March is National Kidney Month and Minority Nurse caught up with nephrology nurse Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN to find out what it’s like to be a nurse in this specialty. She is the national president-elect 2023-24 of the American Nephrology Nurses Association (ANNA).
Please tell me about your role now and how your career brought you to this place.
My current role is as the Clinical Nurse Specialist and ARNP for Renal, Dialysis, and Transplant at the University of Washington Medical Center. Although I am involved in several committees and projects, my primary focus is on the inpatient kidney replacement therapy program. We have an in-house team that consists of over 100 unit-based RNs trained in HD, SLED, PD & CRRT who perform approximately 6,000 procedures a year on one campus with support from the dialysis technician team. My role includes staff training, patient education, regulatory compliance, evidence-based practice, quality improvement, and research. I also am consulted regarding evidence-based practice and care planning.
Following my passion and having the support of mentors in finding my way was invaluable. I started working as a nurse technician on the dialysis and transplant unit while I was in nursing school. When I graduated from nursing school, I was hired as a staff nurse. I had mentors who believed in me as I gained knowledge and confidence. I was able to become a charge nurse, dialysis nurse, and eventually assistant nurse manager. After being an assistant manager for several years, I realized that the parts of my role I enjoyed most were providing education, mentoring, clinical care, and improving systems. At the time I was applying for Master of Nursing programs, I was encouraged by one of the nursing professors to apply for the dual acute care nurse practitioner and advanced practice specialist tracks so that I could have the most flexibility in my future career path. I have been fortunate to find a role where I can still provide patient care directly and impact care at the system level.
How did you decide on nephrology nursing?
Like many nursing students, I was fascinated with labor and delivery and pediatrics. There were no openings there so my first job as a nurse technician was on a dialysis and liver/kidney transplant unit. I had little exposure to nephrology in nursing school but once I started working with this population, I found a new passion. Instead of individuals bringing home a newborn, I was helping individuals bring home a new organ that they were learning to care for and helping them create a new life after transplant. It was inspiring, fast paced, and still a growing field. As I learned more about kidney disease, I also realized that the diseases that contribute to kidney disease, like diabetes and hypertension, run in my family and are prevalent in the community. This added another level of connection to kidney care as a way to advocate and provide the best care possible to other individuals who have these diseases in their families.
What do you especially enjoy about your specialty?
I enjoy that there are several nephrology subspecialties such as chronic kidney disease, vascular access, outpatient dialysis, home dialysis, acute dialysis, and transplant. I have been able to continue working with the kidney community throughout my career and do different kinds of nursing – bedside, clinic, administrative, research. I have the privilege of working with individuals living with kidney disease over time and can support them through different stages of their health. Kidney care is very interdisciplinary, and I enjoy collaborating with colleagues in nutrition, pharmacy, social work, and nephrology. I have also worked on committees with patient advisors which has been so fulfilling professionally and personally. Professionally, I believe the systems that we create with patient advisors are more individualized and patient centered. Personally, I have learned so much about the strength of community, the power of hope, and how essential support systems are.
Please describe some of the activities you do within a week, i.e., patient care, medical records, family interactions, working with your team.
Every day and week vary some. I provide dialysis education to ICU and medical surgical nurses, meet with patients who are having issues with their vascular access or need dialysis modality education, am consulted on potential safety issues and perform chart audits, work with interdisciplinary committees on preventing catheter-associated bloodstream infections and urinary tract infections, consult on research or quality improvement projects, plan for continuing education, cover breaks for dialysis nurses performing intraoperative hemodialysis, and guest lecture at the school of nursing. Some days I am in meetings about developing care pathways with transplant surgery, updating the electronic medical record, discussing supply chain new equipment, or in a patient plan of care conference. With any system or product that impacts kidney care, the medical director, dialysis operations manager, and I are involved.
How do you keep up with all the industry changes around patient care and technology?
I attend ANNA’s National Symposium and Fall Meeting whenever I can. The quality of the presenters is excellent, and the content is evidence-based, relevant, and up to date. I also attend local nephrology conferences, attend online seminars, read the Nephrology Nursing Journal, attend Nephrology Grand Rounds, and subscribe to online nephrology list serves including the regional ESRD Network. The list serves provide highlights on a daily or weekly basis, and have different focus such as quality, new medications, treatments innovation, guidelines, and health policy. I also follow professional organizations on social media to get a sense of what are topics of discussion in the nephrology community.
If you are certified, how did you decide to pursue that additional credential and how has it helped your performance as a nurse and your overall career?
My first certification was the Certification in Nephrology Nursing (CNN) which I earned in 2001 because I knew I wanted to be a nephrology nurse long term. It also helped that I work in a Magnet institution which supports certification with professional development time and certification pay. I was starting to feel more comfortable with my nursing knowledge and skills and saw this as an opportunity to challenge myself and build confidence. I remember feeling so proud when I earned my CNN, and have continued to maintain it. My certification motivates me to stay current and engaged in my specialty. It also lets people know I am committed to nephrology care. I recently received my 20-year CNN pin and it is very special to me.
Can you talk a bit about how joining a professional organization like ANNA has helped your nursing career?
As a newer RN, I looked to ANNA to provide me with education and learning more about caring for people with kidney disease. As my career continued, I became involved in the chapter education planning committee and eventually chapter leadership. ANNA provided complimentary volunteer leadership education and tools to support me as a new leader. These skills carried over into my work as well as I became an assistant manager. When I was in graduate school and my husband was laid off, ANNA awarded me a career mobility scholarship that allowed me to finish my Master of Nursing. I have been able to present abstract posters at ANNA National Meetings and was published in the Nephrology Nursing Journal. I began volunteering on ANNA national committees and eventually became a director with the ANNA Board of Directors. Through ANNA, I met mentors and friends who have encouraged and mentored me over the years. There are so many potential benefits of engaging with a professional nursing organization, and I hope other nurses take advantage of all the benefits that membership offers. ANNA has made my nursing career and life fuller.
What else do you enjoy outside of your work?
Outside of work, I like to spend time with my husband of 26 years, our 24-year-old son, 21-year-old daughter, and our dog. We like to try foods from all over the world, visit national parks, take walks, visit museums, go to musicals, and play board games. My husband and I both have large extended families so we like to visit them when we can. At the end of the day, my introverted side takes over. I like to read, cook, work on puzzles and do crafts like knitting, making photo books, painting, and sewing. I also like to plant things and watch them grow.