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Article Excerpt
At the Nephrology Nursing Shortage and Solutions Invitational Summit, we talked about the positive aspects of nephrology nursing and how to communicate those to potential nephrology nurses. Thus began this project to ask nephrology nurses to share their most memorable nephrology nursing experiences.
As promised, we selected first, second, and third place winners. We were so impressed with the entries, however, that we wanted to share many of them with you. We also asked some of our ANNA leaders to submit their memories. As you read them, you will see stunning examples of not only the effect of nephrology nurses on the lives of our patients and colleagues, but also the effects of patients and colleagues on us. Some stories are short, some are long. Some deal with life and some with death. Some are happy, some are funny, and some are sad. Taken as a group, they paint the picture of nephrology nursing as we know it and love it.
Many people have written in to say how much they appreciated being stimulated to remember and share these memories. If reading them makes you think of your own memory, then please send it to us (email to BethUlrich@aol.com or to Lauren McClintock, NNJ Editorial Coordinator at mcclintl@ajj.com). We encourage you to collect such memories in your units and chapters and to share those with each other and with the journal. We will continue to share these memories in the journal and on our website (www.nephrologynursingjournal.net).
Note: In respect for the privacy of our patients and their families, names have been changed.
More Memorable Experiences in Nephrology Nursing.
Ruben Encino, BSN. RN San Antonio, TX President-Elect, ANNA Alamo City Chapter
The moment that I will remember for the rest of my life is when our Chapter won the Outstanding Chapter award in 2002. I have been a member of ANNA since 1989 and very active in our chapter and have held every office except treasurer and legislative representative. All the years of hard volunteer work, but also having fun, finally paid off. What really captivated me and the audience was the standing ovation from the entire room at the Nephrology Nurses' Luncheon during the ANNA National Symposium in Orlando, FL. It was also really moving to me to see past ANNA national presidents on their feet cheering us on. It literally brought tears to my eyes. I'm dedicated to ANNA and nephrology nursing. I have been blessed over the years to have met so many nephrology nurses and technicians. I hold them close to my heart and look forward to seeing them every year at our National Symposium!
Cynthia Frazier, MSN, RN, CNN Fairfield, AL ANNA Conference Chairperson Member, ANNA Hazel Taylor Chapter
As a freshman nursing student, I was introduced to dialysis when file mother of one of my dorm mates, Mrs. M., was diagnosed with renal failure. We would visit her at the hospital where she would undergo 6 to 8 hour treatments having traveled 200 miles because there were only two dialysis facilities in the state.
The year was 1971, before the days of Medicare. Mrs. M. would always have coins that she would share with us for washing and many times for food. She shared what had been donated to her by community churches, civic groups, and friends who had conducted fund raisers to help sponsor Mrs. M.'s dialysis treatment.
I remember the old RSP dialysis machine; it looked like a washing machine. The unit was an old converted nursing unit. Some days, Mrs. M. did not feel well and mostly slept. But I also remember the nurses. The staff took time for the family--answering our questions, offering reassurance when we showed concern. This compassion and direct interventions and professionalism impressed me.
Mrs. M. improved and went on to home dialysis. Her husband trained with her. Again, I marveled at how these people, who had only a fifth-grade education, could learn to perform dialysis. The home dialysis nursing staff took time and patience, often repeating mid demonstrating time alter time until she and her husband were comfortable. When they graduated from the home dialysis program, the entire family along with several of us nursing students attended the graduation. They were so proud that they had completed the course and that Mrs. M. would dialyze at home. Again, I was deeply impressed that the nursing staff would take the time to celebrate their accomplishments and make them feel so special.
Mrs. M. had been adopted and had no family to donate a kidney and, at that time, the children were too young. She made a decision against cadaver and was supported by the staff that this was indeed her choice.
She did hemodialysis at home for over 15 years until she developed severe cardiac manifestations. It was determined that she was too unstable for home hemodialysis. But she and her husband wanted to remain at home. She returned to the center and they were trained in peritoneal dialysis--first, on CAPD and later on the old octopus-looking AMP cyler. They managed well at home for several years.
All along, Mrs. M.'s dream had been to live long enough to raise her three children. Not only was she able to see all graduate from high school, college and military service, but she was also able to see her grandchildren. Mary died peacefully at home.
Through the years, I continued a professional and personal relationship with Mrs. M. As I went through each of my clinical rotations pediatrics, med-surg, OB-Gyn, public health, and psychiatry--I explored my options for my future in nursing'. Nothing made an impact like nephrology. Upon graduation in 1975, I became a dialysis nurse as a new graduate. At that time, it was unheard of for new graduates to enter into such a specialty. I interviewed with the medical director and explained how the experience of seeing the compassion and support exhibited to Mrs. M. from the staff made me realize that there was no other area of nursing for me.
