The Ten-Minute Interview with...Monica Simpson, RN, MSN, CCRN, CCNS

I have been a nurse for 20 years, with 18 years in coronary critical care. I have had many roles in these years, including staff, manager, director, and CNS. Out of all the places I have worked, I have most enjoyed the cath lab. Why did you choose to work in the invasive cardiology field? I first went to the cath lab because I felt working there would help me to better understand cardiovascular disease. I worked in a CCU for 9 years prior to moving to the cath lab. Since I had been caring for pre- and post-cath/PCI patients all those years, I felt the desire to learn, at the source, more about the invasive procedures for diagnosis and treatment of CAD. I discovered that I loved working in the cath lab. I loved how the nurses, techs and doctors worked together for the benefit of the patient. I felt I was really making a contribution. Working in a cath lab is rather intimate you really get to know everyone’s strengths and weaknesses and have to rely heavily on your colleagues to get the job done. It isn’t for everyone. I was fortunate to have worked in teaching hospitals in Boston, MA and Providence, RI where we participated in device and pharmaceutical trials. I spent about 2 years as a full-time cath lab RN and another 2 years as a manager or director of cath labs. Even when I worked as a CNS for ICU and the ED in another institution, I worked per diem in the cath lab because I wanted to keep that contact alive. Can you describe your role in your CV Lab? I recently left a position as clinical nurse specialist for an invasive lab at a 700+ bed public hospital in south Florida. As the CNS, some of my responsibilities were to help coordinate inservice education, introduce new products, consult on policies and procedures, and serve as a common thread to connect the lab’s staff with the inpatient cardiac units. When I complete my post-master’s certificate as a nurse practitioner in August 2004, I hope to work as an nurse practitioner (NP) in the cath lab. Although I enjoyed my role as CNS, I found I increasingly needed more education to keep up with the many changes in cardiovascular care. I originally started the NP program just to gain knowledge that was not part of my original master’s program. What I have discovered is that I really enjoy providing this type of care to patients. I am learning diagnosis and treatment of health problems in internal medicine. This has greatly enhanced my knowledge of many different types of health problems. It has been good to expand my knowledge beyond cardiac critical care. Cath labs in many areas of the country employ nurse practitioners and physician assistants to work collaboratively with cardiologists to enhance the care provided to patients. They can do work ups and post procedure assessments as well as assist at the table. What is the biggest challenge you see regarding your role in the CV lab? I think the one of the biggest challenges for anyone working in the lab to keeping up with all the new techniques and toys. It is such a dynamic and challenging field in which to be involved. I started nursing as an associate degree nurse because I could not take 4 years off from work. I became a nurse at age 29, with 2 small kids and a very understanding husband at home. I continued on over the years and earned a BSN, then an MSN. I have found value in each of the degrees I have earned. Although my community college taught me to be an RN, each of the other programs have built upon that and helped me to be more well rounded and to think globally. You’ve worked as a staff member, manager, director, and CNS. Did you enjoy being in management? What were some of the challenges you faced? I did enjoy management very much. I like being able to try out new ideas and seeing what transpires. I am a manager that likes opportunities for improvement. Problems always keep me interested and engaged. Management is always challenging. Aside from the human resources issues, budgets are big challenges for any manager in cath labs. Hospital administrators need a lot of education about cath lab equipment and procedures before they are able to understand why we ask for so much money for our labs! You have to work very closely with the CFO and purchasing to get what you need. It helps to have physician champions who will advocate for your lab with administration. What motivates you to continue working in the CV lab? My motivations for wanting to return to the lab each day include the intellectual challenges which we face almost daily, the privilege of being on the cutting edge of cardiovascular care, the true teamwork I have always found within the lab, and, most importantly, the patients. What is the most bizarre case you have ever been involved in? A critical patient from the CCU was brought to the lab for a diagnostic cath. There were a number of staff in the room to assist. A group of staff and docs were in the control room watching the case in between their own cases. As was the usual procedure, the physician first shot the coronaries on the side opposite of where he suspected the culprit lesion to be. As we watched, you could hear everyone gasp. On the monitor, you could clearly see the contrast light up the RCA then continue on to the left side of the heart all the way to the left main! Our director said, Tell him not to take another picture. Where do you see yourself professionally when it is time to retire? I hope that at the time of my retirement, I have enjoyed a productive career and have made a difference in the lives of cardiac patients. Do you have any advice for those just starting out in the cath lab or even just considering the cath lab as a place to work? For a nurse considering working in the lab, I suggest they work about a year in a CCU or ICU where they will be exposed to a fair amount of hemodynamic monitoring and IABs. They could come from tele/stepdown but it will be a longer orientation. CV techs get plenty of exposure in their schooling so they don’t have the same learning curve. When anyone is just starting out in the lab, my advice is to take advantage of the orientation period to absorb everything they can. Orientation should include some didactic besides the hands on work. Sitting with your preceptor or a physician and going over images is great for low-stress learning. What changes do you think will occur in the field of cardiology in the coming decades? I cannot even anticipate what the future holds for cardiovascular care. In the last 15 years alone, the number and kind of innovations that have occurred are mind-boggling. Certainly the total artificial heart as destination therapy is one thing I hope to see before I retire.

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