Difficult Radiologist

[rnmontana12]

Er nurse turned Radiology nurse ( I have recently started working at a small hospital that has never had a radiology nurse) needs some advice. The rads that work for this hospital work for several others in the area and are never here on the same days, in fact they work one week on and 2-4 weeks off. I have been here for 2 months now and am finding nothing but challenges. They do not talk with each other outside of the office, and well there is only one on staff at a time so they never see each other. One rad in particular states he would like order templates, and all these other changes (He is the head of the group), but I have met some great challanges with this and the other rads (because they don't talk). This has become very distressing, I have even been yelled at in front of patient's by the rad on duty:argue:! Any advice out there. I would like to set up a meeting with all of them, but they all refuse to come in. Several are also refusing to become ACLS certified so that I can do concious sedation, yet they complain when the patient does not cooperate with a lung biopsy. Thanks

[dianah, ASN]

Sounds like you need A LOT of admin support!

Is your Chief Tech or Radiology Manager approachable?

Some depts have a lot of trouble adjusting to the newness of having an RN in the dept. . don't know what the RN can/can't do, or is capable of!! And vice versa, the RN has a lot to learn from the techs and Rads. The Rads may be laboring under the VERY simplified notion that "there's an RN here now, I don't have to worry about X or Y, she'll take care of it," without full understanding of the above (your scope of practice).

Are there policies/protocols/procedures in place?

There are potentially a lot of issues and sub-issues bubbling around there . . .

* perceived loss of control on the part of the Radiologists (which includes loss of their primo one week on, 2-4 wk off schedule!)

* Radiologist ignorance about RN duties in general, and Radiology Nurse duties/responsibilities in particular (only because they've never had a Rad. Nurse in the dept before)

* old, comfortable habits to overcome (why should I take ACLS?? And who's going to make me??? -- only guessing here, but you get the idea)

IMO, *You* by yourself can't do much with the Radiologists. The issues involving them require peer input and, as you've pointed out, COMMUNICATION.

Could you interview Rad Nurses working at nearby hospitals, to see how their dept runs/what are the duties/examples of protocols, etc?

At the very least your Rads MUST comply with the standards of the hospital's Moderate Sedation policy. (note: our Radiologists didn't want to be ACLS-certified either, and got that requirement changed. WE RNs had to be certified, however! Eh, you pick your battles . .) I assume you (and they!) have copies of it.

Any way you could sit in on the Procedures Committe or Moderate Sedation Committee, the one that reviews/QA's the Mod Sed cases? It would help to get to know some of the ppl who wrote the policy, so you have someone of whom to ask questions/bring up issues.

I have so many questions, it's hard for me to suggest anything, not knowing the dept and the ppl like you do.

Do your best within your scope of practice, keeping pt safety foremost, and protect your license!

--- D

[rnmontana12]

D,

Thank you for your advice. It seems to be getting a little bit better. I do have the chief Radiologist here today and we are planning on having a meeting (who knows if it will happen). And there are no p&p in place yet because I have yet to write them!, I am doing my best though.

Thank you again.

[Radnurse54]

rnmontana,

As an ER nurse who became the first and only Radiology Nurse in a hospital, I feel your pain. I will share with you what I did to get information about my job and how best to interact with the technologists.

I spent time in every modality as often as I could, I took notes asked questions and helped anywhere I could.

I found the technologists to be helpful when I began to show the value of having a nurse in radiology, to be the liaison between floor nurses and radiology, and trouble shooting for patient care issues as well as doing sedations etc. When I first started I wasnt doing that many sedations, but of course over the next 3 years I became more involved as they added more procedures.

I asked to be placed on the nurse council as one of the adhock members, so that new things that were effecting nurses I would be aware of. I had a strong support with the nurse over sedation/QAQI for all sedation records.

Once the Radiologists realized how much of their job became easier when they followed the policies and protocols as written, that the cases went smoother and patient outcomes were better they would come to me to ask for help with projects such as standardized orders etc.This is a difficult project you have taken on, but it can also be rewarding as you see the changes you can affect in this area.

If your manager is a radiology trained person, then go to the Nursing Officer and ask to have at least a dotted line to a nursing administrative person, to my knowledge it would be required for your evaluations anyway.

I would be glad to share any other information you may need.

Good luck.

[rnmontana12]

Radnurse54,

Thank you so much for the reply. You made my day, knowing that there are others out there willing to share info. This forum has such great advice for us "younger ones". If I have any other questions I'll be sure to let you know.

Thanks!!!!!!!!! (also much thanks to D for support)