Certified Dialysis Nurse

A certified dialysis nurse is a member of the medical team who works to coordinate and plan the activities associated with managing individuals who suffer from end stage renal disease. Nurses who specialize in nephrology complete the same general educational and training requirements as other nurses, but receive specialized instruction and hands-on experience in a dialysis facility. Those who want to pursue this career path are advised to become familiar with their credentialing options before committing to the specialty.

General Nursing Requirements


Becoming a nurse requires more education and training than is needed to become a technician. There are several degree and certificate options available through a local community college and university including a Bachelor’s of Science in Nursing (BSN), the Associate’s Degree in Nursing (ADN), and diploma opportunities. Individuals who complete an Associate’s degree or a diploma will generally qualify for entry-level staff positions, but might be expected to return to school to obtain a Bachelor’s or Master’s degree before advancing in the profession. In addition, facilities may require a nurse to complete a Master’s degree in order to become a certified dialysis nurse.

Nurses are required to complete a rigorous licensing process before providing patient care independent of professional supervision. The exam that is most often used by the agencies that issue licenses is the National Council Licensure Examination (NCLEX-RN). A Board of Nursing is usually established within the state in order to create formal legislative requirements and enforce the competency standards. Individuals who know which state they plan to work in are encouraged to contact their Board of Nursing to find out what the exact expectations are for licensing. Legislative policies vary by state and can impact a nurse’s progression.

The nursing profession is an excellent employment opportunity for individuals who plan to provide an advanced level of care, but who want the freedom to work in many different departments based on their interests and long-term career objectives. Most areas of practice offer specialty certification for those who want to demonstrate that they have met common competency standards. The certified dialysis nurse has a few basic and advanced examination options that can be pursued through well-respected national organizations. Before setting a test date with a particular company, it is a good idea to communicate with the employer to make sure that the examination credentials have been approved and will be recognized.

Benefits Associated with Certification

Formal certification offers several benefits that should be considered when deciding whether or not to take a national examination. Individuals who are required to become a certified dialysis nurse as a condition of employment will have to take an exam, but those who have the option will want to evaluate a number of factors before investing significant amounts of time and effort. Some of the most compelling reasons to pass an exam include the ability to demonstrate competence to patients and employers, the potential to improve earning power, expanded employment opportunities in different states, as a means for safeguarding the health and well-being of society, and to become a well-respected member of a professional group of healthcare providers.

National Certifying Organizations


The 2 largest US companies that administer certification exams for the nurses in dialysis do include Nephrology Nursing Certification Commission and the Board of Nephrology Examiners Nursing and Technology. Some states have developed their own exams that can be completed as an alternative to those offered by these companies. The NNCC has three exams available to all individuals who possess a full and unrestricted license as a registered nurse within the US and who have met other eligibility criteria.

These exams are representative of different skill levels and require varying degrees of education, training, and experience in order to become eligible. BONENT has developed two exams that are available to individuals who are planning to provide either general hemodialysis or peritoneal dialysis. Individuals who plan on performing both services may want to consider completing both exams.

Nephrology Nursing Certification Commission (NNCC) Examinations

The Certified Dialysis Nurse (CDN) exam is available to applicants who have completed 2000 hours of work experience as a registered nurse in nephrology nursing within the previous twenty-four months. Fifteen contact hours of continuing education has to have been completed during the past two years and must be approved by organizations that have been accredited by the American Nurse’s Credentialing Center – Commission on Accreditation (ANCC-COA). Organizations that meet this requirement include the American Nephrology Nurse’s Association (ANNA), American Association of Critical-Care Nurses, the Council of Continuing Education, and Board’s of Nursing in the states of California, Florida, Iowa, Kansas, and Ohio. International applicants must meet the same expectations, but must also meet the standards adopted by the Commission on Graduates of Foreign Nursing Schools (CGFNS).

