Any Rad nurses out there??

Spirit A-glow · Nov 1, 2002

I am new to this position - minimal orieintation - only nurse in department. Would also like information for documentation.

Spirit A-glow · Nov 1, 2002

I am new to this position - minimal orieintation - only nurse in department. Would also like information for documentation.

Editorial Team / Admin · Nov 1, 2002

HISSYTHECAT, the criteria for hiring in the Rad. Dept varies from one facility to another, depending on the RN's responsibilities. The RNs in our dept, as well as helping with just about every Radiology procedure in any modality, also monitor cardiac catheterizations, so we require RNs hired here to have at least one year of ICU experience. The nurses with ICU background know their rhythms and "what to watch for and how to respond," for moderate ("conscious") sedation administration and monitoring. Two recent hires came to us from the ED (trauma), rather than the ICU, though, and are doing very well.

Jaguar and Spirit A-glow, we use the standard Sedation Monitoring flowsheet for most exams where even mild sedation is required. There is a Pre-procedure page (nursing assessment; checkoff for presence of H&P, consent, ASA score, labs . . .), an Intraprocedure page (VS, meds given, presence of essential personnel in room, contrast opened and used, room time in/out, procedure start/finish . . .), post-procedure (charting for PACU/Recovery Room), and an extra lined page for notes which don't fit on any of the other pages.

For simple exams (e.g., Dialysis cath removal, oral anxiolysis for claustrophobic pt for MRI, nephrostogram . . .) we developed a Nursing Procedure Record: what exam/procedure was done, a brief nursing assessment, area for VS pre and post procedure, MD signature, meds given (time, date, route) discharge info (who is driving pt home, what time they left, etc).

We love check boxes!! Got tired of writing in longhand for the MRI oral anxiolysis pts, so we found the preop assessment sheet used in Preop Holding would work for us too. When they phased it out and moved on to something else, we retained it, tweaked it a little for our use and renamed it. Works well also for, say, MS IV for HIDA scan, where you want to document what was done and that you did indeed assess the pt pre and monitor post MS injection, but you don't want to do a lot of longhand writing.

So, in my longwinded way, I should ask, 1) what do you need to document (moderate sedation vs. minor procedure) and, 2)is/are there flowsheets in place in your facility that will meet your needs, or do you need to develop one/some?

Have you tried the ARNA website? Lots of much more knowledgeable Radiology nurses and techs than I post there, on just these topics. American Radiological Nurses Association. PM me if you need more, or post here. I check in every now and then! Best regards, ---- Diana

Editorial Team / Admin · Nov 1, 2002

HISSYTHECAT, the criteria for hiring in the Rad. Dept varies from one facility to another, depending on the RN's responsibilities. The RNs in our dept, as well as helping with just about every Radiology procedure in any modality, also monitor cardiac catheterizations, so we require RNs hired here to have at least one year of ICU experience. The nurses with ICU background know their rhythms and "what to watch for and how to respond," for moderate ("conscious") sedation administration and monitoring. Two recent hires came to us from the ED (trauma), rather than the ICU, though, and are doing very well.

Jaguar and Spirit A-glow, we use the standard Sedation Monitoring flowsheet for most exams where even mild sedation is required. There is a Pre-procedure page (nursing assessment; checkoff for presence of H&P, consent, ASA score, labs . . .), an Intraprocedure page (VS, meds given, presence of essential personnel in room, contrast opened and used, room time in/out, procedure start/finish . . .), post-procedure (charting for PACU/Recovery Room), and an extra lined page for notes which don't fit on any of the other pages.

For simple exams (e.g., Dialysis cath removal, oral anxiolysis for claustrophobic pt for MRI, nephrostogram . . .) we developed a Nursing Procedure Record: what exam/procedure was done, a brief nursing assessment, area for VS pre and post procedure, MD signature, meds given (time, date, route) discharge info (who is driving pt home, what time they left, etc).

We love check boxes!! Got tired of writing in longhand for the MRI oral anxiolysis pts, so we found the preop assessment sheet used in Preop Holding would work for us too. When they phased it out and moved on to something else, we retained it, tweaked it a little for our use and renamed it. Works well also for, say, MS IV for HIDA scan, where you want to document what was done and that you did indeed assess the pt pre and monitor post MS injection, but you don't want to do a lot of longhand writing.

So, in my longwinded way, I should ask, 1) what do you need to document (moderate sedation vs. minor procedure) and, 2)is/are there flowsheets in place in your facility that will meet your needs, or do you need to develop one/some?

Have you tried the ARNA website? Lots of much more knowledgeable Radiology nurses and techs than I post there, on just these topics. American Radiological Nurses Association. PM me if you need more, or post here. I check in every now and then! Best regards, ---- Diana

RadRN2 · Nov 4, 2002

Dianah, I agree with you, the ARNA website is a great place for alot of information, not to mention networking. I am a member of ARNA, too, and the journals and newsletters they put out are really great!

