When I left the care home setup to join the National Health Service (NHS), I was not fully aware of what lay in store for me. To be fair, not much is known in the developing world about how the NHS operates. Perhaps it is because we tend to pursue the American Dream as opposed to a British one. I was part of the rather ignorant crowd.

When I qualified as registered nurse in Kenya a few years ago, my intention was to never work in the hospital setup. I was an okay nurse and carried out my duties, but I did not enjoy the care burnout that I felt for the sick and suffering. I felt I required too much debrief. I walked around shoulders hunched forward as each and every health problem of my patients hung around me like a sulky cloud. I wanted out. That was not to happen because I ended up being a nurse midwife where my love for the kidneys was developed.  I therefore felt a little misplaced in the care home and wanted to go back to the hospital and particularly in the renal unit.

It has been a few months of absolute joy working in a reputable dialysis unit here in the UK. People wonder how I ended up there. Nurses that have especially trained in nephrology nursing reach out to me and ask me how to go about either starting in the renal unit or even on how to move from the private sectors to the NHS, renal units.

Demystifying the transition

What you must realize is that the United Kingdom has not recognized higher national diplomas (HND) as a measure of specialization. They are more into short courses at level 6 which is an undergraduate level. I learnt this when I presented my HND in nephrology nursing from Kenya to my University, the University of Derby, when I was enrolling for a top up B.Sc. Degree in Nursing. They categorically stated that the HND is a level 5 certificate and cannot translate into the award of credits at a degree level.

Registered nurses in the UK do not have to undergo any special training for them to work in the renal unit. They undergo on-the-job-training in renal wards and dialysis units for them to be able to work in these areas. Most of them do not necessarily want a career in renal nursing. In Kenya, on the other hand, nurses working in renal units have undergone a comprehensive renal nursing course or a preceptorship in the same. This blog post therefore is directed to renal nurses in Kenya and elsewhere in the world who know that they really do want to pursue careers in the world of renal nursing.

All you need to do is specifically apply for a job in the renal directorate. Present your HND at the interview and use that as a basis for your argument. The panel of interviewees will not know what you want. Show them. They will respect your choice. It does not matter how long you have been away from the field. Just present your HND and defend your stand.

What next?

What we study in Kenya at HND level is replicated in UK Universities as a master’s degree program. It is that vital. Therefore, do not despise your HND. It may not be recognized in terms of UK Standards of Higher Education, but the content is more or less similar.

It has taken me a while, but I have managed to find out a few of the existing roles within renal nursing which you can pursue. This list is not exhaustive.

1. Vascular Access Nurse (VAN)

A proper vascular access is a lifeline of the patient on haemodialysis. Sometimes these accesses fail to live up to their standards. The Vascular Access Nurse (VAN) plans for their creation and monitors them until they can be safely used for dialysis. In fact, when registered nurses cannot be able to cannulate an arteriovenous fistula or a graft, we always contact the VAN before contacting the Vascular surgeon. VANs act as the link between the patient, the surgeon and the dialysis nurses. They do scans for fistulae, grafts and even suggest ways to manage central venous catheters with inadequate blood flows.

Though you remain a heartthrob of the wider dialysis nursing team, you have prescribing powers and clinical decision-making skills. You need to undergo short courses to achieve this title. You also must be very good with vascular accesses. It needs to be a passion of yours.

2. Transplant Coordinator

Unlike Kenya, the UK does both living and cadaveric kidney donations. The kidney transplant coordinator is a nurse that has undergone specialized training organ donation course on top of renal nursing qualification. You are responsible for supporting patients and their families through the entire transplant process.  You are in a special rank to ensure patients get a new lease of life through the matching of donated kidneys to individual patients. Through matching of living donors to recipients.

You are expected to be passionate in matters of kidney transplantation and have endearing communication skills. You must be able to translate the otherwise intense language of transplantation into a form that the patient and their families can understand. You must keep up with the trends in kidney care because I can promise you most patients in the UK are learned about their conditions and I would hate for you to be caught pants down with obsolete information.

3. Renal clinical Educator

This is an equivalent of a clinical instructor back home. However, your job description transcends beyond showing students how to carry out nursing procedures. Your role requires you to hold newly employed nurses and coach them until they are able to run shifts by themselves. You become the contact person for their studies and revalidation of their practice license.

Needless to say, you must love teaching. It must run within you. Upholding nursing professional standards against all odds and notably against scarcity of resources must be part of what drives you as a nurse. You organize for patient teaching and you as well take part in formulation of protocols and competencies to be followed. You must be well learned in aspects of both critical care and renal care. That is because you will need to be familiar with the renal high dependency unit as well. This should not make you anxious as there is plenty of room for training within the NHS.

4. Renal Conservative Care Nurse

Some patients are not eligible for either dialysis or kidney transplant. This is not a solely palliative role. It is active home visiting and ensuring that patients live as optimally as possible while in end stage kidney disease. You are responsible for signs and symptoms management. You help patients and their families cope with the decision to not have kidney replacement therapies or even withdraw from it. It is an emotive role, and you are called to be empathetic. You must be willing to form a lasting professional relationship with different families and patients with end stage kidney disease.

The above as I highlighted is not exhaustive. I however hope this gives you a sneak preview of what lies ahead for you as a renal nurse in the United Kingdom.