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Nephrology nursing memories: celebrating ANNA's 45th anniversary.

Editor's Note: To celebrate ANNA's 45th anniversary, we invited nephrology nurses to submit their favorite nephrology nursing memories. We specifically invited our Past Presidents to tell us about ANNA in the years they were in ANNA leadership roles. Their memories go back to nephrology nursing even before the birth of ANNA. There are memories about experiences with patients and colleagues--some serious, some fun, some happy, some sad. Together, they paint a vivid picture of nephrology nursing. We hope you enjoy the memories and that reading them will stimulate you to think of some of your own memorable moments. We encourage you to collect such memories in your units and chapters and to share those memories with each other and with ANNA. We will continue to collect nephrology nursing memories throughout this year. To submit your nephrology nursing memory to ANNA, go to http://www.surveymonkey.eom/s/ NNJMemoriesProject

ANNA Board of Directors

Norma Gomez, MBA, MSN, RN, CNN

ANNA President 2013-14

ANNA Chapter: TN-264 Tennessee Valley

Began Nephrology Nursing: 1972

I love nephrology nursing because: I am able to use all my nursing skills when caring for the patient with kidney disease; every day is a new experience.

Memory 1: I worked in a small dialysis unit that was housed in a nursing home. They offered music, art, and occupational therapy to their residents. One day, I stopped the nursing home administrator and asked if the patients on dialysis could be part of the therapy classes. After a lot of discussion and persuasion, we started an art therapy program. Mr. P was a very quiet man; he arrived for treatment but barely spoke to the staff and never engaged in conversations with the other patients. I was surprised that he agreed to be part of the art therapy project. His paintings were amazing. We all told him how beautiful they were. Over the course of a few weeks, he began to talk to the staff and the patients about his paintings and why he selected certain objects to include in his work. Eventually, he became a great resource to the other patients and was one of our most outspoken patient advocates.

Memory 2: In the early 1970s, I was working the night shift at a dialysis facility and had a patient who only spoke Spanish. He would become hypotensive but would not say anything when he felt symptoms. We spoke to him so many times that most of the other patients were aware of the problem. He finally started letting us know by saying "mas salina" --which in Spanglish meant "more saline." After a while, all the patients on the night shift would yell "mas salina" when they felt hypotensive. We had one of the day shift nurses work with us one night; she had no idea what was happening when someone started yelling "mas salina." It eventually became a unit credo "mas salina." Of course, that was before all the technology we have now.

Memory 3: I remember caring for Mrs. U, a patient with polycystic kidney disease. One day she was very upset because her son had just been told he was CKD Stage 4. She began crying and said that it was all her fault, and she did not want him to be on dialysis. I sat with her for a while until she calmed down. I then called up the transplant center to see what we could do for her son. It turned out that they were doing pre-emptive transplants. Her son was a candidate and was transplanted later that year. It was a great feeling to be able to help two people with just one call.

Sharon Longton, BSN, RN, CNN, CCTC

ANNA President Elect 2013-14; ANNA President 2014-15

ANNA Chapter: MI-312 MichigANNA

Began Nephrology Nursing: 1989

I love nephrology nursing because. There is so much heart and soul found in the individuals who have been personally afflicted by renal disease as well as in the people who work diligently to care for them.

Memory 1: Although there are many memorable moments in my nephrology career, there is one in particular that I know has had a profound impact on me both personally and professionally. I didn't start working in nephrology right out of nursing school like many of my friends and colleagues did. I started working in nephrology by a fluke, after the unit I was working on was targeted to close, and I needed to find a new "home." A position became available in the acute hemodialysis unit, and I was lucky enough to be the one hired. Shortly after I began working there, I met another nurse who started me on my volunteer path with ANNA. It started innocently enough...a simple encouragement to work with her to submit an abstract for a poster presentation for the National Symposium. That presentation led to more collaborative efforts, a chapter officer position, a request by the Director of Education Services to work on an educational task force, and then the Conferences Committee with many other volunteer opportunities to follow. And so my journey began. That journey has taken me to many heights, has helped me grow professionally to be able to provide an even higher level of quality care to my patients, and has provided me the opportunity to establish amazing friendships. So...a gazillion thanks to Donna Bednarski for the guidance and friendship she has given me throughout these years and for helping me to create so many other wonderful memories--memories that have had a positive impact on my personal life and professional career. And it all started with one small word of encouragement.

Glenda Marie Payne, MS, RN, CNN

ANNA President 2012-13

ANNA Chapter: TX-208 Dallas

Began Nephrology Nursing: 1970

I love nephrology nursing because: Of the long term relationships you develop with patients, families, nurses, physicians, social workers, and dietitians. Memory 1: Learning to do peritoneal dialysis using bottled fluids and having the doctors place a Tenckoff[R] catheter in the patient room--I can still hear the sound of the catheter "popping" through the peritoneum.

Memory 2: Transplanting a teenage boy who was able to play baseball with a hemoglobin of 9. And watching his lips "pink up" as his new kidney worked!

Lynda K. Ball, MSN, RN, CNN

ANNA Secretary 2013-14

ANNA Chapter: OK-273 Red River

Began Nephrology Nursing: 1986

I love nephrology nursing because: I can individualize care, develop a relationship with the families, and help patients reach a quality of life they can live with.

Memory 1: I had just started working in this transplant center. I met a young man who was 21 years old and had 23 surgeries. His body looked like rail yard. He was a kidney-pancreas transplant, and was in the hospital once every couple of weeks. We were just counting the time when he wouldn't leave us. On one admission, he told us his sister was getting married, and he just wanted to live long enough to walk her down the aisle. As the wedding approached, he became increasingly weak, and this round of rejection looked like his organs would fail completely. He was still so upbeat and kept talking about the wedding. Well, the day had come, and the physician gave him a day pass, and he was picked up by his family utilizing a wheelchair. We worried all day about his strength and his health. Well the day was over, and he wasn't back in the hospital yet, and I was off for a couple of days. When I got back, he was so sick, but he had the photo album of the wedding. We all gathered around his bed as he told us about every picture and person, and then there he was, in a tux in his wheelchair, being wheeled down next to his sister. He didn't live very long after that, and I think of him from time to time and have to marvel at the mystery of the human spirit every day ... and that's why I'm a nephrology nurse.

Cindy Richards, BSN, RN, CNN

ANNA Director 2013-14

ANNA President-Elect 2014-15

ANNA Chapter: AL-239 Hazel Taylor

Began Nephrology Nursing: 1987

I love nephrology nursing because: I am able to have a small part in touching so many wonderful patients' lives--and they are all able to touch me. Each of them is so special and so inspire me every day. When my days are rough, I look around and see all of these amazing patients and family members, and they encourage me. The patients and families I am able to interact with are my heroes.

Memory 1: Just visiting a dialysis unit when I applied for a job there! I had a small child and wanted a "job" with better hours and no nights (which I am betting many of us wanted when we started our families). The director of nursing in that unit was a former colleague, and I knew that I could work with him. He actually offered me the job on the phone--sight unseen--but I asked to be able to I look around first. That was the start of my amazing career in nephrology! Thanks, Ed!

Memory 2: Being invited to "a nursing meeting" with other nephrology nurses. Litde did I know that would translate into a lifelong journey with ANNA! I appreciate Stephanie for inviting me all those years ago to that meeting in Memphis, Tennessee!

Memory 3: Being encouraged to run for President-Elect of this amazing association! I have been active for many years and was very nervous about the idea of being President of ANNA. But I have had so many wonderful mentors along the years and many who encouraged me to run. And here I am!

Paula Richards, MSN, RN, CNN

ANNA Director 2013-14

ANNA Chapter: PA-110 Keystone

Began Nephrology Nursing: 1978

I love nephrology nursing because: I have continued to grow in knowledge, experience, expertise, and also as a nurse. Thirty-six years ago, I entered this specialty and have never looked back or regretted my decision to specialize in nephrology musing. Sure there have been some tough times, times when I wondered why I chose this; but all of the good things that happened with patients, staff, and within me makes me love nephrology nursing to this day...I couldn't dream of being anything else.

Memory 1: During my early years as a nephrology nurse in a large hospital-based acute unit, we were assigned "primary" patients. Care plans needed to be updated monthly, meds reviewed, and family members included in care. Isabel was my primary patient. She was so sweet, accepting her need for dialysis with a smile. She had some dementia and called me "Laura" instead of Paula...her husband only knew me as "Laura" because Isabel corrected him each time he called me Paula. She suffered with severed PVD with leg ulcers. As a team, we researched the most current treatment options and began to use them to help heal the ulcers. Weeks went by, with Isabel's husband helping out at home, and we began to see healing of the ulcers. What a feeling! After a couple of months of treatment three times a week at our hospital unit, the ulcers were healed except for one small area. Not to be deterred, we planned to continue the treatment but noticed a small dark area on Isabel's great toe. Gangrene! She was admitted, and a few days later, had a BK amputation of her affected leg...the one we worked so hard to heal! I felt defeated, but John, Isabel's husband, called to thank me and the other nurses for the care given to Isabel and to tell us of the difference it made in her level of pain and overall well-being. John's praise of the care provided gave me a new definition of success. As a young nephrology nurse, he made me feel wonderful. Isabel died a few months later, and I was able to be by her side as she quietly passed away... John had been called but arrived minutes after her passing. We shared some time together, and his gratitude for the care that our nurses and I had provided to Isabel still makes me smile and validates my reasons for being a nephrology nurse.

Phyllis D. Wille, MS, RN, FNP-C, CNN

ANNA Director 2013-14

ANNA Chapter: IL-319 Heart of Illinois

Began Nephrology Nursing: 1987

I love nephrology nursing because: It is so very rewarding, and there is never a dull moment!

Memory 1: My most memorable nursing experience as a nephrology nurse practitioner was speaking with a patient's daughter and the patient's internist. The patient wanted to stop dialysis but could not tell his daughter. The internist presented all the relevant clinical information and how this would support withdrawing from dialysis. The daughter was devastated. I then shared with her how fortunate I was to have had the opportunity to know her father over the last several years, and was able to recant his sharing with me many of his families events, birthdays, parties, weddings, etc. It was my sharing on how his life was an important part of my life that gave that daughter comfort. She was then able to support his decision to withdraw from dialysis. The attending physician was also greatly moved by my response to the daughter. We are so lucky to be able to have those long-term relationships with our patients!

Memory 2: Discharging a hospitalized patient to the Forest Preserve. He was homeless and did not want to go anywhere else but back to his tent. He showed up for his outpatient treatments, but how sad was that lifestyle.

Memory 3: When a patient drove his car through the window of the unit! He was drunk, but at least he was on time for his dialysis treatment.

ANNA Past President's Memories

Betty Preston Oates, BSN, RN

AANNT President 1973

ANNA Chapter: AL-235 R. Michael Huddle

Began Nephrology Nursing: 1966

I love nephrology nursing because: The challenge of being involved in a dynamic, ever-changing field; the experience of learning something new every day; the thrill of working together as a staff to make life better for our patients; the appreciation of the sacrifices our early patients and their families made; the opportunity that this organization has given me to travel and make friends all over the country. Congratulations, ANNA, on our 45th anniversary!

Memory 1: I started in 1966 when I was employed by Dr. John Bower to be head nurse in the new Artificial Kidney Unit at the University of Mississippi Medical Center in Jackson, Mississippi. Dr. Bower was awarded one of 14 grants funded by a U.S. Public Health Service. The $493,080 grant was used to build the facility and operate it for the first three years. There were few dialysis units in the country. For training, our technician and I spent a month at Wadsworth VA Hospital in Los Angeles. After a month there, I went on to the Seattle Artificial Kidney Center for a week. Much to my great surprise, the head nurse was from Mississippi! Over the course of the next few months, Dr. Bower directed the renovation of an area in the basement of the hospital to accommodate the kidney unit. We used a central dialysate supply system and Kiil cfialyzers. We had six beds for chronic patients and one acute dialysis room. We hired our staff--two more nurses and one more technician--and in December 1966, we dialyzed our first patient. Dialysis on the Kiil was for 12 hours twice a week. In the beginning, we were all in attendance for the entire time (Dr. Bower included!). It was so exciting to be a part of a new treatment for patients with kidney disease.

Memory 2: In October 1966, I attended a "Dialysis Symposium" at Peter Bent Brigham Hospital, sponsored by the dialysis nurses of Boston. Some of the topics were: Kiil Dialysis (hospital and home); Kolff Dialysis (hospital and home); A-V Cannulas (history, care, complications); Unit Planning; Transplantation; and (very important) Discussion for Future Plans. The seed had been planted! There were so few of us, and we were hungry for the ability to share information with each other. Our specialty grew, and in 1968, Bernice Hinckley, who was with the Kidney Disease Control Program, served as the chairman of a "Nursing Symposium on Chronic Renal Disease" in Philadelphia. This was an afternoon program lasting five hours. Two physicians and six nurses were on the program. In April 1969, a day-long program, "Nursing Symposium on Dialysis and Renal Transplantation" was held in Atlantic City, New Jersey. This was the beginning of the American Association of Nephrology Nurses (AANN), and Bernice Hinckley was elected as our first president. The following year, the name was changed to the American Association of Nephrology Nurses and Technicians (AANNT).

Memory 3: In September 1971, the University of Mississippi Medical Center sponsored a three-day program entitled, "Nephrology Nursing Care Workshop." It was attended by 97 nurses from 29 states and Washington, D.C. Very few of those attending had ever been to Mississippi! As I look at the names of those in attendance, I see the early leaders of this organization. It was a great time of sharing and bonding--a great time for the establishment of friendships which have lasted for decades.

Martha L. Orr, MN, RN

AANNT President 1975-76

ANNA Chapter: TX-274 Heart of Texas

Began Nephrology Nursing: 1968

I love nephrology nursing because: I always knew that nurses made a very important contribution to patient care and well-being.

Memory 1: Emory University Hospital had a single "tub"-style dialyzer, and I went with one of my patients to observe the treatment. Imagine my surprise when I learned the RN was there to assist the patient if needed, but only the MD was allowed to make connection to AV shunt, take BP, etc. That changed very quickly when the Kidney Center was opened at Grady Hospital. Our techs "built" dialyzers out of the cellophane-like membrane, sterilized them with formaldehyde, rinsed them, and then filled them with dialysate and tested them for leaks. It was not uncommon for these dialyzers to spring leaks during treatments, in which case, the patient lines had to be instandy clamped off and disconnected. AV shunts were the only form of access for the first couple of years.

