New to Rad. nursing

Rad RN too · May 25, 2007

Sorry I took so long to answer, but I just found your message.

I have been an "Lone Ranger" since 1999, and have been in a hospital/outpatient department since 2004. Like you, we have CT, MRI, xray, Nuc Med, Ultrasound, and a mobile PET scanner. We also do not do conscious sedation (although I've been trained on it), and I end up repeatedly telling JCAHO personnel that, "No, we do not do conscious sedation in our department". They act like they do not believe me, but it is true. The key to a lone RN working in a radiology department is to respect the education, knowledge, and experience that the techs have and learn as much as you can. Then teach the nurses throughout the hospital what the techs do and teach the techs what the nurses do...be a liason between both groups. But most of all give good nursing care and be a patient advocate. The techs will be watching you and learning from you, even if your don't say a word.

Get your director to get you a membership in ARNA (American Radiology Nurses Association) at arna.net because they have alot of help for you. One thing they have is a "Lone Ranger" support area where you can ask your questions. While you are waiting for that, go to ana.org and obtain a copy (see if the department can reimburse you) of "Radiology Nursing, Scope & Standards of Practice". :idea:

There is a wealth of information on the internet to help you understand the various departments (most nurses only have vague ideas of what goes on in the radiology department). That's not egotistical on my part. I also knew little of what went on in radiology myself. When I first came here, I asked the techs what they'd like the nurses to know, got the approval of the rads and director and sent it out to the nurses. It really helped. I also encourage the techs to talk to the individual patient's nurse. Some do, some don't. I've had to teach the nurses that if a patient cannot lie flat or lie still, we probably won't be able to do MRI, CT, or Nuc Med. I've had to advise them that a patient, on NRB or venti mask at max flow, who desats if you lie them down, will not be able to do the exam. :uhoh3:

I did not have an area to get the patients ready for biopsies, drainages, and aspirations, so I worked out an arrangement for the single day unit to prep and recover the patients. It has worked out very well.

Since my director is of a radiology tech education background, we worked it out that the director of the single day unit (an RN) to be a part of my annual evaluation. She starts it and my director completes it, then I meet with both of them. (I am fortunate that my current director worked as a nursing tech before going into radiology school).

I also cover for an outpatient facility in the building next-door (starting IV's, monitoring patients with mild allergic reactions, and checking extravasations). We only do mild sedation in MRI at the hospital, not the outpatient facility. The single day or emergency department nurses help cover in my department when I go to the outpatient facility.

When the main CT scanner goes down, we have to transport patients to the outpatient department. If they can go by wheelchair, I do as many as I can, but the floor nurses need to do some also. If they need to go by stretcher, they go by ambulance, for safety reasons.

Getting patients ready for invasive procedures is another aspect of my job. By making sure everything is in place before the patient comes down, I've taught the floor nurses how to get a patient ready. It helps now that alot of the forms are on our hospital intranet.

ICU transport is also part of my job. My director supports this and the ICU nurses appreciate it. In the process I've taught the nurses there what goes on in radiology and how to get a patient ready for an exam or interventional procedure. I have an ICU background and know how hard it is to have to go off the unit with a patient while your other patient(s) also need your care. Even though someone else is watching them, sometimes they don't have the time to do the ongoing care the patient needs and you have to play "catch-up" when you get back.

I also do chart audits, but that has had to take a back seat as the radiology department takes up too much time to do that.

Updating radiology department policies and procedures is part of my job. Use nursing standards of care to help you in knowing what to include or leave out.

We have gotten the hospital to use the Purple Power PICC made by Bard. It can be used with CT/MRI at up to 5 ml/sec and up to 300 psi. It has made it so much better for both patients and techs alike. :lol2:

I have been proactive in obtaining a nurse to cover me on my days off and sometimes when I need sick time. It was in my favor to find a nurse interested in working in the department. Then I could train them to the department. Of course, I got my director's permission to use them.

Currently I am working on getting an MRI compatible IV pump. The one I want has a ceramic motor that is not affected by the MRI magnet, nor does it affect the MRI magnet. It is part of my long-term goal to have anesthesia in MRI for claustrophobic patients, patients that cannot lie still for the exam (confused, tremors, etc), and ICU patients on drips. We cover a broad regional area that can support this and I am collecting data to prove this.

Whatever you do, don't get discouraged. There are answers out there and there are nurses to help you. You can do it. :smiletea2:

SoccerMomNC · Jun 10, 2007

Thanks so much for all the info!!I am LOVING my job! It is so different from anything i have ever done.

