History
The National Association of Nephrology Technicians/Technologist (NANT)
A Historical Perspective
The beginning of NANT grew out of a necessity that was recognized by a small group of fifteen individuals in Philadelphia in 1983. The dedicated individuals realized the importance and contribution of dialysis technicians to the safe, efficient delivery of dialysis. Their vision and goal was the recognition and acceptance of dialysis technicians as an integral and professional member of the interdisciplinary team replete with identity, respect, principles, association and representation in the dialysis community.
Prior to 1983, dialysis technicians were embraced and were members of the American Association of Nephrology Nurses and Technicians (AANNT). In late 1982, a referendum or change in the articles of incorporation occurred in AANNT. The nursing leadership goal was to have nephrology nursing recognized as a formal nursing specialty. The recognition would be from the American Nursing Association (ANA) or the National League of Nursing (NLN). Each of the two organizations had specific rules or regulations that were mandated as prerequisite requirements for attaining recognition. Common to both of the organizations was the rule that all voting members (or members able to influence the association’s business), be registered nurses. The rule was not elitist but rather for ethical and/or legal considerations.
The referendum or change placed all non-registered nurse members into the associate member category. Associate member status gives all the benefits of full members except for voting privilege. The inability to vote removed the ability for dialysis technicians to participate in the course, direction, mission, advancement and pursuit of professionalism and identity. As the forefathers recognized that taxation without representation was contrary to the growth of the nation, dialysis technicians/technologist recognized that without a voice there would be no advancement or future for dialysis technicians.
NANT became the voice. NANT began with Stuart Kaufer as President, Karin Nelson as Secretary-Treasurer and a working capital of $500 that was generously contributed by Ron Fuller. NANT’s first year was one of uncertainty, lack of organizational structure and depleted funds. Individuals who were supportive of the goal of NANT made personal financial contributions without the promise of reimbursement. NANT survived the first year’s trials and tribulations. The first NANT meeting, outside of the national was staged in the Fall of 1983 by Marilyn Urps in Houston, Texas.
C.W. Miller, as president and Karin Nelson, as Secretary-Treasurer, maintained the leadership of the association for the next three years. The articles of incorporation, the association constitution, obtaining the non-profit status (503C) and the association by-laws were created and obtained. NANT’s first chapter was formed in North Carolina in 1985.
The years prior to 1987 were one of apathy and lacked community and technician participation. Interest in NANT was nonexistent to the extreme that at times, only the president, C.W. Miller was the only active participant. Support came in the person of Karen Osband. The two would endeavor to maintain the existence of NANT without members, without active participation and without a working fund.
At the 1987 national meeting in New York City, the future of NANT was in the balance. With the lack of active and consistent participation and interest C.W. Miller announced to the attending few members that at the conclusion of the meeting, NANT would seize to exist. The prospect of NANT dissolving motivated the individuals present to react, take interest and heed the call to service.
The call to service strengthened the leadership of NANT. Significant contributions were provided by Martin V. Hudson, providing leadership as the choice for president, Jeff Hove, from New York as Secretary, and a Texan who possessed a financial knowledge named Larry McGowan. Others who strengthened the board were Philip Varughese from New York, Wayne Bynum and Wes Watkins from North Carolina (who started the North Carolina Chapter), Betty Verbal from Miami, Mike Nelson from Seattle, Jerry Beck and Randy Gates from Arizona and Maurice Kaufman from Chicago. Major contributions were also provided outside of board membership from Anthony Messana, Sally Burrows-Hudson, Doug Leuhman, Doug Vlcheck, Joan Arslanian, Edith Oberly, Jean Kammerer, Anna Corea and Ben Lipps.
Support and contribution to NANT also came from the vendor community. Contributions of expertise and funds were provided by Fresenius, Baxter, Gambro (Cobe), Renal Systems, AMGEN, Althin (Drake-Willock), AUTOMATA and scores of others. Without their support, NANT would have ceased to exist.
With leadership and active participation, NANT became recognized as “the” technician organization and acquired seats on various regulatory organizations (i.e., AAMI, FDA, etc). The task of defining the various technical roles such as, technologist, patient care, equipment technician, and reprocessing began.