Memory 2: In my first year or two of working as a nurse clinician in the Kidney Center, I learned more than I ever thought possible. I was a part of the team that made the really tough decisions about who would get scarce kidney transplants. In those days, unrelated live donor transplants were not permitted. I accompanied several "harvested" kidneys to other transplant centers by helicopter or small planes.

Memory 3: One of my most exciting times was when I attended my first AANNT meetings, at that time held in conjunction with ASAIO. I think Beth Cameron was my first president. Those meetings were wonderful and very informative. I enjoyed a wonderful career in nephrology nursing, even working in a dialysis unit in Denmark. I did home dialysis teaching and worked in a transplant unit in New York, so I had a very full-spectrum career.

Lois Foxen, RN, CNN

AANNT President 1978-79

ANNA Chapter: CA-517 Surfside

Began Nephrology Nursing: 1967

Memory 1: After graduation in September 1965 from then Jefferson Medical College Hospital School of Nursing in Philadelphia, I took a position in the hospital's ICU where I would remain for the next 18 months. I had my eye, however, on the Dialysis Unit, which was just down the hall from the ICU because as a student nurse in my junior year urology rotation, I had the opportunity to tour the Dialysis Unit, and I found it utterly fascinating. This blending of technology and patient, human being and machine drew me in like a moth to a flame. In my free time, I would spend hours visiting the unit and talking at length with RN Supervisor Mary O'Neill, another Jefferson grad (and future ANNA President 1971-73). So during my tenure in the ICU, I suppose I pestered Mary enough about a position in the unit that one day the magical call came that a nursing position was available and did I still want it?! I guess you know my answer.

When I stepped into that Dialysis Unit in early March of 1967, I had no idea that for the rest of my active nursing career, the next 37+ years, nephrology would be my specialty.

Hemodialysis in those days was on a huge coil dialyzer that had to be primed with six liters of saline and two units of packed RBCs and submerged in a 100 L stainless steel tank (Travenol) filled with dialysate we made up from dry chemicals and DI water that we had to change every two hours. In those days, because of costs and other factors, patients were hemodialyzed once or twice a week for six hours, and in between, supplemented with jejunal loop dialysis at home; an isolated loop of bowel in the abdomen, and its semipermeable membrane served as the vehicle through which dialysate was passed. The bowel loop was, in essence, the dialyzer.

By the end of that year, my medical director, Dr. Jim Clark, had accepted a position as Chief of Medicine at Crozer-Chester Medical Center in suburban Chester, Pennsylvania. He asked me to go with him and start up a new dialysis unit at Crozer. We would do some acute dialyses, but the main purpose was to establish a home training center like they were doing in Seattle, Washington. There was no Medicare payment for dialysis in those days, so funds came either from benevolent insurance companies, or in most cases, community fund-raising events to purchase machines and supplies. This way, Dr. Clark felt, we could serve the ESRD needs of many more patients. Each and every patient was reviewed by "The Committee" for acceptance into the program. To further save money and to fit the needs and budgets of each patient, dialysis employing Kiil dialyzers was much less expensive than with coils, so Dr. Clark sent me off to the University of Virginia to learn how to "build" Kiils--they did not come readily assembled! Believe me, a working knowledge of mechanics, hydraulics, and other technical skills was a must! I even had the maintenance department grind the rounded flat end of my bandage scissors into a screwdriver tip! I have those scissors, my hemostats, and those procedure manuals to this day.

I have very fond memories of my year and a half at Crozer. The patients and their families were so special and came from all walks of life and from four states--Pennsylvania, New Jersey, Maryland, and Delaware. There was an endless number of them as word got out that patients could actually dialyze in their homes! In addition to home training, Dr. Clark was interested in research, so we became the clinical research unit for the (then) Extracorporeal company. We did all the clinicals on the first EX-01 dialyzer, which was the first real competition for Travenol's coils.

Along the way, I was learning and expanding my knowledge base, soaking up everything I could, by attending nephrology meetings and reading what little literature was available. My first meeting was the ASAIO in 1967. Then, at the 1968 meeting in Philadelphia, a separate meeting for nurses was held in the same hotel. Sponsored by the Kidney Disease Control Program of the Department of Health, Education and Welfare and moderated by Bernice Hinckley, the one-day symposium was a resounding success. The presenters were nurses from all over the country who had been invited to come and share their experiences with shunt care, equipment, and the psychological impact of renal disease on patients and their families. A core group of nurses from Philadelphia--Mary O'Neill, Beth Cameron (future ANNA President 1970-71), Marie Reid, Nancy Gallagher (future ANNA President 1995-96), and myself served as hosts for the meeting. Because this meeting was deemed a success, plans for the next one in Atlantic City, New Jersey, on April 20, 1969, were undertaken.

The formal 1969 program, "A Dialysis Symposium for Nurses," again was well received; about 300 people attended. A small group of nurses met to formally begin a new organization, which we named AANN--American Association for Nephrology Nurses. We elected Bernice Hinckley as President and Beth Cameron as President-Elect, developed a charter and bylaws, and set the membership dues at $2.50! This was the beginning of ANNA as we know it today. We were no longer a "tag along" group going to the ASAIO meetings. We would now have our own program (but still in conjunction with ASAIO) at their meeting locations. This "partnership" would continue for the next 14 years until 1983 when ANNA (then AANNT) held its first meeting independent of ASAIO in Philadelphia. Independent meetings continue to this day.

By mid-1969, I was on my way to California to begin the next stage in my life. For a year and a half, I worked at Orange County Medical Center (OCMC) in Orange, California. Then our doctors, Dominick Gentile and Ron Miller, were invited by St. Joseph Hospital in Orange to open a dialysis unit. In February 1971, I left OCMC, took a six-week respite, and on March 15 (isn't there something about beware the "Ides?") joined the staff of St. Joseph Hospital, and along with Mary McKenzie, designed the Renal Center from scratch, opening it in May.

During this time, I was approached by my mentor, Mary O'Neill, who then was the President of AANNT, about starting a chapter in Southern California. I launched the Nephros chapter in 1973 and was on my way to long-term involvement with the organization. About the time I was forming the chapter, the federal government had passed HR 1 in 1972, which mandated payment for dialysis to qualified individuals with ESRD through the Social Security Trust Fund. Once that passed, legions of new patients began to appear, forcing the need for more dialysis facilities and staff. That meant ever-increasing pressure on education and training, and AANNT rose to meet the challenge.

By the time I became President of AANNT in 1978, I had come up through the ranks as a chapter founder and President (1973-75), national Nominations Committee Chairperson (1975-76), Western Region Vice-President (1976-77), and President-Elect 1977-78. Looking back, my nephrology nursing career spans four decades and many sub-fields of the specialty--acute and chronic, adult and pediatric, hemo and PD, in-center and home dialysis, transplant, clinical research, teaching, and consulting. My final 10+ years were spent as a Clinical Support Specialist with Amgen, a position that allowed me to utilize all those years of experience and skills to educate. I feel quite enriched both personally and professionally by it all and would never have traded the experience!

Nancy J. Sharp, MSN, RN, FAAN

AANNT President 1981-82

ANNA Chapter: MD-101 Baltimore

Began Nephrology Nursing: 1964

Memory 1: Exactly 50 years ago--in 1964--I walked into a two-station dialysis unit in Passavant Hospital/ Northwestern University Hospital, Chicago, Illinois. I was fascinated by what I saw and learned that day. That was the beginning of a 20-year odyssey in nephrology nursing, including one year as President of AANNT in 1982. I still remember my first two dialysis patients' names as if it were just yesterday.

Memory 3: Taking HCFA staffers to see three dialysis centers in Washington, DC.

Mary Kirkwood Baker, MS, MSN, RN

AANNT President 1983-84

ANNA Chapter: MI-312 MichigANNA

Began Nephrology Nursing: 1971

I love nephrology nursing because: Nephrology nursing is an exceptional and wonderful profession. The advancements, independence, respect, knowledge, and the patients/clients/families cannot be duplicated. Although I am no longer working, I truly respect nephrology nursing. There is nothing like it!

Memory 1: Mixing the dialysis solution and water the Travenol tanks (huge) and mixing with a stick, then rolling them down the halls to the elevator, and hoping it would not spill. This was at Rochester Methodist Hospital/Mayo Clinic. I had requested to work in Pediatrics after graduation, but no positions were available, so I was assigned to the nephrology floor. At that time, I still remember the "God committees" that would discuss who could begin dialysis. This was before there was Medicare coverage. When there was a transplant, to see urine in the bag after the transplant was "liquid gold." The people/clients/families/patients in nephrology were so special. The greatest happening for me was that I was placed in nephrology.

Memory 2: Relating to ANNA/AANNT, I found in the back of the file cabinet in the dialysis room an application for AANNT. Membership was $15 and being a new graduate and nurse, I wanted to learn all that I could. Thus began my involvement with the association. This was followed by attending the National Meeting in Montreal and looking up at Marti Orr, Lois Foxen, Marsha Clark, and Donna Mapes, and being in awe of who they were. Then I was at the North Central Dialysis and Transplant Association meeting in Minneapolis in 1973 (at this time, I was NC Vice President), and a nephrology nurse came up to me and said "I want to get involved." This was an understatement! The nurse was Janel Henderson Parker One of our exceptional dynamic past presidents who I still miss so much.

Memory 3: Having the honor and privilege of serving as AANNT/ANNA President (1983-1984). The organization that has grown so much is a very well respected group of dedicated nurses that always place their patients/clients first. Because of my association involvement from Bylaws Chair, National Secretary, and years in Presidency, I met so many wonderful people. I was able to travel all over the country, talk to nurses and patients, and truly see what a difference we made. We had become involved in the political arena, and I give credit to Nancy Sharp, another past president, for her foresight in saying to us in San Francisco at our Board Meeting, "You have to get involved politically. You cannot wait and just expect the physicians to do this. You have a very important voice." And lasdy, having such a wonderful working relationship with Anthony J. Jannetti, Inc.--Tony Jannetti, Ron Brady (past Executive Director, who was so great and a big loss), Mike Cunningham, and all of the staff who took a chance with us. The Board of Directors met in Carmella's kitchen when the association was literally down and potentially defunct, but it was Tony and Ron who truly believed in us from the very beginning! ANNA would not be here today without its great leaders and our association management firm!

Beth Ulrich, EdD, RN, FACHE, FAAN

ANNA President 1984-85

ANNA Chapter: TX-204 Gulfcoast

Began Nephrology Nursing: 1973

I love nephrology nursing because: We can make such a positive difference in the lives of so many, and along the way, we learn so much from our patients and each other.

Memory 1: I had the privilege of serving on the ANNA Board of Directors from 1982 to 1986. As an association, we were young enough to think we could change anything and old enough to understand the gravity, commitment, and work that the needed changes would require. Our specialty was changing rapidly as new knowledge and technology were developed, and nephrology nurses were involved with and often taking the lead in improving the care of patients with ESRD.

The 1980s were a time of declaring our independence and expanding our roles. Having been led by Nancy Sharp into the national legislative arena, the association was seen by legislators and regulators as a group whose input and advice should be sought--a voice that would always put the needs of the patients front and center and provide an objective view of the world of nephrology. The first independent meeting of our association was held in Philadelphia in 1983. For years, we had met in the shadow of ASAIO, and while we appreciated being able to meet with them and the collegiality that it promoted, we also knew we were ready to step into our own light. With nephrology nurses increasingly being the strong influencers and/or decision makers of the products and services used in dialysis and transplant centers, it was the time to offer our corporate colleagues direct access to nephrology nurses.

We expanded our horizons into the international world, holding an international workshop in 1983, and when some questioned whether nurses from certain countries should be invited because of the politics of their countries, we passed an apolitical resolution so that it was clearly understood that our association believed all nurses should have access to education and that educational programs must remain free of personal and partisan bias. The Special Interest Groups (SIGs) were created in the early 1980s to meet the growing needs of subspecialties in nephrology nursing, and the Chapters Congress was developed to give local association leadership a stronger voice on the national level. We also went back to our roots as an association for registered nurses. My first presidential act was to unfurl the banner with our new name--the American Nephrology Nurses' Association. We decided that nephrology registered nurses needed their own certification, and under the leadership of Janel Parker, we began the steps that would culminate in the creation of the Nephrology Nursing Certification Board and nephrology nursing certification. Throughout it all, we kept the focus on our patients and the care they received. We promoted communication and collaboration among the various nephrology stakeholders, calling together an Assembly of Nephrology Organizations, and we vigorously championed quality care long before it became the thing to do. The theme and goal of my presidential year was Protecting the Future of Quality Care, and that goal continues in the work of ANNA to this day.

Memory 2: I'm sure many of my patients never realized the influence they had on my entire nursing practice. There was G.N., an 85-year-old gentleman, who walked smiling into the dialysis unit every treatment holding hands with his wife. He had grandkids and great-grand-kids, and was truly enjoying his life and theirs. He taught me that age is a chronological number and that we should never make generalizations or rules about our patients, such as how old was too old to receive dialysis or any other treatment. E.M., my second home training patient, was the least compliant and best adjusted patient I ever cared for. He pushed the envelope farther than any other patient I had, but he knew his body and his psyche well, and balanced them to meet his physiological and psychological needs. Every time the nephrologists told E.M. that he had to do something he thought interfered with the rest of his life, he found a way to achieve the same outcome, but in a way that still allowed him to lead the life he wanted to lead. Early on, I cajoled, I threatened, I pleaded to get E.M. to comply with the "dialysis rules"--all to no avail. And then one day, I realized that E.M. was the best adjusted patient we had and that he was also in the best shape physically. If you met him away from the dialysis setting, you would have never known he was a patient. So why were my colleagues and I continuing to try to get him to comply with our rules, when he seemed to be doing well on his own? E.M. taught me that blind compliance isn't always good--that the knowledge on which to make decisions is the really important information that we have to provide our patients. As a result of what I learned from E.M., I virtually eliminated the terms "compliance" and "noncompliance" from my vocabulary. Later, I did my master's thesis on locus of control and my dissertation on values. Whether working with patients or colleagues, the question in my mind became not how can I get them to do what I think they should do, but how can I best help them obtain the knowledge they need to make their decisions and then how can I best support the decisions they make? I'm sure E.M. never imagined the influence he had on my practice, but he was truly a great example of how nurses sometimes learn as much or more from our patients as they learn from us.