My dept. is separate from cath lab, we do everything except the hearts. We also require a couple of years critical care experience; ICU, ER, sometimes PACU background is good. We do alot of ICU and ER pts, therefore the critical care background really is essential. Sedation/analgesia is a very big part of many of our procedures, and CT/MRI scanning. So, we require yearly competency review for this, also.

We have alot of dept-specific forms but also use some house-wide forms as well. I agree, take advantage of what forms are already available to you and modify as needed. We have a combination of forms (love check-boxes, too!) and also do computer-charting on pre and post angiogram and myelogram pts. When creating or deciding on what forms you need to have, keep in mind JCAHO requirements. Sedation/analgesia and informed consent are a couple of big hot-button issues. I would be willing to send copies of forms we currently use if anyone is interested (PM me).

Just to push ARNA one more time --- once a year, ARNA holds a national conference in conjunction with the Society of Interventional Radiologists (used to be SCVIR) that's about 4-5 days long. The next one is in Salt Lake City I believe March/April. For me, this conference was a Godsend the first time I went! I learned radiology nursing "by the seat of my pants", too, and felt very unsure about what I was doing. Going to the conference and talking with tons of other rad nurses from tiny and huge hospitals helped tremendously!!!!

Editorial Team / Admin · Nov 4, 2002

Yep, I always come away from the ARNA meetings simultaneously humbled, stirred, affirmed and exhausted! Gotta love 'em!!

RadRN2 · Nov 5, 2002

Originally posted by dianah
Yep, I always come away from the ARNA meetings simultaneously humbled, stirred, affirmed and exhausted! Gotta love 'em!!

Not to mention 10 pounds heavier and broke!! (Good restaurants!!)

Editorial Team / Admin · Nov 5, 2002

So, are you going this year? I'm not sure if I'll be able to, although Utah is somewhat closer to me than San Antonio was! One son has a week-long trip to DC with his class in May ($$$$, and more if I want to go too!), and the other son's overnight trip to Santa Barbara is the week before the DC trip (more $$ -- of course, I'm planning on going to both!!). So, I don't know if I can afford to go to Utah. Our hospital only pays tuition, not air or land costs, and only a small am't for meals. Footed the whole bill when I went to San Antonio (reimbursed for tuition, of course). Am not quite ready to do that again, at least this year. Besides, we have two new Rad nurses on board who've never been to a meeting, and it would be a good thing for one of them to go. -- D

Editorial Team / Admin · Nov 7, 2002

Ummmmmm . . . did I kill another thread??? Didn't mean to. Got sidetracked. Continue w/discussion of documentation and credentialing, please!! -- D

earthmother · Nov 21, 2002

Lots of folks go into Radiology the way you are. First nurse in the dept., no visible support (altho you will have, and those of us older Rad nurses can help as well as nursing services, patient care comittees at your facility and your DON- by law she/he is accountable for any nursing practice within your facility. So, these things may be usable to you. Or not, but they are food for thought.

Approach your problems/ concerns slowly and calmly.

Contact any councils that set certain policies/ guideline / standards within your facility ( ex: JCAHO wants EVERYONE doing conscious,ie moderate sedation the same way, same forms. In most places anesthesia is involved in the evolution of just such a policy. So your conscoious sedation worries may be aleviated.) Also know this - you may get some resistance because you are new, not a Rad technologist, ARE a nurse. Be kind, be helpful, don't take offence (altho it is difficult when you are a stranger in a strange land),learn all you can about procedures and outcomes. It helps you understand their job as well as helps you identify patient needs. To help you learn more about radiology nursing I highly recommend the ARNA website, but beware, it is ".org" not "net". Net gets you a nudist colony in France!!! (I had to explain this to Information Systems once). There is also a Radiology certification exam study guide thru ARNA. A good reference tool. :imbar Anyway , good luck!!

frann · Nov 30, 2002

Hi Everyone,

I've Been in IR for about 1 year. I'llnever go back. I love it. I trained otj. I came from a telemetry floor with icu experience.

My biggest problem is I work parttime and it is hard to remember everything we do. Thankfully the techs and other nurses are allways around and are such a big help. I really work with a great bunch. My biggest goof was a few months ago when a sprayed one of our docs with Omni . Got all in his hair. He was really pretty good about it. I'm his new hairdresser now!

RadRN2 · Dec 4, 2002

:Frann

chuckle That's pretty funny about the Omni! Good aim!!! That's one of the things I really love, too, about working in Radiology -- the techs (especially IR techs), nurses, and alot of the Rads become really close. We're like a bunch of brothers and sisters. You have to watch your back all day long for a "kick me" sign!!! :chuckle

I bet it is hard remembering things when you're working PT. It seems that we start doing something new every week. Sometimes its hard keeping up FT! Maybe keeping your own little "cheatsheet" would help. Maybe having a written procedure manual....

Nice talking to other Rad nurses!