A speaker at the 1988 meeting in Reno identified a crucial fact that would challenge dialysis technician and NANT the quest for professionalism, identity and respect. Paraphrasing the speaker, she stated that technicians would never amount to anything due to the lack of goals nor esprit de corps as a profession. In addition, technicians lacked institutes of higher learning, and never received the socialization received by nurses and physicians as to how a professional should act.
The 1989 meeting in Dallas was attended by over 250 members, a small testimonial to disputing the speaker the previous year. But growth had its peculiar problems; there were greater responsibilities, greater expectations, increased work and increased tasks. The existing board lacked adequate numbers to accomplish the work load and the financial stability that at times required personal financial sacrifices. But NANT persevered.
NANT achieved major success in the year (1990-1991) leading up to the San Francisco meeting. The association acquired a seat on the ESRD Coalition (a forum of Renal Care Associations who address issues common to the ESRD Community). The accomplishment was the result of efforts of the sitting President of NANT, Jeff Hover. NANT achieved the seat on the coalition as a result of a motion by the American Association of Kidney Patients (AAKP), seconded by the Renal Physician’s Association (RPA) and a positive majority vote by the Coalition member associations. NANT achieved its voice in the community.
Other notable events further advanced NANT. The FDA “Water Treatment Manual” originally distributed by the FDA to the dialysis community was viewed as the “bible” for hemodialysis water treatment. The FDA had exhausted all the available manual and had no plans to print further copies. NANT realized that the unavailability would be a significant loss to the dialysis community. NANT petitioned the FDA for the rights to the document with the intent of reprinting for distribution. The template for the manual was sent to NANT. The original reprinting was published with the financial assistance from Continental Water, Zyzatech and others.
Another achievement was the genesis of NANT’s marketing plan. Corporate sponsorship was minimal from a few generous corporate sponsors. Recognizing the contribution of technicians and supporting their advancement was emerging. NANT adopted the philosophy that all technicians deserved any and all education that could be delivered. Opportunities would be available for patient care, reuse or biomedical technicians regardless of membership, affiliation or employer. The underlying value to the marketing plan was that a better educated practitioner would deliver higher quality of care. Dialysis providers, industry, regulatory agencies, and most importantly the patient, embraced the idea.
The 1990-1991 symposium was especially significant in that the keynote speaker was the “Father of Dialysis”, Dr. Willem Kolff. Dr. Kolff’s inspiring and informative message was possible as a result of Martin Hudson’s efforts in convincing Dr. Kolff to participate in the symposium.
Martin Hudson’s tenure as president recognized that business management was critical to the success of the association. NANT needed to be run as a business. NANT’s emerging success produced new commitments and demands. Successfully meeting the new challenges was critical to the continued existence of NANT. A restructure of the Board of Directors resulted in the elimination of the Vice President-elect positions, the installation of Director of Education (Dr. Maurice Kaufman), Director of Chapter Activities and Membership (Dennis Kennedy), Director of Regulatory Affairs (Mark Rolston), Director of Public Policy (Martin Hudson) and Director of Industrial Relations (Jim Boag). The offices of Secretary and Treasurer were combined into one (Mike Nelson). The western region was divided into the Southwest (Randy Gates) and the Northwest (Tom Suttle). Mark Rolston was voted in as the President-Elect (unopposed).
Marketers, managers, salesperson, technical writers, orators, symposium coordinators and financial resources were critical to business management. The board of NANT recognized that their governing body lacked the skills and resources to maintain the business management of NANT. The business management was given to MOE-TEK*. The firm was an association management company formed by NANT’s treasurer, Larry McGowan. With the formal business relationship between NANT and MOE-TEK*, Larry McGowan relinquished his position as treasurer of NANT to become MOE-TEK*’s Executive Director. MOE-TEK would be paid to provide many services sporadically performed by volunteers. Enhanced internal and external communications, financial management with accounting, budgeting and investment, marketing, symposium management, membership date base management, image and industry presence would be provided by MOE-TEK*. Without Larry McGowan and the service provided by MOE-TEK* NANT would not exist.
