I have been a registered nurse for 34 years. The first 15 years of my career were spent in high-risk obstetrics. I have worked in the cardiac cath lab for the past 18 years, at St. Luke’s Episcopal Hospital in Houston, Texas, working in association with the Texas Heart Institute.
Why did you choose to work in the invasive cardiology field?
I chose to work in invasive cardiology in a somewhat illogical manner. The first 15 years of my career in nursing were spent in high-risk OB nursing (which I loved). However, in obstetrics, working weekends and holidays was not an option, it was mandatory. I find it ironic that 18 years later, our lab stays open until 11:00 pm, is open weekends for 7am-7pm shifts, and all holidays must be covered.
Can you describe your role in the cardiovascular (CV) lab?
There are 11 functioning rooms here at St. Luke’s. I am Room Leader of one of the rooms. My room does about 130 cases monthly, and specializes in diagnostic and cardiovascular invasive procedures. I manage the flow of cases through the room, oversee care of the patients and am active in the educational development of the room staff. I communicate with lab management on problems and challenges in the lab. As an ACLS instructor, I assist in the code validation of the entire lab staff. As a Nurse Clinician Level IV on the Professional Development Model, I assist in the education of the entire lab staff.
What is the biggest challenge you see regarding your role in the CV lab?
The biggest challenge regarding my role is to work with other Room Leaders, management and physicians to move cases in a more efficient manner throughout the lab. I am convinced that when cases are moved through the lab more efficiently, there will be decreased overtime and more time for staff to balance their home and work lives. I am currently working with the LEAN project in the hospital to standardize each position in the lab in an effort to enhance efficiency.
What motivates you to continue working in the CV lab?
I love the work. I enjoy my co-workers. I also enjoy working with the truly bright minds of the staff cardiologists and interventional cardiology fellows. The fascinating field of invasive cardiology is always evolving and challenging. It keeps my mind active and fertile.
Can you share a particularly unusual case you have been involved with?
A patient came in by lifeflight that was experiencing an acute infarction. The patient was an older lady who was acutely ill, but still quite feisty. As we hurried to proceed with her cath, she was loudly demanding more blankets. She went into ventricular fibrillation as she was fussing and was promptly defibrillated. She came back from the defibrillation still fussing and did not miss a beat. We proceeded to open her totally occluded vessel, defibrillated her once more, and she never stopped fussing. She left the room with an open artery and warm blankets.
When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high?
When I experience low moments, I remember that the goal of my job is patient care. It puts my situation into perspective. I remember that each of these patients are concerned about their future and their lives at the moment. When the staff in my room gets down, I find the time to stop and allow them to truly vent and lay their issues on the table. I then work with them and administration in handling issues and concerns. A recent example was a day when I pushed the staff through 9 difficult cases with minimal downtime and only a 30-minute lunch break. The physician who was scheduled in the room that day completed his cases and left the room at the end of the day without a single “thank you” to anyone. I took the matter to administration and the physician was addressed and the staff acknowledged for their hard work.
Are you involved with the SICP or other cardiovascular societies?
I am a member of the Gulf Coast Chapter of SICP. I have been a national member for several years. In April, I taught several sessions of the RCIS review course that was presented by SICP and was part of the Concepts of Cardiology Conference in Houston, Texas. I am also a member of the American College of Cardiovascular Nursing. I teach certification review classes for that organization. I am on the Speakers Bureau for the American Heart Association. In that capacity, I visit community organizations and talk about cardiovascular disease, its prevention and treatments. I am also on the executive board of the Gulf Coast Chapter of the American Association of Critical Care Nurses. In that capacity, I keep the issues of cath lab nurses as critical care practitioners alive.
Are there websites or texts that you would recommend to other CV labs?
I recommend blaufauss.org and biosensewebster.com. These websites are both excellent for initial training and refreshing the knowledge of cath lab staff. I also recommend the Wes Todd RCIS review CD as part of your cath lab library.
Do you remember participating in your first invasive procedure?
Yes, I do remember my first invasive procedure. I was fairly comfortable with the procedure suite and sterile setup, having come from L&D. I was used to care of acute patients and even x-ray exposure. I was in awe of the heart. I remember wondering how I would ever learn the difference between all those vessels of the heart. I also remember how frightening the ST elevation and chest pain were (both the patient’s and mine). Back then, there were no stents or anti-platelets in use at our facility as yet. I remember how tense it was in the room when the vessel was ballooned. The possibility of recoil and abrupt closure was very real.
If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give?
I honestly don’t think that I would have done it any differently. I came to the lab with no cardiovascular experience. I knew then that any hope of my staying in the lab would only be with intense studying and learning the job completely. I immersed myself in every class and in-service that I could, and I have not stopped yet.
Where do you hope to be in your career when it is time to retire?
I am a bedside nurse. I plan to remain by the patient’s side. I have worked in management before, only to find that my strength and calling are at the bedside. I have skill as an educator and use that skill instructing ACLS, BLS and various other classes and engagements when requested. But my heart and mind belong at the bedside.
Has anyone in particular been helpful to you in your growth as a cardiovascular professional?
Yes, I have had had three cath lab managers and one preceptor that have greatly influenced me. Derrick Johnson, Gwendolyn Rangel, and Kristen Turner have all been my direct supervisor in the lab. Each person has been very supportive of my educational endeavors. Without their support, I could not have developed the skills and expertise that I bring daily to the lab. Also, 18 years ago, Janie Yanez, BSN, mentored me. She was tough, but without her strength, I would not have developed as well.
Where do you think the invasive cardiology field is headed in the future?
Don’t forget that I work at St. Luke’s, which is affiliated with Texas Heart Institute. We do abdominal aortic aneurysm (AAA) exclusions, stem cell research, carotid stenting, Tandem heart placements, Impella ventricular assist devices, intravascular Doppler wires, intracardiac echo, athrectomies, septal ablations, cardiac resynchronization therapy (CRT) and many more procedures. There is currently a 3D imaging room under construction and a Stereotaxis room also in the works. I think I am already working in the future! Aside from the technological advances, the patient acuity level of hospital-based cath labs has and will continue to go up. With the growth of free-standing labs that are now doing a large number of the simple diagnostics, the hospital-based labs need to prepare staff for more complicated cases and sicker patients.
Yvonne B. Singletary can be contacted at firstname.lastname@example.org