The changing image of radiology nursing

February 2013   Comments

Technological advances in surgical procedures are transforming the role, but “homegrown” opportunities to network and share experiences remain limited

Cathy Brown assesses a patient prior to sedation. A digital fluoroscopy unit (or “C-arm”) is used to examine the patient’s liver.
Emir Poelzer

In the 1990s, when Helen Patton scrubbed in for a case of gastrointestinal bleeding, she took her place in the operating room, where a surgeon cut open the patient’s abdomen in search of the cause, repaired the vein and sent the patient for a lengthy recovery.

Today, Patton prepares for a similar case by pulling on a heavy lead jacket and skirt over her scrubs. She then heads into the interventional suite in the radiology department at Edmonton’s University of Alberta Hospital, where a patient lies on a table, waiting for an abdominal angiogram. Above the patient is a machine with a sliding C-shaped X-ray arm, called a fluoroscope.

Nearby, a medical radiation technologist (MRT) transmits an X-ray beam through the patient that shows up as an image on a computer monitor. An interventional radiologist watches the continuous, real-time image, first to find the source of the bleeding and then to perform a coil embolization to staunch it. As a radiology nurse, Patton’s role is either to assist the radiologist or to track the patient’s pain medication, sedation and vital signs.

From diagnosis to treatment
Treatment of gastrointestinal bleeding is one example of a growing number of procedures that are being shifted from the OR to the radiology department, thanks to advances in technology. The use of fluoroscopy, in particular, has transformed the mission of Patton’s department and the nurses who work there. “It’s incredible what we’re able to do now,” explains Patton, who has watched the list of procedures performed in radiology grow during her more than 13 years in the department. “We used to do angiograms to diagnose patients. Now, we can go beyond diagnosis and right into treatment.” Among the other procedures conducted with the help of fluoroscopy are angioplasties, uterine fibroid embolizations, biopsies and radio frequency ablation (used to relieve pain and destroy tumours).

In the past dozen years, Patton has seen the number of full-time radiology nurses in her department grow from six to 30. But national numbers are hard to come by: radiology does not even appear as a category on the RN registration form in Patton’s province.

Patton says there is a general lack of awareness about her field — even among colleagues in her own hospital: “Many nurses feel radiology would be a good place to work before they head into retirement. But when we give them an overview of what we do here, they say, ‘I had no idea.’”

One of the most challenging parts of the job, she says, is the protective gear. “Everyone who works in the interventional suite has to wear a lead apron. For the angio team, that can be six or seven hours per shift in an apron weighing up to 26 pounds — it can be exhausting.”

A diverse role
Many of Patton’s responsibilities lie in the interventional suite. But some radiology nurses also serve as a liaison between their department and their patients’ care everywhere else in the hospital.

As a nurse navigator, Cathy Brown fills this role at the Royal Alexandra Hospital in Edmonton. Patient groups she is responsible for include women who spend a day in the hospital for a uterine fibroid embolization and people with liver cancer who return for tests and treatments over several years. During an hour-long consultation with each patient, Brown answers questions and explains the risks and benefits of the procedure. She also reassures patients before they are wheeled into the interventional suite and ensures that the medical staff are up to date on the patient’s history. Brown typically does 100 to 150 consultations a year, and that number is going up as the number of interventional radiologists performing procedures in her hospital increases.

While the consultation process provides an in-depth history on patients receiving treatment, Brown says the nurses almost never have much history on patients scheduled for diagnostic exams. “For outpatients, the requisition to book the test is not immediately available to us, and sometimes even inpatients show up without a chart. So we have limited information to go on, yet must respond to changes in their acuity. Physical assessment and critical thinking skills are very important for a radiology nurse.”

Brown often assists in the interventional suite, and she keeps track of her patients afterward. “I let the recovery nurses know what to expect, and they’ll call me if a patient’s pain is out of control.”
She recalls the case of a man who bled into his stomach muscle after a procedure. “We had inserted a needle into his liver and inadvertently poked through a vein. When he called us, complaining of abdominal discomfort, I knew what it was right away. I told him to come in so we could ultrasound it. If he had gone to the emergency department, they might have thought it was no big deal.”

Radiology nurses are also sometimes involved in teaching. Brown and Deborah Johnston, who works at the University Hospital of Northern British Columbia in Prince George, teach patient safety practices and intravenous therapy to new MRTs. Johnston, who is the clinical resource nurse for medical imaging, also gets inquiries about patient care from other hospital radiology departments in the region that don’t have a radiology nurse on staff.

A need for a network
Johnston says there are times when she would like to consult — or commiserate — with others in her field, but they’re not easy to find. “I feel a bit isolated,” she says. “I’m the only radiology nurse in my hospital — in fact, the only one in all of northern B.C. — so it’s difficult to network with people and share experiences.”

Even in Edmonton, where there are three hospitals with radiology departments, Brown says there’s no sense of community among radiology nurses. “Sometimes you feel like you’re a little ship sailing in the ocean all by yourself,” she says. “There’s no conversation between the hospitals and no conference we can attend in Canada to network.”

In fact, she sought certification in the U.S. — with the Association for Radiologic and Imaging Nursing (ARIN). “I felt I should know as much about my specialty as I can,” says Brown, who is the only certified radiology nurse in her province and only one of three — Johnston is another — in Canada.

Brown has attended the ARIN annual convention a number of times. “I’ve learned tons. In one procedure, they give vastly different medications than what we give in Canada, and I was able to talk to our radiologist about that. The information coming out of these events has really opened my eyes to best practices.”

Patton, too, has attended the ARIN convention and found it educational. But what she, Brown and Johnston would prefer is a forum and recognition within Canada. They hope the growing field of radiology will lead to the creation of a nursing organization and a network for communication. In such a dynamic field, they say there would be plenty to talk about.

Karen Kelly

Karen Kelly, is a freelance writer in Ottawa.

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