Since 1975, I have worked in all areas of nephrology. I continue to love nursing and especially nephrology nursing. This specialty allows you to maintain a degree of professional autonomy while demonstrating compassion, understanding, and support for the patient.
Raymond Yuro, BS. RN. CNN Mount Arlington, NJ Treasurer, ANNA Garden State Chapter
It literally was a dark and stormy night! The rain had begun falling late that morning and continued in torrents throughout the afternoon. Nobody was prepared for how much rain would eventually fall, and it was only when the roads started to close that we tuned into the local television stations for more information. Being a big weather fan, I logged onto an Internet weather page and marveled at how the local radars were "lit" up.
It was now early Saturday evening (of course). I was the charge nurse for the last shift, and the covering doctor said we could end treatments early. One by one we somehow managed to find a way to get the patients home--all except one! She and her family happened to live right smack in the middle of the town that was hardest hit and the road was blocked from the rest of the area. Nobody in and nobody out was the word we received. None of the local transport or emergency services would take her anywhere! We are a hospital-based unit, so I figured the emergency department could help her out. Even after consulting with the nephrologist, who said he would admit her if he had to, the ED doctor told me that they wouldn't get involved in a "social services issue." I called the Red Cross, and even they were unable to help.
At this point, it was only me, a technician, and the patient! The rain was still pouring down, and this patient was really stuck. So, against all wisdom ever instilled ha me about liability, I decided I would transport the patient in my own car to a nearby hotel where she said she wanted to stay for the night. "And by the way," she told me, "I also need oxygen when I sleep." She could have taken our oxygen tank, but, of course, it was nearly empty and would not last the night. So I called the respiratory department and fortunately talked with someone who was sympathetic to our situation and gladly brought another full tank to us "off the record." Off to the hotel we went. I arranged everything and set her up in her room with everything nearby. I left her there wondering if this was the right thing to do and hoping she would be okay.
The next day, I spoke with the family and the patient. It seems that everything worked out just fine! Eventually, I relayed my story to my coworkers, and we brainstormed about ways to provide for patients in emergency situations. As a fairly new nurse, I've listened to more seasoned nurses tell me that the days of creative nursing are over--that protocols and liability issues keep us on a straight and narrow path. Not so. What a learning experience it was being forced to be creative!
Suzy Sims, RN Pflugeville, TX Treasurer, ANNA Heart of Texas Chapter
I have only been in nephrology nursing for about a year and a half. From nay first day in an outpatient clinic, I observed hemodialysis patients being quite particular when it comes to new employees. Of course I experienced first hand just how picky some of the patients could be during nay first few weeks on the job. However, there was one gentleman, let's call him Mr. Smith, who had been on hemodialysis for about a year. Mr. Smith had a more positive attitude toward new employees. He was about 82 years old and a retired policeman. From nay first day, he was always very kind to me, asking where I was from and where I had gone to nursing school, etc. When it came to the time in nay training to start cannulating accesses, he was almost eager to have me "give it a go" on his right forearm graft. Needless to say, I was very nervous. The cannulation went off without any problems, at least from my end of things. And from that moment forward, all the other dialysis patients started being more friendly and accepting of me and let me cannulate their accesses. It was shortly there after that Mr. Smith was diagnosed with metastatic stomach cancer, and he did not wish to prolong things by continuing hemodialysis. I was devastated for Mr. Smith and his family. It didn't take long, and he passed away. I think about Mr. Smith often. How he was so friendly, always wore his police hat, and was willing to give me, "the rookie," a chance.
Barbara Prowant, MS, RN, CNN Sturgeon, MO Member, ANNA Central Missouri Chapter ANNA National Secretary
I have two special memories. The first occurred when I was 8 months pregnant, and my boss, the chair of our Nephrology Division, and I were walking together down seven flights of stairs at the University. "How are you feeling?" he asked. "I feel fine", I responded. "No, tell me how you're really feeling", he countered. "I'm really feeling just fine," I replied emphatically. His excited response to this was, "Well you ought to be--you know your glomerular filtration rate is probably higher than it will ever be in your entire life!" So much for the nephrologist's perspective of a normal pregnancy!
The next memory involved our new nephrology professor from Poland who was conscientiously working at perfecting his English. During a routine team meeting, a PD nurse reported to him that an elderly gentleman on CAPD was having trouble maintaining his blood pressure and had "passed out" at home earlier that morning. It was decided that he should come to the PD clinic for evaluation later that day. The physician walked into the exam room, greeted the patient and his wife, and said, "The nurses tell me that you passed away this morning."
Veta Cumbaa, RN Gainesville, FL President-Elect, ANNA North Central Chapter
Years ago I was working in a large (120-patient) dialysis unit. We held a large barbeque for all shifts of patients that fall. The chief tech was a great cook and he set up his huge smoker out in front of the clinic. We were under a canopy and set up all the side dishes, iced tea, etc. for the patients to see as they walked in the clinic. The wonderful aroma of cooking chicken was detected for miles, and we had all the drivers, patient families, and staff who were scheduled off that day coming by for a taste. It was a wonderful feeling of community that day!
