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Article Excerpt
ANNA Board of Directors 2008-2009
Sue Cary, MN, RN, NP, CNN
President
Fleur De Lis Chapter
Living in Louisiana, I experienced Hurricane Katrina and worked with people who came to the shelters in Baton Rouge. My husband and I went throughout one of the shelters that housed over 6000 evacuees from New Orleans looking for people who needed dialysis. We did this by screaming to ask if anyone needed dialysis. We found many people and transported them by our family volunteers to the dialysis units. I had asked the police at one of the entrances if anyone had identified him or herself as a dialysis patient. They told me there was a lady with a green shirt that had just come through. You can imagine how many people I saw with green shirts! I found her. She was a woman who had come to the shelter with her 9-year-old daughter who had a mental handicap. When I told her I was a nurse practitioner and could bring her to a dialysis unit, she clung to me and cried on my shoulder saying she had not dialyzed for several days and was so afraid that she was going to die and her little girl would be left in the shelter alone and by herself. To add to the situation, her access was clotted. After calling a vascular surgeon, we brought her and her daughter to a hospital and left them in the capable hands of the nurses who provided them with clothes and food, and watched the daughter while the morn had surgery. I had to get back to the shelter, and the surgeon took my patient to the dialysis unit, and I picked her up after going shopping for clothes, toys, and personal care items for them. I introduced them to a social worker in another state who came to help with the evacuees of Katrina. The social worker arranged for her church to give them a home and a new start. Several days later, before they left, we both cried on each other's shoulders for what we had gone through and the blessing of having met each other in such tough times.
Donna Bednarski, MSN, RN, ANP-BC, CNN, CNP
President-Elect
MichigANNA Chapter
Assisting patients and their families dealing with end-of-life issues can be emotionally challenging, particularly when it is your previous boss, a nurse. Not long after my boss retired, she developed a rapidly progressing terminal illness, which ultimately included acute renal failure. Unfortunately, her time was limited, not giving her family much time to prepare and say goodbye. She was admitted to the hospital and promptly to the intensive care unit. Her father was not ready to let her go, stating he should be the one to die first. It was very difficult to see this once strong leader, mentor, and role model lose her battle, but I was going to ensure her family was able to say goodbye. Her condition deteriorated rapidly, and I spent many hours working with the family. I also had an opportunity to say goodbye, and my boss simply stated, "You are an amazing nurse; what a wonderful experience you have given me." To this day, that moment brings sadness but a feeling of great joy and honor. After she left this world, each member of the family hugged and thanked me. Her father pulled me aside and let me know that if it hadn't been for me, he would not have been able to say, to his daughter, everything he needed to say. He shared how he was able to tell her how proud he was of her, even more so now that he truly knew what nursing was all about, and although he wasn't ready to let her go, he realized the decision wasn't his to make... "Thank you for this special gift."
Sandra M. Bodin, MA, RN, CNN
Immediate Past President
Gitchee Gumee Chapter
I loved being ANNA President. The opportunities to learn and to meet interesting people seemed endless. The 2007-2008 year contained many personal and professional highlights. The most gratifying was the successful work ANNA members did to retain the RN presence rule in the Conditions of Coverage for ESRD Facilities that was released by the Centers for Medicare and Medicaid Services (CMS) that year. Corporate and political forces lobbied CMS to drop the rule, which would have allowed individuals with ESRD to be dialyzed without a nurse. Many ANNA members contributed to the education of CMS staffers and the nephrology community to understand why individuals on dialysis need and deserve care provided by a professional nurse. I received wise counsel from many former ANNA presidents and ANNA's health policy and advocacy leaders. In the end, it was the ANNA-sponsored research findings of Charlotte Thomas-Hawkins and Lynda Flynn regarding nurse-related patient outcomes that cemented the RN presence rule in the Conditions of Coverage. The fact that a grant from ANNA funded this research made the victory even more satisfying.
