319 bed hospital, 2 RN's

Editorial Team / Admin · Jul 21, 2008

Get stats from area hospitals on how many RNs they employ in Radiology, what their duties are and then compare to yours.

Present your findings to your superiors (MDs and Manager), and be willing to negotiate for changes.

For example, in long-ago-and-far-away days, we monitored all the ICUs that came through our Rad. Dept for exams (~250-bed County hospital). We started all CT and IVP IVs, placed Foleys for VCUGs, helped w/CT- and US-guided bx, assisted w/angios AND heart caths (set up and sometimes scrubbed, sedated, monitored -- no, not at the same time, lol!) and did some CT and MRI sedations.

Then IR exploded and we had to give the monitoring responsibilities back to the ICU nurses, as we just could NOT do it all! (we had 4 RNs at the time)

We never did any PICC/Mid lines, the IV nurses did most of the PICCs and the ones they couldn't do, the Radiologist did, under fluoro.

Tally up all the OT you do, too, and figure that against another RN salary.

Present the SAVINGS, EFFICIENCY and PATIENT SAFETY angles (not to mention RN burnout and what it would cost to train new nurses coming in after you've left!!).

Good luck!! :)

tinnnk · Jul 26, 2008

dianah, we do go to breast care, US, CT, and our own area doing all the procedures with the IR, plus the PICC/MID insertions, there isn't an IV team, they did away with that years ago.....but I am hoping they start it again.....patients come to us after being stuck multiple times, and they complain about it too, sometimes I will go to the floor and put an IV in for them.....but I get reminded that we aren't an IV team......I see you are in S.Cal.....I am in Florida, probably should have stayed in MA.....I really like what I am doing but to me there is a safety issue, this past pay period I had 109 hours (2 wks), and yesterday I broke down at work......they keep telling me what a great job I am doing, but I get to the point where I can't think straight.......and doesn't seem like they care. I am concerned for the patients, that's why I went into Nursing in the first place. The hospital is for profit, and that seems to be what they are more concerned about. There's only so much a person can do in a day, and oh well just needed to vent some more......I will look into your suggestions too, they sound good.....thanks

'

Editorial Team / Admin · Jul 26, 2008

I hear you, loud and clear.

Is your dept admin behind you? I'm sure they don't want to lose good nurses, and it would be in their best interest to do what they can to go to bat for you, for retention.

Sometimes if THEY (the Chief Radiologist, Chief Tech, etc) make suggestions (or draw the line in the sand!), upper level listens.

Sounds like they need a good, strong IV team, and your dept giving them a few months heads-up (e.g., "after Sept 1, 2008 we will no longer be able to accommodate the PICC/Mid requests. Please forward all such requests to Sally Nurse, Head of the IV Team," etc) may be the impetus needed to create/organize one.

Perhaps some of the nurses in your hospital would be THRILLED to be on that team (and Nursing Admin can take the ball from there).

Would it help if your dept hired a NA or PCT (whatever your hospital calls 'em) to assist you?

We used to have Imaging Assistants: they can bring pts to and from the waiting areas, have them change into gowns, take initial VS, etc. I'm sure you could find something else they could do, in their scope of practice, that may help ease your burden.

Would Radiology be willing/able to organize their scheduling, such that blocks of time are allotted to do certain things: CT-guided bx's on Wed and Fri in a certain time frame (so you're not being pulled all over during them)? (yes, I do know 'things come up' but maybe some organizing of elective procedures may free up more time for add-ons ? ? ?)

Does ARNA site have a similar BB, where you could get suggestions from others working in same area (I only work Cardiology/Cath Lab now, not Radiology/IR, so I'm not 'there' real-time :D).

Hang in there, put your heads together and brainstorm! I wish you the very best (loved IR when I was there, it's a good field but you have to have support)!

tinnnk · Aug 3, 2008

Dianah, could you please tell me if it is within the scope of the US techs to assist the IR in

the performance of thoracentesis and paracentesis without the nurse present. This is what I have been told is going to happen at our hospital........he also told the director that we don't need to go to the biopsies...........................is that the CT,RT ®'s responsibility? And wouldn't they require some formal instructions from the education department or us to train them before they are pulling the catheters out of the para's and thora's?????? :confused:

Editorial Team / Admin · Aug 3, 2008

Hmmmmmmmmm, I can't answer your question about the RT's scope of practice for para's and thora's. Can your Chief Tech find anything out from your state's regulatory organization (I have no idea what it's called :))?

If it IS in their scope of practice for your state, with proper training they can certainly set up and assist the Radiologist.

I have to assume, if no nurse is present, that only local anesthesia will be used (no anxiolysis or moderate sedation).

I do have a few thoughts:

* Policies and competencies need to be written/done, and responsibilities designated:

* Proper skin prep, sterility of setup table needs to be maintained, dressings/securing devices properly applied

* Will the pts be monitored (ECG, NIBP, O2 sat, RR) during the procedure?

* If so, who will be monitoring the pt? (I'm sure the techs are capable of attaching all the mon. equipt)

* Who will recognize s/sx of distress/problems? (side note: our Radiologists were excellent Radiologists but they were NOT trained ICU Hospitalists nor were they required to have ACLS; WE RNs were! They depended on us to help triage the pt and initiate what needed to be done!)

* Who will call the shots in case of an emergency (hoping it's recognized sooner, and doesn't become a code!!)?

Yes, paras and thoras can be some of the lower-risk procedures done in IR. But, as you know, there's always that one . . .

These are just off the top of my head.

Sounds like your admin. recognizes how stressed you nurses are, and is trying to take some burdens off you.

That's OK as long as the procedures are done safely, with protocols in place and being followed, FOR THE PT.

tinnnk · Aug 3, 2008

dianah,

I will definately present these questions to the US Supervisor and my Director. We don't have a department manager for special procedures and I don't believe we have a head radiology tech either......CT & MRI, US, and radiology have supervisors.........and we are pretty much 2 new RN's on our own, but thanks for the info.......I will be back I'm sure.. :banghead:

Editorial Team / Admin · Aug 3, 2008

Another thought: I'll bet the US techs will be uncomfortable with the proposed changes!!

Radnurse54 · Mar 18, 2009

I think there are two words that need to be used here "PATIENT SAFETY" trust me, learn the key words that are used by Joint Commission, etc and see how much more willing admin will be about your concerns. Talk to your patient safety coordinator or head of clinical practice or whatever you may call those folks in your institution and tell of your concerns. Sometimes in the rush to "do more procedures to make more money" the thought process of what needs to be in place to make that happen just "flies out the window". Advocate for your patients and their safety....and by the way......advocate for yourself and your stress level and your ability to do your job well.......as long as you keep doing it...they will keep letting you.....learn to say no in a professional manner. Good luck.