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The growth and development of nephrology nursing.

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I am tremendously pleased to have been invited to keynote this meeting. It isn't often that one is given the privilege of "official" reminiscence, especially with a captive audience! I am a little awed at the assignment, however, for three reasons: 1) there are probably some of you present who have more tenure than I in your experiences with nephrology nursing; and 2) like most people who participated in the making of history, the events often passed by me without being recognized for their importance. Many times I have wished that I kept a diary! Third, interpretation of history is a particularly personal business, since each of us sees events and trends according to our own perceptions and biases. With these reservations, I have approached this address with what I hope will be a useful model, that of the growth and development of our specialty practice and of our organization, with some apologies to the pediatric nurses for the liberties I plan to take with the concepts.

Infancy and Early Childhood: 1965-1970

Nephrology nursing had a very long gestation during the span between 1950-1965. During this time there was ongoing research into the techniques and equipment for dialysis, but there was limited application to patient care. Special nurses were involved in these early research efforts, I know, but I do not know of documentation of their work. So my time horizon begins as I finished graduate school in 1965, when my university hospital had just acquired its first Travenol tank hemodialysis equipment. Before this time, only peritoneal dialysis had been available in my hospital. Imagine the excitement as a small room in the research unit was made ready for the first hemodialysis treatments. I recall that the room was packed with physicians, lab technicians, nurses, and observers. The nurse, when she could get close enough to the patient, took blood pressures, drew blood specimens, hung replacement solutions, and otherwise acted the part of the veritable handmaiden. Six physicians attended the entire dialysis!

I imagine that similar beginnings must have characterized the first dialysis units around the country, most of which had been organized as demonstration projects under the Regional Medical Program or in the Veterans Administration System. The medical specialty of nephrology had not really emerged yet, and dialysis services were so widely scattered that there was little awareness of ourselves as "nephrology" nurses. The nurses associated with these programs were truly pioneers, and quickly demonstrated that they had the knowledge and skills to carry out dialysis procedures largely unassisted. These nurses were selected primarily from those with intensive care unit experience and were viewed as having extraordinary competence. (We required at least two years' experience.) Their achievements cannot be over-emphasized, because they started us on a road to recognition and professional independence.

From a developmental perspective...

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