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Interested in IR nursing

Radiology   (1,592 Views | 11 Replies)

BeatsPerMinute has 5 years experience as a BSN, RN and specializes in Cardiac.

4,924 Profile Views; 136 Posts

I have an interview for IR coming up! I am excited! I hope to be changing specialties and moving to a procedural area. My background is critical care. I am very detail oriented, I like learning about how things work, do best having one patient at a time ( I get super focused on that person's care and enjoy that). I also find the technology fascinating, so the procedural area seems like it could be a good fit for me. I have shadowed in IR already and have a basic idea of what it will be like as a nurse in IR, but want to ask about people's experiences, and for tips transitioning to IR from critical care, any challenges to anticipate, etc, (IF i get this position 🙂 ) 

Also, what should I expect for orientation?

Do you have any interview tips?  

Edited by BeatsPerMinute

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dianah has 45 years experience as a ADN and specializes in Cath Lab/Radiology.

2 Followers; 9 Articles; 2,760 Posts; 68,641 Profile Views

I worked in IR for 20 years, but have been in Cardiology now for 15 years.  Your duties as an IR RN may differ from what mine were.  You already know your hospital's policies, that is a plus.  Your critical care background will help you respond in an appropriate manner in emergent situations.  

I would inquire about the IR dept. policies, so you are covered when making decisions / giving patient care during "situations."  

Our Radiologists were good at what they did, yet they expected the RNs to handle situations -- e.g., contrast reactions -- kind of independently.  We would send the tech to call for the Rad, but we were the first line of treatment and contrast reactions require fast treatment to head them off quickly.   I instituted the practice of having a standard box in each CT room, of emergency medications.  It was inspected daily, and kept in the same place in each room, so all us IR RNs knew where it was and that the meds in it were present and in date.  No scrambling during an emergency!

We explained procedures and called the Rad to obtain informed consent.  We sedated for certain procedures, scrubbed for others.  Know your facility's moderate sedation policy, and whom to approach if you have questions.

We set up for the procedures, and re-ordered supplies we used.  Once a month we (or the techs) would go over inventory and ensure all was in date and that we had adequate supplies, so we didn't come up empty during a procedure.

I really enjoyed doing the procedures, as I am task-oriented and have critical care background.  I appreciated the trust the Rads had in us, and appreciated our techs for their expertise.

I have read of some RNs facing hostile Radiologic Technologists, and others who were expected to almost assume the role of MD -- were left to work things out themselves.  It is important to have their support but we are NOT MDs.  You may have to educate some on the RN's scope.

Befriend the techs and hopefully you can work as a team.  Our techs knew what to do and how to help, in an emergency situation (they helped with a lot of traumas who came to CT in the middle of the night, could set up O2 and suction and do other things to help).  We had a good relationship, and I valued that!  

Anyway, you will find or make your way.  Will you be the first IR RN in the department or are you replacing someone?

The department politics can be strange; is your Imaging Department under Medicine or under Nursing?  In my experience being under Medicine (or Medical) is better.  Nursing really doesn't have a clue what we do in IR, I kinda didn't want their fingers in the department.  Yet we must work within the Nursing guidelines and parameters, so best to maintain a working relationship, so we fulfill all the Nursing requirements of practice, and have a resource to approach if we have questions from a Nursing perspective.  We must be the ones to bring the Nursing perspective to the Rads and Techs.

Check out the Association for Radiologic and Imaging Nursing and their publications/recommendations for books for RN practice in the field:

https://www.arinursing.org/ 

They have a certification exam for IR nursing and are a gold mine of information.

Keep us informed, hope you enjoy it as much as I did!

 

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BeatsPerMinute has 5 years experience as a BSN, RN and specializes in Cardiac.

136 Posts; 4,924 Profile Views

Wow this is super helpful!!! Thanks:D 

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BeatsPerMinute has 5 years experience as a BSN, RN and specializes in Cardiac.

136 Posts; 4,924 Profile Views

Oh and to answer your question - they have nurses in IR already and are looking to hire more into the department. 

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DextersDisciple has 7 years experience as a BSN, RN.

314 Posts; 3,993 Profile Views

Find out what your holding area/recovery/preprocedure area is like. Do you have nurses assigned to JUST be in pre/post area and others to be JUST in the procedure room? Or do you have a patient from start to finish (pre procedure work up, be in the case then recover the pt)? Are the nurses assigned to certain bays for the day or everyone just kinda works with whoever? An unorganized area can be a nightmare.

Thats one thing I would say you may have to transition to. Other than that I love working in IR. Nurses in my facility monitor the pt and their vitals, give sedation/other IV meds and document timeout, drugs given by MDs and amount used (i.e. contrast, lidocaine) and sheath/device/LDAS placed and removed. 

