with ESRD.