IR: the hidden gem of the hospital

Episode Transcript

Recorded live from the Cook booth at SIR and featuring leading experts in the field of interventional radiology discussing a wide range of IR-related topics, this is the Cook@ SIR Podcast Series.

Welcome to today’s episode coming to you live at SIR. I’m Dr. Grace Knuttinen, and I’m thrilled to be here with Bianca Sorensen, one of our IR nurses, as we dive into a critical topic that’s really close to our hearts: the hidden gem of the hospital. And I think that’s why Bianca and I were talking about how we love the topic of this episode, because it really prompts people to think about, What are we actually talking about today? What is the hidden gem of the hospital? You see, minimally invasive procedures, we all know it’s a future of medicine in our specialty, from treating blocked arteries to cancer with an incision that’s smaller than your fingertip. But truly, the average person still hasn’t heard of the specialists behind the scenes who really make it all happen. Welcome to the world of interventional radiology, the hidden gem of the hospital.

The hidden gem. I love that analogy for obvious reasons, but also because it’s a perfect way to describe the specialty. I’ve quickly found that, just like a gem, there are many facets that make interventional radiology unique.

And as a nurse, Bianca, I mean, I know that you’ve worked in multiple different specialties, and we were honored when we finally got you down here in IR, but can you speak from both an outsider’s perspective and someone who is now currently working with us in the field of IR?

Right. What’s crazy is that I had been a nurse for seven years before I came to IR after working in ICU and med-surg, and I had no idea what interventional radiology nurses did or what really went on down there in this mysterious room. As an ICU nurse, I knew that I would send my patients off to IR if they were having a GI bleed, and then they would come back to me magically fixed, or I would recover patients after cerebral angiograms, but like I said, it was all mysterious and I didn’t really understand how these things were happening. As nurses, we all know about the ICU, the emergency room, OR, L&D, nursing, but IR is not as familiar.

So then, Bianca, how did you get into this specialty, I mean, if you didn’t really know what the job was?

Honestly, really just by chance. I had done travel nursing prior to coming to IR, and after I finished travel nursing, I thought that I was ready to leave hospital nursing jobs completely. I kind of thought my only options if I stayed were bedside positions, management, or education, so I started looking at medical device sales or work-from-home options, and then I kind of stumbled upon this posting for an interventional radiology nurse job. So I figured that I would just try it out, see what it was about, and I thought, “If I don’t like it, I can just quit.” But I’m so grateful I did, because this job has really opened my eyes and inspired me to remind other nurses that they have so many options for their careers that don’t just involve being at the bedside. And I found that there’s so little information out there about interventional radiology and what we actually do. I love sharing about this specialty and opening people’s eyes.

Yeah, so that’s really interesting. I actually had the privilege of speaking yesterday at the AVIR meeting, and that was exactly one of the topics that came out. It was about recruitment into the specialty, really understanding the collaboration that works with our allied health workforce, nursing and techs. And so the session really revolved around, What can you see the specialty doing to really recruit more techs and nursing into interventional radiology?

Yeah, I mean, I think I’ve found, really, just word of mouth and, in this day and age, social media, I feel like, is a very powerful tool. It’s kind of like the new Google, like that’s how people are finding out information, so obviously within reason, sharing about our specialty online has been a passion of mine. I love sharing with other nurses and, like I said, opening their eyes to our field. I think that’s been a major way that people have been able to explore options that they have within the nursing specialty. And even for techs, rad techs, they get their eyes open just from seeing videos about what we actually do and procedures that we do. I think that’s a really great way for them to disseminate the information because it’s available for everyone. It doesn’t have to be just at a talk that we’re doing here for people to get the information. This information is available for everyone.