The existence of NANT can also be credited to contributions and support given by the American Nephrology Nurses Association (ANNA) and its members such as Sally Burrows-Hudson, Barbara Bednar, Gerry Biddle, Ron Brady (ANNA Executive Director) and scores of others. Other significant contributions came from the National Kidney Foundation’s Council of Nephrology Nurses and Technicians (CNNT) Jean Kammerer.
In 1991-1992 the ESRD Coalition impaneled the ANNA/NANT/CNNT Task Force on Patient Care Technicians (PCT). The task force was convened to reach consensus on PCT role description, minimum qualifications, educational curriculum and certification. Consensuses on all the items were reached by the task force within three years. Community endorsements on the consensus documents did not materialize and the materials faded into obscurity. Nevertheless, many of these consensus documents actually form the basis for many of NANT’s position papers.
During this period a program that would provide a streamlined application process, quick evaluation, tracking and security for Contact Hours was incorporated. NANT had been certified to grant Contact Hours (CH) by the California Board of Nursing (CBN) in 1989. The program incorporated allowed NANT to retain the rights to offer contact hours for its education symposia, but also to chapter programs and other industry in-house training programs.
For years NANT has been trying to acquire for dialysis technologists/technicians the recognition as a legitimate allied health profession. Originally, the recognition would have come from the Coalition of Allied Health, Education, and Accreditation (CAHEA) an arm of the American Medical Association (AMA) and the Federal Bureau of Health Professions (BHP). Jeff Hover did a tremendous amount of work in this area. The AMA, however, dissolved CAHEA and in its place the Coalition of Allied Health Professions and Accreditation (COAHPA) was formed. NANT has been in dialogue with COAHPA since its formation. Coincidental to the formation of COAHPA, the federal government contracted with the Pew Foundation to form the Pew Health Commission to study American healthcare and to make change recommendations for the new millennium. Largely through the auspices of Dr. Maurice Kaufman’s efforts, NANT has kept abreast of these developments. These developments form an integral portion of NANT’s long range strategic goals.
The 1992 Chicago NANT Symposium debut three tracks that incorporated into the program: basic, intermediate and advanced tracks. The symposium delineated the tracks thus allowing attendees the tracks of their choice. The Chicago symposium remains to this day the most successful NANT symposium. Some of the highlights of the meeting included field trips to Baxter’s research facility at Round Lake and the City College of Chicago Malcolm X Campus Dialysis Technologist Program (the oldest program of its kind in the nation).
TECHSPO was introduced in 1992 as a means to reach and educate more practitioners by bringing the meeting to the practitioners. The first TECHSPO was in Atlanta and was viewed a tremendous success. The cooperative efforts of NANT and the Renal Physician’s Association (RPA), staging the meeting in conjunction with Dialysis Clinic Incorporated’s annual chief technician meeting and the manufacturer’s of dialysis delivery systems and water treatment vendor’s support and a combined meeting management by MOE-TEK* and Nephrology Management Group contributed to the success of the meeting.
Joint symposium management was necessitated by the fact that NANT’s business affairs were increasing exponentially. In addition, regional meetings were not part of the MOE-TEK*’s contract. The association was outgrowing MOE-TEK*’s capability. With MOE-TEK*’s request and mutual agreement between the managing firm and the association, a new management firm was sought. The Institute of Association Management Group drafted a “Request for Proposal” for the management of NANT’s then 90 member association. Of the 38 proposals received, NANT’s board selected Sherwood Groups as the managing form, due primarily for their marketing expertise. By January 1993, NANT had a new association management, a treasury including Certificates of Deposit and there was optimism for growth and stability.
NANT acquired a new professional logo, stationary, professional documents, a presentations booth for shows, an association banner/standard and a professional marketing plan, membership database management with monthly demographic reports and trend analysis that facilitated long-range strategic planning, and a person-to-person call line for assistance. In addition, NANT received a grant from Renal Systems to produce the Core Curriculum for Reprocessing Technicians.
