New position in stress lab

Virgo_RN, BSN, RN · Oct 4, 2008

Listen to your instincts.

Editorial Team / Admin · Oct 5, 2008

1..no md in the room, in the area. over in the clinic you can call internal med to come over if there is a problem or concern.

we always have a cardiologist or a cardiology fellow next door, with an rn in the room for the etts and nucs. if the rn is absent, the fellow or cardiologist is in the room during the test (stress lab technologists run the machines).

.2. no code blue button in the room. no paging system over head. in the evern of a code, you must dial 8 for an ourside line then 911.

we would call the cardiologist or use the phone to call an in-house code blue if needed. our stress lab is in a medical center, so the code blue team is readily accessible.

3. one rn in the room to monitor the continuous ekg and the patient.

as stated above, we have an rn and one or two stress lab technologists in the room during the stress tests (whether they be etts or nucs). cardiologist or cardiology fellow next door and readily accessible.

4. crash cart down the hall.

crash cart is in the room at all times. we always have sublingual ntg and albuterol inhalers in the room as well, for quick use.

5. only stress tests which require iv meds get iv's otherwise iv's are inserted if needed.

the patients undergoing mpis (nuclear scans) all have a saline lock (they've been injected with the radioisotope and imaged before they report for the stress portion of the exam). patients undergoing a 'regular' stress test (ett) do not have an iv.

6. when asked if could be sent to a class to learn about stress testing and how to do them, what to watch for etc. was given a book.."secrets of a cardiovascular nurse" read this and highlight what you want, just return when done.that was the note left on it.

our cardiologist in charge of the stress lab has been revamping our policy/procedures. we received training from the cardiologist in our first rotation there, and we regularly sit in on the reading/interpretation of the etts and mpis by the cardiologist (they're often teaching residents and dental anesthesia fellows who rotate through the stress lab as well). if we rns have any questions about the appropriateness of doing an exam, or question of a murmur (as) or question about switching from an adenosine stress test to a dobutamine study, or a question that arises during the patient interview, or any other question, we consult with the techs (who have been doing this for years) and the cardiologist or cardiology fellow. i do not claim to be any kind of expert in this area, am still learning, imo.

i'm sorry to say, your situation does sound unsafe. who is in charge of the area, and can you schedule a meeting with this person immediately? how were the studies done before you were hired (was another rn there)?

perhaps you can institute much-needed changes, with risk management to back you up, in the interest of patient safety (and so you don't put your license in jeopardy by not addressing these issues in a 'reasonable and prudent' way).

let us know the outcome. good for you, for pinpointing the problem areas.

if management is unwilling to work with you to improve the process, you know what to do.

Editorial Team / Admin · Oct 5, 2008

I just noticed in your original post, the ER/Stress Lab area.

Where is the Stress Lab located? Next to Nuclear Medicine? In Cardiology? In the ER? Is it used by the ER only???

b eyes · Oct 5, 2008

I just noticed in your original post, the ER/Stress Lab area.
Where is the Stress Lab located? Next to Nuclear Medicine? In Cardiology? In the ER? Is it used by the ER only???

Thank you so much for your response. First off, there is one RN who has been doing stress testing for 15 years. I was hired on to assist in giving her breaks, vacation, etc. the stress lab was moved from the hospital and is now located in a clinic. the reason I said stress lab/er is that I will continue to do ER on the weekends and fill in when needed over in the hospital.

Thank you very much for your detailed reply. I really appreciate it a ton. Any learning material or anything you can tell me to help me learn would be great. I am feeling quite a bit lost right now .

B EYES

Editorial Team / Admin · Oct 6, 2008

When I first rotated to the Stress Lab I did a lot of reading of material I found on the Web, as well as the dept protocols/policies and the many pages of handout given to the Residents who rotate thru.

Know absolute and relative contraindications for the exam(s).

Timing for the Cardiolyte/Myoview/Thallium injections.

Radiation Safety (all your pts coming from their resting scan are 'hot', plus your Nuc Med techs should have a protocol for spills -- which do happen)

Rhythms and ST changes

When to bypass MPI or ETT and send pt straight to cath lab

Ohhhhhhh, lots to learn!!! :)

b eyes · Oct 6, 2008

When I first rotated to the Stress Lab I did a lot of reading of material I found on the Web, as well as the dept protocols/policies and the many pages of handout given to the Residents who rotate thru.
Know absolute and relative contraindications for the exam(s).
Timing for the Cardiolyte/Myoview/Thallium injections.
Radiation Safety (all your pts coming from their resting scan are 'hot', plus your Nuc Med techs should have a protocol for spills -- which do happen)
Rhythms and ST changes
When to bypass MPI or ETT and send pt straight to cath lab
Ohhhhhhh, lots to learn!!! :)

OOOH OOOH OOOH, Thank you so much. I will definetly find those answers. I have been looking up and reading tons, and it sure showed today at work. I felt more confident and it showed (from what I was told :yeah: ) Anyway, I am going to go to a larger hospital for training and am very excited. Thank you for your wonderful help. I really appreciate it.

B eyes