In my nephrology nursing career, I worked in the Miller-Dwan Medical Center (Duluth, MN) dialysis unit for 23 years. I often think that I grew up there. I loved my job and thought I would finish my career in that dialysis unit. I have many memories, and I would like to focus on the three that changed me. One thing I learned early and often was to live in the present. No matter what age I was, the individuals I provided care for encouraged me to enjoy life and not put off living. They taught me that it is OK to make life plans, but not to defer my dreams to a later time. I also learned that health is very important and that I will never understand what good health means until I lose mine. Thirdly, I learned to differentiate what was truly worth worrying about. I tend to be the type of person that if I did not have anything to worry about, I would create something. I found out it is not worth wasting precious time worrying about things that are not very important. I try to use this wisdom everyday and remain grateful to the individuals with CKD who shared their insight with me.
Rowena W. Elliott, PhD, RN, CNN, BC, CLNC
Secretary
Magnolia Chapter
It is funny how you can plan your life one way and it takes you in an entirely different direction. When I was a nursing student back in the 1980s, my goal was to be a pediatric nurse. A couple of rough and stressful times in pediatric clinical changed all of that! After graduation, I worked as a staff nurse in a small, 37-bed hospital in Port Gibson, MS, for 9 years. After leaving there, I worked in home health and was the Director of Nursing in a long-term care facility. Although I loved my older patients (do you notice I went from pediatrics to the older adult ... ha! ha!), I did not like working in that particular facility and decided to do something different. This is when everything changed, and I found my nursing niche.
The hospital where I was previously employed was looking for a Director of Nursing for the chronic hemodialysis clinic. I didn't know the first thing about dialysis. I never saw a dialysis machine, tubing, fistula, or graft. I didn't even remember the first thing about the renal lecture, but who does? I enjoyed the challenge to try new things, so I applied for the position. Can you believe I was hired? Talk about a nursing shortage!!
I had a very knowledgeable nurse to teach me the basics in nephrology. Her name is Sheila Mitchell, and she taught me the "right way" to do things. I appreciate the way she took her time to explain and demonstrate how to cannulate, set up a machine, mix dialysate, test water, etc. I found that I loved nephrology nursing. I loved the patients, the environment, and the vast opportunities to learn in this field. My love grew when our medical director required all directors of nursing to be members of ANNA. I am so glad he made this a requirement because I truly enjoy being a member of this wonderful organization. Now I am faculty in a school of nursing, and I grasp every opportunity to teach the renal content (no one is really fighting to teach it!) and share the joy of being a nephrology nurse.
Molly Lillis Cahill, MSN, RN, ANP, BC, NP-C, CNN
Heart of America Chapter
North Central Vice President
As I sat down to write, the more than 30 years of nephrology nursing memories flooded back. Some of my favorites were when I first started in the field and worked inpatient with the new kidney transplant patients. Our hospital had a relationship with the Children's Hospital to do their transplants. The kids were so animated and fun. More recently, I find the fondest memories are associated with successes in prevention efforts. Sometimes I am not sure who is more excited in clinic when "they get it" in a way that is reflected in lab results, or blood pressure readings, or blood sugars. When I talk about prevention or delaying progression, I cannot be sure whether my strategies have been successful until the patients return for more follow up.
Other stories I could tell go from very high to very low. The memory I share here is one of those. Each year our local NKF affiliate asks for nominations for patient awards. Most every year, I work with staff to make sure some of our model exemplary patients are nominated. This past fall was no exception. Over the years, I have been involved in writing many of the essays for the process, but none were quite as exciting as this past fall. Ask Z. any day of the week how she is doing and you will hear, "I am blessed." And thus, Z. lived her life in a state of thankfulness and wellness despite her diagnoses. She started dialysis in July 1998 and kept to her regular treatment schedule, always adhering to her dialysis regimen with a smile and an encouraging word for all those who were lucky enough to cross her path. Whenever any staff members would visit with her to give her lab results or education on some aspect of her treatment or disease process, she responded with openness to direction and to doing all she could so she could be ready for transplant. She always remained independent and a contributing member to society, and did not let her desire to help others become dampened by any misperceived disability. In her spare time, she was busy making and serving meals to the homeless. Every year, during the weeks before Thanksgiving, she cooked close to 100 turkeys. Her goal was to be sure many, many people had the opportunity to celebrate and be thankful. Needless to say, she won the award. At the award ceremony, I sat with Z. and her family; we were all so proud of her. Two months later, Z. died. While I was unprepared for that, I was comforted by the recent incredible events and felt equally blessed for having the chance to know her.
