Our decision to look at updating the skills-mix of renal nurses was prompted by audit visit to a renal unit in South Wales.

We were auditing against the Renal Association Standards primarily, but the question of how well the nursing skill-mix there matched that outlined in the so-called “Blue Book” of 1984: Provision of Treatment for Patients with End Stage Renal Failure, arose.

The nurses on the audit visit were very concerned that this skill-mix no longer met the needs of the more elderly patient who had a higher level of co-morbidity.

It was clearly time to try and standardise the nursing skill-mix and provide guidelines to units around the UK.

This decision was reached just before the launch of National Service Frameworks (NSF) and we wanted to try to provide this information in time for it to be fed into the NSF for Renal Services. So, following a national workshop to launch this work, we developed links with the Nursing Directorate within the Department of Health to get its support for the venture.

The core team working on the document consisted of professional, experienced renal nurses from across the UK. They included practitioners, educationalists and managers.

Significant need emerged

It became clear, as the work progressed, that there is a significant need for this work, and this has been acknowledged by all that have become involved. This need has obvious links with the continued demand for renal services within the UK, and an identified staffing structure is needed to underpin any further expansion of services.

The work has reflected several previous initiatives, including:

		Making a Difference and Realising the Potential -- the English and Welsh Nursing Strategies;
		Fitness for Practice -- the report of the UKCC Education Committee; and
		Agenda for Change, which looks as modernising the NHS pay structure.

Although a NSF for Renal Services has not been announced yet, we want to continue to work towards creating a level of standardisation. We recognise that units are employing staff at very different skill-mix levels across the country.
We believe that there is an opportunity to provide a standard that is both safe and takes into account the current lack of trained renal nurses currently available.

Our work is also intended to reflect the different types of facilities across the country.