Memory 3: My first nephrology position was as a home training nurse. ("Welcome! We'll teach you dialysis! Your first home patient--and the first in our program--starts training in three weeks.") Thank goodness for two nephrologists, John VanStone and Bob Fortner, who were willing to teach me indepth about renal function and for Jim, an Army corpsman, and Rick, a dialysis technician, who taught me how to safely and effectively dialyze a patient. I was one of the first "corporate nurses" in the country, working for Cordis in the early years of hollow fiber dialyzers. As a Cordis nurse, I got to visit dialysis units all over the country. It was a time when everyone was experimenting a bit and trying new things to make care better; I got to learn so much from so many people. The nephrology teams I worked with all became family. In fact, when I got married, the team at Mills Hospital not only came to my wedding, they helped prepare and serve the food! Over the years, I moved from nephrology into CNO and COO roles in hospitals and healthcare systems, and led healthcare research and consulting practices, but my clinical home is and always will be nephrology nursing and ANNA.

Geraldine Biddle, RN

ANNA President 1985-86

ANNA Chapter: NY-120 Northeast Tri-State

Began Nephrology Nursing: 1968

I love nephrology nursing because: It has been my life's work--work which I can characterize as a continuous stream of lifelong learning and an ever-changing landscape of practice opportunities. I started in dialysis 46 years ago, and my journey has taken me down many avenues. It seems to me now that at each new juncture in my career, I encountered the most incredible and inspiring individuals from whom I learned how much I did not know, where to go to acquire new knowledge, and how to apply it. As I moved from clinical practice to management to teaching and consulting, new challenges presented themselves to me, and I was blessed to be able to work with individuals who recognized me for who I am and what I have to offer. Nephrology nursing and ANNA have also provided me close special and lasting friendships. Now at age 70,1 find it hard to say goodbye to all that has Been--to my sense of self and identity--it has been a terrific trip.

Memory 1: My first memorable dialysis experience (exposure) took place at the Colorado General Hospital in 1967.1 was working in the surgical ICU and was asked to relieve the dialysis nurse for lunch. I managed to survive the half hour, staring at the steel tub with the bubbling fountain in the middle, and prayed there would not be any alarms. In January 1968, I returned to Philadelphia and accepted a position at Thomas Jefferson University Hospital in Dialysis. I was comforted by the fact that a dear physician friend was in his nephrology fellowship there, and he assured me that I would receive the proper education and training necessary to feel comfortable with the job. The first day was incredible. During my pre-employment physical, I was told that I would have to receive 10 cc of gamma globulin in each hip. It seems that my friend forgot to mention that the entire staff had turned over from an epidemic of hepatitis B. At the time, the coil dialyzers needed to be primed with blood and a patient's blood was collected and stored from one treatment to another--in the same refrigerator as the patient and staff food and drinks. No one wore gloves at that time, and there were no diagnostics or precautions available. However, this incident contributed to ongoing research which within two years identified the Australian Antigen and Antibody as markers for HepB, and to the CDC publication of Anti-Hepatitis Precautions (which later became Universal Precautions). I did forgive my friend, quickly adapted to dialysis technology, and did not get hepatitis.

Memory 2: A second memorable experience in nephrology nursing was in 1981 when I was invited to Japan to present several papers on dialysis care and nurse education in the U.S. I had only been out of the country once with my husband, but I decided to accept. I had twin six-year-old daughters at the time, but my family convinced me that all would be well, and my sponsors assured me I would be well cared for. The morning of my departure, I cried all the way from Rochester, New York, to Chicago, but got a grip after that and moved forward. I was greeted at the airport in Tokyo and taken care of every minute of the day by the most wonderful group of Japanese nephrology nurses. I spent two weeks with them. None of us were able to speak the other's language, but the universal language of nursing, nephrology, and of just being women (augmented by hand signals and an occasional translator) made it all work. As a result of that trip, I made several lifelong friends, returned several more times, and led a delegation of American nephrology nurses to Japan for an exchange program. That first trip was a seminal moment in time for me because it solidified my desire to continue to travel and experience nephrology nursing around the world. In the years since, I have traveled a good part of the world, visiting dialysis centers and their staff. With each new country and exposure, I am awed by the intelligence and talents of the nurses I work with, especially in the poorer countries, and am humbled by their generous hospitality and gratitude to have myself and others visit them.

Marilyn Neff, MBA, RN, CNAA

ANNA President 1991-92

ANNA Chapter: GA-224 Dogwood

Began Nephrology Nursing: 1968

I love nephrology nursing because: It provided me with the opportunity to work closely with patients for a long period of time and also work with machinery, something my mechanical brain enjoyed. It was a perfect blend. When I moved to administrative roles, I enjoyed working with and seeing my staff provide excellent patient care.

Memory 1: Working with Beth Cameron, who not only taught me nephrology nursing but was actively involved in starting ANNA. She spent endless hours on the phone, and "we" did many mailings to accomplish her goals and that of several other pioneers. That first meeting was held in Atlanta City and my "job" was to stay in Philadelphia and dialyze our patients. Beth could go to the meeting and participate, fully knowing that things back home were under control. When she returned, I enjoyed a full report of that special meeting!

Memory 2: Again, working with Beth Cameron, who taught me outstanding infection control. During the first two years of my working in nephrology, there were many units that had significant outbreaks of hepatitis. We never had any patients or staff convert to positive! We even dialyzed patients from another unit for a short period of time because all their staff were ill with hepatitis, and still, no one in our unit converted. Our IC people said it was because of our technique, all of which I attribute to Beth's procedures.

Karen E. Schardin, BSN, RN, CNN

ANNA President 1994-95

ANNA Chapter: CA-509 Sacramento Valley

Began Nephrology Nursing: 1976

I love nephrology nursing because: I have enjoyed being able to be involved in home therapies, seeing patients being empowered to do their own treatments and live their lives on their own terms. It is inspiring to work with nurses and patients who see that dialysis is a way to allow people to truly live their dreams. Nothing is more touching than to hear patients say that they have their life back.

Memory 1: Home hemodialysis has a long history but fell by the wayside when reimbursement was provided for ESRD and dialysis units popped up "on every street corner." In 2004, there was a re-emphasis on more frequent home hemodialysis. Working with Wellbound as they trained their first four patients was inspiring. All of these patients drove to the unit six days per week up to two hours one way so they could be the first patients to go home with the NxStage system. They learned quickly, helped each other, and were ecstatic when they took their equipment home. Three of those patients remain on HHD today. The other patient was transplanted but still meets regularly with her trainers and fellow pioneers.

Memory 2: As I meet with groups of nurses around the country and talk to them about their experiences in nephrology, I am often left surprised. Sometimes, the nurses have no more than 10 years of experience, but other times, there are many who have worked in nephrology over 30 years. No matter their years, I find that they are dedicated to their patients and want to make a difference in their lives.

Christy Price Rabetoy, NP

ANNA President 1997-98

ANNA Chapter: TN-264 Tennessee Valley

Began Nephrology Nursing: 1976

Memory 1: Professionally, my most memorable experienced was taking collaborative practice to a higher level through the committee work involving ANNA and the RPA. The first position paper on collaborative practice, which incorporated the role of the nephrology nurse practitioner in providing care for patients with chronic renal failure, was developed. From these early beginnings in the mid 1990s, the nephrology nurse practitioner is now well established, and furthermore, is recognized as a valuable asset in coordinating care for patients with either acute or chronic kidney disease.

Memory 2: The early days of treatment of acute renal failure with continuous arterovenous ultrafiltration (CAVU), which became CAVH (hemofiltration), which became slow continuous ultrafiltration (SCUF), which advanced to CAVHD (hemodialysis) and then on to CVVH/HD (venonvenous). and CWHDF (hemodiafiltration). In the early 1980s, I published an article on continuous therapies and first coined the now widely accepted acronym-CRRT--continuous renal replacement therapies. Since these early days, more acronyms have been added: IU (isolated ultrafiltration), SLED (sustained low-efficiency dialysis), and EDD (extended daily dialysis). There has probably never been any other organ failure treatment so customized and that continues to be debated as to the effectiveness of the modality as CRRT. Having been involved since the beginning, even before CRRT received FDA approval for treatment of ARF, it is a lifelong memory of the expertise and adaptability of nephrology nurses.

Karen C. Robbins, MS, RN, CNN

ANNA President 1997-98

ANNA Chapter: CT-103 Colonial

Began Nephrology Nursing: 1970

I love nephrology nursing because: Of the many and unique career opportunities that exist in the specialty. It is not possible to think about memorable moments or events in my career in nephrology nursing without including ANNA, which has been inextricably intertwined in my professional life. I remember being a relatively new nurse working in kidney transplantation and asking a clinical nurse specialist colleague at that prestigious medical center about AANNT (now ANNA), and about potentially becoming a member. She responded by saying that it was an organization for people working in dialysis and had no relevance for us. Being young and naive, I listened to her without exploring it further, only to realize that was not the case. I did not join at that time. Had I done so, I would have now been a member for 43 years rather than a mere 41.1 soon realized that ANNA was not a "dialysis-only" organization but also one that offers many opportunities for professional and personal growth that can only enhance one's career and life. The ANNA Presidency is a unique experience, one that affords the opportunity to work with professionals who are committed to advancing nephrology nursing practice, and ultimately, the care our patients receive. I take pride in a number of accomplishments that occurred during my presidency in 1997-98. One of those was working with Janel Parker, a Past President of ANNA and editor of the first Contemporary Nephrology Nursing textbook that was released at the National Symposium in San Antonio in 1998. I recall holding up a copy of the book, new from the presses, with great satisfaction during Opening Ceremonies. Little did I know that Janel's extraordinary efforts in this book and her earlier ground-breaking work in certification for both nephrology nursing and nursing specialties in general, would be cut short by her untimely death five years later. Janel was embarking upon the revision of the book when she was taken from us. To have known and worked with her was extraordinary, professionally and personally. Her joie de vivre was unsurpassed and filled a room as did her laughter; her professionalism was unparalleled and a model for all. It was indeed a privilege and a treat to have known and worked with her--the only one of her kind and she is an example of the distinctive people who enter our lives through our participation in ANNA.

Memory 1: The excitement of working in kidney transplantation when it was a relatively new therapy to offer patients with kidney failure who were approaching death. After working on the Transplant Unit at a prestigious medical center as a new grad, 1 joined the Transplant Team one year out of undergraduate school. I remember going into the OR during a living related donor kidney transplant, sitting on a stool under the OR table, and monitoring the urine output in the urimeter that was draining urine via the ureteral stent that was placed in the transplanted ureter. It was exciting to see this "liquid gold," and the prospects and hope it represented for the recipient of the transplant. While this practice of sitting under the OR table is thankfully no longer in vogue, the promise and hope a transplanted kidney (or any other organ) brings to its recipient is no less profound or important than it was during the infancy of renal replacement therapies as we know them today.

Memory 2: Being in the OR when organs were removed from a donor who was deceased. The organ donor was a young girl who had been hit by a car, running to catch the school bus. It was the first time I was in the OR for organ retrieval from a donor who was deceased (or as it was called then, "organ harvesting"). The girl had been declared brain dead, and cardiopulmonary support had been maintained to perfuse the organs being removed for transplant. As a young woman and young nurse in my mid-twenties, I was extremely moved by this experience. Once the organs were successfully removed, wound closure was achieved, life support was discontinued, and everyone walked away. I stood there, staring at the young girl who had departed this life. It seemed so wrong, but in the end, her death had the good fortune of bringing hope to those recipients of her young, healthy organs. It is wonderful to be able to offer something so positive to the lives of others while the experience of organ donation can provide optimism to those family members and friends grieving the loss of their loved one. I can think of no better way to provide comfort and hope to those who survive the donor's loss. We, as nephrology nurses, have an exceptional and inimitable perspective and role in the care we provide our patients, both in the short and long term.

Carolyn E. Latham, MSN, RN, MBA, CNN

ANNA President 1998-99

ANNA Chapter: TN-228 Music City

Began Nephrology Nursing: 1977

I love nephrology nursing because: It is a specialty that focuses on a complex patient population and makes a positive difference in the lives of so many. Nephrology nursing offers the ability to utilize nursing expertise; it allows nurses to be nurses, applying the nursing process and contributing in such a valuable way. In addition to the wonderful career opportunities that exist for nurses in the specialty, nephrology nurses can be part of a specialty nursing organization that offers so much: networking, mentoring, education, leadership development, and up-to-date information.

Memory 1: Working in a very progressive, state-of-the-art, hospital-based dialysis center. We had such an engaged and supportive medical and surgical staff, a collaborative and motivated team, and readily available and talented nursing leaders. To this day, I can remember patients and family members who forever touched my life. I think back at the limited technology we had compared to today, particularly with regard to the safety features, immunization, pharmacology, and informatics. However, we insisted on a sound general nursing foundation coupled with specific nephrology nursing expertise with the overriding mission of providing patient and family-centered care, and it worked.

Memory 2: Having the opportunity to learn and grow with a dynamic specialty nursing organization--ANNA. It has been wonderful being able to be part of the organization in so many different roles. From being a chapter officer to holding a national office, each has been an enriching experience. I have developed lifelong friendships along the way, and have grown personally and professionally throughout my journey with the organization.

Memory 3: The opportunity to have so many different types of careers in nephrology nursing. I have worked in the service and product/manufacturing sectors of the industry. Nephrology nursing offers such a broad range of job opportunities--education, administration, research, product management, marketing, and clinical practice. In each of the nephrology nursing roles I have held from clinician to executive and from dialysis to product development and marketing, the overall purpose has always been the same: to be able to provide the best care possible for our patients.