Debby Casmer, MSN, RN, APNC
Northeast Vice President
South Jersey Chapter
My first orientation to dialysis was in conjunction with the training of patients who wanted to be home with the Travenol RSP machine. My home buddies were a middle-aged man who had married a woman from Korea when he was stationed there. His wife spoke very little English, yet she was determined to learn what to do so her husband could be home with the family. Having her remind me of which clamps to close and how to string the machine was an eye opener and humbling experience. She was meticulous in how she set up her area and cared for the machine and her loved one. It was a life lesson for me to see how important motivation to learn can be, and I often remind myself of that when I speak with patients.
Loretta Jackson Brown, MSN, RN, CNN
Southeast Vice President
Dogwood Chapter
When I became an Air Force nurse, I knew that I was in for an adventure. One of my most memorable adventures was as the Nurse Manager of the Hemodialysis Unit at Travis AFB in CA. A patient followed in our clinic who was on peritoneal dialysis took a cruise to the Carribean. He was having such a great time that dialyzing was the last thing on his mind. Well, that great idea resulted in bad consequences as the lack of daily dialysis led to a chain reaction. The patient became uremic, electrolyte-imbalanced, and fluid-overloaded, all of which caused alterations in mentation and resulted in him passing out and hitting his head--causing a contusion. The cruise ship stopped in Puerto Rico, letting the patient off along with his traveling companion. That's when I got involved. I received a call from a nurse in the hospital in Puerto Rico who informed me of the patient's condition. The patient was placed on hemodialysis, and was now stable and ready for airlift back to CA. I orchestrated the patient's transfer back to the continental U.S. via a Lear jet. On the flight back, the patient's traveling companion became ill, which necessitated an emergency plane landing in Florida. Lo and behold, the traveling companion, who had no known history of kidney disease, was now in acute renal failure and required emergent dialysis. My care for my patient was now extended to his traveling companion as well. I worked with the dialysis staff in Florida and the airlift medical staff to orchestrate transfer of now 2 patients on dialysis back to CA. Both patients eventually made it back. The patient was taken off peritoneal dialysis and switched to hemodialysis, and he then shared a chair right next to his traveling companion every M-W-F. We all learned the value of travel insurance, and I learned how much heart I have for all my patients no matter where in the world they are.
Nancy Pierce, BSN, RN, CNN
Big Sky Chapter
Western Vice President
Two years ago, I celebrated the 30th anniversary of a patient on dialysis who I had cared for in our unit since the first day he came as a scared 32-year-old patient who couldn't believe he had kidney failure. Over the years, he worked full time as a job counselor, and we dialyzed him after work. He continued to have an active life and work full time until retiring at age 55. We held a party to celebrate his 30 years on dialysis, and I put together a "remember when" handout that I read in celebration of the event.
Remember when:
* Dialysis machines (Travenol RSPs) were filled with a garden hose.
* Dialysate concentrate was poured in and stirred with a stick.
* The nurses were the air and blood leak detectors.
* Dialyzers were "coils."
* Dialyzers were "air tested" prior to use to help detect ones that would have blood leaks.
* Blood leaks were commonplace, and you could actually smell a leak--they sometimes sprung a leak under pressure and the ceiling got sprayed.
* Weight loss was calculated with a formula-and it wasn't an exact science.
* Screw clamps were used on the blood lines to force fluid out using positive (not negative) pressure.
* Patients were allowed to eat whatever they wanted on the machine.
* Patients frequently had horrible leg cramps.
* Most patients ran 6 hours as a routine run.
* The nurses had very small number of patients to care for at one time. In fact, the nurses and patients could watch the "soaps" on TV together and play Yahtzee.
* Cleaning the dialysis machines frequently got the dialysis nurses in trouble when the floor underneath flooded if they forgot to turn off the hose during the many rinses needed after bleaching the machine.
While the dialysis equipment and technical end of the treatment has become much better over the last 30 years, I still somewhat long for the days when my patient shuffled cards using his one-handed mechanical card shuffler, and all patients and staff played card games together and bonded as the dialysis team. I'm sad to say that the patient passed away about 2 months after his 30th anniversary. The times we had together in those early days helped make me into the dedicated dialysis nurse that I am today.
