Alison Wiebe calls the endoscopy unit at Northside Hospital the Taj Mahal of gastrointestinal labs. While this may be an exaggeration by the director of emergency services, critical care and the endoscopy unit, she maintains that it's spacious and bright, with state-of-the-art equipment and good doctors and nurses.
"One way to demonstrate how you
care is to have a nice facility," Wiebe said. "Patients love the
welcoming atmosphere,
and the staff takes pride in it. It elevates
things to a higher level."
While looks count, the technological
advances and the new leadership staff
make the real difference. "With a growing
patient population, we revamped all our
processes for a more efficient flow that is
better for everyone," she said.
In the past, many nurses were under the misconception that a GI lab is a place to work when they're burned out and want to slow down. With a growing number of technical tests, screenings and therapies on the esophagus, stomach, intestines and rectum, that's no longer the case, said Kevin Daniel, supervisor.
"With 30 to 50 cases a day and patients
needing a high level of sedation and recovery,
it's a very quick pace," Daniel said.
"About 70 physicians use our lab, and
we have students rotating through the
unit now. It's anything but slow, and our
nurses get to use a variety of skills."
"The students like it because we stick them right in the procedure room," said Mike Smith, RN, CGRN, who entered gastroenterology nursing eight years ago directly from nursing school. "They see the nurse administering sedation, [and] the doctor operating the scope, and they can see exactly what's going on inside the person as it's projected on the screen.
"What we do is high-pace and highstress; these are invasive procedures with sedation, and most people don't realize how much is going on. It's a dynamic workplace, where you're constantly using your assessment skills."
Most people associate GI labs with colonoscopies. Colon cancer is the most preventable cancer - as long as people do the routine screenings that detect it early, Smith explained. The American Cancer Society advises the screening for everyone older than 50, and advances in technology and patient preparation make it possible for doctors to see more in the colon with a greater degree of patient comfort.
Besides colonoscopies, the staff performs several diagnostic and therapeutic procedures in all parts of the GI tract. Broncoscopies find nodes and tumors in the lungs and identify tuberculosis. Physicians snare polyps, locate hard-to- find sources of bleeding, and cauterize varcies (high-blood-pressure veins that could burst and bleed) in the stomach and esophagus.
An ERCP (endoscopic retrograde cholangiopancreatography) is a technical and difficult procedure that allows doctors to diagnose problems in the bile ducts leading from the liver to the gallbladder and small intestine.
The gastroenterology nurses in the lab at Northside rotate through all procedures, as well as pre- and post-operative care. The technical aspect of this type of nursing attracted Smith to the field initially.
"I'm a hands-on kind of person, and I like that much of what we do is preventive medicine," he said.
Along with the changing technology, Smith enjoys interaction with patients and their families.
"Most of them have that deer-in-the headlights look when they come in, and they're not looking forward to a highly personal procedure or what the doctor might find," Smith said. "You have to engage them and gain their trust immediately. It helps to have a sense of humor and be able to lighten things up."
Meeting and taking care of new patients every day is the best part of the job for Joanne Brunke, RN, a 16-year astroenterology veteran. She's seen a growth in the variety of procedures and the number of patients over the years.
When Brunke started working in gastroenterology, the labs didn't have video and only the doctor could see through the scope.
"Now we use fiber-optic scopes with video, so that I can see what's going on, and it's much more interesting," Brunke said. "When a doctor asks me to apply abdominal pressure, I can see it working. And when I see things I don't understand, I can ask. I'm learning all the time from the doctors and the patients."
With more patients taking medications, a higher level of sedation is needed, requiring careful post-operative nursing. Thanks to the Internet, more patients research procedures and come in with more intelligent questions.
"I like to educate patients. The bettereducated
they are, the better they do,"
Brunke said. "That's the greatest satisfaction
to me. I enjoy sending them home
knowing more than when they came in."