The Ten-Minute Interview with: Kathy Groce, RN
March 2006
In January 2005, I returned from a 120-day deployment to Balad, Iraq. My job there was as an officer in charge of the Aeromedical Evacuation (AE) crew management cell. Our seven-person crew management cell was responsible for ensuring that our five AE crews were ready in every way to fly urgent medical missions out of Balad, Iraq, to Germany. An urgent mission for us was one that involved moving a critical patient to save life, limb, and eyesight or to prevent further dire complications. The largest medical treatment facility for our military in Iraq is the Air Force Theater Hospital, located at Balad Air Base. Wounded soldiers, airmen, sailors and marines are brought to Balad prior to being medically air-evacuated to Germany. Our AE crews consisted of a minimum of one flight nurse and two AE technicians or a Critical Care Transport Team, which was a team consisting of a medical intensivist, a critical care nurse and a cardio-respiratory technician. These crews rarely ever flew daytime missions; they spent long hours in the back of a C17 aircraft taking great care of our wounded heroes. We helped a lot of people during that time…and I am quite sure that those who preceded us and those after us have done the same.
At present, one of my primary concerns is preparing new flight nurses and AE technicians to go to Iraq or to meet the local challenges that nature brings our way, such as Hurricane Katrina. Our unit is one of 10 Air National Guard Aeromedical Evacuation Squadrons in the United States tasked to support their state’s homeland security mission and the ongoing efforts in OPERATION IRAQI FREEDOM. Why did you choose to work in the invasive cardiology field? After obtaining a great critical care (coronary care) education at Mercy Hospital in Charlotte, NC, I found that I was intrigued by the function and dysfunction of the heart and the cardiovascular system, and was determined to learn as much as I could about it. I was particularly interested in hemodynamics and dysrhythmias, and wanted learn how and when to anticipate changes in both. The cardiologists I worked with were great teachers and they also helped inspire and challenge me to learn more. Our most intense clinical challenges back then were dealing with left heart failure and cardiogenic shock. Luckily, my intrigue and a job transfer to the cardiovascular lab occurred just as interventional procedures were beginning, so I was quickly ushered into the brave new world of interventional cardiology. Can you describe your role in the cardiovascular (CV) lab? I worked as a registered nurse in three different CV labs during my growth in nursing, and in each setting, my role as a CV technologist meant that we rotated in each of the jobs, scrubbing in with the cardiologist, recording and monitoring events, and circulating in the room during the procedure. Since I was a CV nurse, I often was asked to provide in-services for nurses in the critical care units on topics such as assisting with intra-aortic balloon insertion, care of patients on the intra-aortic balloon pump (IABP), sheath removal and hemodynamics. What is the biggest challenge you see regarding your role in the CV lab? Although I am not currently working in the CV unit, one of the biggest challenges I see is staying abreast of the new cardiovascular technologies, treatments and medications that are being used to treat cardiac problems. What motivates you to continue working in the CV lab? My greatest motivator when I worked in the CV lab was the personal satisfaction I got from knowing that I had been a positive part of a patient’s life that day. The cardiac catheterization procedure tends to become routine for the personnel who do it every day, but it is never routine for the patient lying on the table. Patients and their families do not forget the kindnesses shown to them and their families during this stressful event in their lives. The collegial atmosphere and the mutual respect that developed between the CV staff and the cardiologists with whom we worked also motivated me. We were all one team and worked in an atmosphere of respect. What is the most bizarre case you have ever been involved with? The most memorable case for me was bizarre only because of the immediate changes that took place when a normal-appearing left heart catheterization went downhill. I remember it like it was yesterday. Several injections of the patient’s left coronary artery appeared to be normal. Then after an injection of the LAD, for a brief moment, I thought I saw a shadow of something that didn’t look right. Naturally, I questioned myself and presumed that I was wrong. We injected the LAD again and this time the cardiologist also saw that shadow. A replay of the view confirmed that a dissection had definitely occurred in the LAD and it seemed that instantaneously, the case became emergent. This patient began experiencing chest pain, her blood pressure dropped, and she became diaphoretic and unstable. From that point on, the CV staff went into overdrive. Within minutes we had inserted an intra-aortic balloon, notified the CVOR and a surgeon, and were talking with family, getting consents, and moving the patient across the hall to surgery. The lesson I learned from this case was to always trust my gut and to speak up during a case, even if I could be wrong. Complications can and do occur unexpectedly in invasive procedures. A replay of that first injection would not have changed the outcome for the patient, but I will always wonder. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? When my morale needs a boost, I try to do something to help someone else. Getting outside my own problems and doing something positive rather than dwelling in the negative is helpful. I also regularly share my concerns confidentially with a friend and try to seek answers or clarity about what is bothering me. Sometimes friends can help more than anything. And really good friends will even tell you when it is you that needs to change! Are you involved with the SICP or other cardiovascular societies? I am not currently involved with cardiovascular societies, but maintain membership in the American Nurses Association, the North Carolina Nurses Association, Sigma Theta Tau, and American Medical Society of the United States (AMSUS) Do you remember participating in your first invasive procedure? I remember few details about the very first experience in the cardiovascular lab. What I do recall was that the experience was extremely overwhelming. As a critical care nurse, I felt comfortable with my nursing knowledge and skills, but when I moved to the cardiovascular lab, I remember feeling like I had started all over again. Everything about the experience was new and different for me. I remember trying to grapple with understanding hemodynamics, reading right and left heart waveforms, calculating cardiac outputs and valve areas, making sense of what seemed to me to be confusing views of the coronary arteries, learning to operate different types of equipment and developing film in the dark room. Even though I felt totally overwhelmed with the information and probably made lots of mistakes early on, I was genuinely curious and motivated to excel as a technologist, and to get involved and learn something with every case. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? First of all, don’t get discouraged. Be patient. Take each day of learning just one day at a time, and eventually all the pieces will fall into place and you will enjoy every part of being a cardiovascular specialist. Also, don’t stop learning. Open yourself up to new experiences and try to see each learning experience through the eyes of the teacher. I was fortunate to have some extremely good teachers when I was a novice in the CV lab. Find someone who will take you under his or her wing and teach you well. Where do you hope to be in your career when it is time to retire? When I retire, I hope to have completed a PhD in Nursing and be involved in helping nursing students in whatever capacity that I can or doing relevant nursing research. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Absolutely! My first mentor in the cath lab was Chuck Williams, RPA, RT(R). We worked together at two cath labs in two different hospitals for about seven to eight years. He impressed upon me the importance of learning the technical aspects of each of the jobs in the lab, from hemodynamics, the details of cardiac anatomy and physiology, to understanding radiology. He was instrumental in my development as a total cardiovascular technologist and challenged me to always stay a step ahead.
Other vitally important professionals and friends who helped me grow were Scott Cameron, Rhoda Hammer, Deborah Turner, Sarah McNeal, Pam Rojas, Sonya Hardin, Sue Head, Pauline Mayo, Sally Nicholson, Mary Patelos, George Stokes, Ira and Barbara Hutchison, Renee Morgan, Tara Romine, Betsy Cobb, Betty Wilson and Donna Ackley.
Some excellent and impressive teachers were cardiologists Drs. Joel Webster, Ravi Rao, Jonathan Mclean, William Roberts, Gary Niece, and Mark Kremers. I owe each of these folks a debt of gratitude for inspiring me and pushing me towards excellence. Where do you think the invasive cardiology field is headed in the future? I think that minimally invasive cardiology will eventually be the norm for treating most cardiac problems that require any intervention. Just in my brief experience in the CV lab, our methods, equipment and technology changed dramatically in order to reduce procedure and recovery time for patients. The breadth of imagination is the only limitation for what can be done.
At present, one of my primary concerns is preparing new flight nurses and AE technicians to go to Iraq or to meet the local challenges that nature brings our way, such as Hurricane Katrina. Our unit is one of 10 Air National Guard Aeromedical Evacuation Squadrons in the United States tasked to support their state’s homeland security mission and the ongoing efforts in OPERATION IRAQI FREEDOM. Why did you choose to work in the invasive cardiology field? After obtaining a great critical care (coronary care) education at Mercy Hospital in Charlotte, NC, I found that I was intrigued by the function and dysfunction of the heart and the cardiovascular system, and was determined to learn as much as I could about it. I was particularly interested in hemodynamics and dysrhythmias, and wanted learn how and when to anticipate changes in both. The cardiologists I worked with were great teachers and they also helped inspire and challenge me to learn more. Our most intense clinical challenges back then were dealing with left heart failure and cardiogenic shock. Luckily, my intrigue and a job transfer to the cardiovascular lab occurred just as interventional procedures were beginning, so I was quickly ushered into the brave new world of interventional cardiology. Can you describe your role in the cardiovascular (CV) lab? I worked as a registered nurse in three different CV labs during my growth in nursing, and in each setting, my role as a CV technologist meant that we rotated in each of the jobs, scrubbing in with the cardiologist, recording and monitoring events, and circulating in the room during the procedure. Since I was a CV nurse, I often was asked to provide in-services for nurses in the critical care units on topics such as assisting with intra-aortic balloon insertion, care of patients on the intra-aortic balloon pump (IABP), sheath removal and hemodynamics. What is the biggest challenge you see regarding your role in the CV lab? Although I am not currently working in the CV unit, one of the biggest challenges I see is staying abreast of the new cardiovascular technologies, treatments and medications that are being used to treat cardiac problems. What motivates you to continue working in the CV lab? My greatest motivator when I worked in the CV lab was the personal satisfaction I got from knowing that I had been a positive part of a patient’s life that