We do not scrub or circulate but we can help the techs set up their table to prep the pt, grab supplies when they can’t, etc. The attendings trust us and we sedate based on our own nursing judgement. We also have a fellow or resident in the case as well. We are under Radiology (not nursing). 

Also ask about call hours. We are required to take call but it’s easier to switch call days or even have someone take your call if they want the OT. My nurse colleagues are flexible and we help each other out. Techs are great too. I are with Dianah-befriend them and if possible ask what’s going on, they know A LOT. I love my job! If only we didn’t have to work 5 days a week... lol

 

Edited by DextersDisciple

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DextersDisciple has 7 years experience as a BSN, RN.

314 Posts; 3,993 Profile Views

Oh also helps to know who your boss is. Is it a lead technologist? Or do you have a nurse manager? We have a Charge and a nurse manager. Our charge is a huge help. I’ve heard of nurses disliking IR because their boss was a tech and did not understand nursing issues/concerns. 

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dianah has 45 years experience as a ADN and specializes in Cath Lab/Radiology.

2 Followers; 9 Articles; 2,760 Posts; 68,641 Profile Views

My bosses were always the Tech Manager, but they were very respectful of our expertise and judgment, and supported us.  As did our Radiologists.  Great team. 🙂

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SFANURSE2011 specializes in ICU, IR, PACU.

42 Posts; 1,541 Profile Views

My biggest thing when I transitioned from ICU to IR was the call. We ended up taking 7 to 14 days of call a month. This was in due to being part of a teaching facility who was also going for stroke accreditation and we have to have two IR teams one for neuro and one for body. Once I came to terms with that, I love procedural nursing. My IR we take care of critical care patient without the ICU nurse. Manage drips, vents, A line along with providing adequate sedation for procedure is what I was meant to do. 

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emmjayy has 2 years experience as a BSN, RN and specializes in ICU, CCRN.

504 Posts; 7,854 Profile Views

Anyone have anything to add to this? I have gotten burnt out, absolutely fried to a crisp on ICU and am applying to IR (among other procedural areas). I don't think I mind the sound of taking call, am familiar with sedatives, and am detail-oriented to a T. In the ICU, I watched over my patients through many types of bedside procedures, so I feel familiar with timeouts and documenting new lines/drains/etc.  I've also managed plenty of reactions as well. The only thing that I am really worried about is administering the moderate sedation without the safety net of a breathing tube in case things go too far. I'm worried that my time in ICU has maybe desensitized me to what a good dose of midazolam/fentanyl is for someone who ISN'T intubated. 

Edited by emmjayy

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DextersDisciple has 7 years experience as a BSN, RN.

314 Posts; 3,993 Profile Views

8 hours ago, emmjayy said:

Anyone have anything to add to this? I have gotten burnt out, absolutely fried to a crisp on ICU and am applying to IR (among other procedural areas). I don't think I mind the sound of taking call, am familiar with sedatives, and am detail-oriented to a T. In the ICU, I watched over my patients through many types of bedside procedures, so I feel familiar with timeouts and documenting new lines/drains/etc.  I've also managed plenty of reactions as well. The only thing that I am really worried about is administering the moderate sedation without the safety net of a breathing tube in case things go too far. I'm worried that my time in ICU has maybe desensitized me to what a good dose of midazolam/fentanyl is for someone who ISN'T intubated. 

Many of them are outpatients I.e. chest port placement, drain placement so sometimes knowing they need to go home right afterwards can remind u to not overdue it. If they have a difficult airway, OSA or other throat/airway issues then they will only get fentanyl -no versed. Or they have anesthesia on board so you are covered. 

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emmjayy has 2 years experience as a BSN, RN and specializes in ICU, CCRN.

504 Posts; 7,854 Profile Views

13 hours ago, DextersDisciple said:

Many of them are outpatients I.e. chest port placement, drain placement so sometimes knowing they need to go home right afterwards can remind u to not overdue it. If they have a difficult airway, OSA or other throat/airway issues then they will only get fentanyl -no versed. Or they have anesthesia on board so you are covered. 

Awesome, thank you for this. I think it will help me to realize that I'm just giving them meds to take the edge off and make the procedure comfortable, rather than doing it to knock them out and keep them from self-extubating or hurting themselves/staff :) 

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SFANURSE2011 specializes in ICU, IR, PACU.

42 Posts; 1,541 Profile Views

Exactly. Just enough to get them through the procedure since you are doing moderate (twilight/conscious) sedation. They are suppose to respond to you during the procedure. Any deeper, you might be crossing over into Deep Sedation where you run into airway problems. Not the end of the world if it does happen, but it happens just gotta maintain and if applicable reverse. 

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