Lesley C. Dinwiddle, MSN, RN, FNP, CNN

ANNA President 2004-05

ANNA Chapter: NC-201 Cardinal

Began Nephrology Nursing: 1979

I love nephrology nursing because. We, nephrology nurses, love long-term relationships with each other as well as our patients, our interdisciplinary colleagues, and our colleagues in industry. I have been a nephrology nurse now for 35 years, and I not only have nephrology nursing friends all across the U.S., but also around the world. I have been involved in every aspect of nephrology nursing and worked in every modality. It has been an amazing experience in patient care, academically, as a consultant and educator, and as a volunteer with ANNA and other nephrology organizations.

Memory 1: In 1979, as a part-time float pool nurse, I was exposed to many different nursing experiences at the University of Arkansas Medical Sciences. One evening shift, I was assigned to the neurosurgical intensive care unit to care for a 26-year-old male who had severe head injuries from a car accident and had been declared brain dead. The care I was giving was organ maintenance pending organ recovery. It was both a sad and depressing duty. During the evening, the transplant nephrologist, William "Pat" Flanigan, at UAMSC, came to check on the patient. He told me the history of the patient, explained to me the determination and laws concerning brain death, and then told me that though there was nothing more we could do for this young man, our care of his organs meant that two people currently on dialysis would be able to regain kidney function and live more normal and healthier lives as a consequence. The next day, as luck would have it, I was assigned to the nephrology floor, and Dr. Hanigan told me that both kidneys had been successfully transplanted overnight, one out of state and one locally. The short end of this story is that I went on to become a nephrology nurse and Dr. Flanigan's transplant coordinator--the first in the state of Arkansas. It was a role I loved, both the patient care and the teaching that evolved from it. To this day, I still have contact with a patient from that time. I remember asking her back then to give me a slide showing her doing something that she could now do because of her renewed energy and health that I could use to illustrate the benefits of transplantation. She brought me a slide of her vacuuming her home!

Memory 2: One of the most satisfying roles I had as an FNP transplant nurse was to do the living donor evaluations with Dr. Hanigan. We would admit the potential donors for a two-day assessment. My first donor was a 28year-old mother who was a perfect HLA match for her brother who lived on the west coast. She was very nervous, not only about the evaluation, but also about the prospect of the donation surgery. I told her that I would be with her throughout the evaluation, and then Dr Hanigan would let her know if she a suitable donor. I wanted to experience every step of the evaluation with her. Not only did I do the complete history and physical evaluation, but I also accompanied her for all the radiological studies that included renal arteriogram and IVP. I was also present for all the lab work. The results showed that she was normal in all respects anatomically and physiologically. Dr. Hanigan presented her and her husband with the results, and told her that if she wanted to give her brother a kidney, she would be a very good donor, but that if she didn't want to do, it he would let the nephrologist caring for her brother know that she wasn't a suitable donor. She said that she would do it on one condition. The condition was that I should accompany her to the west coast for the surgery. I did, and both the donor and recipient did very well!

Suzann VanBuskirk, BSN, RN, CNN

ANNA President 2005-06

ANNA Chapter: DE-134 First State

Began Nephrology Nursing: 1977

I love nephrology nursing because: My mother said my decision to select nephrology nursing as a career was a result of divine intervention when my father was diagnosed with chronic kidney failure in mid-1990. In retrospect, she was right. I would not exchange one hour or a single decision I made to become a nurse and to be part of this nursing specialty. I cherish my volunteer work with the American Nephrology Nurses' Association. Happy 45th anniversary, ANNA!

Memory 1: Growing up, I did not aspire to be a nurse. In high school, I was active and interested in music, but during my senior year, I realized that there were too many children in our family to support my attending an expensive college. So my first impetuous youthful decision was to enroll into an inexpensive diploma nursing program recommended by a classmate with a bargain tuition of $1,000 for three years that included courses, books, lodging, and meals. Following graduation in 1971, I worked night shift in critical care for five years before moving to the day shift when I became intrigued by the nurses who wheeled those large machines to dialyze patients at the bedside. In May 1977, I made the second impetuous decision of my nursing career and transferred to the large hospital-based dialysis unit that provided services to patients with chronic and acute kidney failure in a state with rigorous "certificate of need" regulations, limiting the growth of outpatient dialysis clinics while supporting the proliferation of home hemo and peritoneal dialysis.

Memory 2: Fast forward to the present, as I prepare to write my "memories," I have been flooded with many wonderful thoughts of my nephrology nursing career. My experience has been varied and remarkable, allowing me to explore the full range of nephrology nursing opportunities throughout the country. I have been blessed to work closely with some of the most dynamic nephrology nurses and ANNA leaders, to the extent that I fear I would be remiss in excluding many, if I were to begin to list them.

Memory 3: And now, as I look toward the anniversary of my 37th year in the specialty, I have deliberately chosen to return to direct care as a staff nurse on a full-time basis. I have found the patients that nephrology nurses and professionals care for still have the same need to have access to quality care to which they were entitled in the early 1970s.

Jo Anne Gilmore, BSN, RN, CNN

ANNA President 2006-07

ANNA Chapter: AZ-501 Desert Vista

Began Nephrology Nursing: 1977

Memory 1: I was National President of ANNA in 2006-07. At the time, our membership was strong, with almost 12,000 nephrology nurses and 114 local chapters. We revised our Mission Statement; we felt the nephrology community could better serve our patient population by early recognition and treatment of chronic kidney disease (CKD) to prevent or slow progression to end stage renal disease (ESRD). This change reflected the change in our philosophy and was consistent with our core purpose. We continued our strong partnerships with other nursing organizations and nephrology organizations. We remained proactive with numerous health policy activities. We were blessed with continued strong support from Anthony J. Jannetti, Inc., and its management team. My presidency was an exciting time and one of those great opportunities for friendships and learning on my part, and it remains a fond memory that I will always cherish.

Sandra Bodin MA, RN, CNN

ANNA President 2007-08

ANNA Chapter: MN-316 Southeast Minnesota

Began Nephrology Nursing: 1978

Memory 1: It is with pride and just a touch of disbelief that can reveal I have been a nephrology nurse for 35 years. I can still remember as a nursing student, looking through a window into the dialysis unit and deciding right then I wanted to be a dialysis nurse. Several of the nurses I met at that time have remained lifelong friends. I have many personal memories of the individuals I cared for and their families. They taught me the most wonderful lesson --enjoy each day and not put off adventures until a more "appropriate" time. I am extremely grateful for that advice. I consider my volunteer involvement with ANNA to be a blessing. I have had countless opportunities and made the most wonderful friends here. The first time I served on the Board of Directors, ANNA had lost some focus, and fortunately, Gail Wick stepped forward to save us from ourselves. While I was President, over 70 current and future ANNA leaders were called together in September 2007 to attend a Critical Issues Conference in Philadelphia. The goal for the Critical Issues Conference was to create an environment for ANNA's continued growth and success over the next five years. The objectives of the conference were to complete an assessment of all ANNA programs and products, review the ANNA strategic plan, develop strategic thinking skills in ANNA's current and future leaders, and evaluate the governance of ANNA. Some of our recommendations are still in action today.

Memory 2: In 2008, the Centers for Medicare and Medicaid Services (CMS) published the new Conditions of Coverage for ESRD Facilities, which had not been revised in 30 years. The proposed rules contained language that facilities must ensure a registered nurse is present at all times that patients are being treated. In 2006-2007, several organizations lobbied CMS hard to repeal that language. These organizations used the excuses of the nursing shortage and health care in rural settings to advocate for treating patients without the presence of a registered nurse. We understood that other organizations, depending on their interests, may respond differently than ANNA to the proposed rules. As ANNA's interests are the patients, we put our advocacy to work. We focused CMS' and our attention on nurse-sensitive quality indicators, which are defined by the American Nurses Association as those that capture care or its outcomes most affected by nursing care. The turning point in our advocacy was when Charlotte Thomas-Hawkins presented her preliminary research findings with CMS staff from Clinical Standards, Quality Improvement, and Survey and Certifications Groups. Charlotte and her colleague, Linda Flynn (both professors at Rutgers University School of Nursing, New Brunswick, NJ), were the principal investigators for a comprehensive research study entitled, "The Work Environment and Nurse-Reported Outcomes in Dialysis Centers." The data demonstrated the important role registered nurses have in dialysis units and their influence on patient safety and outcomes. When the final rule was published, the nurse presence guideline was included. This was a historic event because many ANNA members took this opportunity to influence patient safety and outcomes by requiring a registered nurse presence in the dialysis unit.

Sue Cary, MN, ANP-BC, RN, CNN

ANNA President 2008-09

ANNA Chapter: LA-263 Fleur-De-Lis

Began Nephrology Nursing: 1977

I love nephrology nursing because: It gives me the opportunity to work with and meet the complex needs of special people who also give back so much more to my life through their courage and love.

Memory 1: The year I served as ANNA's National President. This was the highlight of my nursing career. The year proved to not disappoint me. Some of the accomplishments of that year by the Board of Directors of ANNA included initiating the first "3 for Free" campaign. Once a member recruited three people to join ANNA, the member received ANNA membership free the next year. Being a nephrology nurse practitioner in the clinical areas, it was very important to me to reach out to the staff nurses who are at the grassroots level taking care of patients with kidney disease. I was so proud of the fact that as of March 31, 2009, ANNA had 12,669 members. This was the highest number of members ANNA had ever had. In the political arena, those years ANNA had input into the Medicare Improvement for Patient and Provider Act (MIPPA) that was passed by Congress on July 15, 2008. ANNA was also cited in the Interpretive Guidelines V715 for its contributions on the minimal nursing assessment that is required before a patient's first dialysis in an outpatient setting. As ANNA President, I wrote a President's Message for each Nephrology Nursing Journal issue during my presidency. Many tides of the articles I wrote were in relation to being a nephrology nurse, such as "The Specialty of Nephrology Nursing" and "Celebrate You--A Nephrology Nurse." The one I am most proud of was titled "What Is in a Name?" which addressed what being a nephrology nurse means. In the article, the complexity of nephrology nursing is discussed. "Nephrology nurses understand that kidney damage affects the whole person. This body of knowledge that the registered nurse uses to work in nephrology brings value and promotes patient safety... The patient has a certain level of expectation of care from a health provider called a nurse practitioner (NP), or a clinical nurse specialist (CNS). Both of these titles retain the name 'nurse.' This is an important point since it denotes a level of care that only nurses can bring to the patient as a member of the healthcare team." Throughout my years working in nephrology, I have met many nurses who have touched so many lives of those who are in a world of living with kidney disease. This world is only known by those who live it but open to all. It takes special nurses to enter this world and stay with it to serve the people affected by kidney disease. I am proud to call these nephrology nurses throughout this country my colleagues and friends. When I go to ANNA meetings, my memorable experiences come from these relationships.

Donna Bednarski, MSN, RN, ANP-BC, CNN

ANNA President 2009-10

ANNA Chapter: MI-312 MichigANNA

Began Nephrology Nursing: 1983

Memory 1: When a delightful housekeeper was retiring, having spent her entire career within the organization, I wanted to make sure she knew how much her smile, wonderful personality, and constant positive attitude brightened the day of all those around her. I attended her retirement celebration, and she came straight up to me and gave me a big hug, stating, "I knew you would be here." She proceeded to introduce me to her family, telling them, with tears in her eyes, I was the nurse that helped her son when he needed it most, and he would not be where he was today without me. I was taken by surprise, as I do not know who her son is, and unfortunately, he was not in attendance. What an honor and wonderful reminder of the impact a nurse can have on our patients and their family.

Donna Painter, MS, RN, CNN

ANNA President 2010-11

ANNA Chapter: TX-208 Dallas

Began Nephrology Nursing: 1983

Memory 1: One of the best things about nephrology nursing is ANNA. I was fortunate enough to be President of this great association 2010-2011. I have made my best friendships through ANNA and have learned a lot about myself. In fact, I am sitting with one of them in Phoenix, Arizona, having a glass of wine while I write this. Through all of the challenges and opportunities, the most important thing that I have learned is the value of a sense of humor. For my story, background information is important. The Board of Directors typically sends the President-Elect to the Canadian Association of Nephrology Nurses and Technicians (CANNT) meeting each fall. The year I was to go, the meeting was to be held in St. John, New Brunswick. A good ANNA friend was from Canada, but when she heard that the meeting was there, she declined to go with me. I had been very busy with work travel, and an administrative assistant asked if there was anything she could do to help me. She agreed to arrange my flight and called me later to say that she was having trouble determining what airport I should fly into. I directed her to contact the National Office. She was given the airport code, YXJ (remember that for later in the story). I travel frequently and did not pay close attention other than making sure to make my connections, and upon arrival to the airport in Canada, my first impression was it was a very small airport. I had been told that this meeting was considerably smaller than an ANNA meeting, but based on this airport, it was a lot smaller than I had expected. When the cab arrived, and when I say cab, I use the term loosely, it was an old Sedan and wasn't marked as a taxi. As I got in, the gentleman asked where I wanted to go, and I gave him the specific name of the hotel. He replied that he did not know where that was. I explained it was likely near the convention center. He inquired from me where I thought I was. I explained that I was in St. John, New Brunswick. He informed me that I was in St. John, British Columbia. He had stopped the car and wanted to know what I want to do. Thinking quickly, I asked him to take me to a hotel where I could figure this out. He asked me which hotel to which I replied that I was going to have to trust him on that. When I arrived at the hotel, I began by calling Air Canada, explaining what had happened and that I really needed to get to St. John, New Brunswick. They informed me that it might take a little while and they would call me back. I waited all night for that call back, but it never came. Finally, I reached Air Canada the next morning. I was informed of the exorbitant price to get me to the other side of Canada or even change my ticket to go home. This is like going from Portland, Oregon to Portland, Maine. I realized that it was now time to contact our executive director Mike Cunningham and tell him what I had done. After hearing my story, Mike advised that I should just go home. He would send a gift to the CANNT Board apologizing for my absence. I explained that I would get home without it costing ANNA anything. In person, I can be very persuasive. I jumped in the shower, planning to head home. When I got out of the shower, I had missed calls, and in particular, Mike called to tell me that he had talked with his staff who indicated she had directed me to the wrong airport. It seems that she was advised to have me fly into YSJ, but with the CANNT contact's French accent, she heard YXJ. As I have said, this was a very small town, and I had to wait for the airport to open but was able to change my ticket to go back home that day without a fee. The moral to the story is if going to the wrong side of Canada, what is the worst thing that could happen? What are we really afraid of? Who knows, right?

