10-Minute Interview: Brenda D. Rechtman, RN, BSN

Brenda Rechtman, RN, BSN, is the Manager of the EP lab at Carilion Roanoke Memorial Hospital in Virginia. She recently was one of only 11 Carilion Clinic nurses to receive the prestigious ‘Healthcare with a Human Touch’ Award. In this interview, she talks about her career in nursing.

Why did you choose to work in the field of electrophysiology (EP)? Truthfully, EP chose me. I was looking for a job in cardiology, having worked primarily in that area for many years, including CCU. I was called by a friend to interview for a position in a new department called electrophysiology. I had not heard of EP at that time. At my interview, I heard my first description of the EP lab from the new medical director, Dr. William Welch. He decided to give me the opportunity to work in the lab. I have been here 17 years, primarily in the role of staff RN, team leader and manager.

Describe your role in the EP lab. What is a typical day like for you? Our lab has grown from 1 to 3 electrophysiologists and from a staff of one to a staff of 10. I still work in the rooms with EP studies and implants, but find management responsibilities take consistently more of my time. I manage staffing, including hiring, work schedules and performance; supply and equipment purchases; and device inventory. I work closely with hospital coders and the billing department. We are a Magnet hospital, and I am responsible for helping my staff with educational and career development. I also oversee Joint Commission and other regulatory standards in the lab. I have recently been involved in the initiation of a system-wide electronic medical record. I serve on various committees in our hospital, develop and update policies, and coordinate our AICD Support Group. I was also involved in the construction of our EP lab 12 years ago, and a few years ago, the addition of our second invasive room.

What is one of the more unusual EP cases that you have ever been involved with? We have had many challenging cases. Some of these involve venous access, especially during bi-v implants. We have also had sedation challenges during procedures. Nurses have to be resourceful in the EP lab.

What aspects of your work do you find most rewarding and/or challenging? It has been challenging, but very exciting to be part of the changes that have occurred within the scope of electrophysiology. We treat many rhythm disturbances through ablation or device implants that could not be treated until a few years ago. I love patient contact. Developing and working with our AICD support group for the last 16 years has been a wonderful experience. I have made countless friends among our patient population and hopefully we have simplified their lives with their AICD implant.

Describe your work with the AICD support group at Carilion Roanoke Memorial Hospital. What patient concerns do you most often hear? I started the support group less than a year after the EP lab opened in 1991. We met with 40 patients and spouses in the first meeting. Since that meeting we have had terrific support from our hospital and also from our patients. We plan 2 to 4 meetings per year. Our doctors, device representatives, cardiac rehab nurses, pharmacists, cardiac surgery clinical nurse specialist, nutritionists, and others assist us with presentations. Topics include device updates, congestive heart failure, dietary instruction, and assistance with the psychological aspects of living with an AICD. Patients at the meetings are relieved to hear from other patients that many do not get routine shocks. The possibility of receiving a shock is one of the most serious concerns. Many describe their gratitude that the shock saved their life. I actually met a patient who went home from the hospital and sat in his recliner and waited for a shock for over a year. He was immobilized by fear of the shock. We try to educate the hospital nurses regarding the serious problems patients must face, such as shock therapy, activity level including driving, worsening heart disease and death. We are now initiating a more intense education program in the hospital with post discharge follow up from the EP lab staff.

What personality traits do you think are important for a cardiac nurse to have? A cardiac nurse must be analytical, observant, and quick to respond to a crisis, and must have patience to work long procedures. They must also be warm and caring and like to work with patients and staff. A respect and appreciation for machines and technology is certainly valuable.

What advancements do you hope to see in the field of cardiac electrophysiology in the next five years? What specific areas of EP and/or patient care need more attention? I hope that leadless devices are in our future. We have so much wireless technology; I know there is a brilliant engineer out there who can apply similar technology to pacemakers and defibrillators. I believe we will have much improved atrial fibrillation therapies, either surgical or ablation. Improvements in bi-v implants have occurred over a short period of time, and I am sure even easier procedures will be developed. I have seen many changes in steerable catheters, size and function of devices, ablation catheters, and improved electrophysiology computer systems. The sky is the limit with five more years of research.

What advice would you give to EP allied professionals who are currently at the start of their career? Stick with it. The work is demanding and encompasses long hours. Planning a life outside the lab is difficult. However, it is a fascinating place to work. Technology improves monthly. EP professionals are elite in that there are few of them and they are highly skilled. Electrophysiology is a chance to become part of the fasting growing specialty in cardiology. (I was given this information 17 years ago and it is still true!)

Has anyone in particular been helpful to you in your growth as an EP professional? I am grateful to Dr. Welch and to the hospital system who gave me the opportunity to work in the lab. My senior director, Charlie Cole, has been invaluable in helping me to develop and expand the lab. I am also grateful to my family, who has waited to share many late-night dinners with me after work.

Is there anything else you'd like to add? I work with a special team of physicians, nurses and techs in our EP lab at Carilion Clinic. They prove every day that patients are the most important reason we do what we do. I could not do my job without their daily support.