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Debra Castner, RN, APRN-C, CNN Nephrology Nursing Consultant Nephrology Associates of Tidewater Exmore, VA Tidewater Chapter #241

How long have you been a nurse?

I have been a registered nurse (RN) and nurse practitioner (NP) for 45 years. I also was a medical assistant for 2 years and licensed practical nurse for 1 year before finishing my diploma for RN licensing. Nephrology nursing caught my eye during nursing school. I started nursing school in 1973, a year after Medicare approved funding for the ESRD program. As soon as I visited a hemodialysis center, I knew that was the specialty for me. I almost became a dialysis assistant for a gentleman who had his home set up for dialysis. He would hire nursing students to take care of his dialysis machine while he slept during treatment at night. He received a transplant before I had an opportunity to be his assistant.

How long have you been in nephrology ?

I have worked in nephrology for 44 of my 45 years (I had to work in an ICU/CCU for a year before they would hire someone for dialysis in the early days) and recently retired. I still use my nephrology skills doing consultant work, lecturing, writing, and participating with my local ANNA chapter. People seem to know my background is in nephrology as I shop in local stores. People come up to me to ask questions and I soon realize they have chronic kidney disease or high blood pressure, so I do free consultations on the spot!

What is unique about nephrology nursing?

Nephrology is such a unique blend of technology, fast-paced thinking, time management, and, best of all, building lifelong relationships with people and their families who are affected by kidney disease. I have been very fortunate to work in many aspects of kidney care from diagnosis to end-of-life treatment. I have seen so many advances in nephrology care and yet we still have so much more to do on the prevention side.

What do you value most about your ANNA membership?

I joined ANNA in 1990 at a time when I was becoming discouraged with how people on dialysis were being treated. It gave me a chance to network with others who were overcoming similar feelings or had accomplished dramatic improvements in patient care. I soon became involved in my chapters activities as education planner and president, then on the Board of Directors as a regional vice president. One of the reasons I became an NP was because I was mentored by others. ANNA broadened my view of nephrology nursing and gave me a sense of pride and collegialism.

What would you tell a newly practicing nurse about nephrology nursing?

I encourage new nephrology nurses to never lose sight of the fact that we are in this specialty to serve people affected by kidney disease and their families. It can be such a rewarding career that now has so many ways to keep connected whether you prefer bedside, administrative, advanced practice, or other areas such as vascular care, care coordination, pharma, and so many others. Also, recognize the importance of belonging to professional organizations like ANNA so the information you receive is balanced, current, and you will have a space to network.

Do you have a favorite patient story?

One of my favorite stories is about a person I had known for over 20 years. I met her when she was 18 years old and she had glomerulonephritis ESRD. She went on to have a kidney transplant and over the years she kept coming back to me for hemodialysis, then continuous ambulatory peritoneal dialysis (CAPD), continuous cyclic peritoneal dialysis (CCPD), another failed transplant, and again on peritoneal dialysis (PD). I cared for her as a staff nurse, charge nurse, renal instructor, and in her last years as an NP. She became a dialysis technician and our Transonic technician. She was a friend and asset to the dialysis center. She was the “buddy” for many people who were afraid to try home dialysis or transplant. It was not unusual for her to show others her PD catheter under her scrubs. I admired her spunk and ability to overcome so many odds. Her mother was an alcoholic, her father was absent, and she continued to care for her siblings and her spouse up to the time she succumbed to heart disease in her mid-forties.

Share an interesting fact about yourself.

I still have the pen that was used to sign the bill in new Jersey that started the movement to add the glomerular filtration rate (GFR) calculation to lab results in this country. It was inspired by a nephrology nurse manager and a nephrologist who was my NP preceptor.

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