Rowena W. Elliott, PhD, RN, CNN, BC, CNE, AGNP-C, FAAN

ANNA President 2011-12

ANNA Chapter: GA-224 Dogwood

Began Nephrology Nursing: 1991

I love nephrology nursing because: It provides me an opportunity to share knowledge with my colleagues, students, patients, and individuals in the community about a topic that I absolutely love ... awareness, prevention, and treatment of chronic kidney disease!

Memory 1: My first and memorable experience is when I became the Director of Nursing for a five-chair outpatient dialysis unit. I didn't know a thing about dialysis, didn't remember anything about the kidney from nursing school, and didn't really know what dialysis was! The funny and ironic thing is ... I got the job! I am so glad they hired me because I found my love in nursing. Little did I know that nephrology nursing would become my passion!

Memory 2: My second memorable experience in nursing was when I became the National President of ANNA. It was definitely memorable because I was the first African-American ANNA President, but it was more memorable because I knew this opportunity would open up avenues where I could share with others the message of "Dare to Soar." I was able to let others know that you can do more that you ever think in your mind. Your can truly SOAR in your personal and professional life.

Memory 3: My third memorable experience in nephrology nursing came when I became a Past President. A member came up to me and said that she really respected what I did as President and that I was the "People's President." That was the biggest and most humbling compliment any member could have made to me. It is because I always told the Board of Directors, "Don't forget the members," as we made decisions on the future of this organization. I was blessed that members realized I was looking out for them at all times. One other thing that is a precious memory is when I established the "Dare to Soar" scholarship. On my last day as President, I was surprised with a commitment from five ANNA chapters to support the scholarship for five years. I was beyond blessed!

Memories

Deborah H. Brooks, MSN, ANP-BC, CNN-NP

NNJ Editorial Board

ANNA Chapter: SC-203 Palmetto

Began Nephrology Nursing: 1980

I love nephrology nursing because: Throughout the years, I've seen a parade of pictures bearing witness to life's events--weddings, anniversaries, memorials, births, graduations, and reunions. I'm so thankful that nephrology nursing and I found each other. I can say with heartfelt thanks that I've had the best profession.

Memory 1: As I reflect on nephrology nursing, all types of tidbits float through my memory. Because these patient relationships are so long and so deep, I've laughed, cried, scolded, and applauded many times. I remember the man who always had slightly elevated blood pressure and poor pill compliance although he swore he took all his meds. One day, his blood pressure and his pill count were correct. He told me it occurred to him we only wanted the best for him, and he had decided to take better care of himself. He and his wife took in foster children under emergency and often grim circumstances, and he needed to be there for them. Another man had to hide on the floor board of the back seat because he was so terrified of riding over the bridge on his way to clinic. He also told me with a straight face he couldn't write down his blood pressure readings because his children had taken all his pencils. I just burst into laughter, and he started laughing, too. I didn't laugh when he cleaned out the family checking account to buy crack cocaine. There was the man with the inoperable dissecting thoracic aneurysm and heart failure who went home on peritoneal dialysis with comfort care only. Several months later, I saw his wife and an unfamiliar man walking down the hospital hall. When I stopped to talk with her, they started telling me how the miracle of prayer had cured him. Nobody could explain his recovery, and he certainly didn't resemble his former self. I also remember a quiet woman in her 60s who was on peritoneal dialysis. She had never been out of the state. She won a trip to Hawaii, and accompanied by her daughter, experienced the vacation of her lifetime (infection-free). She beamed telling us about the trip. Decades ago we made a home visit after teaching a 10-year-old boy and his mom how to do CAPD. They lived two-and-a-half hours from the clinic, their house was in the middle of a tobacco field, and they didn't have indoor plumbing. That home was so tidy and clean, I still think of them when my kitchen floor needs mopping. He went on to have a successful transplant.

Paula Dutka, MSN, RN, CNN

NNJ Editorial Board

ANNA Chapter: NY-122 Long Island

Began Nephrology Nursing: 1981

I love nephrology nursing because: Of our ongoing relationship with our patients and the technological aspects of the therapy that continue to evolve.

Memory 1: One of my most unusual memories reminds me that patients have lives outside of the Dialysis Unit that can be very different from what we envision. It was a cold wintery evening when a woman came to visit one of our younger male patients whom we hadn't seen before. She was dressed quite warmly in a beautiful full length mink coat. Shortly after her arrival, this patient's wife came into the unit, whom we all knew well. Not looking happy, she no sooner went by her husband's side when loud voices were heard. Then yelling and tugging at the fur coat ensued. As this confrontation appeared to be escalating, we quickly called security. By the time they arrived, the mystery woman visitor had left, and the wife appeared to have a new fur coat!

Tamara Kear, PhD, RN, CNS, CNN

NNJ Editorial Board

ANNA Chapter: PA-110 Keystone

Began Nephrology Nursing: 1989

I love nephrology nursing because: It allows me to know my patients like very few other nursing specialties.

Memory 1: In January 1996, the Philadelphia area was buried in 30 inches of snow on the heals of a weekend. Public transportation wasn't running, and snowplows could not make it down the narrow historic streets of our city. The city was shutdown by the snow. I was working as the clinical nurse specialist for a large hospital-based dialysis unit. On the day of this snowstorm, a few of us made it to work and advised the patients to take Kayexalate[R] based upon their potassium trends. On day two, a handful of patients were able to get to the unit for treatment. As we entered the third day of this weather emergency, we knew we needed to be proactive to save the lives of our patients as streets remained blocked, and some of our patients could not even open their front doors. And then a turn of events saved the lives of our patients. The Pennsylvania National Guard arrived at the doors of our dialysis unit in their Hummer. For the next three days, we gave these men and women addresses and directions. They navigated the blocked streets and transported the patients to our unit. My favorite story surrounded a long-time patient who had experienced a double-amputation. She had called us many times worried about the days that had passed since she had dialysis. We gave the National Guard her address and warned that she was wheelchair-dependent and would need assistance. The National Guard entered her house, placed her on a stretcher, and carried her nearly a block to the Hummer. There were no words to describe her appreciation and relief for they had saved her life. As dialysis staff, we worked 16-hour days with the National Guard, ate meals together, and quickly became one efficient team. Due to the dedication of the National Guard and teamwork, we did not have any untoward patient events during Philadelphia's "Storm of the Century."

Charlotte Szromba MSN, CNN, NP

NNJ Editorial Board

ANNA Chapter: IL-305 Windy City

Began Nephrology Nursing: 1980

I love nephrology nursing because: It helps me touch another person's life in a meaningful way.

Memory 1: When I worked in the Detroit area in the late 1980s and early 1990s, I had a support group for individuals newly diagnosed with CKD. At that time, there were very few online or other resources available. At one meeting, I had a panel of patients with CKD on various therapies act as speakers for that night. They talked about their collective experience both positive and negative. Several attendees afterward shared how helpful it was to see and talk with "the veterans," the individuals who experienced the same things that they did. One of the more moving parts of the evening occurred when one of the speakers on the patient panel came up afterwards, took my hand, and said, "I forgot how far I came from the beginning; thanks for reminding me and letting me share my story ... warts and all." As nephrology nurses, we often forget what a resource we have in a patient already living with CKD. They not only provide education based in everyday reality, but are a powerful reminder that a successful life can continue after CKD.

Marilyn Kay Dye, BSN, RN

ANNA Chapter: MO-318 Central Missouri

Began Nephrology Nursing: 1993

Memory 1: The first person who comes to mind when I think of nephrology nursing is Barb Prowant. She was an exceptional nurse who was always looking for ways to assist in making our world a brighter place for both patients and staff. Not only here, but all around the world, she shared her knowledge and expertise. No question was too small or too big. She encouraged us to step out of the "box" and our comfort zone, spread our wings, and explore new territory. Always striving to move forward. The research, the publications, the presentations... her legacy lives on. What a huge contribution was made to our profession during her nursing career. She was my friend and mentor. I wish I would have asked more questions and listened more closely. Thank you Barb. May you rest in peace.

Beverly G. Grier-Smith, BSN, RN, CNN, MSHCA

ANNA Chapter: VA-241 Tidewater

Began Nephrology Nursing: 1978

I love nephrology nursing because: It has become a part of my professional and personal life. I will treasure every experience as long as I live. In addition, it is a treasure I will never, ever forget. Finally, my decision to continue my education came directly from the encouragement by all of the contacts, members, leadership, and relationships that were afforded me during my years as a member of ANNA!

Memory 1: I'm not sure of the exact date, but it was prior to ANNA as we know it today. The nurses were combined with the techs' and the nephrologists' national meetings. The first one that I attended was in Chicago. A week after we left that hotel, the spiral suspended staircase collapsed. That was a great tragedy. I was amazed that the doctors actually attended our sessions, and we actually attended theirs. Companies were allowed to wine and dine members. Later, ANNA was formed, and I was young and really did not have a lot of money to attend the meetings, so I did not pick up with ANNA after that time of separation until several years later. When I did, I was encouraged by Millie Morris who had started a chapter in Northern Virginia/Richmond area and another one, which is the Tidewater Chapter # 241. Millie encouraged me to attend national meetings. We slept four to six deep to be able to afford the trip. Wow! It was so much fun, and we created friendships that I still enjoy today. I met Cynthia Frazier, and at the time, she was the Regional VP and later the scholarship chair (Apply, Apply, Apply). I do remember having leadership training in Dallas, Texas, each year, and then the national meeting would occur in another state. I would always say that it did not make sense to separate these two meetings. Money could be saved by having the leadership training in the same venue. In addition, I was tired of Dallas (smile). I also said it would encourage more members to stay over to the actual national meeting. There was no such thing as VLW. Eventually, VLOW was created. I remember presenting my first abstract at the ANNA National Meeting and paid a small fortune to bring the presentation board on the flight with me for fear that it would not make it to the venue if I sent it by UPS or U.S. mail. The reason that I had that feeling was because one year in Las Vegas, the Tidewater Chapter decided to mail the chapter board, and it cost $500. When we got to the MGM hotel, they could not find our board. It had been mailed over a week prior to the meeting. We went to the receiving area so much that finally the staff allowed us to go into the area and look for the board ourselves. Guess what? We found the Tidewater board with other items sitting on top of our beautiful board. Needless to say, we did not ship boards anymore. It was so fancy, and we really wanted to show it off.

Ana Endaya, BSN, RN

ANNA Chapter: SC-229 Western Carolina

Began Nephrology Nursing: 2006

Memory 1: A patient came to visit me to tell me the good news that he is no longer on hemodialysis after being discharged for being admitted for AKI and started on hemodialysis.

Memory 2: Teaching about renal disease to patients and their families; catered to their level of understanding and seeing their positive reactions after understanding what I taught them.

Memory 3: Being part of the ANNA family since 2007.

Molly Cahill, MSN, RN, APRN, BC, ANP-C, CNN

ANNA Chapter: MO-313 Heart of America

Began Nephrology Nursing: 1983

I love nephrology nursing because: Of the friends I have made.

Memory 1: Reflecting on more years than someone 50+ wants to admit, I am filled with a mix of emotions. I became a member of ANNA in the 1980s and fairly quickly became involved at the chapter, regional, and national levels. Throughout those years, I had professional, collegial, and life experiences that are irreplaceable. As a member of the North Central region, we found competition for our reception a challenge in outdoing the prior years and of course outdoing the other regions! Our script and song writers for the reception were challenged each year with finding a catchy tune and changing the words to accommodate the theme for the party. YMCA--changed to ANNA--performed by leaders in "period costume" nursing uniforms compliments of The Mayo Clinic--was a fan and leader favorite. Who could forget playing name that tune with our phantom pianist on the grand piano and the participants literally duking it out for coupons for prizes? The regional team dressed as the Dallas Cowboy cheerleaders, literally doing cartwheels and cheers. Of course, we were also in trouble having been called by security for our practice of these routines and disturbance to other hotel guests. At Disney, we dressed as characters, and all the attendees wanted their pictures taken with us, and we were restricted on where we could be in the hotel and property in our costumes because dressing as a characters was against "Disney rules." I have traveled to many meetings and met nephrology nurses all over the U.S. and the world who I still communicate with regularly through email and Facebook and wouldn't trade that time or experience for anything! I know these friends, their kids, their spouses; have shared happy and sad events; and I left ANNA leadership with some friends that I will have forever. I am now enjoying a part of life where I am working less and doing more that people do in later years and very often it involves my ANNA friends.

Lorraine M. King, BSN, RN

ANNA Chapter: NC-201 Cardinal

Began Nephrology Nursing: 2004

I love nephrology nursing because: It has given me inspiration and the ability to give my patients my all.

Memory 1: Through my 40-plus years as a nurse, I had always thought that cardiac and critical care were my niche. After moving and taking a job as a hemodialysis nurse, my world and thoughts changed. I had many people tell me that I would be sorry, it's a tough job, but oh how wrong they were. I found it filled my heart as cardiac nursing never had. I also came to the realization of how many individuals were effected by kidney disease. I have truly been inspired by those that mentored me and my patients who have become like family. I would like to tell you about one very special man. I will relate to him as SJ thoughout my story. SJ, when I first met him, had been on dialysis for over 20 years. A shock to me because I had been told that many passed long before this. There was something very special about SJ. He was always upbeat and had a positive attitude that I had not often seen in my other patients. SJ took his positive attitude and used it to mentor patients both old and new. Even in his rougher days, he always tried to see the sunshine. He would come to the clinic, and if he saw someone struggling, he would take them under his wing. SJ mentored many to their adjustment to dialysis, always showing them the positive and not concentrating on the negatives. SJ also inspired the staff with his outlook on life and how he kept on even in the dark days. Toward the end of his life, SJ had been on dialysis for 28 years. It seemed fitting that we celebrate, and celebrate we did in july 2012, as we knew his days were limited. Those attending were physicians, staff, friends, family, and patients. It was a true celebration of SJ's life. I will never forget that glow on his face; he was a king. I learned so much about SJ that day and what true a friend he was to all those he met. In December 2012, SJ passed away, and that left us all with heavy hearts and many precious memories. Those memories I will never forget. The greatest gift he left me, as well as others, with was this: "Never Give Up," no matter how bleak it may seem. Before he passed, I gave him a gift. I had reunited him with a nurse who had taken care of him when he first started dialysis. It meant the world to him, and I was glad that I could make it happen. It takes just one person in life who can make your world brighter, and SJ was that person.

