Working in transplant programs can be challenging as life can move quite slowly for waiting patients and then suddenly speed up when an organ becomes available.
But have you ever wondered what it would be like to work in pediatric transplants?
We interviewed Gerri James, RN, BSN, CCTC (Certified Clinical Transplant Coordinator), manager of the Pediatric Kidney Transplant Program at Stanford Medicine Children’s Health, and she told us all about what her job entails.
What follows is our interview, edited for length and clarity.
Gerri James, RN, BSN, CCTC, manager of the Pediatric Kidney Transplant Program at Stanford Medicine Children’s Health
How did you get interested in working with the pediatric kidney transplant program?
I started my nursing career on a surgical floor at a large academic program on the East Coast. We cared for patients waiting for organ transplants (liver and kidney) and those who had received transplants. Once I cared for these patients, I was hooked.
What drew you to it?
Transplantation is a fascinating and rewarding field! Witnessing the patients receive a second chance at life was–and still is–amazing. Transplantation is a miracle that, unfortunately, not every patient experiences.
How long have you been doing it?
I’ve been involved in transplants for approximately 35 years.
Please explain what you do as the Pediatric Kidney Transplant Manager. What types of patients do you serve—what ages and how are they approved to be in the program?
Stanford Medicine Children’s Health has one of the country’s biggest and busiest pediatric kidney transplant programs. We care for patients from birth to up to age 18. For the newborns, we follow them closely until they are appropriate for a transplant evaluation.
What do you provide for them?
At the time of the referral to our Kidney Transplant Program, we reached out to the family to introduce ourselves and explain what to expect. We are meeting them at a very vulnerable and terrifying time of their lives. A big part of the conversation is deceased donor vs. living donor options.
We walk them through the evaluation process, the wait for a transplant, the transplant event, and their post-transplant life. My team also collaborates with many other disciplines to assist with travel and lodging, consults with other services, etc.–all in hopes of making the experience as easy as possible.
As the Transplant Manager, I wear many different hats. Transplantation is highly regulated and has many rules, and part of my job is to ensure we keep up with changes. I manage a large pre- and post-transplant team and participate in various meetings throughout the day. My role is unique as I have a full patient assignment (recipients and potential living kidney donors) and my manager’s responsibilities. My first love is patient care; I wouldn’t want to give it up!
Did you need to get additional education for this position?
I had on-the-job training right out of nursing school. I was lucky enough to work at a world-renowned transplant center. Attending conferences is also imperative to keeping up-to-date on the latest in transplantation, an ever-evolving field. I learned and continue to learn from the very best every day!
What do you like most about working in your job?
Every day is different, and there is always something to learn. I have the honor of helping parents/guardians navigate an unfamiliar world. Often, when they hear that their child needs a kidney transplant, they are devastated. I try to make this new journey a little less terrifying. Providing education and letting them know they are never alone is a big part of what I do.
What are your biggest challenges as the transplant manager?
Time—there never seems to be enough of it. Another challenge is the lack of organ donors that are allocated to pediatric patients. Not every donor is appropriate for every child.
Many nurses might think this would be a tough job–how do you get through that?
This is a tough job. It’s always hard to watch a child with a chronic illness. But, luckily in kidney transplants, most of the children do well and go on to enjoy a life free of dialysis.
However, most children will go on to need a second and maybe a third kidney transplant in their lifetime. We help prepare the families for future transplants while planning the first.
What are your greatest rewards in your work?
Watching a child not expected to survive, walk, or thrive running down the clinic hallway to hug me is incredible. Getting a graduation announcement or any big event following a transplant. Hearing how the family celebrates not needing dialysis, going on vacations, and living their best lives. I’m always so proud of these children and all of their accomplishments!
Anything else to add?
No one ever wants their child/loved one to need a transplant. I am blessed to be able to guide them through the process and take some of the stress away. I often tell the families, “Let me worry about that part. You have enough on your plate.”
Meeting the family where they are in the process is critical to a successful and trusting relationship. Educating them as to what to expect and being honest that the journey will have some bumps in the road is key.
Transplantation is a miracle and life-changing for those fortunate enough to receive an organ, as not everyone gets this opportunity due to the shortage of organs. Transplantation is a fascinating and rewarding field that significantly impacts patients’ and their families’ lives. Sign up to be an organ donor—it’s the greatest gift you’ll ever give!