As previously mentioned, NANT had established a dialogue with the AMA’s CAHEA and subsequently with COAHPA and the Pew Health Commission in an attempt to acquire status as an allied health profession. Attaining such status had prerequisites. One critical issue was certification. The PEW Commission and the Bureau of Health Professions recommended that the professional allied health associations be the accrediting bodies with either an in-house certification/registration arm or have an independent but closely aligned certification board. The board must be members practicing in the field and the dialysis technician/technologists could not be subject to any other health profession, industry, or other entity’s possible or potential influence. The Pew Commission’s position was delineating the real and potential ethical/legal conflict-of-interest scenarios that could exist or arise in any other type of relationship.
NANT’s long range strategic planning generated many initiatives in order to comply with the Pew recommendations. Ad hoc committees were established to deal with each compliance issue. One of the committees established was to address certification. NANT had no intent to be in the certification business, which would violate their charter as an educational organization. An association of understanding and agreement with the Board of Nephrology Examiners Nursing and Technician (BONENT) certification organization was a plausible strategy. Unfortunately, due to miscommunications, misunderstandings the arrangement between the two organizations did not develop.
The Ad Hoc Certification Committee had continued in its development of articles of incorporation, a constitution, bylaws, position papers and started test item writing activities. In early 1994, NANT’s committee ceased to exist and in its place the independent Ad Hoc Committee on Dialysis Technician Certification was formed. This organization evolved into the entity known today as the National Nephrology Technology Certification Board.
In keeping with the philosophy of PAX NANT (NANT Everywhere), the association was involved in 1993 in numerous activities: participated in the revision of the State of California’s Dialysis Technician Certification program through the Department of Health, testifying before various state regulatory agencies, commenting on various position papers, and active involvement with the ESRD Coalition, AAMI and the FDA.
The year 1993 also saw some major growing pains which jeopardized the stability of the association. The MOE-TEK* database was not compatible with the Sherwood Group’s database. Furthermore, some of the MOE-TEK* database had deteriorated. Expensive time and effort would be required to rebuild the database. In addition, there were other projects that required additional time and money that were originally not budgeted. In 1993, the symposium was held in Orlando, FL. Several factors, including poor attendance, led to the symposium incurring a serious debt for NANT.
Other disastrous events befell the association. Sam Swann, who had won the 1993 president-elect position, resigned in December dues to personal reasons. Attendance at TECHSPO continued to decline, accumulating greater debts. But, the 1993 election provided some new leadership to NANT: Keith Miller (North Central), Larry Byers (Northwest), Joe Sala (Northeast), Melody Devenport-McLaughlin (Southwest), Belinda Bethea (Chapters and Membership Coordinator), and Dan Ghesquiere as Secretary-Treasurer.
Despite the low attendance, the Orland meeting did have a number of significant noteworthy events. The Torchbearer Award debuted and was awarded to fifteen individuals. The award is bestowed upon individuals who either held aloft the spirit of NANT or introduced and encouraged NANT in areas not familiar with NANT. The Lifetime Achievement Award was given to Jeff Hover, Mike Nelson, Sally Burrows-Hudson and Larry McGowan. Also debuting at the meeting was NANT’s highest honor, the Martin V. Hudson Award which symbolized a lifetime of significant contributions to the field of Nephrology Technology. The first recipient was rightly bestowed on the namesake of the award, Martin Hudson. The keynote speaker was Colin Aldridge, President of the European Dialysis and Transplant Nurses Association (EDTNA) and European Renal Care Association (ERCA). The NANT Town Hall meeting debuted and was received with a “rousing” success.
In serious debt, NANT’s executive committee (President Tom Suttle, President-elect Sam Swann, Immediate-past president Mark Rolston and Secretary-Treasurer Dan Ghesquiere) worked very hard to address NANT’s financial situation.
The 1994 election was unique in that every position up for election was contested between multiple candidates. Dennis Todaro (President-elect), Pat Parra (Southwest), David Small (Southeast) would bring new insights and capabilities. The year would bring a change in how NANT would evaluate projects on the basis of conservative revenues; if the project was revenue neutral it was accepted, if there was any potential for loss of money, the project was denied.
The 1994 meeting in Dallas had mixed results. The meeting was financially successful as a result of NANT. The Dallas budget was extremely conservative, attendance was up and corporate sponsorship funded the many social events. Doug Luehman received the Martin V. Hudson Award. However, other management decisions resulted in a closed door NANT board meeting without Sherwood Group representatives. The consensus of the board was that the board never felt confidence in Sherwood Group and that Sherwood Group did not have NANT’s best interest at heart.