Susan B. Carter, BSN, RN, CNN

ANNA Chapter: PA-104 Three Rivers

Began Nephrology Nursing: 1978

Memory 1: I started at an outpatient dialysis clinic in 1990. I was a young mother with two small children. I worked at an outpatient dialysis clinic for 15 years, then I transferred to an acute program in a large city hospital. I enjoyed the outpatients as I worked in the evening and dialyzed many patients who came for their dialysis treatments after working their day job. These patients did very well. Many of them drove themselves to and from their dialysis treatments, and they went to work again the next day. I felt as though I was giving them a life-sustaining treatment that kept them alive so they could do what meant the most to them. This gave them the best quality of life they could have on dialysis while many of them waited for kidney transplant. We saw each other three times a week and spent four to five hours together each night. We talked to each other about their medical regimen, their treatments, their diets, their dialysis access, and their blood work. After that, we "entertained" each other with stories from home. Over the 15 years I worked with these patients, many of them heard about my children's activities, kindergarten, tee ball, grade school plays, and high school graduations. It was small talk, and it seemed to pass the time for both the patients and myself. Then I went to the acute side of dialysis and worked in the hospital full time. Two years, five years, and then eight years passed. Then one day I was sent to the transplant ICU to dialyze a patient who had been on dialysis for some 20 years and had just had his first transplant. He wasn't doing well post-op and needed to be dialyzed. It was Mr. X, a patient I had spent many an evening dialyzing in the outpatient center many years ago. I felt bad that the transplant did not go as well as expected. I dialyzed him in the ICU, intubated, post-op. He certainly did not know I was there, and he probably would not have remembered me, or so I thought. It was about a week later, and I was assigned to the renal unit where the patients came for their dialysis treatments from their hospital rooms. To my surprise, there in the comer bed was Mr. X. I thought I should go over and say hi, but wondered would he really care or even remember who I was. Well, I did go over to him, and he did remember me, or at least he said he did. I was so glad that he survived the transplant surgery and was relieved that he was progressing as well as he was. As I stood by his bed he said, "I saw you over there and was wondering when you would come over to talk to me." I was so glad that he was going to be alright that I said to myself, I'll talk to him for a minute and whatever he says I'll agree with as we reminisced. He asked about my son by name and my daughter. I said they are all grown up now. Then he said, "Do you remember the story about your son and the Christmas tree?" I really didn't know what he was referring to but I said, "Uh huh." Then he elaborated, "You said he didn't know why we take a perfectly good evergreen tree, cut it down, decorate it, and look at how pretty it is for a month then we toss it out to the garbage." Well, this story is about 12 years old because my son is 18 now. I was truly amazed that this patient not only remembered me but truly remembered me. I no longer had to pretend I remembered because I did remember. It was my son's story. The point of this story is to remind us of the great impact we all have on our patients. They respect us, they rely on us, they believe us, and they trust us. We in turn must reciprocate and treat them as individuals who deserve the best care and the best outcome a safe and efficient dialysis treatment can bring. And yes, whether you realize it or not, your patients will remember you. Keep it a positive experience.

Memory 2: Are pediatric patients difficult to cannulate? A 14-year-old was on dialysis since he was a baby--on peritoneal dialysis, then transplanted, then hemodialysis. He dialyzed for three years with a TDC that became infected and had to be removed and replaced several times. Now the decision to have an AVF created was made. The surgery went well, and six weeks later, it was time to use the fistula. Did this patient agree? Yes. It was summer, and the one thing he hadn't done for the last three years was swim. Yes...to get to go swimming was so important to him that he agreed it was time to use the fistula. The first time was the hardest for both the patient and myself. Success--the needles were placed, and the dialysis treatment went well. But the fistula needed to be cannulated two more times before the TDC could be removed and he could go swimming. The second time was a bit more difficult and the area for cannulating was small. The button hole technique was discussed and tried. Nine treatments with a sharp needle then the blunts. Well, if you have ever inserted the blunt needles into the tract of the buttonhole, you understand this statement "you insert the blunt needle into the tract, and then you have to find the door, and the blunt needle will push on through." Easier said than done sometimes. I was the nurse who created the buttonhole. I cannulated it with the blunt needles successfully twice. The third time was crucial. If successful, the TDC would come out, and the swimming pool would be next. But the third time was not the charm. I could not "find the door"--the blunt needle would not cannulate. "I'm sorry, but I must take this needle out. I don't want to do any harm to your fistula." So out it came. A big disappointment for me and the patient. To my surprise, this 14-year-old little boy reached out his arm onto the blue pad and said, "Try again, Sue. I think you can do it this time. You'll be able to find the door this time." With heart pounding and hands sweating, I did just that. Success! The blunt needle went in. We were both smiling now. The next week, the TDC was taken out. Another successful cannulation of his AVF and a stable treatment. The next day he went swimming--something he had wanted to do for the last three years. Sometimes your patients will give you encouragement to do what you may think is the impossible. Are pediatric patients more difficult to cannulate? No, and this patient's positive attitude is contagious.

Sharon E. Swofford, MA, RN, CNN, CCTC

ANNA Chapter: FL-272 Sunshine Central

Began Nephrology Nursing: 1983

I love nephrology nursing because: I can work with clients of all ages and stages of kidney disease. My current concentration in transplantation allows me the satisfaction of seeing clients attain an improved quality of life.

Memory 1: My first experience occurred in the late 1970s at Beth Israel Hospital in Boston. I came on duty for a 3-11 shift and learned I was to care for a patient in whom a trocar had been placed for peritoneal dialysis. We used glass bottles of dialysate that were warmed in a warm water bath.

Memory 2: Learning to use a PD cycler in the mid-1980s.

Memory 3: Observing my first living donor kidney transplant and watching the kidney perfuse and change color from grey to pink and the ureter begin to expel urine before the surgeon had begun to connect it to the bladder.

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Nancy Gregory, RN, CNN

ANNA Chapter: VA-258 Central Virginia

Began Nephrology Nursing: 1976

Memory 1: My first memorable experience in nephrology nursing was realizing, in 1976, that I was really part of a team with physicians where we were given responsibilities like no other place in nursing (at that time). If we wanted to learn it, they showed us how, explained it, and then stepped aside so we could try it. It wasn't easy learning the equipment as we had unipunctures, tanks, and the water systems. Then there were shunts to take care of, fistulas to stick, and above all, the patients. They became our extended family, these patients whose lives depended on what we did. And it was long, what we did. With treatments lasting seven hours three times a week, we spent time with these people and their families. They brought their kids who sat on their beds while we dialyzed them. They brought us food and kindness and shared their lives with us. We celebrated their successes and cried with their (or our) failures. Thirty-seven years later, I still remember the first patient I stuck, the first shunt I pulled out, and the first one in my large extended family who died.

Gail Dewald, BS, RN, CNN

ANNA Chapter: TX-205 Alamo City

Began Nephrology Nursing: 1985

I love nephrology nursing because: We can make a difference in so many lives every day.

Memory 1: Networking with other ANNA members is one of the greatest benefits of being a member of ANNA. Back in 1994, I was practicing as a peritoneal dialysis nurse. I had attended sessions at one of the ANNA conventions, and Barbara Prowett was one of the speakers. She was such an engaging speaker and very knowledgeable in PD and the topic she presented. She told the audience, "If you have any questions in the future, please feel free to call me." Within the next six months, I needed advice about a procedure one of our physicians wanted to introduce. I called Barbara, and she took the time to discuss my question, and she even faxed me a journal article that addressed my topic. Barbara treated me as a trusted colleague, and she shared her knowledge to help my practice and my patient. The value of her interaction gave me confidence to change my practice. Nephrology nurses make a difference! Thanks ANNA.

Memory 2: In the mid-1990s, I was practicing as a peritoneal dialysis nurse. I remember an elderly couple in which the wife was the patient. The husband was a very attentive and competent caregiver. He would call often and always followed the directions he was given. After several years of treatment, the woman died. It devastated this man. About two weeks after the funeral, I called the husband, and he came to the clinic. Still noticeably upset, I asked him to sit down and talk. We both cried and talked. I remember telling him what a wonderful man he was to care for his wife. Several weeks later, I received a note from him letting me know how much I helped him be freed of the guilt and made him feel that he had done his best to care for his dear wife. As nephrology nurses, we not only impact our patients, but we can support and care for their families.

Wayne Christenson, RN

ANNA Chapter: MN-316 Southeast Minnesota

Began Nephrology Nursing: 1979

Memory 1: Unfortunately, after 35 years of dialysis, I will probably be remembered most for is... Well, let me start from the beginning. Years ago, we did not have bicarbonate dialysate, so everyone ran on lactate, which our bodies convert to bicarbonate. Unfortunately, the patients with diabetes did not do this as efficiently, so you had lactic acid build up, and the result of this was they became very nauseated and often threw up. About two hours into a run, one of our patients began to get sick and threw up into an emisis basin. I took the basin and proceeded to the bathroom, where I flushed it down the toilet. I brought the basin back to the patient, and the nurse taking care of the patient asked what I had done with the contents. I said that I had flushed it down the toilet, and she gasped and said that his false teeth were in there. Great! I went to the bathroom, and there wasn't anything floating around, so I put a sign on it that said, "Do Not Use" and called the plumber. Believe it or not, we got the teeth back that got caught in the trap. Yes, we did have them cleaned and gave them back to the patient, and he kept a very good sense of humor about the whole thing.

Laura Upton Webb, RN, CNN

ANNA Chapter: MI-312 MichigANNA

Began Nephrology Nursing: 1989

Memory 1: I wanted to share a funny story about a delightful patient who was in her late 70s with some early Alzheimer's. She lived alone at home in a trailer park, it was 10:00 p.m., and the dialysis unit was closing. She remained in the lobby waiting for the bus to pick her up. The bus never came, phone calls were made, and it ended up being easier to take her home myself because I drive right by her park. Imagine the frustration as we circled all the homes through out the park consisting of over 200 trailers and she could not remember which one was hers other than "the one with the barbecue machine on the porch." Eventually, she recognized her place, but not after multiple trips "around the outside." Fast forward to another incident with the same dear lady. Post-dialysis, she had to use the restroom ASAP, so with secured needles she went out to the lobby to use the facilities. When she came out of the bathroom, the bus driver was there ready to take her home. She took her coat off the rack, put it on, and hopped on the bus, needles and all. She realized what she had done while riding home, and the bus driver had to bring her back. She is no longer with us, but my memories of her make me smile.

Marycela Zaragoza Tamez, RN, CDN

ANNA Chapter: CA-532 San Joaquin Valley

Began Nephrology Nursing: 1990

I love nephrology nursing because: I love serving my patients!

Memory 1: A girl's dream. Once there was a young girl who cared for patients on dialysis as a certified hemodialysis technician (CHT), most mornings arriving at 4:00 a.m. to open the unit and preparing the dialysis unit. Cleaning the dialysis system with formaldehyde was not a favorite assignment. Practices have changed over time, and today, there are better and safer alternatives to cleaning and other processes. This girl's passion grew in caring for her patients on dialysis and their families. She only dared to dream of becoming a registered nurse (RN) someday. She believed that as an RN, she could serve her patients better. While continuing to work as a CHT, she finally achieved her dream of completing nursing school. Graduation was greeted with joy and the bittersweet remembrance of "J.Q.," who had passed away in 1995, two years prior to her accomplishment. She affectionately recalled his words, "Tu vas a ser una buena enfermera" (you will make a good nurse). Of all the hundreds of patients she cared for throughout the years, J.Q. and his family stand out because of their strength and grace as they endured together his kidney failure, repeat hospitalizations, CHF, and bilateral amputations. She was unaware that the day she walked the stage to receive her RN degree, she also received a gift from J.Q/s family and a beautiful card. She never knew that this family was keeping track of her progress over the years. Her soul was touched and filled with such hope for her future. This girl is me! My desire to excel is a continual process and all started because I dared to...imagine, believe, achieve!

Teresa "Terry" Commeans, RN

ANNA Chapter: CA-526 Inland Empire

Began Nephrology Nursing: 1974

I love nephrology nursing because: It has allowed me to meet so many different and wonderful people, families, and team members. I've been allowed to play a role in their lives, hopefully making a difference in their dialysis experience.

Memory 1: I began my dialysis career at the Artificial Kidney Foundation in 1974. It was a non-profit organization and quite a different experience. We did fundraisers and various events for our patients. We participated in product testing and different studies, very interesting.

Memory 2: Moving out of the area, I did acute dialysis for 15 years. I loved the fast pace and working in different ICUs.

Memory 3: Fifteen years ago after working in the hemo unit, I started working in PD. I never thought I would enjoy that area of dialysis, but I love it! I consider my patients like extended family. Training and seeing the fruits of your labors be fulfilled in their lives is so rewarding. For the last 20 years or so, I've been involved in CKD training. I have witnessed the benefits of early modality and kidney education--making the patients' transition into dialysis much less fearful. I especially love prompting their involvement with their healthcare decisions, education being the key. I myself ended up on dialysis for a short period of time. This personal insight gave me a whole different perspective on what it is to be a patient on dialysis. I'm grateful for my health now and aware that we need to be respectful of what we have. How we treat our patients is so important; it could be us sitting there.

Christine Schrauf, PhD, MBA, RN

ANNA Chapter: CT-103 Colonial

Began Nephrology Nursing: 1974

Memory 1: Who can remember the coil hemodialyzer and the large recirculating single pass (RSP) machines with a separate water reservoir? We had at least one of these at our first Hartford Hospital Dialysis Unit in the 1970s. One of my primary patients recognized the value of treated water before this became a standard in hemodialysis and purchased his own water treatment unit to filter his water for dialysis in the early morning hours. Since we set up the system for Andy at 5:00 a.m., the timing of water treatment was critical so that there would be enough (but not too much) treated water available for his treatment as it was initiated. That meant middle of the night visits by him to start the water treatment process and then again to shut it off three times a week--a grueling chore for anyone! One day as I entered the unit and approached the room where Andy's system was housed, I knew that his timing had been off that night. Water was pouring out from under the door--he had fallen asleep and had not returned to shut off his water treatment machine. All the extra fail-safes he had created for himself had failed that night. Many mopfuls of water and sodden blankets later, we were able to start dialysis. We are still plagued a bit with water emergencies in hemodialysis, but nothing like processes using the old coil dialyzer machines!

