The Ten-Minute Interview with… Cindy Dirkes, RN, MSN

I had a number of years of nursing experience in pediatric critical care that led to an advance practice position in pediatric invasive cardiology. As that niche relegates itself to larger metropolitan centers, I entered into the world of percutaneous coronary intervention in a busy community setting, when I felt the need to forego the commute to be closer to my teenager at home. Currently, I am in the coronary lab of a small community center that is in the process of growing into a larger program, aspiring to develop services in both cutting-edge coronary catheter and surgical interventions. Why did you choose to work in the invasive cardiology field? I had accepted a position as a clinical nurse specialist (CNS) with a rapidly expanding pediatric heart center at the same time as one of my peers after we finished graduate school. It turned out we had to learn each other’s jobs in order to cover one another. Fortunately, my original job description appealed to my peer’s interest in cardiac transplant and the clinical post-op setting. Since everything at the heart center appealed to me, we arranged to exchange positions temporarily, and I entered the cath lab. We each became so involved in developing the other’s position and identified with our work so strongly that we never switched back. Can you describe your role in the cardiovascular lab? Currently, I have the good fortune to work in a lab as an RN where the care of the cardiac cath lab patient extends beyond the procedure itself. Frequently the same nurse who originally contacts an outpatient to confirm a procedure date also instructs them on preparation, does their pre-admission testing and pre-cath prep, and follows them into the lab where they sedate, monitor and then recover the patient in the holding area. We deliver their discharge instructions/teaching or deliver them to their monitored bed if they are admitted. We then follow up with a call two weeks later. Patients and their families love the personal attention. Our manager’s expectation is that we must remain current in our practice, thus there are numerous opportunities to attend educational conferences and seminars. We then share this information with our staff in both the lab and the units where our patient population resides. We also assist in the development of protocols and train with the technologists whenever new devices or therapies are introduced. For acute cases outside of regularly scheduled hours, we have a four-person call team, which typically includes two RNs, a cardiovascular technologists (CVT) and a radiologic technologist (RT). An RN usually plays the role of call team contact person with the on-duty hospital supervisor and interventionalist, and monitors, sedates and provides guidance for pre- and post-procedure care to staff on the cardiac nursing units. What is the biggest challenge you see regarding your educational role? The biggest challenge is dealing with the administrative issues related to working in the hospital setting. It heavily impacts our practice with respect to staffing, inventory and equipment. It also creates an ever-fluctuating dynamic with respect to interfacing with other departments, and our relationships with the physicians and on-call responsibilities. What motivates you to continue your involvement with the cath lab? I enjoy the challenge of learning and assimilating new therapies and technologies, as well as the feeling of satisfaction when you save a life or help someone avoid a heart attack or surgical intervention. What is the most unusual case you have ever been involved with? Wow! There have been many, although I think the most interesting among occurred in the university hospital setting during my advance practice days in pediatric invasive cardiology. Many times we seemed to be “writing the book” when it came to devising an intervention to suit the needs of a particular patient. There was one procedure in which the fenestration of an infant’s Fontan had closed too soon and they still needed the pop-off or R-L shunt. The interventionalist went in with a transeptal needle and a few other devices with which he ad-libbed and created a shunt until the pulmonary pressures could be managed so the baby hopefully wouldn’t need the shunt anymore. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? Why, goof around of course! There is always room to have some fun, even in the most serious situations. Patients always appreciate good humor if they are confident you know what you are doing. In fact, if you can cut up at the right moment, it seems to give them more confidence in your experience. Now I’m not advocating anything unprofessional or risky, but it seems that our setting is very intimate in many ways. Being in this type of situation, it is helpful to be able to lighten up once in a while. Are you involved with the SICP or any other cardiovascular societies? Yes, I am a member of the SICP. Are there websites or texts that you would recommend to other cardiovascular labs? The Pulmonary Artery Catheter Education Project (PACEP) is a good website for right heart and the relation between the various heart chamber pressures and waveforms, including how to make use of them clinically. Do you remember participating in your first invasive procedure? Yes, I do remember. Like most of us, I think I started out as an observer for the first one or two cases, then dove in as expected. I was much younger then, and everything fascinated me about the relationships between the catheter, imaging, monitoring and outcome. I guess I took for granted how amazing the technology was at the time. When I think of the strides we have made and the sophistication of our work today, it seems we still take things for granted because we are so comfortable with it. However, when you try to explain what you do to a layperson, you quickly remember how specialized and amazing our field is. If you could send a message back to yourself at the beginning of your career, what advice would you give? Oh, if I could have known then what I know now! I would tell myself to stay slim, wear support hose, beware of painful varicosities, always stand up straight and choose the lightest lead they offer. Where do you hope to be in your career when it is time to retire? I suspect that when I get too old to see in the dark, I will turn to a clinical educator-type role of some sort. What’s that old adage? Has anyone in particular been helpful to you in your growth as a cardiovascular professional? No hesitation on this one — it was Dr. Brian David Hanna. He was the pediatric interventionalist all-around know-it-all: the clinically and academically astute pediatric cardiology expert who mentored me at Rush when I finished grad school. When I thought I hated the cath lab, he taught me to love it. Where do you think the invasive cardiovascular field is headed? It seems that “less is more” is where all of health care is headed. So my guess is that we will do less diagnostic and more interventional procedures with less invasive catheters and more refined imagery. As less invasive diagnostics methods and technology improve, medications evolve, and holistic approaches to lifestyle modifications become more of the norm, cardiovascular disease treated in the lab will decrease in volume and increase in complexity. Cindy Dirkes can be contacted at dirkescindy@sbcglobal.net

NULL