Have you ever seen a problem in the nursing field at work or in nursing school and thought, “I know just what to do to fix that?”
Latoya Smith did. She’s an RN who works with critically ill patients in a long-term acute care hospital (LTACH). She teaches nursing students at the Tulsa, Oklahoma, Health and Safety Education Training Center. (She was recognized as “Nurse of the Day” in both houses of the Oklahoma Congress in 2020.)
What follows is our interview, edited for length and clarity.
How did you develop the idea for teaching nursing students about dosage calculation?
I kept seeing nursing students fail out of nursing school because of dosage calculations! I kept thinking they just needed it to be simple and fun—and then they would do great.
And that’s when I had my Steve Urkel moment and said, “I can do that!”
Why did you decide to start your side gig with this? When did you start it, and how did you go about it? When did you write the book, and why? Do students buy the book to go along with what you teach?
I spent a year writing the book and ensuring all graphics were right. The goal was to make it fun, simple, and bright. It’s a dosage calculation that clicks and sticks! ™And it speaks to nursing students in a way that traditional texts do not.
The book was released in the fall of 2020 during the pandemic when nursing students were forced online, and it was a real struggle for them and nursing instructors, too.
No nursing student should fail dosage calculation.
My curriculum has been adopted by the Health and Safety Education Training Center in Tulsa, OK. I also consult other nursing instructors on the best techniques to teach dosage calculation.
When did you decide to create an app? What’s it called? How did you go about doing it? Is it solely for nursing students? If not, who else would benefit from using it? What does it do?
I created the app because nursing students were asking for it!
Nursing students need an app that is in touch with their needs, speaks to them in their language, and can take it anywhere they go. And the Dose Calc App does all of the above.
I took all of my knowledge and put it into this app. I also have an incredible partner named Carmen, who is building (coding) the app alongside me. What’s fantastic is that Carmen used to be a medication aide. So, both of us together make an excellent team.
The app is for nursing students, nurses, pharmacy technicians, and pharmacy students. It’s for anyone who needs to be proficient in drug calculations.
Did you have previous entrepreneurial experience? Or did you learn on the go? Did it take a lot of time or money to establish your business?
I have been learning on the go! What’s pretty awesome is that I use all my nursing skills as an entrepreneur. I did have a business where I created super cute merchandise for nurses, and then I pivoted during Covid and focused solely on helping nursing students.
Do you plan to add anything else to this side gig—in products, speaking/teaching more about dosage calculations, etc.?
Yes! I will be headed to student nursing conferences this fall, so say hi if you see me out there.
I’m writing a pharmacology mnemonic book that will mesh well with The Trap Guide to Nursing Dosage Calculation. And if I am available, I’ll also speak at nursing schools and student nurses’ associations.
What did you enjoy most about your side gig?
The thing I enjoy most is seeing nursing students make that connection! When they finally get it, it’s incredible. I love it so much.
It is a game-changing experience where they realize they can do anything. The confidence and motivation that they receive make my heart so happy!
What are some of the challenges?
I think one of the challenges is getting to nursing students before they’re at the point of failure. I want to help them way before failing on the table.
We need more nurses, and dosage calculation won’t be why they fail if I have anything to do with it!
Another challenge is that I still work full-time for three 12-hour weekly shifts. It can be challenging, but this is my purpose and passion, so I power through.
What are the most significant rewards of having your side gig?
My biggest reward is doing something I love and am good at.
I have been tutoring and teaching students since college. It is a gift, and I am so thankful for it. I am energized and fulfilled by what I do. This is so cliche, but it doesn’t feel like work when you love what you do!
What would you say to someone considering starting their side gig?
I recommend: DO IT! And I mean right now. Take whatever you have and get to work.
Too often, we wait for the right time, situation, or amount of funds. This is it for any nurse on the fence or waiting for a sign to start their side gig. Start your side gig today!
Anything else to share?
Readers need to know that nurses must be expert and confident calculators.
We are the line of defense between the patient and medication administration error. Dosage calculation is an integral part of what we do, and there is no shame if you need a little help learning dosage calculation after graduating.