Marilyn Eilert, RN, CNN

ANNA Chapter: NJ-126 Jersey North

Began Nephrology Nursing: 1968

I love nephrology nursing because: I have the opportunity and privilege of getting to know patients and their families over a long period of time. They allow me to share their joys as well as their sorrows. What an honor!

Memory 1: I have had the privilege of being a nephrology nurse for 45+ years. I have many fond memories of patients and their families over these years, but one patient will always have a special place in my heart. His name was Ed, and he was diagnosed with pyelonephritis at age 31. He started hemodialysis in 1971 at our regional hemodialysis center. Ed and his wife were trained for home hemodialysis, which they did for 25 years before he returned to in center dialysis. He survived on hemodialysis for 39-3/4 years and died the day before his 71st birthday. Ed and his wife had two daughters who were toddlers when he began hemodialysis. While he was learning home hemodialysis, he asked me if I thought he would live to see his daughters grow up. After thinking a few minutes, I told him that no one could really answer that, but if he watched his diet, took his meds, and tried to be as compliant as possible, he had a good chance. Many years later, Ed reminded me of that conversation. By then, his daughters were adults, had married, and Ed had six grandchildren! He thanked me for giving him hope that day so many years ago. He said, "Not only did I get to see my daughters grow up, but I got to know my grandchildren."

Patricia J. Brooks, BSN, RN

ANNA Chapter: NC-262 Blue Ridge

Began Nephrology Nursing: 1980

Memory 1: I started in hemodialysis in 1980 when free-standing clinics were fairly new and reuse was in its infancy. Formaldehyde was used as the reprocessing agent, and measuring air levels was not done. The clinic I worked for was collecting some of the initial research data on reuse. If patients chose not to reuse, their only option was to use a coil. Regional heparinization with protamine was common practice. CVCs were unheard of, and they were only used in the hospital setting. If patients had no other options, they remained hospitalized so they could receive their treatments. Once CVCs were used in the outpatient clinics, it was the RN who removed them, in the clinic, post-dialysis. Grafts were more common than fistulas, and transonics were not developed yet. Patient bathrooms were not Male/Female; instead, they were Positive/Negative to denote hepatitis status. There was no formal dress code, and jeans and sandals were not uncommon work attire (in Florida). Ratios were 1:3, and there was always at least one RN on the treatment floor at all times. Patients were much sicker, acetate dialysate was the only option, no bicarbonate. We had albumin and IV Valium[R] as PRN medications. We stood our patients hourly during their treatment to weigh them--UF and sodium modeling had not been "discovered" yet. Yes, the times they are a changing, and getting better all the time!

Stephanie Sheridan, DNP, ANP-C, CNN-NP

ANNA Chapter: TN-269 Scenic City

Began Nephrology Nursing: 1996

I love nephrology nursing because: It allows me to use my nephrology nursing knowledge to give my patients the best care that I am able to provide.

Memory 1: One of the my most memorable moments was performing CPR in the front of the dialysis facility after the patient's daughter drove past three hospitals to bring the patient to the clinic where she could trust the staff. Kim Lingerfelt, DNP, FNP, CNN-NP, and I performed CPR on the patient in the parking lot until the ambulance arrived to transport the patient to the hospital.

Memory 2: Remember when we used formaldehyde to sterilize the machine? Behind the machine, we had bleach in a jug and formaldehyde in the other jug. One day at the end of the day, the tech was closing the unit, and she accidentally poured bleach in the formaldehyde and created a chemical reaction. Suddenly there was a loud boom, then smoke started coming from the jug behind the machine. We still had a few patients in the clinic, and we quickly had to evacuate the patients from the unit. The tech was trying to remove the jug from the unit, and she would not leave the unit. Once the fire department came, the tech had to go to the ER. She ended up having chemical bums to her nares and irritation to her eyes.

Memory 3: Back in the early 1990s, I was stuck with a dirty needle when I went to the emergency for Big H. When they gave me my shot, they gave me almost triple the dose according to my weight at that time, and once my administrator received the bill from the ER, that's how I found out. At that time, I weighed about 135 lbs, and they gave the amount of Big H for someone who weight 330 lbs. So you know my immune system was boosted for a long time.

Debra Hain, PhD, APRN, ANP BC, GNP-BC

ANNA Chapter: FL-206 South Florida

Flamingo

Began Nephrology Nursing: 1987

I love nephrology nursing because: I love being an advocate for people with CKD and for nephrology nursing. This has been an extremely rewarding career, and I look forward to continuing to discover ways to improve the health of this population.

Memory 1: I was providing care for an older man undergoing dialysis in ICU, and I was so intrigued with the whole process, I searched until I found a physician-owned dialysis center where I could learn about dialysis. Fortunately, I was successful because it has been my passion for over two decades.

Memory 2: It would be very difficult to say what the most memorable experiences were because all have been very special. So if I had to answer this question, my response would be all the people with CKD that I have been blessed to be part of their lives. One very special young man taught me how precious life is. I first met him when he was 18 years old and cared for him until his death at age 25. He was a very ill young man who lived life to the fullest. I was the manager of an acute dialysis service in a small hospital. Going to work was like spending time with family. This young man with CKD was admitted so many times that he was like a member of our family. He taught me that it is important to come to know the person and that discovering "what matters most" to the person is essential if you want to achieve the best outcomes. One day, his father approached the nephrology team and asked if he could bring a special treat to Nathan because it was his 21st birthday. Can you imagine spending your 21st in a hospital? We totally understood the importance of doing something special enough to keep his spirits alive. Well, that surprise ended up being a stripper. All the nursing staff working that evening knew what was going on in that room, but we just looked the other way. Years later, after he died, I saw a picture taken that evening showing a young man smiling in a bed of white; a smile so big it filled his face. This moment will be with me forever as I always remember how critical it is to find out "what matters most" as a person lives with CKD.

Memory 3: A memorable experience was when I became a nurse practitioner and I was able to improve health outcomes of people with CKD by being a healthcare provider. In my current role, I am able to make a difference by being an advocate and always taking a patient-centered approach. When I first became an NP, I had a patient who started hemodialysis. He was so angry and depressed that for one year, he barely said a word. I walked with him on his journey of discovering how dialysis fits into his life and determined the best way to live with ESRD. Over time, he became a spokesperson for people undergoing dialysis. He later tried PD for two years, and four years ago, he was transplanted. He is one of many who have touched my life and make me realize that I was destined to be a nephrology nurse.

Angie Kurosaka, DNP, RN, CNN, NEA-BC

ANNA Chapter: AL-239 Hazel Taylor

Began Nephrology Nursing: 1990

I love nephrology nursing because: It is the only nursing job that I am aware of where every single day we all go to work, we save lives. What an empowering feeling knowing that what we trained for as nurses can and does make a difference.

Memory 1: As nurses in acute dialysis, we typically started patients in the hospital for their first treatment. J was a healthy man in his 30s; he was very nervous. I explained everything to him and performed his first several treatments. He did great, and one day, even after I had moved to another state, he showed up in my waiting room to hug my neck and tell me "Thank You for taking care of me. Your kindness made a difference." I still get teary-eyed thinking about him.

Memory 2: In the fall of 1994, I went to Chicago to sit for the CNN exam. I was pregnant at the time with my first-born. I sat beside someone that I didn't know, we struck up a conversation, and have been close friends ever since. My oldest will be 19 years old in a few weeks, and I am so blessed to have made a lifelong friend doing what we both loved to do, and that is nephrology nurses. Yes, we both passed the exam.

Deborah L. Cofrancesco, BSN, RN, CNN

ANNA Chapter: CT-103 Colonial

Began Nephrology Nursing: 1994

I love nephrology nursing because: It challenges me to seek more effective ways to manage the care of people burdened with chronic kidney disease.

Memory 1: It is difficult if not impossible for me to single out one patient memory or experience since there have been many in my nephrology career. However, the common thread that runs through many of my memories is the courage, spirit, and fortitude inherent in many of my patients. They did not let their disease define them even as they fought their last battle. How can you not admire a young, blind man with the medical history of a typical 80-year-old who insists on working a full-time job and then manages to navigate the public transit system to get himself to dialysis? Or the patients who are told they are down to their last access and are forced to face their mortality? Or the patients who return to dialysis after a failed transplant, who instead of being bitter are forever grateful for the precious time they were "machine free?" People with ESRD live their lives on a day-to-day basis, much like people with cancer. They don't really plan for the future as many of us do. We, as their caregivers, sometimes get frustrated when they are not compliant with our rigorous treatment plan. But are we looking at long-term complications while they are looking at tomorrow or next week? Although the words are not often verbalized, do they simply not concern themselves with the long-term issues? I suppose no one truly knows how they would react if they were given the news that their organs were failing them. It is all the more reason to admire those individuals who have faced the challenge of living with a chronic disease and have chosen to celebrate each day on the journey of life. Perhaps that is the most memorable experience or most valuable lesson I have learned from caring for people with chronic kidney disease.

Lillian A. Pryor, MSN, RN, CNN

ANNA Chapter: GA-224 Dogwood

Began Nephrology Nursing: 1992

I love nephrology nursing because: It gives me the opportunity to be a part of people's lives and make a difference and impact on how they and their families can survive and thrive as a patient with CKD. It brings something new to my life every day!

Memory 1: Working with the nephrology dialysis team to help successfully manage care for a young mom to deliver a healthy baby.

Memory 2: Being a part of the inauguration of the First African-American President of ANNA.

Angela Taylor-Smith, BSN, RN, CNN

ANNA Chapter: GA-224 Dogwood

Began Nephrology Nursing: 2000

I love nephrology nursing because: It's inspirational, touching, challenging, innovative, and educational. The importance of having knowledge that you can share with others in the prevention, pre-stages, initial stages, and end stages of kidney disease.

Memory 1: As an experienced nurse, you become knowledgeable in learning how to deal with each patient situation differently. Learning different approaches to patient care can result in positive outcomes. These positive experiences can help teach healthcare workers to better manage the care of their patients and help you become a resource for others. As healthcare workers, we must understand the importance of establishing a relationship with our patients in order for the patients to develop a trusting relationship with us. My career in nursing has taught me that those little things count and reflects how you care for and respect others as unique individuals. One situation I recall as a peritoneal dialysis nurse with previous experience as a hemodialysis nurse. I was approached by a hemodialysis nurse I previously worked with in the hemodialysis clinic. She had an issue with a patient who always came to the clinic with an elevated blood pressure and fluid overload. The patient refused to take her blood pressure medications prior to hemodialysis. The patient had psychosocial issues that interfered with her care. I reviewed the situation from a patient perspective, as if I were the patient. I believed the patient felt threatened by the staff and felt a loss of control over her life. Some of the examples that brought me to this conclusion were 1) the majority of the information provided to the patient on hemodialysis is from a standing position which can make a patient feel threatened and helpless; 2) the patient is new and may not trust the information that is provided to her; 3) the patient is not knowledgeable of her situation; 4) the patient does not feel a sense of security with the health care staff or feel the healthcare staff care about her well-being; and 5) the patient may feel a loss of control. I suggested the nurse sit down and talk with the patient to show that she cares and then discuss the concerns with the patient's health. I then suggested the nurse ask the patient to bring in her medications to her next treatment and obtain a copy of the patient's medication list from her physician to review with the patient. I told her if the patient complied with her request, to ask the patient to bring her medication to the clinic each dialysis day. The nurse reported that the patient takes her medications as prescribed and brings her medications to the dialysis unit each dialysis day. The patient's blood pressure is better controlled pre- and post-hemodialysis treatment. The outcome of the nurse and patient relationship has improved, and the patient showed appreciation to the hemodialysis staff. In conclusion, the patient has to establish what is important for him or her, and it's the healthcare worker's position to guide the patient in the right direction. We must first establish a relationship to build trust, and then we can impact the care of our patients. The time and patience we take with our patients help the patient appreciate the little things we do may have a big impact on their life.

Memory 2: This is a situation my co-worker and I encountered. We had a new patient in denial of her failing health and who had been afraid of needles all her life. The patient progress note stated that patient had panic attacks and might faint when having her blood drawn. The patient shared that the nurses have difficulty with "sticking her veins." My first time I had to obtain her blood, it took about 20 minutes because I had to try and calm the patient down before inserting the needle. She was crying and shaking. I talked about everything else except of doing the venipuncture. Once I did the venipuncture and started to obtain the blood specimen, the patient moved, causing a small infiltration. It took another 20 to 30 minutes to try and calm the patient down because she started hyperventilating, shaking, became nauseated, and then started vomiting. The other nurse assisted me with the patient to keep her calm. I laid her back in the chair and waited until she calmed down before starting again. Once we got past that point, I redid the venipuncture and obtained the blood samples. I noticed the patient was a little better once the needle was in and having her focus on something else other than the needle. During the conversation with the patient, she stated she was terrified of needles since she was a child and was never able to deal with needles. She said they would hold her down as a child to give her a shot, and she never liked being held down. I asked her physician if the patient could have a prescription for lidocaine or numbing skin cream for when her labs need to be drawn. I explained the patient's fear and what I encountered on the patient visit. The physician said ok. I explained to the patient how to use lidocaine when she comes back for her next visit. The patient returned the next month for lab draw. The patient was still in fear but anxious to see if the lidocaine cream was going to work. It still took about 15 minutes to calm her down before inserting the needle, but once it was done, the patient was relaxed. The patient asked why no one told her about the lidocaine a long time ago. She said she was very thankful and would carry the medication with her all the time when she has to have labs drawn. I explained to the patient how to apply the lidocaine cream again, and the patient followed the procedure every time. I had no problems with the patient after the first visit, except for the patient asking to be scheduled when I was there. The patient loved when I started drawing smiling faces on her bandaid, and then I purchased the children bandaids for her. She wanted the bandaids to be specifically for her. She stated this makes her day and makes her feel better. When the patient went into the hospital, the nurses and the physicians would not respect this little requirement for the lidocaine cream. The nephrologist would get many calls because the patient would decline the lab draw. The nephrologist asked me should she prescribe it. I said yes because this made a difference in the patient and allowed her to receive the proper care in the hospital. I reminded the nephrologist of the patient's childhood history. The nephrologist agreed, which eliminated most of the calls she was receiving regarding the patient. In conclusion, patients have to establish what is important for them, and it's your job to work with patients to help guide them to understanding the importance of their role in their care. First, establish a trusting relationship. Sometimes it may take time and patience, but remember the little things you do may be big things to the patient.