It was decided that in the fall, which ended the second year of the three-year contract, the Sherwood Group would be evaluated per contract. In addition, the Sherwood Group desired a raise in fees. The evaluation meeting with Sherwood occurred in October 1994. The broad view was that neither party was happy with the other. Accordingly, NANT received a formal letter indicating that Sherwood Group would severe its relationship with NANT.
As a contingency plan, Management Excellence Institute (MEI) was contacted in the spring of 1994. MEI’s president Fran Rickenbach stated that in whatever capacity NANT desired they would be ready. MEI had been the runner-up to Sherwood during NANT’s original search for a management company. Upon receipt of Sherwood Group’s letter of termination, MEI was contacted and six days later, the transition had begun. By January of 1995, the transition to MEI management was complete. In the transition, two TECHSPOs were scheduled as planned in February and March, as well as the National Meeting in Philadelphia. Much of the success of the transition was owed to the fact that items, which would take time for MEI to learn, were vested with experienced board members. This allowed MEI to focus on their immediate strengths in data base management, the elections and especially, communications.
The Philadelphia national meeting highlights were Dr. Derrick Latos (RPA president) keynote address that charged technicians to embrace their larger roles and practice the “art of the possible” and Dr. Eli Friedman’s tremendous rendition of dialysis past, present and future. Edith Oberly received the Martin V. Hudson Award. The inaugural meeting of NANT’s Industrial and Medical Advisory Board occurred, laying the foundation for enhanced communications.
After the Philadelphia meeting, NANT experienced a period of unprecedented growth. Under President Dennis Todaro’s leadership NANT solidified itself as the technician organization. Tremendous demands were placed upon the organization such as speaking engagements, business meetings, and position papers, commentaries and especially testimony before various state legislative committees, state nursing boards and chapters. Mr. Todaro continues to represent NANT and act as a resource for state legislative issues such as the Ohio Technician Task Force where he appointed Keith Miller, Mark Parks and James Glenn Johnson to represent NANT and Ohio technicians on the Ohio Legislative Task Force. The task force included participants from the ANNA, Ohio Renal Association (ORC), Ohio Nurses Association, Ohio Renal Physician’s Association (ORPA), and representatives from various state legislators including State Senator Grace Drake. In addition, Mr. Todaro steered the TECHSPO seminar back to its original intent: to provide hands-on experience for equipment technicians and real-life practical knowledge for patient care practitioners. Subsequently, TECHSPO was renamed “Advances in Dialysis” to reflect more accurately what the seminar represents. NANT had always been an accrediting body of formal dialysis technician programs. It was under Dennis’s leadership that the process was formalized and enhanced.
The 1996 national meeting was held in Anaheim, California. It was a success both in attendance and in content. The highlight of the meeting was the joint ANNA/NANT sessions on team dynamics. Mark Rolston received the Martin V. Hudson Award. Philip Varughese took over as President. This was the first year that NANT offered scholarships to technicians interested in attending the symposium. Over the years, Baxter Healthcare Corporation, AMGEN, Fresenius Medical Care, NA, Integrated Biomedical Technology, Minntech Corporation, RPC, and Serim Research have funded more than 200 technicians’ participation at the annual symposium. An anonymous scholarship was set up on 2008 in memory of Tom Blackstone, Dialysis & Technology and a great supporter of technicians.
Philip Varughese has helped NANT achieve recognition both nationally and internationally but his most important contribution has been in membership recruitment. Phil had recognized membership as an important component requisite to NANT attaining its strategic goals. Membership steadily increased first under his leadership as the President of the New York Chapter and secondly, as the National President. In 1997, Philip authored the Study Guide for Dialysis Technologist and the second edition in 1998. Philip Varughese continues to be one of the industry’s strongest supporters of certification, education, standardized training, and professional recognition of dialysis technicians.