ANNA Past Presidents' Memories
Betty Oates, BSN, RN, CNN
ANNA President, 1973
R. Michael Huddle Chapter
Memories of Nephrology Nursing
My career in nephrology started in July 1966, when I was hired as head nurse for the new Artificial Kidney Unit at the University of Mississippi Medical Center, Jackson, MS. Dr. John Bower had received a grant of $350,000/year for 3 years from the U.S. Public Health Service. We were one of 16 units funded in the United States. We were the first unit in Mississippi and one of few in the Southeast. Our technician and I went for a month of training to the Wadsworth Veterans Administration Hospital in Los Angeles where they used the Kiil dialyzer and central dialysate system that Dr. Bower had chosen for our unit. I went on to Seattle for another week. Over the course of the next few months, our unit was renovated, equipment was ordered, and staff were hired. We started with 3 nurses and 2 technicians. Our first patient was dialyzed on December 21, 1966. For the next several months, all of us were in attendance for every dialysis!
Our unit consisted of 7 beds (no chairs) for chronic patients and one room for acute dialysis and special procedures. The dialysate was "piped out" to each station--all patients used the same dialysate. Prior to the initiation of dialysis, the conductivity was checked manually by technicians. After each dialysis, the Kill dialyzer was "torn down" by the technicians, re-built with new cellophane (cuprophane), and sterilized with formaldehyde. The access device used was the Silastic/Teflon (Scribner) shunt. When initiating dialysis, "bulldog clamps" were used on the arterial and venous portions of the shunt to stop the flow while the shunt was connected to the blood lines. The nurses wore gloves only for sterile procedures!
We had no blood pumps--the patient's arterial pressure moved the blood through the dialyzer. The dialysis took 12 hours, and we dialyzed each patient twice a week. The fluid removal was not scientific at all! Fluid removal was done by gravity. There was a drain tube mounted on the wall behind each bed through which the dialysate would be discharged. If the patient needed to lose a lot of weight, the discharge hose would be pushed all the way to the floor. If they needed to lose less weight, it would drain higher up in the tube. It was a guessing game. We weighed the patients during dialysis and adjusted the drainage hose as necessary! There was no automatic monitoring of any sort--blood pressures were taken with mercury manometer cuffs, and patients were monitored frequently by the nursing staff for any symptoms of hypotension and cramping. Each dialysis, we would obtain a blood sample for a hematocrit level. It was acceptable if the Hct was 20% to 25%. One patient consistently ran an Hct of 12% and functioned very well. You see, we had only one way to handle anemia, and that was to transfuse. Because of the possibility of introducing hepatitis, we transfused only when the patient was symptomatic. We had a very special patient population, and they were very compliant. Most of them had been told that there was no treatment for their disease. With the advent of the artificial kidney, there was hope again for those selected for dialysis. Yes, with limited funds, patients had to be evaluated for dialysis, and the fortunate ones were selected. It was an agonizing decision for the members of the "selection committee," which was made up of physicians, a psychiatrist, members of the clergy, and some members of the community.
The staff did not punch a clock--we worked until we were finished. Dr. Bower, our director, was a hands-on leader and great teacher. He appreciated us and made us feel important. As the end of our grant money was approaching, we worked with Mississippi Vocational Rehabilitation who funded a Home Dialysis Program. Patients and their helpers were trained for about 6 weeks, equipment was installed in their homes, and they were given a 3-year supply of items needed. They were taught to re-use their dialyzers and blood lines, and they made their supplies last!
Several more creative programs were used by our facility to minimize costs over the next few years. Those of us who have been in the field for awhile remember the enactment of HR-1, Public Law 92-603, which became effective July 1, 1973. This provided funding for patients needing dialysis and transplant through the Medicare program. The number of dialysis centers grew after this funding was available. We expanded limited care dialysis and added home peritoneal dialysis to our treatment choices.
My career spans more than 4 decades: from shunts to AV fistulas and grafts; from 12-hour to 4-hour dialysis; from non-disposable to disposable dialyzers; from no automatic monitoring of dialysis to great equipment with sophisticated monitoring; and from few drug choices to the advent of drugs which have allowed us to treat many problems that are present in this population. Nephrology nursing has been challenging and so much fun. I have friends in many areas of the country as a result of our common bond of this nursing specialty.
Early Years of ANNA
Before...
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