Karen M. Rosenburg, RN Clinton, MS Member, ANNA Magnolia Chapter
I was just getting started in outpatient hemodialysis in 1982. A patient came in with over 12 pounds of weight after an extremely difficult run at her last treatment. I was very perplexed and asked her if she remembered her last treatment and how sick she had gotten. She answered that she did but that this weight gain was not her fault. I looked at her and said, "Excuse me, what do you mean?" She then proceeded to tell me how she had gone to her doctor and he had told her that she could gain fluid weight by just walking through a rain puddle. This woman really trusted her physician so no matter what I said was taken with no believable sense. I spoke with the nephrologist and told him what she had informed me, and he then called her family physician and explained how important it was for him to encourage her to limit her fluid intake. This poor woman was so sure that she was gaining fluid by walking up her drive to get the mail everyday that she had asked her husband to please fill in all of the holes in their drive way" so she wouldn't have to walk through rain puddles.
Alice Wheat, RN, CNN Columbia, MO President, ANNA Central Missouri Chapter
I have had so many memorable moments, it is really hard to choose just one. Renal patients become almost like family. I work in an acute care setting. I was dialyzing a man in the ICU around the holidays 2 years ago. He was acutely ill. We dialyzed him almost every day for a month prior to Christmas. His family became my family.
As I was dialyzing him the day before Christmas, I told him I needed to make peanut butter pies for my family when I got home. lie told me he would do just about anything for a taste of those pies. On Christmas, I just had to run a pie up to his family and see that he got a taste.
We lost this fine man just before the new year. His wife and son told me, as we all cried together, that he talked about that peanut butter pie until he could no longer talk. When I think of this patient, I remember his smile when he tasted that peanut butter pie and it makes my heart smile. It also challenges me to give the best care I have to offer and always go a step better.
Karen E. Schardin, BSN, RN, CNN Carson City, NV Member, ANNA Sacramento Valley Chapter ANNA Past President
My most memorable experiences in nephrology happened one day a few years ago. It was a trio of "happy moments" that can go unrecognized in an otherwise busy environment. The first one was a 24 year-old male patient who was transplanted after almost 1 year on outpatient hemodialysis. Transplantation, especially for the young, is always a joyous occasion. Everyone in the unit had been rooting for him and his family. He had been able to continue to work full time while on hemodialysis but you could see the toll it was taking on him. As a dialysis nurse receiving the transplant news, there are no better words than, "it started making urine on the table."
The next two experiences were more subtle. One of our older (above 80) patients came in with his photo album. He shared his photos and newspaper clippings from his youth. He was a minor league baseball player who had played baseball with many of the Yankees. He never made it in the Major Leagues, but you could tell by the look in his eyes that he was happy with the experience and opportunities he had. The best was that "I've been married to my wife for over 64 years and still going strong." He added that this would not have been possible without the care given to him by the dialysis staff. Later in the day, another one of our patient came in with a birthday cake. It read "Thank you to all of you who helped me make it to 75 years!"
Most of our patients say thank you every day in their own way. I happened to enjoy three great moments in one day!
Alice Luehr, BA, RN, CNN Helena, MT Member, ANNA Big Sky Chapter
The end of life stage of our dialysis patients is always bittersweet for me. I am comforted by the fact that the patient who has made a well thought-out and careful decision to quit dialysis has an aura of serenity around him/her. I have asked several of these patients during his/her last dialysis treatment to come back and "piddle on the windows" of the unit for me to let me know that he/she is okay. Living in central Montana it does not rain very much, but sure enough the next day after the patient dies, I look out to see rain. So the true meaning of the phrase "Right as Rain" comes shining through.
Deborah Brooks, MSN, RN, CNN Folly Beach, SC Secretary, ANNA Palmetto Chapter Editorial Board Member, Nephrology Nursing Journal
Mr. A. and I were about the same age and had both grown up in the same city, but what a contrast in our lives. We met for the first time when I moved back to my home city after being gone for 12 years. I was a seasoned nephrology nurse, having worked in acute and chronic hemodialysis as well as home dialysis with peritoneal dialysis (PD) and hemodialysis. I had recently finished my master's degree and was now working as the case manager for the nephrology service. Most of my time was spent with high-risk patients and the challenges of helping them limit their hospitalizations. Mr. A. had been on hemodialysis for several years and due to an active IV drug problem, his accesses were frequently infected and often nonfunctional.
The day came when it was decided that PD was this man's last option. I was skeptical but willing to put my expertise to use. Mr. A. was skeptical and let it be known that he wasn't very interested. The nursing staff were skeptical that he would even try to learn the procedure. The medical staff were skeptical that he would not actually ever do the procedure. However, we all rose to the challenge, and Mr. A. did learn to do PD, he did go home, and did stay out of the hospital for extended periods of time.
