arnfinally

Advocacy can be defined as: pleading a cause on behalf of another, such as a nurse pleading for better care of a patient or for the patient's desires to be honored. Most nurses take this role very seriously, especially if and when the patient is unable to speak for themselves such as the very old or the very young. My nurses administer conscious sedation to patients requiring procedures and they all recognize being the patient's advocate in this circumstance is vital. The nurses insure that the patient is well cared for, that they are treated with dignity and respect and that they receive the utmost care during a time when they can not speak for themselves. Some specifics are insuring that the patient is prepped and draped modestly, pressure areas are padded to prevent skin break down, Patient is wishes are adhered to during the procedure. Nurses can best be a patient's advocate when they have truly taken the time to assess the patient's understanding of their condition, taking the time necessary to educate and inform the patient and or family so that they can make informed decisions relating to their health care and then doing everything possible to insure that their wishes are carried out when at all possible. Being an advocate can also have it's challenges as it generally involves ethical or medical dilemmas which are highly emotionally charged issues. Advocacy for a colleague is an opportunity to build professional relationships that strengthen our profession in countless ways. Nurses put themselves on the line on a daily basis for their patients, it is very important when a nurse steps up to advocate for her patients that she know that she will have the support of her colleagues in the process. Nurse Manager Imaging Services

I started in Radiology Nursing about 8 years ago and have gone worked from staff nurse to supervisor and now am the Nurse Manager of Imaging Services. There are a couple of considerations that you should make before you jump into this arena of Nursing: While most people would not consider Radiology nursing all that challenging or requiring expertise, I would beg to differ. Radiology Nurses must have excellent critical thinking skills, decisive judgment and unmatched assessment skills as they are often the first responders to any emergency occurring in the Radiology department. These emergencies can range from Severe Allergic reactions, complications of sedation and the most challenging the patient that "crumps" while in the radiology department that have originated from the ED, nursing units or an Outpatient that has no documented health history to work from. Also you should consider that working in a Radiology department is a completely different atmosphere as traditional nursing units. When interviewing nurses for our department I explain that all members of the Multidisciplinary team are required to be able to provide safe, diagnostic patient focused care. The technologist main focus/training is to obtain the highest quality diagnostic images, while the nurses are focus is to provide the safest, high quality continuum of care for that patient while in our department. Each are equally important to achieving our departmental goals. I think you might find the following links helpful as you make you decision: http://www.acr.org/ this link provides standards of practice in the various modalities of Radiology. https://www.arinursing.org/ This is the National Association of Radiology Nurses and there is a great deal of information and support that you might find helpful if you choose to join our profession. Although Radiology nursing has it's challenges, I find the blend of advanced technology and caring (*nursing) a very fulfilling career. *I had a nursing professor that was an excellent teacher that drove home the importance and differentiation of nursing and medicine as that Physicians focus on CURING while nurses focus is on CARING. Good Luck! arnfinally

We offer CTAC's (CT Angiogram - Cardiac) currently as scheduled procedures (outpatient) and in very specific circumstances for inpatients when special arrangements are made by the ordering physicians if the patient is not a candidate for a Cath or Surgery, but they want to confirm a diagnosis. There is a initiative at my facility to offer this procedure 24/7, which will potentially present additional on-call responsibilities for my Radiology RN's that cover an extensive amt of call already. Not to mention the fact that these exams are not read by all Radiologists/Cardiologists, therefore are often not even read until the next day or later anyway. What is everyone else doing? There has been a suggestion to cross train ED, CCU and PACU nurses to manage these patients, but I know that this will not be a process that will be eagerly embraced by these units. We currently have 4 full time Radiology RN's and they are truly for emergent cases in the Interventional area. I fear that this will become a process to prevent/delay calling in the cath lab. Besides the cross training issue or the increased on-call burden to the nurses, there are other concerns; One, if something is diagnosed that needs immediate intervention in the Cath lab, the patient has already had a signficant dye load, increase cost for the dual procedures are just a few of the many concerns that come immediately to mind. Please share your experienes with me so that I might be able assist with setting up this process with reasonable expectations/understanding on all parts. Thanks, arnfinally

We assume total care of CCU/ICU patients when they come to Interventional Radiology only, including transporting the patient from the unit down to our area. If the patient is coming down to CT, NM or MRI the Primary RN is expected to accompany the patients while in our department. My nurses and I do whatever is typically required of a nurse, titrate drips as necessary, personal care needs, address immediate medical needs and administer conscious sedation. Most often we return the patients in much better shape than we received them, they are cleaned up as needed, the beds are changed as this is easier to do and the correct thing to do after a invasive procedure and all the lines and monitoring equipment are detangled. Which is most often not the case when we go get the patients regardless that we have called to inform them that we were on our way to tranport patient. While Radiology/Imaging RN's often get little support and their practice is scrutinized by their peers, often they give the staff or primary RN "leaway" (sp?) or attempt to understand that we do not know what has been going on during her shift that might have understandably delayed routine care/caused the patient's current situation. Nursing also needs to remember that not all procedure room/imaging room have all the same resources that are required to care for everyday needs of an CCU patient, because it would be cost and space prohibitive, especially if you are only expecting the patient in the department of a diagnostic exam. Radiology/Imaging RN's through their committment to persevere, their level of expertise and flexibility to deal with all age groups and manage a continually flexing environment is a testiment of the skill level, which is way to often overlooked in Hosptials accross the country.

I attended a Coronary CTA Seminar in August. They routinely push 50mg lopressor and even go as high as 100 mg of Lopressor for coronary CTA's and then monitor the patient for only 30 minutes prior to sending them home. I explained to them that I was very concerned about the doses, they looked at me as if I had just fallen off the turnip truck. (This was a outpatient clinic that was affiliated with a cardiologist office, yet they performed this exam often when there was not even a cardiologist on site). Besides my concern regarding the amount that was being administered for obvious patient safety reasons, I suggested that that they had a little more freedom to manage these patients than we did as we are a hospital based Radiology department and therefore subject to regulatory agencies such as JCAHO, TDH, CMS etc. My personal experience if 25-35 mg of Lopressor does not obtain the targeted heart rate of 55-60, then you are better off canceling and approaching heart rate control a little differently. Our refering cardiologist have had great luck with premedicating with 50mg PO Lopressor BID for 2-3 days prior, then we administer IV lopressor as needed the day of. These patients seem to respond much easier to the IV with the premedicaion on board. Hope this helps.

The ACR (American College of Radiology) acknowledges that there is no medical evidence to support cold or warm compresses for infiltrations. On their website they have a "Manual on Contrast Administration" which is downloadable and a great reference tool. Our facility applies warm compresses initially, has the pt keep their arm elevated for the first 12-24 hours. The patient is then instructed that they should apply compresses for comfort (their choice, heat or cold) 15 minutes on and 15 minutes off. We track all infiltrates with physician follow-up with those infiltrates that are less than 100cc's. If any infiltrate results in blistering, is 100cc's or greater, or patient has any s/s of compromised profusion with potential for tissue sloughing they are referred to a plastic surgeon for evaluation and follow up. Hope this information is helpful.