Nursing is the future! Look out for nurses changing the game in all arenas all over the world!
Do you have the guts to be a gastroenterology nurse?
All joking aside, this facet of the field is often overlooked because it may not be as exciting as, for example, working in an ED. But it truly helps to save lives.
Daily Nurse interviewed Alicia Carter, RN, BSN, BS, MHA, an endoscopy nurse at the University of Maryland Capital Region Health, about what it’s like to work as a gastroenterology nurse. What follows is our interview, edited for length and clarity.
How did you get interested in being a gastroenterology nurse? What drew you to it? How long have you been doing it?
I have always been interested in becoming a circulating nurse, and when I moved from out of state and began a job search in the area, I came upon the posting for my current position. After much research, I applied and waited impatiently to hear back. I was excited to train and learn as much as possible when I was hired.
Since it is not a “popular” sector of nursing, like ICU, ED, or OR, I was drawn in by knowing that I was entering into a specialty with more specific missions in each procedure than I had previously known.
I have been a gastroenterology nurse for two years.
Did you need to get additional education for this position?
Outside of nursing school, I did not get additional education for this position; however, it may not be best suited for a new grad nurse.
What do you like most about working as a gastroenterology nurse?
What I like the most about working as a gastroenterology nurse is that it’s fast-paced, for the most part. I like being on the move; working in Endoscopy gives me exactly that.
We get patients who are just coming in for a routine screening colonoscopy, and we get patients who are getting scoped because we are trying to find out if their cancer has spread, so we are getting the full spectrum of acuity in our patients.
Our advanced cases are much slower than EGDs or Colonoscopies, but as a whole, the day moves steadily when our schedule is full.
What are your biggest challenges as a gastroenterology nurse?
The biggest challenge that I have found as a gastroenterology nurse is trying to please everyone all at once—including the patient, the proceduralist, the anesthesia, your manager, and your techs.
Because many wheels are turning simultaneously, you can do your best to try to make sure that they all stop and arrive at the same point at the same time, but that doesn’t always happen, no matter how hard you try.
What are your greatest rewards as one?
My greatest reward as a gastroenterology nurse is that you are an integral part of someone’s journey to either fixing a problem or diagnosing a problem.
In addition to your position requirements, you are there to hold hands with a patient before they go in the room, you are there to give them comfort before them being sedated, and you are there as one of the first faces they see after they wake up.
Knowing that I am the person that the patient looks for to make sure that everything goes smoothly with their procedure and care is heartwarming, and when the patient wakes up and thanks me for being there for them, it makes my day.
Is there anything else that is important for our readers to know?
It is important to note that no one size fits all for GI nurses. Depending on your facility, there will be different responsibilities for a GI nurse—whether it is an outpatient or inpatient facility. Either way, the work can be very rewarding, and even though it is not a specialty that many know a lot about, it is worth checking out for yourself to see if it fits.
While the average person probably thinks that nurses working via telehealth is something new that came about during COVID, that couldn’t be further from the truth.
“I have personally been practicing in telehealth for the past eight years,” says Mariea Snell, DNP, APRN, FNP-C, an associate professor of nursing and the director of the Doctor of Nursing Practice Programs at Maryville University. “I think the pandemic changes how people access care in large numbers, but it is not new. Many people with access issues due to physical disabilities or needs have used these systems. Others did not fully understand what it could do until put to the test.”
Georgia Reiner, MS CPHRM, a Risk Analyst at the Nurses Service Organization (NSO), agrees that telehealth has been around for a while. She adds, though, that its use has dramatically increased.
“Some nursing professionals, mainly advanced practice registered nurses (APRNs), including nurse practitioners (NPs), worked in telehealth before the beginning of the pandemic. However, there has been a dramatic increase in the utilization and availability of telehealth services due to policy changes implemented in response to the COVID pandemic,” says Reiner. “For example, an analysis by McKinsey & Co found that telehealth accounted for less than 1% of Medicare services before the onset of the pandemic, but by July of 2021, telehealth services accounted for about 13-17% of claims submitted to Medicare. Additionally, licensing requirements were relaxed in many states, which helped enable nursing professionals to practice across state lines via telehealth, as were requirements that patients have an established relationship with a provider before they could receive telehealth services. However, many of those policy changes are set to expire at the end of the public health emergency, leaving the future of telehealth services somewhat in question.”
