Lessons from background in nursing help new president of ANNA set goals for future
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Author’s note: From an early childhood introduction to kidney replacement therapy to her new role as president of the American Nephrology Nurses Association, Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN, shared her journey and her goals for the organization in a recent interview with Healio | Nephrology News & Issues.
Sheila Deziel, MSN, RN, CNN, FNKF: What was your first introduction to nephrology?
Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN: My father came to Seattle with a professional visa and met my mother, who also came to the U.S. on a visa and was working as an accountant. They married and decided to stay in the United States. He was a physician, a general practitioner, in the Philippines but he was unable to practice here. He wished to continue to work in the health care field.
In 1973, he met Belding Scribner, MD, who asked him to work in the dialysis program at the University of Washington. Scribner felt that my father’s chemistry background was a perfect fit for creating the dialysate that was used in dialysis solutions.
My father trained with Scribner and became a dialysis technician. He also worked with the transplant team under Thomas Marchioro, MD, and retired after a 26-year career. He had a certificate signed by Scribner that hung above his desk and still does since he passed. I heard Scribner’s name while growing up but I only met him once.
Photo courtesy of the American Nephrology Nurses Association.
My introduction to dialysis was as a 5-year-old child playing with discarded bottles used during peritoneal dialysis. The bottles were glass, and so my goldfish swam in one of these bottles. I also would accompany my dad over the years to the hospital if he got called in for a case while we were out. I would wait by the dialysis lab until he finished.
Sheila Deziel, MSN, RN, CNN, FNKF: So, your plan was to become a doctor?
Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN: Yes, but I was in college studying premed and not enjoying it. I was encouraged to take a nursing course and fell in love with this profession. While in nursing school, I applied to several hospitals for a job as a nurse technician. The University of Washington Medical Center called, and the openings were in neurology and transplant. I came home and told my dad that I would be working in the transplant unit; he said, “That’s where I worked.” At the time, I had not put it together because I had only seen the dialysis lab. After I was hired, a few people asked me if I was related to Rene Colobong, but I was proud to know that I got the job on my own.
Upon graduation, I was hired as a transplant nurse and went on to learn all facets of dialysis and nephrology nursing. When I was the assistant manager, I decided I wanted more direct patient care duties. The University of Washington had a dual program of acute care nurse practitioner and the advance practice specialist – a certified nurse specialist program. I was one of the few individuals with this dual certification and I have been an acute nurse practitioner and certified nurse specialist in nephrology for the past 15 years.
Sheila Deziel, MSN, RN, CNN, FNKF: That makes for a great background for your work as ANNA president. What are your priorities?
Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN: I have three things that I want us to focus on in this coming year: leadership, innovation and inclusion. As our chapters evolve, we as leaders need to consider new ways to reach our members. Hosting a meeting regionally that meets members’ needs and that can be offered virtually will be important.
Innovation is an easy one for me to think of with my experience with Victor Guru, MD, and his wearable artificial kidney (WAK) project that I worked on.
Sheila Deziel, MSN, RN, CNN, FNKF: Explain the connection between the WAK project and how you want ANNA to grow.
Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN: In all the patient groups I worked with at the End-Stage Renal Disease Network and for the Centers for Dialysis Innovation, what I heard from patients is they want to cut the tether of dialysis. I was able to keep seven patients safe as they completed wearing the WAK device for 24 hours. Despite it being a large external device, the patients were pleased to be a part of it. One patient wanted to be able to dance in the hall with his wife; he sent photos of him doing just that. The innovation must continue, and nurses should be part of the innovation to give the patients something that is a step up in the right direction. That would be huge.
It has been tough for several years for nursing in general. We have had to do a lot of innovation to get our workforce through all the different challenges that we are facing. I want [nurses] to share what they are doing, to share that pride in what they have done and share it with each other so that hopefully they can get more ideas and make their work lives better as well. Because it is not just about research –we are doing processes differently.
We are reaching out to new nurses, nursing students and into new markets with younger students who are deciding on nursing as their career. I have been to some talks where they report more community health workers being used because there are not enough people to care for all the patients who need it. And so, using these models where we are bringing teams of different people with different levels of skill, this is part of the innovation as well.
Sheila Deziel, MSN, RN, CNN, FNKF: Do we need to do more work on inclusion?
Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN: I am the first Asian American president of ANNA in its 55-year history. Representation matters, and there are many more firsts for ANNA to look forward to.
Some questions we need to ask include, “What are the issues impacting the population? What are the social determinants of health, health care equity and the issues that are impacting outcomes? Every group has more renal disease than Caucasians. What are we going to do about that?”
The GFR equation with a race factor, for so many years, put people even further behind. If they had access to health care, they still were not getting diagnosed or treatment to slow the progression of kidney disease. In 2020, an American Society of Nephrology and National Kidney Foundation task force unanimously agreed to remove the race factor from GFR equations. Although many institutions and labs across the country have done this, there is still work needed to make sure this is the standard everywhere.
In other instances, community workers are partnering with the hospital systems and community leaders to create a safety net to pass health education through trusted channels, and they are starting to make headway. It is going to be important to stay aware of these innovations for care access and determine how nurses can support them. Hopefully, we can create enough care hubs to support health education and slow progression of kidney disease in the future.
ANNA’s focus on health equity has been expanding over the last several years. Health equity impacts our current workforce and future nephrology nurses, as well as individuals living with kidney disease. ANNA is committed to providing education on social determinants of health and outcomes, supporting the diversification of the workforce at all levels of nursing and advocating for improved access to kidney care.
- For more information:
- Sheila Deziel, MSN, RN, CNN, FNKF, is a senior clinical consultant with Fresenius Medical Care North America and a Healio | Nephrology News & Issues Editorial Board Member. She can be reached at sdeziel@cox.net.
- Nancy Colobong Smith, MN, ARNP, ANP-BC, CNN, is a clinical nurse specialist and nurse practitioner at the University of Washington Medical Center.
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