Commonly innovative proposals for service development in
specialties such as nephrology involve expanded or innovative
roles for nurses. Over the years renal services, as they have
become more complex, created a range of new nursing roles,
encompassing pre-dialysis, vascular access and transplant
coordination. Nurses in central government can envisage
and (through contracting processes) design new nursing
roles that provide solutions in implementing proposed policy
initiatives intended to improve patient care. A current area for
development is in new renal nursing roles, based in specialist
renal services but working in primary care settings, to support
better management of chronic kidney disease (CKD).
Within the Ministry the nurse with a specialty background such
as nephrology can discreetly work with a variety of individuals
and groups who can influence others, gradually creating
an awareness among a range of stakeholder groups that can
eventually be crystallised as a new policy initiative. The renal
nurse, as facilitator and integrator, can be a change agent at the
centre.