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10-Minute Interview

The Ten-Minute Interview with… Jennifer Titzer, RN, RT, RCIS

October 2008
Write a 2-to-3 sentence biography that introduces you personally and professionally. I started my career in healthcare as a radiologic technologist (RT). I cross-trained in special procedures and found that I loved invasive procedures. I wanted to increase my knowledge of nursing care and pharmacology, which led me back to nursing school. I then transferred from the special procedures area to the catheterization laboratory, which allowed me to gain extensive nursing experience while still utilizing my radiology background. I was encouraged by my supervisor in the cath lab to sit for the registered cardiovascular invasive specialist (RCIS) exam, so I took and passed the exam in 2002. Since then, I have worked in inpatient and outpatient cardiovascular and peripheral vascular labs, as well as moved into the education field. I currently teach full time at the University of Southern Indiana in the Radiologic and Imaging Sciences. Why did you choose to work in the invasive cardiology field? I love learning and teaching others about cardiovascular diseases. I enjoy the challenge of learning the new technologies involved in the diagnosis and treatment of cardiovascular disease. I also find it very satisfying to be able to assist in the diagnosis and treatment of patients. With the new endovascular treatments for cardiovascular (CVD) and peripheral vascular disease (PVD), the invasive cardiology field will continue to grow. I have also found a new passion for the education and prevention of CVD; I think it is the new “treatment.” Describe your role in the CV lab. My role evolved as credentials were added to my name. I began my career as an RT in special procedures with no RNs in our suite. We were responsible for all patient care, conscious sedation, scrubbing, documentation and imaging. Working in such an all-encompassing role is what led me to nursing. I moved to the cath lab as an RT and was able to scrub and monitor on cases. When I graduated from nursing school, I was then able to circulate on cases. In our lab, the RNs are able to work in all three roles. In Indiana, an RN is eligible for a Limited Cardiac Catheterization Radiology License after documentation of the requisite curriculum and clinical requirements. The RTs are not able to circulate because it requires the administration of medications. We currently have no registered cardiovascular technologists (RCVTs) working in our lab. However, I feel that an RCVT would be a great asset to a lab. I would like to see a program initiated in our state that would allow the introduction of RCVTs to our area. What is the biggest challenge you face in your role in the CV lab? My biggest challenge has been working on BOTH sides. When I first started in the cath lab, there was a very visible line drawn between RTs and RNS. I had an RT tell me to take a seat after scrubbing because it was the RN’s job to take care of the patient. Having come from a lab where I performed all roles, I found it difficult to accept. Obviously, I did not take her advice. I felt that working as a team was better for patient care. I am happy to say that is not the situation today. There is a much better working relationship with great respect between the RTs and RNS. I find that sometimes roles are assigned by tradition and some professionals are not open to change. What’s most important for the cath lab is that its team members be qualified and educated, working according to their particular experience and strengths within their scope of practice. What motivates you to continue working in the cardiovascular laboratory? The outpatient lab I was working in closed a year ago. I found myself not working in a lab for the first time in 16 years. After a year, I found that I missed the patient interaction and technology, so I am now working on a part-time basis in a lab while teaching full time. What is the most bizarre case you have ever been involved with? The most bizarre case was early in my career when a radiologist inserted a wire into the patient’s brachial artery. We then snared it through the femoral artery, using a “dental floss” technique. I was amazed. Today that technique is used much more frequently and is not as shocking as it was when I first saw it used. When work gets stressful and you experience low moments (as we all do), what do you do to help maintain your morale? It helps to remember how fortunate we are to work in a setting where we can have such a positive impact on someone’s life. Also, in the labs I have worked in, my coworkers have been one of the best things about the job. You become an extended family that you have for life, which is so hard to find in a job. I also make sure to take time for self care. I work out on a regular basis, eat relatively healthy and spend time doing things I truly enjoy. I think that as health professionals, we need to be role models for our patients. It is hard to talk with patients about CVD and PVD when we ourselves don’t follow the advice. Are you involved with the SICP or other cardiovascular societies? Yes. I have just become involved with the SICP and wish I had become more involved earlier. Are there Web sites or texts that you would recommend to other cardiovascular laboratories? Since beginning a career in education, I use the Internet for resources daily. I use Medscape for CEs, www.cathlabdigest.com, www.americanheart.org, www.vascularweb.org. Of course, I always recommend Morton Kern’s CCL handbook for anyone new to the CCL. Do you remember participating in your first invasive procedure? Can you describe what it was like and how you felt? My first interventional procedure was back in 1992, and we were using Palmaz stents that had to be hand-crimped! I was scared to death that I was not going to get it crimped tightly enough and that it would fall off during delivery. Then, of course, out would come the snares, the biopsy forceps, or as a last-ditch effort, a surgeon to perform a cut-down! If you could send a message back to yourself at the beginning of your cardiovascular laboratory career, what advice would you give? Learn all you can from the doctors and others working in the lab. Don’t fight taking the RCIS; it won’t kill you! Pay more attention in your electrophysiology studies; you may need to know the answers to the questions a physician asks you some day during a procedure. Also, don’t remove any towels unless you are certain the physician has not clipped the catheter to it. And when Dr. Schen is hooking up the pressure injector, DUCK! Where do you hope to be in your career when it is time to retire? Currently, I am finishing up my graduate degree in nursing. I saw a job advertised the other day that I would love. It involves working in a cath lab as a nurse practitioner performing patient histories and physicals, groin assessments, discharging patients and coordinating staff and patient education. I would also like to get more involved with evidence-based practice within the cath lab and the prevention of CVD and PVD. In other words, there are so many options — who can choose just one? Has anyone in particular been helpful to you in your growth as a cardiovascular professional? The first person who was instrumental in my career was Linda Winchell, an RT who introduced me to special procedures. She was very particular about how things were done and kept me on my toes. She taught me the importance of “details.” From there I have had many mentors to follow. It would be hard to give all of them credit. I owe a special thanks to all the cath lab RNs who were willing to take me on as a new graduate nurse at St. Mary’s Medical Center. They knew I had the radiology and peripheral vascular knowledge, but I had never worked in a cath lab. They taught me so much. Where do you think the invasive cardiology field is headed in the future? I think that invasive cardiology will continue to grow with the development of new device and imaging technologies. We are already seeing tools used in the past become more advanced and user-friendly. I think that vascular imaging will change, with an increased use of computed tomographic angiography for diagnostic procedures. This will improve invasive interventional procedures performed in the lab. Greater use of cross-trained individuals and CVTs as part of the vascular team is something that I see happening in the future as well. Jennifer Titzer can be contacted at: jltitzer@usi.edu
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