Moreover, stakeholders find that it is beneficial to recruit certified nurses, it is advantageous for the institution. Payment for dialysis treatment has changed to the pay for performance reimbursement by Medicare and commercial health plans. Healthcare facilities providing dialysis services have encountered financial penalties if poor outcomes are demonstrated. (Williams, Lopez, & Lewis, 2013). The certified nephrology nurse can analyze data appropriately, can increase patients’ understanding of the importance of adhering to their treatment plan, and overcoming patient barriers (Williams et al., 2013). Furthermore, retention of certified nurses’ help the bottom line of healthcare reimbursement. Advanced certification increases the self-confidence,
