The Essence of the Radiology Nurse | Joanna Po Lecture Series: Totally Rad Introductory Competencies
The Essence of the Radiology Nurse | Joanna Po Lecture Series: Totally Rad Introductory Competencies
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- [Kristina] Alright, everybody still awake, right? Alright. Sound familiar to some of you? Good. Alright, so what is the essence?

When we talk about the essence of a job, it's what makes a radiology nurse different from a med surg nurse. What makes a radiology nurse different from an OB nurse. If you've ever heard Donna Wright speak, she talks about the essence of something

that we took from her process. She'll tell you for an ICU nurse, one of the essence of an ICU nurse is you gotta have a little bit of a 'tude. Because the advocacy that you have to have for your patients is a little different than in med surg.

You could be a phenomenal med surg nurse, but not a be a great ICU nurse because you just can't stand to those physicians to say, "Ain't happening on my watch." So, but you have any successful ICU nurse who is not wiling to put his or her foot down

and say, "This is the way it's going to be." So, pull up our phones again, last time for this one, and what makes a radiology nurse a radiology nurse? What's specific to us? What specific knowledge, skills, behaviors

do we need to be successful radiology nurses? Independent is huge, flexible, safety. - [Nikki] Works in the dark. - [Kristina] Works in the dark.

Yes, you gotta be able to see in the dark. Scope of cares. Can do anything, who said that one? Yes! Collaboration. (laughs)

Okay. Those on my staff, development team, we're gonna have to find a way to add that one to ours. Multi-tasking, conscious sedation. You're absolutely right. And this, we did the exact same thing.

I sat down with both my gen rad staff and my IR staff and said this exact same question to them. And then these are kinda sort of the things,

the themes that came out of their brainstorming session. Environmental safety there is safety on the floor, but the floor doesn't to worry about an MRI magnet. The floor doesn't even realize

that the magnet is always on. It doesn't mean anything to them. It means a great deal to us. Nuclear medicine safety. Yeah, standard precautions for them, well it is for us, too,

but I'll be honest with you. I was doing nukes one day and I was doing a pediatric patient. We're doing a urinary study and I took his catheter out at the end, and this little boy decided he wasn't done peeing.

And it ended up right here. That is not necessarily a concern for a floor nurse. They don't have to take their clothes off and leave them at work because they've been peed on with radioactive urine. I had to do that.

If you ever worked in nuclear medicine, always keep a pair of change of clothes in your locker. Always. Shoes, too. Because I've also walked into a patient who has peed all over the floor

and it was in the dark. Now my shoes are radioactive and I can't walk around the rest of the hospital with them. So, shoes, too. Collaboration. That was one you guys mentioned.

Independence you mentioned. How many times are you the only nurse around? Attention to detail. Critical thinking. Again, you're the only nurse around in a lot of times. You don't have another nurse

to bounce things off of, so you have to have incredibly strong critical thinking skills. Flexible because things are constantly changing. Picking up the changes with little information. We're not floor nurses.

We don't have a chart this thick. When they come down to the lab, we're only looking at, the most recent labs, what meds have they had, and what's the diagnosis, and why are we doing this procedure.

We don't know the rest of the history. And in gen rad, you know less than that, because more often than not, the technologist has put them on the table, done their scan. They've had a contrast reaction and then you're just brought in.

You have no idea what meds they're on. You have no idea what they're allergic to. You're just responding to that symptoms and treating from there, problems solving, communication, assessment, monitoring, advocate for the patient,

responding to emergencies. We have to respond to emergencies a little bit different than the floors do, because again, we don't have the volume of people. If a code happens on the floor, every nurse on the floor is there to

lend a hand or try to help pick up the other patients while the code is happening. If it's Saturday morning and you're coming in on call, it's you, your tech, you might be lucky have an extra tech floating around, but probably not, and your radiologist.

And I mean no disrespect to our radiologist, but let me ask you, and you don't have to be honest if you don't want to. Who runs codes in radiology until the team gets there? We do.

Yeah. So, we have to have that knowledge above and beyond because our docs care about the procedure. They are care about the image. Yes, I actually was doing some mock codes,

and I sent out to our chief radiologist. We're gonna start including the physicians in our mock codes. Any problems with that? She wrote back to me, "Oh, I think that's a great idea.

"I'll gladly come and follow directions." And then I went to her and I said, "Hey doc, do you realize "that until a code team arrives, "you're running the code?" Uh.

So, medication administration. And as Nikki already mentioned learning on the fly, IR procedures change all the time, that the procedure we did today, we're not doing anymore because tomorrow we've got a totally different way to do it.

And so there isn't a way to orient you to that so much. So you've got to figure it out quickly. For us, our thrombolysis, the thrombolysis dressings, I've worked really hard on ongoing competences because my IR nurse has went thrombolysis dressing

on as an ongoing competency every year. When Nikki mentioned ongoing, you shouldn't keep repeating ongoing competency because if you've shown your competent, like riding the bike, you don't really forget. You don't necessarily lose competence.

You just need to refine it a little. And I finally got them to... You're coming in on call and you have that thrombolysis dressing, whatever competency we did for you six months ago, you're still not necessarily gonna remember

because you wanna do that thrombolysis dressing. There's enough nurses that you may do to a year. depending on the flow. You still have to know where your resources are. So do we have the resources in IR to tell you how to do a thrombolysis dressing

if you don't know. And if we don't, we need to add that. And then when we have it, where is it? Can you find it?

Just finishing up, neurolysis and nerve ablation. We talked a little bit about this, but the goal is to permanently disrupt the axons and the myelin sheath. You can do it chemically with alcohol or phenol. But more and more people now are offering

radiofrequency ablation or cryoablation as a more precise way of performing these ablations. Radiofrequency ablation probably has the most data after alcohol and phenol. It's inexpensive and it has a long track record. Cryoablation is now being reported in the literature.

It's easy to see on CT as my colleagues have demonstrated. It's good in soft tissue tumors, but we still have very early data. Some people are actually looking at MR-guided focus ultrasound, very sexy, very expensive technology, very niche.

I don't really see that becoming a major player. I think it's really gonna be RFA and cryoablation,

review of the electrical conduction pathway here.

We're gonna, this is a slide that just shows how normal conduction would work initiated at the sinoatrial node on down. And then here the yellow color within these diagrams, shows the areas of the heart that are depolarized. And, of course, our patients who

have ended up at the electrophysiologist have some kind of disruption in this conduction. And so, when these patients, when and if these patients end up with a device and end up in radiology we need to have a basic understanding

So now we move from a potential case like this

where the patient has a large renal mass and a metastasis into their left femur, and that patient underwent a surgical resection here, replacement of that, a big operation for a patient with metastatic disease, now we take a similar kind of patient

with a left renal cell carcinoma and has two metastases, one in a rib and a small one in the acetabular region. And they undergo the nephrectomy and then ablation of these two areas. That may be the new model.

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