Yeah. It’s so interesting, because I mean even when I tell people that I’m a radiologist, they think all I do is to sit in a dark room all day and look at images, and I don’t like to sit in dark rooms. So it is interesting to our specialty. I feel we really need to put ourselves out there and, like you say, almost get with the times and realize the different tools and the availability of social media and other recruitment working through industry and helping them support us. I think all of those work with us to really open people’s eyes to what we do, both from an interventional radiology perspective, but also from the nursing and the tech side of things too.

Yeah. There is kind of this obscurity of our specialty, and I think that also can play into the patients’ anxiety and unease when they come to us. They’re told they have a cancer diagnosis and they’re going to go get their port placed in interventional radiology. Not only are these patients anxious about their new diagnosis, but where are they going for their port? Interventional radiology? What is that? It sounds kind of scary. Most people can envision what an OR looks like, because that’s kind of mainstream. You see it on TV. You know what the ER looks like, you see that on TV, but not an IR suite. I’ve actually had so many patients, they frequently tell me after their procedures finish, “Wow, that was not as bad as I thought it was going to be.” And I think it’s largely because they have no idea what to expect, so they just are kind of thinking the worst before they come to us, just because everything about our specialty is so unfamiliar to people.

Yeah. I mean, I think it’s interesting because one of the things that is important is that sometimes patients not be brought directly to the IR radiology suites. I mean, I know you go up and you talk to the patients and you tell them, like you said, they’re going to come for a port, but what does that really mean? What are their surroundings going to look like? What is the environment? Who are the people that they’re going to run to around their way when they get down for procedures? So I think it’s nice when we have the opportunity, when we create opportunities to really let the patients know what goes behind the scenes and maybe getting them down to preprocedural units and really having the team, whether it’s the nurse, the tech, and the physician come and talk to the patient and tell them about the procedure and maybe have hands-on where they can actually see what the port, for example, looks like, or the coils that we’re going to use. I think that really speaks a lot in terms of going to the patient rather than the patient coming to us. And I think that also kind of lends itself to developing new apps or new opportunities to maybe be on app creation and develop ways to sort of explain procedures, I guess, that can be more open to the patients and their availability to really see what’s happening.

I think—I know one thing I do when I see some of my patients in clinic that I know that I’m going to be doing procedures on, one of the things I do is, I actually recommend them to see the “Without a Scalpel” that has been put on by the interventional radiology folks, because I think it’s very powerful. I tell them, “Hey, you got to watch this video about, for example, the uterine fibroid embolization, because not only does it tell you about the procedure, but you can kind of see what the angio suite looks like. What is this big camera that’s going to be around you? Who’s going to be there? What’s going to be happening?” Because I think sometimes patients come down for a procedure and they look around, and it’s almost like, “What am I doing here? What am I having done?” Without really having them truly understand what’s going to be happening.

Right. I think that visual, especially knowing what you’re getting into before you come, is definitely a great way for them to ease their anxiety a little bit. Just knowing what to expect, I feel like that helps them have a little bit less anxiety and fear on their procedure day if they know what to expect. And I always try to really prepare them before coming back on—obviously depending on what procedure they’re having done—a little bit of a down-and-dirty rundown of what we’re doing: “You’re going to feel some pressure here,” or the pinching and the burn of the lidocaine, just so that they know what to expect.

Yeah. And I think that really brings up another facet of the terminology that we’re using, the hidden gem, because to some extent, I really think it’s actually you, the nurses, the rad techs, who are really the face of interventional radiology when it comes to patient care, when it comes to patient procedures, when it comes to even taking them back to the recovery area. You are the ones that are getting the patients, you’re bringing them into the room. Sometimes you’re the first faces that they see.

And I really think that is a huge difference that really makes, and impacts, the patient’s overall experience in our department. And I think this is where education comes into play in the field, because you, as the nurses by our side, the rad techs by our side, I mean, you also have to know the procedures that we’re doing, too. I know we’re lucky we have rounds in the morning, we talk about the procedures, we have the opportunities to get you involved and to journal clubs and a lot of industry events so that you can also understand what a patient is going to be going through through a procedure. And I think that’s really important, because I think you’re really the face, the first person, that, really ,a lot of these patients are going to see when they’re coming down for procedures.