Over the next year his drug habit would reemerge and he'd be back on our unit with uremia, fluid overload, and peritonitis. His mother and sisters vacillated between despair, frustration, and resignation. Mr. A. could be moody and remote, bristling with irritation at what he perceived as meddling, nagging questions--but he could also exhibit a droll sense of humor that I found touching. He reminded me of a stray cat--independent and wary but willing to take some succor, provided no one tried to "pick him up" or make him change his life.
Finally the day came when his PD access was gone, his peritoneum no longer able to adequately provide dialysis. Imaging studies revealed not only sclerosed, inadequate vessels but also needle shards that had broken off during bouts of drug use and were lodged in various parts of his arms and thorax. Without fanfare, he announced that he didn't want to dialyze any more. He didn't intend to make any fife changes and he seemed at peace with his decision. Various other professionals were consulted but Mr. A. was uninterested in pursuing more medical care.
One morning while his sister was visiting, I was ha his room talking with them. The conversation was light--almost more like a visit. He asked his sister for a cigarette, something he did often although he never was allowed to smoke in the hospital. For some inexplicable reason I agreed, closed his door, and opened his window. It was spring and I can still see that cigarette smoke wafting slowly toward the window and rising up on the air current. Suddenly, Mr. A. gave a little grunt and gasp and I realized he was arresting. I looked at his sister and said, "This is it, do you want us to do anything?" She shook her head and said, "Let him go, it's what he wants." For several peaceful moments, we sat and watched as the tension left his face. I could almost imagine his soul lifting from that worn body and following the cigarette smoke into the warm spring air. I will always feel a sense of wonder that such a private man chose to die with me as a witness. Maybe it was coincidence or maybe he had a final lesson to teach me. I find myself thinking about him at odd moments and hope his afterlife has brought more peace than his time on earth.
Kathryn Devlin, BSN, RN, CNN Hicksville, NY Member, ANNA Long Island Chapter
I graduated from college with my nursing degree 23 years ago. My most memorable experience occurred while I was a nursing student, during one of my clinical rotations.
My patient was a resident in a long-term facility. She was only 47 years old and suffered from spina bifida, paraplegia, and a congenital anomaly, which caused renal failure. She had no immediate family, therefore visitors for her were a rarity.
I had never worked with a nephrology patient before. Fellow students had warned me how "difficult" these patients could be. But despite her situation, my patient was amazingly upbeat and positive. We were able to spend a lot of time together during my 3-month clinical and developed a close relationship.
On the last day of my assignment, my patient gave me a special gift. Since she had no family, and no one to go shopping for her, she gave me one of the few personal possessions she had. It was a yellow scarf. She explained that the color yellow symbolized hope.
This year marks my 21st in nephrology nursing and I have never forgotten my very first renal patient, even though I never saw her again. I still have that yellow scarf she gave me. Every once in a while I come across it, tucked away in a drawer and I remember why I became a nephrology nurse. I try to pass along the message of hope that was given to me all those years ago.
Tamara M. Kear, MSN, RN, CNN Doylestown, PA Member, ANNA Keystone Chapter
It requires courage and grace to express that you are ready to die and an understanding that you are not living the quality of life that you are satisfied living. Mrs. S. had lived a productive life as a wife, mother and school teacher. Now" in her 80's, she was widowed and required dialysis.
Despite these challenges, she continued to be an active member of society and lived independently. She enjoyed playing bridge with her friends, attending her synagogue and enjoyed the fine restaurants, arts and culture offered in her metropolitan city. Mrs. S. was involved in the lives of her children and grandchildren and visited them frequently. Mrs. S. did not allow dialysis to interfere with her life and quickly incorporated the hemodialysis schedule, dietary restrictions, and mediation regimen into her daily life. When she arrived at dialysis, Mrs. S always had a story to tell about the latest show or restaurant that she had visited. Her love for life radiated from her being.
Unfortunately on the way to bridge on evening, Mrs. S. fell and, upon hospital admission, it was determined that she had suffered a stroke. Mrs. S. progressed through rehabilitation, but never regained the independence that she was accustomed to having in her life. She was required to move into her daughter's home. Mrs. S. maintained her cognitive abilities, but had physical limitations and was not content with her quality of life and lack of independence. She soon expressed to her children the desire to stop dialysis and die a peaceful death. A family meeting was called and at this meeting of the nurse, physician, social worker and her children, Mrs. S. clearly stated that she had made the decision to stop dialysis. She proceeded by explaining that she had lived a "full and happy life" and was ready to die. She spoke these words with great confidence and certainty. She continued by stating that she wanted to end her life with one final, grand party that she would throw for...
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