Additional Training
If you’ve never worked in telehealth before, you may wonder if it’s necessary to receive additional training before working in it. The answer is yes and no.
“All nurses can participate in telehealth,” says Snell. “They would provide the level of care that each are currently licensed to provide. In the case of a DNP/NP, they would treat patients the same way they would in an office setting.”
However, the training that nurses would and could receive will depend on several factors.
“Nurses and advanced practice registered nurses may receive training through their educational programs on the use of telehealth. If nurses do not receive this training in their educational preparation, they may receive it through their employment or workshops and educational programs. There are certification courses that are available for healthcare providers to take as well,” explains Robin Arends, DNP, CNP, FNP-BC, PMHNP-CE, CNE, FAAN, FAANP, the APRN Program Director at South Dakota State University as well as a nurse practitioner at Avel eCare. She’s published and presented both workshops and talks about all aspects of telehealth—regionally, nationally, and internationally.
Nurses have worked in a variety of settings in telehealth—such as school nursing, critical care, emergency care, specialty care, and geriatrics, Arends says. Be sure to check if the state you’re practicing in mandates training or taking a test before providing telehealth services.
She continues: “Nurses should be trained to use the telehealth equipment to complete the assessment and how to help others at a remote location use the equipment. They should understand how to appear on camera and communicate with patients through technology. Nurses should be aware of the background that the patient sees on camera and any sounds occurring in their environment. Nurses must know and comply with HIPAA, information security, and confidentiality. Nurses should also be aware of licensing requirements as they need to be licensed in the state where the patient is located.”
Because she works as a risk analyst, Reiner takes a deeper dive when explaining the training nurses need and why.
“Nursing professionals working in telehealth need to verify with relevant state professional licensing boards the practitioners — known as “qualified providers” — who can legally provide telehealth services. Nurses must be appropriately credentialed to practice in the state(s) where their patients or clients are located and work under that state’s scope of practice for nursing professionals,” Reiner says.
“Prior to beginning any telehealth work, nurses need to be prepared and have a backup plan in place in case of an emergency or technology breakdown. In addition to obtaining their patient’s/client’s consent before participating in telehealth services, nurses must also clearly convey to their patients/clients the inherent technical and operational hazards that may impede communication, such as:
System compromise or hardware failure, which could lead to an incomplete or failed transmissions.
File corruption or other data transmission issues, resulting in less than complete, unclear, or inaccurate reception of information or images.
Unauthorized third-party access, which may lead to data integrity or information security problems.
Natural disasters, such as hurricanes, tornadoes, and floods, which can potentially interrupt operations and compromise computer networks.
Whether a nurse can or should provide telehealth services from their residence depends on factors including state regulations, their employer’s policies, and procedures, their home environment and infrastructure, their ability to comply with technical, security, and confidentiality considerations from their home, as well as the nurse’s comfort level with engaging in telehealth practice from their home.”
Challenges
Working in telehealth may seem much easier because it can be done from nearly anywhere. However, there are some challenges to working in it.
“The biggest challenge is that providing services via telehealth is so different from traditional, in-person care, where a patient is physically present in front of the nurse. When providing telehealth services, the nurse relies entirely on technology for the patient encounter. In addition to adhering to traditional clinical standards of care and practicing within the scope of practice authorized by law, there are also technical considerations,” says Reiner. “Equipment and software must be routinely tested, maintained, and updated for quality assurance. Nursing professionals and their employers must also track how well a telehealth program functions carefully. Indicators should capture clinical, efficiency, and satisfaction outcomes, including:
Patient/client complication and morbidity rates
Compliance with provider performance criteria
Diagnostic accuracy
Adherence to clinical protocols
Referral rates
Patient/client satisfaction levels
Cost per case
Delays in accessing consultations, referrals, or specialty practitioners
Arends says that another challenge is that nurses must remember to maintain licenses in the states where their patients are located—and follow that state’s practice rules and regulations.
Remember Documentation
Just as you would if seeing a patient in person, nurses need to do documentation.