Right. Definitely. And I think another facet, if you will, is, IR is the perfect example, in my opinion, of a true healthcare team. The relationship that the nurses and rad techs have with the physicians is very unique. Working in the ICU as a nurse, there is a degree of collaboration between the nurses and doctors and obviously all the other modalities that are supporting, but it’s mainly doctors putting in orders, nurses carrying out the orders. If you have some concerns, obviously you bring them to the physician, but that’s really how it works at the end of the day, and at our hospital, specifically, we have nurses that are scrubbed in with the doctors—and I know other facilities, it’s mainly the rad techs—but I feel because you’re working alongside each other, there’s this synergy between you, the two of you, and not even just the two of you. There’s also the circulating nurse, and they’re very much so a part of this team effort, because they have to be in tune with what’s going on during the procedure so that they can effectively keep the patient comfortable, keep them updated on what’s going on. You know, if we are putting in a sheath, if we’re doing some venoplasty, angioplasty, the more painful parts of the procedure, that is very helpful for them to know so that they can effectively keep the patient medicated for those more painful portions and then, obviously, okay, don’t overmedicate them when you need a breath hold or anything. So they’re also very in tune, everyone’s in tune with what’s going on in the room.

Yeah, I mean I think—

And—

I think also, too, I mean we also started where we do these pauses in the IR rooms and we all go around and we introduce ourselves, right? Even though we’ve been working together as a team, because sometimes we have these visiting anesthesiologists or other outside of our little IR team, and so we like to know who’s in the room, and so we say our name, what our role is, and I think that’s really important. I also think, what you talked about, it’s this collaboration that occurs, so I like to see all of you as active participants in the care and the procedures that we’re doing with the patients. It’s not just, “Hand me this.” It’s not just, “Hand me the wire,” or whatever. I mean, it’s because we’re all there for the patient, number one, and, number two, because you’re also the one in post-procedure, when you take them back, and sometimes they wake up and they’re like, “What happened?” And you’re actually the first person that they wake up to. And so, I think it’s really unique, and I almost think it’s such a welcoming environment when we work together and, for example, if I’m doing an intravascular ultrasound on a vein, we gather you round around the IVUS and we talk about what we’re seeing, too, because, like you said, I think it’s important that when patients are going through painful part of the procedures—we all know, rather than I know but nobody else knows, right?—so I think it’s the togetherness, the collaboration that really works not only for the team perspective but also in terms of the patient’s perspective from undergoing the procedure.

Definitely. And I think—at least I can speak for us, specifically—patients have commented after the procedure, “Wow, I can tell you guys are a really good team. You guys enjoy working together. I, as a patient, can see that.” And so, that to me speaks volumes that, as an outsider, they’re coming in and they can tell that we’re just, we have a really good teamwork. And I think that also helps put them at ease, knowing that and seeing that. And it was part of the reason I really fell in love with this specialty after coming. I’m like, “Wow, this is a true teamwork effort. You’re never in any situation alone; there’s always people around. You have three people, at least, in your room, and you’re all focused on one patient, and so whatever things come up, you just tackle it as a team.” And I love that aspect.

Yeah. And I think it’s interesting when—also when we run the board, for example, in the morning, we all know what’s going to be happening in each of the rooms and we go through the procedures, where we’re going to go. And you guys always just, I think the allied health staff always, almost, inspires us to think a little bit more outside the box of what we can do to really bring the patient to a comfort zone if it’s going to be a higher-level procedure, and thinking about, “Should we be all standing on this side of the room or on that side of the room? Where should the IVUS machine be? Where should the ultrasound machine?” All those little things, I think almost decrease—perhaps the word chaos might be too big, but I think just making it a little bit more of a warm and cozy environment when the patients undergo their procedures.