Memory 3: Making sure my patients in any possible way are recognized for their accomplishments and how they deal with dialysis. One patient was interviewed for an article in my company's magazine. The patient was doing well, and then, his health started to decline. The elderly gendemen's article was written but not completed or shared with others. Before he passed away, it was nice to know that he and his family had the opportunity to have a written article from his point of view about his life, accomplishments, and dealing with kidney failure and dialysis.

Jacci Reznicek, MSN, RN

ANNA Chapter: NE-324 Platte River

Began Nephrology Nursing: 1986

I love nephrology nursing because: We constantly learn from each patient and their situation. The resolve of these patients and their families is incredible. We become witnesses to the unique, incredible coping abilities of some families. Others who are not as far down the path of acceptance, we can share with them things that have worked well for others.

Memory 1: Watching a patient struggle with the decision to voluntarily stop dialysis. This patient was the "life" of the unit, always smiling and happy, and playing practical jokes. When our new unit was being built in the 1980s, we had a contest to the name the dialysis unit. "Willy" won the $100 prize for naming the unit, and rather than keep the money, he took all of the nurses out to eat. After years of being on dialysis and no longer able to drive himself to the dialysis unit, Willy made the decision to stop dialysis. The decision was not easy. One day he called the mini-van driver up and asked for a ride to the dialysis unit. We thought he may have changed his mind. Rather, he just wanted say goodbye to all of the patients and staff. It was a very tearful moment for all patients and staff that day at our unit. He was completely at peace with his decision. The character of this man has stayed with me throughout my career. The ultimate honor was his family asking me to speak at his funeral service.

Memory 2: When I had a patient come to the dialysis unit and her sister indicated that "Flo" had an issue with her dialysis catheter, but not to worry, they had fixed it. Of course, this made us worry all the more, and for good reason!. Upon further inspection, the catheter tips (above the clamps) had been cut off, and the entire sub-clavian catheter was taped to the patients chest wall!

Memory 3: When our dialysis unit (the only one in our city) had to close due to several episodes of hemolysis that was caused by faulty tubing. This story made national headlines and CNN. The Herculean task to transfer patients to several different dialysis units in another city that was 60 miles away was staggering. The commitment of our staff and of the staff of the neighboring dialysis facilities was absolutely incredible. Nurses rode buses with the patients to the neighboring city and worked in the facility alongside nurses from other facilities. Everyone worked many, many hours of overtime to accommodate the extra load of patients. I received a call from one of my nurses stating, "We lost Chuck, we can't find him." Apparently, the bus had parked in a mall close to a dialysis facility, and the patient had wondered off into a store to get a bite to eat!

Bernadette H. Maloney, MA, RN, CNN

ANNA Chapter: NY-122 Long Island

Began Nephrology Nursing: 1977

Memory 1: I have worked as a nephrology nurse for 36 years and for 28 years in my current facility. Twenty years ago, I was one of the home peritoneal nurses, and we had a large population of pediatric patients ranging in age from one month to 16 years. We were always successful in getting them transplanted within a year. I have since run into these patients in routine everyday situations that has made me feel proud to be a nephrology nurse. One day, I was in a local pet store with my young son and a staff member was following me closely. She finally confronted me and asked if I knew her. Turns out she had been the motherless 16-year-old CAPD patient of mine who was now in her mid-20s and was the manager of the store. She had never forgotten me and the assistance and emotional support I had given her in getting through that difficult time until her father was able to donate his kidney to her. I now work in hemodialysis and have been caring for a few of my old pediatric patients who, after 15 years with a kidney transplant, have now returned to dialysis. They have gone to college, gotten married, and had families and careers. But they have never forgotten their nurse! They are always happy to see a familiar face as we provide the bridge to their next kidney transplant. I have felt proud to be part of the interdisciplinary staff that has helped give these patient a normal life as active members of society.

Memory 2: The first time a patient's venous needle fell out while on hemodialysis, it was 1977, and the machines did not have alarms! I remember this ribbon of blood flowing across the floor, and my fellow nurse slipping in the blood as she tried to reach the machine to stop the pump. Without Epogen[R], most patients' HCTs were 15 to 20 back then. But despite the blood loss, this patient got up and left the unit, refusing to be transported to the ER and was fine. We were left to clean up the mess, and it was not a pleasurable experience. We also had exploding coil dialysers, which left telltale marks on the ceilings. I remember after one such episode, I had to discard all my clothing, including my socks and shoes. Back then, the facility provided your uniform, so I was able to change my clothes before leaving the unit, but my shoes had to be discarded before I entered my apartment. This was before hepatitis B vaccinations.

Louise Elpers, MSN, RN, CNN

ANNA Chapter: KY-336 KentuckiANNA

Began Nephrology Nursing: 1981

Memory 1: Renal patients can be found in all parts of the world. Renal disease knows no age limitation; it is not limited to certain cultures, gender, or social status. Differences in the dialysis process vary around the world, especially in terms of the length of treatment time. The physical layout of a hemodialysis unit offers limited privacy. Many patients new to dialysis are unprepared for the sights (amputations), smells, and sounds of a hemodialysis unit. These patients go through so much--diet restrictions, transportation concerns, scheduling issues, and lifestyle changes. Whatever I may have given these very special people, I can't help but feel that they have always carried the greater burden 'to live.' I have been blessed to serve these special patients for 33 years. Membership with ANNA, and intermittently with EDTNA, has given me opportunities to learn and to be involved professionally beyond my own unit. I have used the Hemodialysis Unit where I worked as my "classroom" to teach new teammates and student nurses. My unit has been my "research lab" to develop projects that have made a difference in the lives of those we care for. I have published these works in the NNJ and other nephrology publications in an effort to "grow" others working in nephrology nursing. I encourage every nephrology nurse to continue his/her personal and professional learning as members of ANNA. Participate actively when and where you can so that patients with kidney disease can benefit from your contributions. After all, any one of us could one day be a renal patient.

In 2014, I will seek the Emeritus status to maintain my CNN certification. I'm not just a "nurse." I'm a Nephrology Nurse! Thanks to all who blazed the trail before me.

Kenneth R. Kolnacki, MSN, RN, CNN

ANNA Chapter: NE-120 Tri-State

Began Nephrology Nursing: 1982

Memory 1: I have been a nephrology nurse in both adult and pediatric dialysis since 1982. I have spent some time reflecting on the many joyful, sorrowful, and downright comical patient experiences I have had over those 30plus years and have chosen a few of those fond memories for this submission. Jamie was a four-year-old boy on PD with very nurturing parents and a supportive family. Despite the scrupulous oversight of his parents, all of us were unable to identify why his fluid intake was always higher than expected. One day, his grandmother finally found the answer. Jamie was drinking out of the toilet! When asked why, he told them he had seen the family dog quenching his thirst that same way! We modified the nursing care plan based on his grandmother's observation.

Memory 2: Sometime afterward, we had a similar situation with a three-year-old boy, Mark, whose family were dairy farmers. Mark was chronically hyperphosphatemic despite diet controls and dedicated administration of titralac liquid with meals and snacks. His lab values showed adequate serum albumin levels, but his BUN was higher than expected, despite aggressive CCPD. The cause of Mark's high phosphorus and BUN was discovered when he was found eating the cow grain in the bam during milking times when his family was distracted. The cow grain had a high-phosphate, high-protein formulation. New nursing diagnosis based on this assessment: Potential for bone/mineral disorder due to cow grain hyperphosphatemia.

Memory 3: In my pediatric dialysis practice, I have employed many different strategies to provide a peaceful and therapeutic environment for the children and have even used some of the same successful approaches to calm the adult population. One of my favorite diversions was a puppet called Dr. Moody. The doctor has a shock of white hair, a lab coat, name tag, spectacles, and moving parts. Mrs. Thornton was a particularly challenging middle-aged patient on dialysis with early onset dementia and a long-term hospitalization. We employed Dr. Moody to visit Mrs. Thornton during dialysis to help distract and relax her. This strategy worked well during dialysis, but Mrs. Thornton's calm didn't continue back on the nursing unit. One day, our nursing staff in dialysis heard several overhead pages for Dr. Moody to call E5, Mrs. Thornton's nursing unit. Soon after, the Dialysis Unit received a phone call from E5 asking if we knew a Dr. Moody. Mrs. Thornton had been screaming all night for Dr. Moody and was continuing her tirade into the day shift! A collection from the nursing staff was taken up, and she was given her own personal physician puppet... Dr. Moody, Jr.

Mary R. Perrecone, MS, RN, CNN, CCRN

ANNA Chapter: SC-203 Palmetto

Began Nephrology Nursing: 1982

Memory 1: I have been an acute care nurse for 22 years. Not long by some standards; however, I have a tale to tell. Starting my career as a critical care nurse, I learned PD using the UV light machine by being assigned the VIP who no one wanted to take care of. My patient was the Chief Finance Officer of our hospital, and he taught me how to use the machine; surprisingly easy, and I received my first letter of commendation as an ICU nurse. As time went on, I learned CRRT using the Gambro Prisma, then the Prismaflex.

My love of acute care hemodialysis did not come until 14 years ago when I was offered a six-month contract as an agency nurse in a dialysis unit at a Level I trauma center. During time as an HD nurse, I fell in love with hemodialysis! Not because of the fun technology, but my friend, Susan Fallone. Sue, as the renal clinical nurse specialist, actually interviewed me with the nurse manager for an acute dialysis RN agency position. Sue shared with me the intensive history of dialysis, including that of our very own medical center where I was the manager for 13 years. Sue made me excited to learn as well as "aggressively encouraged" me to pursue my certification and be an active ANNA member.

What is to follow is a compilation of Sue's experiences over her years as a dialysis nurse. In 1977, Sue became interested in dialysis while working in a MSICU at Cooper Medical Center, Camden, New Jersey. The patient population included open heart and a potpourri of critical care patients, including AAA who went into renal failure.

The ICU nurses were trained to perform hemodialysis at a local chronic unit since the hospital did not have a unit of their own. Arterial-venous shunts were the access of choice, and no catheters had been developed yet. If you could not get a shunt in, then PD was the modality. A standard hemodialysis treatment time was six hours.

Hemodialysis consisted of coils and one jug acetate mixed with tap water. Sue says you would have to mix it up. The conductivity meter was a little scoop with meter. Sue recalls having to write down the conductivity on a slip of paper, which came with dialyzer, and leaving the paper on top of machine. There were two types of coils--one with higher surface area and one "normal" surface area. The circuit was primed with saline, and if a second dialyzer was needed, the nurse would throw the dialyzer into the bath to wet it.

For positive pressure, Sue remembers the C clamp used on the venous line to increase the UF. The clamp wrapped the venous line, and you would tighten it down to expand the surface area, thus increasing UF. If the patient became symptomatic, or had low blood pressure or cramping, it took a while for the coil to go back to normal. Hypovolemia was a common side effect.

Additionally, bubble air detector on the venous line would have to be manually squeezed by two metal handles on the clamp to open the clamp. Some machines did not have any air detectors at all. An arterial pillow square in the tubing with a pigtail was used to hook up saline or mannitol. Mannitol, at the time, was the drug of choice for cramping. At the beginning of each day, 60 ml syringes of mannitol were drawn up, sat around unlabeled, and ready to give to their patient if they started cramping. Patients becoming hypotensive and vomiting were common.

Hemodialysis used regional anticoagulation with heparin. Then, Sue would give the patient protamine at the end of hemodialysis to reverse any effects. In order to adjust the heparin dose, Sue used the Lee White clotting time method. This was a method of determining the length of time required for a clot to form in a test tube of venous blood. Sue remembers manually watching the blood in the test tube while inverting it every 30 seconds. "It took forever!" She would observe the tube until a clot would form and then document that time. If less a clot formed in than 20 minutes, you were at risk for clotting the system.

Sue remembers dialyzing patients on PD who were receiving gentamycin and went into ATN from drug toxicity. The dialysate bottles were warmed in the sink. You would run hot water on over the glass bottles. The bottles were spiked like you spike IV bags with tubing. To drain the peritoneum, an empty glass bottle was used. The same tube was used to infuse and drain. Thus, you saw a lot of peritonitis. Sue also saw the start of the first automated cycle for PD. The patient would stay overnight three times a week in the clinic with the nurse.

At her unit, Sue was involved with trialing the first negative pressure machines and the first hollow fiber dialyzers called Cordis Dow. As part of the research, it was Sue's job to calculate out dose and set rate on the machine. She recollects having to continually adjust the rate. In 1984, Sue remembers the first acute catheters where there was only an X-ray to confirm placement. Either the surgeon or nephrologist would place the acute catheter all performed bedside with blind stick. No Vascular Interventional Radiology.

This procedure placed the patient at high risk and needing massive blood transfusions. There was no EPO. Chronic: fistulas and grafts--necklace grafts out of bovine (the carotid artery from a cow). Last, in 1992, Sue had her first experience with the use of flat plate dialyzers, which were supposed to cause less clotting in patients.

Sue's first exposure to dialysis in ICU set the stage for the rest of her career in nephrology. After the ICU, Sue accepted a position in a chronic hemodialysis unit in Philadelphia at Metropolitan Hospital (no longer there). I had the privilege of working with her for 13 years at Albany Medical Center. Sue is currently our Acute Care SPN leader for Education and will be speaking at the Acute Care Preconference in Anaheim.
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Publication:Nephrology Nursing Journal
Geographic Code:1U9CA
Date:Mar 1, 2014
Words:24704
Previous Article:Do no harm.
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