We are currently having test subjects for cardiac CT. Our biggest problem is getting the HR to 50-65 bpm. We are giving 100 mg Lopressor 2 hours prior to procedure. This usually works..however it does lower the BP and patients c/o feeling weak after taking this. We have tried just giving 5 mg IV doses just prior to scan instead of po. A CRNA suggested Esmolol IV instead of Lopressor. Have you used this drug? I understand it is metabolized more quickly than Lopressor. BTW, we have a 64 slice scanner-Siemens.

DutchgirlRN, ASN, RN · Jun 10, 2007

We have the 64 slice scanner also. We've been doing CTA's for several years. One of our docs was instrumental in developing it. Anyway....

Our protocol is Lopressor 15mg IV over 5 minutes. If HR still not down after 15 minutes we give Lopressor 35mg over 7 minutes. It is very well tolerated by the patients. The first 15mg seems to have the most effect. The last 35mg doesn't seem to do hardly anything but they wanted it given regardless. Generally we can get the HR down into the 60's. About 25% of the time we can get it into the 50's. I love my job too! Are you doing conscious sedation for CT guided biopsies? I like that too.

SoccerMomNC · Jun 10, 2007

Thanks for your quick reply! Post procedure, how long do you monitor pt? Do they have a driver or drive themselves home? I worry about the BP making them unsteady. Do you have a post procedure info sheet for them? We are still working out all the kninks......

We do not do conscious sedation for CT guided biopsies. All the pt gets is local (lidocaine). I have wondered about this. Especially on kidney and liver biopsies. Most pt's do OK with just local. I have only been in this dept. for ONE month! I got about 4 days orientation with the previous RN!! :uhoh3: The tech's have been great to show me/tell me what to do.

DutchgirlRN, ASN, RN · Jun 10, 2007

Inpatients we take directly back to the floor, the same with ER patients. Outpatients we monitor for 1 hour post CTA. Vitals Q 15 minutes. We use the same flow sheet we use during the CTA just keep it going until DC. Last thing we do is pull the IV. Some patients come alone, some don't. I can't imagine CT guided biopsies without conscious sedation. I have experienced one this week with a patient who couldn't have the Versed/Sub because her BP was too low and it was awful. I felt so bad for that pt. It was a liver biopsy.

JSN908 · Jun 11, 2007

Hello! I have been in Interventional Rad for just over a year now. There is no formal training but the nurse I work with is seasoned and a wealth of knowledge. She will be retiring in Dec which increases my anxiety as I will at that time be a Lone Ranger also. I am sad to report there is a great divide between techs and nurses here. The animosity is so great, it is next to impossible to make any or even suggest changes. I greatly appreciate the advice from Rad Rn too! It is so important to bridge the gap! I still have so much to learn; I often feel I don't know where to start. You folks keep posting!

SoccerMomNC · Jun 11, 2007

Hello! I have been in Interventional Rad for just over a year now. There is no formal training but the nurse I work with is seasoned and a wealth of knowledge. She will be retiring in Dec which increases my anxiety as I will at that time be a Lone Ranger also. I am sad to report there is a great divide between techs and nurses here. The animosity is so great, it is next to impossible to make any or even suggest changes. I greatly appreciate the advice from Rad Rn too! It is so important to bridge the gap! I still have so much to learn; I often feel I don't know where to start. You folks keep posting!

Sorry to hear that you have a prob with the tech's and nurses. How has the seasoned nurse dealt with this? Was this a prob. before she started? I greatly appreciate the tech's at my hospital..most are willing to help me and answer my questions. they need to remember that they were once "the new kid" also!What does interventional rad. involve?

Try to soak up as much as possible from the nurse you are working with. At least you know you've got until Dec.

P.S. I noticed you are from Texas..our head Radiologist is from Texas..even though he's beedn in NC for 20+ years he STILL talks about Texas!!

Radnurse54 · Jun 13, 2007

I too started out as the "only" radiology nurse, however there had been no one before me. The most important things you can do are:

1) Find out who your nursing support people are, are you under radiology or nursing

2) Learn from the techs and study, study about all things radiology

3) Be a source of educational information and patient advocate in radiology

4) Go to all the other nursing units to introduce yourself and explain what you do in Radiology as well as what you dont do in Radiology

5) Join ARNA local chapter for no other reason that support in what you do

Also take advantage of the learning opportunities at the ARNA conventions nationally. There is much help and information sharing within ARNA, we are all more than willing to help each other and they have a special interst group called "the lone rangers".

Hope this helps or if you need more information I would be happy to help you.