The Ten-Minute Interview with: Ernie Livingston, RN, BSN

Why did you choose to work in the invasive cardiology field? Honestly, I just wanted to learn more about cardiology. I had seen the surgical aspect and I wanted to experience the less invasive side of cardiology. I had no idea it would lead to a career. Can you describe your role in the cath lab? I was originally hired by Thomas Hospital to build their open heart program after having been part of a start-up team at a prior hospital. I accepted the job of open heart coordinator and built 2 open heart suites, a perfusion room and two general operating rooms as part of a brand-new hospital expansion. Shortly after completion, the former manager of the cath lab left and I asked for the opportunity to take the diagnostic cath lab to interventional status in anticipation of opening the heart center. My current role is Director of Cardiovascular Services, which includes the two cath labs, EKG and echo departments, cardiac rehab, and an 11-bed cardiovascular unit that takes care of all our cath patients, both diagnostic and interventional. What is the biggest challenge you see regarding your role in the lab? I would have to say the business aspect is the most challenging area. The external environment, with vendors and capital equipment, also has its challenges. The reimbursement changes make running an efficient and profitable service line a constant work of art. My staff are absolutely wonderful. I often have them on autopilot. I have some excellent team leaders in the different departments that make life internally much easier. What motivates you to continue working in the cath lab? I love this question. It is knowing that I make a difference. The patients’ lives we have touched and those saved are worth it all to me. My staff feel the same way. We genuinely care about what we do. Is there an unusual case you have been involved with? Yes, I can think of one in particular, which was a carotid stent case. We placed a stent and everything was going well. We were about 15 minutes into the procedure and had just taken out our post dilatation balloon. We were going in to retrieve the filter when it just detached from the wire. We were all in shock. The filter was still open and doing its job, but wasn’t attached to anything. We tried to snare it, but with no effect. We finally took a sterile biopsy forceps from the GI lab (those things look huge under fluoro), grabbed the filter and pulled it into the sheath. It took about an hour from start to finish, but it seemed like an eternity. The patient did fine, with no problems whatsoever. When work gets stressful and you experience low moments (as we all do), what do you do to keep your morale high? Our lab experiences these moments in the fall. We don’t have much turnover, but if we do, it is usually late summer or early fall. Then we have to go through the winter short-staffed. We talk a lot amongst ourselves and do several things together outside the hospital to help improve morale. We do this year-round. I have good people dedicated to their jobs and that makes a difference. I have an open door policy “ no appointments necessary for staff. They can vent to me (and often do) and make suggestions. I like to take a hands off approach to managing my staff. I treat them as professionals and I believe that keeps morale higher. I don’t stand over them watching every little thing they do. Personally, I reflect on my own core values and motivations to carry me through. Are you involved with the Society of Invasive Cardiovascular Professionals (SICP) or other cardiovascular societies? Yes, I have been elected the Chairperson or President of our local chapter. We are just getting started with the chapter, called the Jubilee Chapter. It was named after a local natural phenomenon that takes place here and one other place in the world. Are there websites or texts that you would recommend to other CV labs? We are big fans of Cath Lab Digest. We also look to theheart.org and the various other sites like the TCT (tctmd.com) and American College of Cardiology websites (acc.org). We rely on the textbooks Grossman’s Cardiac Catheterization, Angiography, and Intervention by Donald S. Baim, MD and William Grossman, MD, and The Manual of Interventional Cardiology by Robert D. Safian, MD and Mark S. Freed, MD. Do you remember participating in your first invasive procedure? I can’t say that I remember my first interventional procedure. However, I do remember the physician with whom I did most of my work. He pushed me to be more than what I was at the time. There were times when I wanted to quit, he was so demanding. After a while, I realized he wanted the best for his patients and that meant his team as well. I owe those early days a lot of credit for giving me the strength to persevere to where I am today. If you could send a message back to yourself at the beginning of your career, what advice would you give? Pay more attention to what is happening. Don’t just do the procedures. Know why you do what you do, not just what to do. I would say there are going to be days that momma didn’t know to warn you about. I would say it is not all about money and career, it is about making a difference…because in the end, that’s what matters most. Where do you hope to be in your career when it is time to retire? Wow, a good question. I don’t really think much about retirement. I am 35 and there is still so much ahead of me. I do, at times, look forward to my career and obviously I want to accomplish more. I am not going after an MBA just to have something to do. I see myself in possibly an administrative role or maybe in some form of management position within a company on the industry side. Currently, I am focused on May of 2008, which is graduation. I am starting to look around at the lay of the land and the future opportunities within my current organization. Truthfully, I think that we should all evaluate opportunities as they present you never know what is around the next corner. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? I can’t thank the physicians that I have worked with enough. They have all played a crucial role in the development of my clinical expertise. In particular, Dr. Frank Bunch has played a big role in that area. The person that comes to mind from the administrative side is Doug Garner. He is the Vice President of Thomas Hospital and to whom I report. He has spent an extensive amount of time over the last six years mentoring me. I owe both of these gentlemen a tremendous debt of gratitude. Where do you think the invasive cardiology field is headed in the future? I think we are going to see some really neat things. I am looking forward to the bioabsorbable technologies, which will be exciting. I think we are going to continually improve upon our diagnostic capabilities external to the cath labs (i.e., CT and MRI). I see some big changes in the industry, particularly with the big companies. Probably we will see some interesting mergers and acquisitions over the next few years¦that fascinates me (that’s the MBA coming out). I also see a tough road ahead for hospitals as Medicare makes changes, and reimbursement tightens and is re-appropriated. It will be a case of only the strong survive. *Jubilee is the name used locally for a natural phenomenon that occurs usually once every two to three years on the shores of Mobile Bay, AL. Blue crabs, shrimp, flounder, stingrays, and eels swarm toward the shore in such numbers that the shallow water near land seems to boil with life. Source: https://en.wikipedia.org/wiki/Mobile_Bay_Jubilee Ernie Livingston can be contacted at ernie.livingston@infirmaryhealth.org

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