Building a Shared Competency Identity for Nephrology Nurses in Italy: Development of a National Framework Through a Modified Delphi Study

Abstract

Introduction. Nephrology nursing requires advanced competencies across chronic kidney disease care. In Italy, their definition and recognition remain heterogeneous. This study aimed to develop and validate a national competency framework for nephrology nurses.

Methods. A multi-phase modified Delphi study was conducted. An initial framework was developed through an integrative literature review by the Italian Society of Nephrology Nurses (SIAN) research group. Twenty nephrology nurses (≥5 years’ experience) participated in two Delphi rounds using a four-point Likert scale, with consensus set at ≥70%. The framework was then shared nationwide among SIAN members to assess transferability and validated in a third expert round. Quantitative ratings were complemented by thematic analysis of qualitative comments.

Results. The final framework achieved high consensus and was organized into five macro-areas: general and cross-cutting nephrology competencies; inpatient and pre-dialysis care; hemodialysis; peritoneal dialysis; and kidney transplantation. Emerging domains such as digital health, telemedicine, and environmental sustainability were included. Therapeutic communication emerged as a transversal competency supporting safe, person-centered care.

Discussion. The framework provides a reference for nephrology nursing competencies in Italy and may support education, professional development, competency assessment, and recognition of specialist roles within healthcare organizations.