Right, definitely. And I think IR, as a whole, we do support almost every hospital specialty, and I think that is another really unique aspect of our department. When, in nephrology, they need a patient to start hemodialysis, we are the ones who place the lines. When oncology needs their patient to start chemo, we’re going to place the port. And even if a patient has a stroke, then we can do a thrombectomy. And the diversity of the cases and body systems, I think, keep this department so interesting. Even if I work every single day of the week, I will never have the same day twice, just because of all the variety that we get, and I love that aspect.

Yeah, and I think this also brings up the point that—what I think is unique is that, not only that we support all these specialties, but really, it’s the technology that we use to do the procedures is really advancing all the time, and I think that’s so important, where we need industry to also partner with us, create partnerships where they can tie in innovation, what’s going to be out, the leading edge, the cutting-edge stuff that’s going to be coming out looking forward. And they can help foster innovation through R&D and providing advanced technology and really supporting education, all to really create that endpoint of improving patient outcomes.

I know any time we have new devices or new ideas or new tricks, I know we try to really include all of our allied health. I mean, the techs and the nurses in terms of if there’s a new device, they come and they teach all of us, not just the physicians, about what it is, or even sponsoring some journal articles where we distribute them to you guys too, because it’s not just us that really needs to know, but I think it’s also you guys that also have to be partnered with us in terms of innovation and thinking outside the box for new ways to help patients.

Right. And I think that’s part of why IR is so cool. When people use the term “modern medicine,” it really is interventional radiology. None of these things that we’re doing now would have been possible 30, 40 years ago without patients having to undergo a major surgery, because of all the technological advancements, and now these patients can have these procedures done with just a small incision, minimal recovery time, and usually going home the same day, which I think is incredible. And that’s why I feel like this specialty is so underrated. We’re doing all these amazing things, and the outcomes are so much better than a patient having to have a large surgery for something and going through this long recovery time. I think that’s really unique for us, and interesting.

Yeah, I know. I mean, I think technology is going to advance, medicine is going to continue to evolve, and it’s clear—obviously you and I are in the gem of IR, so we get that—but it’s not just the future. I mean, I think it’s here, it’s right now. It’s the present that we live in every day. And I think the procedures are definitely much more minimally invasive. Recoveries are quicker, and the impact is really huge, and I’m really hopeful that the procedures, as they become more common, the gem of IR will no longer be hidden. And so I think when we talk about, taking it back to the topic that we really like here is the hidden gem, right? So it’s the hidden gem of the hospital, right? So it’s being IR and making sure all the teams in the hospital know who we are, but also the hidden gem of you as a staff. You are the hidden gem to the patients. You know, you are the face of what we do. And I think those are the two things that are special about what we do, what we do together. And hopefully, that’s something that people can take away after our podcast, is really going back and looking at the teamwork, the collaboration that exists, what you can do for patient recovery, what you can do for when patients come down from procedures and things like that, and working with industry to really make new advances, make new technologies, make new applications and software that is really modern right now, where people want it at the click of their phone, to really click on something and know what they’re going to get. And I think keeping up with all the latest technological advances outside of IR is also important to tie that into our specialty. So, any last thoughts on the hidden gem?

Well, hopefully it won’t be as hidden, but with increasing time, continuing just to spread the word and, like you said, as these procedures become more mainstream, maybe one day it will be as mainstream as the OR or something. As we continue to be able to do all these incredible things for patients, I think that maybe one day it will be.

We are going to plant the bug of IR in everybody.

Continue to share about it online and have that presence grow and just have more people be aware of all the cool things that we are able to do.

Well, thank you so much, Bianca. I consider you one of my hidden gems. So I—

Oh. Thank you. Love you.

But also, I know that you are awesome at recruiting other people to IR. Well, thank you so much for listening into our podcast. I appreciate all of you, and thanks, and I appreciate Cook for allowing us to do the podcast.

Yes, thank you Dr. Knuttinen, and shout-out to all the IR nurses and rad techs.