Kimberly Keaveny has held many roles in her 12 years as a DaVita teammate (employee).
When she was still a licensed practical nurse (LPN) early in her career, she had the chance to shadow nurses in a dialysis unit, and the experience motivated her to go back to school to become a registered nurse (RN).
“I really loved it,” Keaveny says. “It felt natural. It felt like I was supposed to be there. I went to nursing school to make a difference. And people on dialysis just felt underserved to me.”
Her first job as an RN was with DaVita. But her journey in nephrology care was far from complete. Keaveny then became a facility administrator — then a group facility administrator overseeing several DaVita® centers.
About two and a half years ago, she made another move that has a special sense of fulfillment for her.
“I have so much energy and passion for home dialysis,” Keaveny says, now a regional home manager where she manages patients who are exploring home modalities with their doctors. “I fell in love with it.”
Modality and service provider decisions are made exclusively between the patient and their treating nephrologist.
DaVita teams take an active role in providing education on all treatment modalities. This includes talking about transplant, in-center hemodialysis (ICHD), and home modality options, including home hemodialysis (HHD) and peritoneal dialysis (PD). They also answer any questions or concerns individuals might have. Potential benefits individuals might enjoy on a home modality include greater flexibility, shorter recovery times between treatments and, potentially, fewer dietary restrictions.
She describes the role as an opportunity to connect with many different patients throughout their dialysis — and specifically their home dialysis — experiences. Keaveny meets weekly with a core team, which includes social workers, dietitians, nurses, and the local facility administrator, to discuss what differential support is needed for patients experiencing challenges. Keaveny follows up to make sure that they are receiving the resources and services they need to start or succeed on home dialysis — from connecting to physicians to coordinating training and access placement surgeries to sitting down with patients to better understand what factors in their lives might be having an impact on their kidney health management.
“I go out of my way to be at everybody’s clinic day so I can meet the patient,” Keaveny says. “I get close to my patients, and I honestly think my nurses do, too. We spend so much time with them. So even though they’re treating at home and, on paper, they look great, we’re reaching out and making sure they really are doing well.”
Dr. Mark Kaplan, vice president of medical affairs at DaVita, has worked with Keaveny for years as she’s explored and succeeded in her different roles. “Once she started at a Home program, she really found her calling,” he says. “She loves it — and that enthusiasm spills out to all those who come in contact with her, whether it’s teammates in the surrounding area or patients.”
This enthusiasm may be what has helped Keaveny and her teams grow their home program — more than tripling the number of people on a home modality in one center since she started in 2020. However, Keaveny attributes her knowledge and passion for home dialysis to the education DaVita requires for direct patient care teammates and the ability to learn from her teammates’ experiences. She sought and found information from those on her team, people from other centers and regions and the leaders Keaveny works with:
“They’re a wealth of knowledge. [Home leaders] have a lot of passion, so it was easy to ask them for information. And they were lovely to provide it.”
Leading with Curiosity and Empathy
Keaveny says that when patients are pursuing a home modality, they often face a lot of questions and concerns.
“The most common comment I get is, ‘I don’t want to burden my family,’” she explains.
Keaveny and her team aim to help people work past this feeling and discover the sense of independence they may experience when they start home treatments. And to do this, Keaveny understands that anyone may have a barrier, but she and her team are often able to find a solution. They have trained care partners unable to read on how to facilitate the home dialysis process, as well as trained someone on solo HHD who experienced weakness from a stroke. She tells her team regularly, “Don’t come to me and tell me that we can’t.”
Instead, Keaveny believes strongly in digging into better understanding the barriers and challenges someone might be experiencing, whether it’s transportation, childcare responsibilities or something else, and seeking a solution through true understanding. While not every barrier has a solution, Keaveny encourages her team to continuously understand a patient’s lived experience and consider if there’s a way to support them and help them succeed on home dialysis.
Her solution-oriented mindset has helped the team make a difference, just as she’d hoped when first thinking about becoming a nurse. She’s witnessed a truck driver tearfully tell his PD nurse that she had changed his life. Another patient came to the team with swelling due to excess fluid. With the help of his nephrologist and care team, he reduced the swelling, stabilized his blood pressure and even regained the ability to walk through physical therapy.
One patient believed he lost his job because he needed dialysis. When he found work again, he was nervous that his employer would find out and put his job at risk again. He missed many in-center treatments as a result. When his nephrologist talked with him about changing to home dialysis, Keaveny worked with the patient, the nephrologist and the rest of the care team to determine a good time for him to start on the home treatments. Keaveny discussed with the patient’s nephrologist her concerns that the patient might not be adherent with an at-home schedule based on prior adherence to in-center treatment schedules.
When the nephrologist and the patient decided to pursue home dialysis, Keaveny worked with the team to help reinforce the patient’s education on the flexibility home treatments offer as they began training. The registered nurse trained the patient and his wife—a teacher—during the summer for home treatments when the patient’s wife had more time. Now, the patient feels more comfortable and confident with balancing his work and treatments, making it easier not to miss treatments.
“A wise woman taught me to put my judgement away,” Keaveny says. “She always said, ‘Be curious, not judgmental.’”
1 Shafiee MA, Chamanian P, Shaker P, Shahideh Y, Broumand B. The Impact of Hemodialysis Frequency and Duration on Blood Pressure Management and Quality of Life in End-Stage Renal Disease Patients. Healthcare (Basel). 2017 Sep 2;5(3):52. doi: 10.3390/healthcare5030052. PMID: 28869490; PMCID: PMC5618180.2 Service provider and modality selection are choices made exclusively between the patient and nephrologist. 3 Per CMS, dialyzing at home or receiving a kidney transplant may be better options than in-center dialysis for more beneficiaries than currently use them. Researchers have reported that greater support, training, and education to nephrologists, other clinicians, and patients would increase the use of both HHD and PD. 4 Per DaVita policy, HHD requires a care partner unless the nephrologist orders solo HHD after discussing potential clinical risks with the patient.