The written CDN exam consists of 200 questions that must be completed within four hours. A computer version is available that includes 150 questions and lasts for three hours. At least 70% of the questions on the written exam or 75% of the questions on the computer version must be answered correctly in order to receive a passing score. The concept distribution for the computerized version is represented by four general areas including hemodialysis (54%), kidney disease (28%), peritoneal dialysis (14%), and the kidney transplant (4%). Each content topic is further broken down into nine objectives which can be reviewed by clicking here. An application for the exam can be found here. There is an application fee of $300 or $350 that is required depending on whether or not the applicant is a member of ANNA. Preparation strategies, administration sites, application deadlines, and other fee information can be found on the NNCC site.

An advanced option known as the Certified Nephrology Nurse (CNN) exam is offered for individuals who have 3000 hours or more of work experience as a registered nurse in nephrology over the previous 36 months and who have a Bachelor’s or Master’s Degree in Nursing. Beginning on January 1, 2015 those who completed the experience requirement in an outpatient facility must spend 25% of those hours performing home hemodialysis, home peritoneal dialysis, renal replacement therapy for an inpatient kidney injury or chronic kidney disease, transplant, or apheresis. The 750 hours can be completed in one or more of these areas. Applicants must also have thirty-six hours of continuing education over the previous three years that has been approved by an organization accredited by the American Nurse’s Credentialing Center – Commission on Accreditation (ANCC-COA).

The paper-and-pencil CNN exam consists of 200 questions that must be completed within four hours. A computerized version is available that has 175 questions and must be completed within three hours. A score of 70% or better is considered passing on the written exam while a score of 75% is required for a passing score on the computer version. The test is broken up into five content areas that include kidney disease (35%), hemodialysis (30%), peritoneal dialysis (20%), the transplant (10%), and acute therapies (5%). Each of these content categories is further divided into nine objectives that can be reviewed here. Applications can be found here and the fee for the exam is either $300 or $350 depending on ANNA membership. Preparation strategies, administration sites, application deadlines, and other fee information can be found on the NNCC site.

The third and most advanced certified dialysis nurse opportunity offered through the NNCC is the Certified Nephrology Nurse – Nurse Practitioner (CNN-NP) exam. In order to qualify for this exam, an individual needs to have a full and unrestricted license as a registered nurse and be a certified nurse practitioner. In addition, 2000 hours of work experience as a nurse practitioner in a dialysis unit must have been completed in the preceding two years and the applicant must have a Master’s Degree in Nursing. Also, 60 hours of continuing education approved by an organization accredited through the American Nurse’s Credentialing Center – Commission on Accreditation (ANCC-COA) needs to have been completed over the previous two years.

There are 175 questions on the CNN-NP exam that must be finished in four hours. A score of 75% or better is considered passing. The questions are distributed among five content areas that include kidney replacement therapies (57–59%), stages 4 and 5 of chronic kidney disease (CKD) not on kidney replacement therapy (19 – 21%), stage 3 of CKD (11 – 13%), stages 1 and 2 of CKD with other general nephrology (4 – 6%), and acute kidney injury (4 – 6%). The content areas are broken down into nine objectives which can be reviewed in detail by clicking here. The application for the examination can be found here and preparation strategies, administration sites, application deadlines, and other information can be found on the NNCC site. The exam costs either $350 or $375 depending on whether or not the applicant is a member of ANNA.

Board of Nephrology Examiners Nursing and Technology (BONENT) Examinations

The Certified Hemodialysis Nurse (CHN) exam is available to nurses who have at least 1 year of experience in nephrology and who are currently active in an end stage renal disease clinic. Experience is verified through two signed letters of reference. There are 150 multiple-choice questions on the test that are representative of four content areas that include dialysis and related issues (74.5%), supervision and administration (10%), environmental control (10%), and professional development (5.5%). Details about each area can be found here. The paper-and-pencil exam costs $220 while the computer version costs $250. An application can be downloaded by clicking here and additional information can be found on the BONENT website.


A second exam is offered by BONENT that is called the Certified Peritoneal Dialysis Nurse (CPDN). The eligibility expectations are the same, but content areas include the nursing process (60%), education (20%), professional development (10%), and the administration (10%). 150 questions are included on the test to be completed within three hours. The fees are the same and a certified dialysis nurse is allowed to take both exams. The application can be found here and additional details are available on the BONENT website.

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