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The provision of comprehensive care to patients requiring maintenance hemodialysis has developed into a complex multidisciplinary effort involving nurses at all levels. Nephrology nursing has evolved over 15 years into a model of so-called "expanded practice," i.e., one in which technical expertise and broad scientific and professional education are necessary as well as significant commitment to quality of care. This practice includes unusual responsibility for management of many aspects of patient care. Described in this paper are the specific responsibilities expected of nurses in hemodialysis, including the response to clinical problems during dialysis. Also reviewed are the more independent contributions of nurses to home and self-care dialysis. An outline of recommended educational content for nephrology nurses is included.