10-Minute Interview: Melanie Gura, RN, MSN, CNS, FHRS, FAHA

Melanie T. Gura, RN, MSN, CNS, FHRS, FAHA, is the Director of Pacemaker & Arrhythmia Services at Northeast Ohio Cardiovascular Specialists in Akron, Ohio. In this article, she describes the importance of the IBHRE exam as well as provides some valuable advice for allied professionals. 

Why did you choose to work in the field of electrophysiology (EP)?

My professional nursing career began at the patient's bedside in the coronary care unit. During those years, I was fortunate to identify the areas of clinical practice that I enjoyed the most and to develop my professional strengths. I was very interested in the mechanisms of arrhythmias and the technical aspects of pacing. There was so much to learn, and I found this subspecialty very exciting and challenging. As the field of pacing and EP continues to evolve, so does my enthusiasm and excitement not only for myself, but also for my colleagues. In my first letter to the allied professional community as NASPE/CAP Chair 2000-2001, I stated that I believed we were entering the Golden Era of pacing and EP. Remarkable technical and conceptual advances continue to occur in our subspecialty, bringing extraordinary opportunities to improve patient care and expand our horizons.

Describe your role as Director of Pacemaker and Arrhythmia Services. What is a typical day like for you?

The Heart Group and Akron Cardiology Consultants recently merged practices to form Northeast Ohio Cardiovascular Specialists (NEOCS). Our practice has 32 cardiologists and 260 clinical and clerical staff in seven locations in Summit, Portage, Wayne and Medina counties in Northeast Ohio. Our pacing and arrhythmia services division consists of three board-certified electrophysiologists, advanced practice nurses, registered nurses and technologists. Since we serve multiple locations, we consider our service as one without walls. My duties consist of managing, monitoring, coordinating and facilitating the provision of nursing and technology-based interventions and therapies to offices and hospitalized patients in our service. Fortunately, the majority of my week is spent in the clinical arena. My typical day begins with a review of the schedule to confirm we have the appropriate staff for the day. We evaluate approximately 70 patients a day with implanted devices. In addition to these patients, I also see cardiac patients for follow-up office visits in collaboration with our physicians. I seem to have the best of both worlds.

What is the most bizarre or unusual case you have ever been involved with?

The most bizarre and unusual case that I remember was the first time I saw open chest massage at the bedside in the coronary care unit. However, there are many unusual cases that occur in the EP world.

What aspects of your work do you find most rewarding and/or challenging?

The most rewarding and challenging aspects of my work have been my involvement and activity in professional societies for the advancement of quality patient care. My most rewarding professional moment was when I received the Heart Rhythm Society's Distinguished Service Award in 2002. It has been my privilege to serve HRS throughout the years.

Outside of your role as Director, what other projects or groups are you currently involved with? (i.e., research or writing projects, etc.)

Currently, I am on the writing committee of the International Board of Heart Rhythm Examiners (IBHRE), formerly NASPExAM^®, and the Heart Rhythm Society (HRS) Membership Committee. I am the HRS representative on the Task Force Writing Committee for the Scope and Standards of Cardiovascular Nursing. This document will be published by the American Nurses Association later this year. I also serve on the Nursing Education Committee of the American College of Cardiology (ACC). This committee is in the planning stages of developing a Core Curriculum education package that will address the learning needs of the entry level cardiovascular nurse to the master level. The Cardiovascular Nurse Curriculum is to be based upon Scope and Standards of Cardiovascular Nursing, 2007. I am also the Cardiac Care Associate (CCA) Committee Chair for the Ohio Chapter of the ACC, and the Ohio State CCA liaison for the ACC. I serve as the nurse planner for the conference entitled Arrhythmias in the Real World 2007, which is co-sponsored by both the ACC and HRS. It will be presented at the Heart House, Washington, D.C., September 6 - 8, 2007.

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?

My wish list includes a leadless ICD system, as well as a pacing system that is MRI-safe, both of which are on the horizon. More research into gene and cell therapy will allow us to test hypotheses about mechanisms of cardiovascular disease and tailor therapy accordingly. The application of genomics will allow us to improve healthcare, identify patients at risk for cardiovascular disease, unusual drug responses and identify targets for the development of new anti-arrhythmic drugs.

Are there any particular Web sites or texts you would recommend to others in the field of EP?

Web sites: www.acc.org www.cardiosource.com www.medscape.com www.hrsonline.org www.heartauthority.com www.IBHRE.org Textbooks: Ellenbogen KA, Kay GN, Lau CP, Wilkoff BL. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy, 3rd Edition. 2007. Philadelphia: Saunders. Saksena S, Camm AJ. Electrophysiological Disorders of the Heart. 2005. Philadelphia: Elsevier. Policy Statements and articles that apply to the AP in Pacing and EP: HRS Policy Statement: Gura MT, Bubien R, Taibi B, Belco K, Schurig L, Wilkoff B. (2003). Standards of Professional Practice for the Allied Professional in Pacing and Electrophysiology. PACE 2003:26:127 - 131. Gura MT. Clinical considerations for the allied professional: Standards of professional practice for the allied professional in electrophysiology and pacing. Heart Rhythm 2004:1(2):250 - 251. Journal Issue dedicated to Pacing and EP: Mannos D, Gura MT, Shea J. (Guest Editors). Device Therapy. AACN Clinical Issues: Advanced Practice in Acute and Critical Care. 2004:15(3).

What advice would you give to EP allied professionals who are currently at the start of their career?

Identify a mentor, develop a sense of professional pride, place value on lifelong learning, and be willing to mentor others. Allied professionals in our specialty must support one another. Those new to our specialty require guidance, encouragement, and mentoring. Those of us who have more experience must come to believe that mentoring is our professional responsibility, as well as an opportunity for growth. In order for us to evolve into quality care practitioners, each of us will need to play the role of both mentor and mentee throughout our professional careers. I encourage you to study and sit for the IBHRE Examination, formerly NASPExAM^®. Studying for the IBHRE examination can assist you in the acquisition of our discipline's specialized knowledge and improve your clinical skills. Successfully passing the examination affirms the specialty knowledge and skills needed to deliver high-quality care to patients with cardiac rhythm disorders. Other benefits include peer respect and professional recognition, career advancement with increased autonomy, the ability to meet competency standards, better job security with health care reform and downsizing, recognition by the community and third-party payors as a quality provider, and personal growth and satisfaction.

Has anyone in particular been helpful to you in your growth as an EP professional?

Dr. Philip H. Keyser launched my career in pacing and EP, and has continued to mentor me throughout the years. My nursing mentors throughout the years are Rosemary Bubien, RN, MSN, CNS, FAHA, FHRS and Suzanne Hughes, RN, MSN, FAHA. Betsy Bogdansky from the HRS mentored me throughout my service to HRS. Dr. Michael Pelini and Dr. Jason Smith are two of our electrophysiologists that have recently started to mentor me.

Is there anything else you'd like to add?

I encourage allied professionals in our field to join and become active in their professional societies. Our professional societies function as our advocate to promote quality care for our cardiovascular patients. They lead the way for research promotion, education and healthcare polices and practice guidelines. Attend at least one major annual scientific session a year if possible. HRS, ACC and AHA annual scientific sessions are venues for state-of-the-art education. One of the greatest benefits of involvement in a professional society is the opportunity to network and interact with colleagues across the U.S. and beyond. Different disciplines bring unique knowledge and perspectives to the art and science of providing patient care. This will facilitate in the development and fulfillment of one's potential.