day. The cardiac catheterization procedure tends to become routine for the personnel who do it every day, but it is never routine for the patient lying on the table. Patients and their families do not forget the kindnesses shown to them and their families during this stressful event in their lives. The collegial atmosphere and the mutual respect that developed between the CV staff and the cardiologists with whom we worked also motivated me. We were all one team and worked in an atmosphere of respect. What is the most bizarre case you have ever been involved with? The most memorable case for me was bizarre only because of the immediate changes that took place when a normal-appearing left heart catheterization went downhill. I remember it like it was yesterday. Several injections of the patient’s left coronary artery appeared to be normal. Then after an injection of the LAD, for a brief moment, I thought I saw a shadow of something that didn’t look right. Naturally, I questioned myself and presumed that I was wrong. We injected the LAD again and this time the cardiologist also saw that shadow. A replay of the view confirmed that a dissection had definitely occurred in the LAD and it seemed that instantaneously, the case became emergent. This patient began experiencing chest pain, her blood pressure dropped, and she became diaphoretic and unstable. From that point on, the CV staff went into overdrive. Within minutes we had inserted an intra-aortic balloon, notified the CVOR and a surgeon, and were talking with family, getting consents, and moving the patient across the hall to surgery. The lesson I learned from this case was to always trust my gut and to speak up during a case, even if I could be wrong. Complications can and do occur unexpectedly in invasive procedures. A replay of that first injection would not have changed the outcome for the patient, but I will always wonder. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? When my morale needs a boost, I try to do something to help someone else. Getting outside my own problems and doing something positive rather than dwelling in the negative is helpful. I also regularly share my concerns confidentially with a friend and try to seek answers or clarity about what is bothering me. Sometimes friends can help more than anything. And really good friends will even tell you when it is you that needs to change! Are you involved with the SICP or other cardiovascular societies? I am not currently involved with cardiovascular societies, but maintain membership in the American Nurses Association, the North Carolina Nurses Association, Sigma Theta Tau, and American Medical Society of the United States (AMSUS) Do you remember participating in your first invasive procedure? I remember few details about the very first experience in the cardiovascular lab. What I do recall was that the experience was extremely overwhelming. As a critical care nurse, I felt comfortable with my nursing knowledge and skills, but when I moved to the cardiovascular lab, I remember feeling like I had started all over again. Everything about the experience was new and different for me. I remember trying to grapple with understanding hemodynamics, reading right and left heart waveforms, calculating cardiac outputs and valve areas, making sense of what seemed to me to be confusing views of the coronary arteries, learning to operate different types of equipment and developing film in the dark room. Even though I felt totally overwhelmed with the information and probably made lots of mistakes early on, I was genuinely curious and motivated to excel as a technologist, and to get involved and learn something with every case. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? First of all, don’t get discouraged. Be patient. Take each day of learning just one day at a time, and eventually all the pieces will fall into place and you will enjoy every part of being a cardiovascular specialist. Also, don’t stop learning. Open yourself up to new experiences and try to see each learning experience through the eyes of the teacher. I was fortunate to have some extremely good teachers when I was a novice in the CV lab. Find someone who will take you under his or her wing and teach you well. Where do you hope to be in your career when it is time to retire? When I retire, I hope to have completed a PhD in Nursing and be involved in helping nursing students in whatever capacity that I can or doing relevant nursing research. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Absolutely! My first mentor in the cath lab was Chuck Williams, RPA, RT(R). We worked together at two cath labs in two different hospitals for about seven to eight years. He impressed upon me the importance of learning the technical aspects of each of the jobs in the lab, from hemodynamics, the details of cardiac anatomy and physiology, to understanding radiology. He was instrumental in my development as a total cardiovascular technologist and challenged me to always stay a step ahead.
Other vitally important professionals and friends who helped me grow were Scott Cameron, Rhoda Hammer, Deborah Turner, Sarah McNeal, Pam Rojas, Sonya Hardin, Sue Head, Pauline Mayo, Sally Nicholson, Mary Patelos, George Stokes, Ira and Barbara Hutchison, Renee Morgan, Tara Romine, Betsy Cobb, Betty Wilson and Donna Ackley.
Some excellent and impressive teachers were cardiologists Drs. Joel Webster, Ravi Rao, Jonathan Mclean, William Roberts, Gary Niece, and Mark Kremers. I owe each of these folks a debt of gratitude for inspiring me and pushing me towards excellence. Where do you think the invasive cardiology field is headed in the future? I think that minimally invasive cardiology will eventually be the norm for treating most cardiac problems that require any intervention. Just in my brief experience in the CV lab, our methods, equipment and technology changed dramatically in order to reduce procedure and recovery time for patients. The breadth of imagination is the only limitation for what can be done.
NULL