The national meeting in Minneapolis continued the success of recent years. It included another ANNA/NANT joint session on personal empowerment. Club NANT debuted as a casino-like social event. John Sweeny was presented the Martin V. Hudson Award. Over the years, John Sweeny, Global Training Manager, Baxter Healthcare Corporation has continued to provide NANT with important core education for technicians. He has participated in almost every educational program that NANT has offered to technicians, on both the national and regional level. He has contributed to both NANT publications, A Study Guide for Dialysis Technologists and Dialysis Technology Manual for Dialysis Technicians, both of which are now considered essential publications for technicians preparing for national certification. John Sweeny’s lectures on the dialysis process have taught thousands of technicians over the years and have added greatly to NANT’s educational program.
In 1997-1998 NANT continued to achieve success under the leadership of President Jim Curtis. Mr. Curtis was the project manager for Dialysis Technology released in Minneapolis. The publication serves as a study guide for clinical technicians. Jim Curtis worked to cement relationships with co-existing educational organizations such as the ANNA, RPA and AAKP. He also was a driving force for greater dialogues with other nephrology organizations.
In 1998, Jim Boag received the Lifetime Achievement Award for his significant contributions to the nephrology technology profession. Shortly after receiving this award, he passed away. In 1999, this award was renamed the Jim Boag Lifetime Achievement Award and was first presented to Jim Curtis.
Over the past several years, the aforementioned individuals have provided the energy for NANT’s achievements but most certainly, MEI has provided the vehicle by which NANT has achieved success. As a professional association manager, Fran Rickenbach has prevented NANT from making the same mistakes of the past.
In the 21st century, NANT continues to recognize outstanding contributions to the nephrology technology profession. A noteworthy recognition was given to an industry leader in technician education, and in 2010 an award was presented to John Sweeney for his life-long devotion to the education of nephrology practitioners, an unselfish contribution of time and effort to the professional growth of others, and dedication to the growth and success of the NANT. In honor of his contributions, the John Sweeny Education Award was developed.
Awards have been established in the names of other key industry leaders including the Jerry Woods Memorial Award.
NANT continues to partner with ANNA and industry leaders on projects. In the aftermath of Hurricane Katrina, NANT served as the distribution point for funds for displaced technicians with the support of AMGEN.
A national recognition has been achieved in the April 15, 2008 publication of the Centers for Medicaid/Medicare Services Conditions for Coverage, for a formal requirement for dialysis technician national certification. As a result, NANT has become the focal point for educational preparation material for all the technician certification exams. Technicians throughout the country are cooperating with dialysis units and ANNA Chapters to organize study courses for certification.
NANT’s presence on the web has been continually updated to reflect the most current activities.
In 2012, the venue for NANT’s annual meeting relocated to the Tropicana Hotel, Las Vegas, Nevada. The response to the venue was very positive and to date, has since been the site for the annual meeting.
With the recognition that technicians are an integral part of the renal inter-disciplinary team, the generic title of patient care technician did not reflect the increasing responsibilities and role of dialysis technicians. In 2016 NANT introduced the more professional and identifiable title of Nephrology Clinical Technician (NCT), for dialysis technician involved in performing the dialysis treatment, and Nephrology Biomedical Technician (NBT), for technicians involved in the maintenance and repair of dialysis related equipment.
To keep with the changing times, in 2019 the annual NANT conference was rebranded as Dialysis Tech ConneXion (DTX), and the Torchbearer Award was renamed as the DTX Inspiration Award.
The intent of this historical perspective was to document the contributions made to the ESRD Community by a few dedicated and committed technologists/technicians. Failures were made but, they were far outweighed by the successes. Dialysis technologists/technicians maintain the largest number of professionals in the interdisciplinary delivery of dialysis care to the dialysis patient.
NANT’s presence in the dialysis community is undeniable. NANT continues its collaboration and participation with organizations such as ANNA, RPA, NRAA, AAKP, AKF, CMS, FDA, AAMI, NKF/CNNT, BONENT, NNCC, NNCO and KCP. It has participated in task force and projects such as the FFBI, KCER, and the CMS Community Forum for the conditions for coverage. NANT remains committed to improving the quality of care of the CKD patient as an integral member of the health care team.
Mark Rolston (edited and condensed by Danilo Concepcion)