“Telehealth sessions should be as thoroughly documented as all other patient/client encounters. Just because some information may be automatically captured by software doesn’t negate the nurse’s professional responsibilities around documentation,” Reiner states. “Documentation in the patient’s medical record should be in accordance with the same documentation standards of in-person visits—including documentation of all communications with the patient or other providers (whether verbal, audiovisual, or written), clinical observations, orders, test results, and patient education and follow-up instructions.”
Telehealth Helps Nurses Become a Key Player
According to our sources, if you haven’t decided whether to look into providing telehealth, you should.
“Nurses should consider getting into telehealth because this is the direction that healthcare is going in. Incorporating technology in care will continue to develop and will never go back,” says Snell. “It is important to stay current with this trend. You won’t necessarily make more money, but you will be more marketable and have a better work-life balance.”
Arends agrees. “Nurses should consider working in telehealth because there are increasing opportunities in this area of healthcare. Patients saw the benefit of telehealth during COVID and want to continue to receive healthcare through this modality. Telehealth has shown high patient and provider satisfaction. I predict that telehealth will only continue to grow and expand.”
In addition, Arends believes that nurses will become key players in telehealth. “Nurses are the core of healthcare. In traditional settings such as hospitals, they are the first to alert providers to changes in the patient’s condition and are truly the front lines of healthcare. This will continue to be seen in telehealth,” she says. “Many studies have shown that nurses utilizing telehealth for remote monitoring as well as real-time audio video telehealth formats have reduced complications and readmissions and increased access to care.”
The benefits to patients are seemingly endless. “Nurses work where the patients are. Some patients cannot travel to clinics because of weather, physical condition, or other factors. Nurses who work in telehealth can care for patients when the patients are not able to seek care from traditional locations. Like home visits, nurses can visit the patients in their home environment. They can assess how the patient moves and works in their environment. They can assess for safety hazards in the home environment as well.”
Finally, working as a nurse with patients in telehealth can also be immensely rewarding. “The greatest award of working in telehealth is helping the patient achieve the best health outcomes while minimizing barriers to accessing healthcare,” says Arends. “Helping a patient who may not be able to access healthcare for various reasons achieve control of chronic diseases or feel healthier is a huge reward for telehealth. In addition, helping patients meet their personal care goals in their preferred environment is also optimal.”
For this edition of A Day in the Life, we interviewed a certified registered nurse anesthetist (CRNA) to profile what these nurses do so you can decide if it’s a specialty for you.
Duncan answers our questions about working as a CRNA. What follows is our interview, edited for length and clarity.
Keesha Duncan, DNP, CRNA, is the northeast regional director of advanced practice providers at Envision Healthcare, a chief anesthetist at Hackensack University Medical Center
How did you get interested in being a certified registered nurse anesthetist (CRNA)? What drew you to it? How long have you been doing it?
I worked as a cardiothoracic intensive care nurse (CTICU RN) at St. Vincent’s Hospital in New York for almost six years. I soon realized I wanted to venture into advanced practice nursing.
The question at that time was, “What specialty?” I decided on anesthesia, much accredited to my mentor, Michael Greco, Ph.D., DNP, CRNA, who encouraged me to shadow a certified registered nurse anesthetist. I did, and I was utterly fascinated by the skill and dexterity displayed by the CRNA.
I quickly knew that this specialty was my calling. Therefore, I began to embark on the journey that led me to where I am today. I’ve been practicing as CRNA for close to 16 years.
Explain briefly what a CRNA does. What types of patients do you serve? What do you provide for them?
CRNAs are advanced specialized nurses trained to provide anesthesia during a procedure or surgery. Some have additional training in pain management and perform functions that treat chronic pain.
I serve the adult, pediatric, and obstetric populations in my career and am proficient in placing labor epidurals and spinal anesthesia for C-sections. Furthermore, I administer general anesthesia or moderate to deep sedation when needed and perform or participate in peripheral nerve blocks.
Did you need to get additional education for this position?
I needed additional education to transition from an ICU RN to a CRNA. I was a diploma RN, so I had to go back and obtain my BSN to apply to CRNA school while working full-time and being a single parent.
I received my MSN with a concentration in anesthesia when I graduated from CRNA school in 2007. I also graduated with my doctorate in nursing practice in 2012.
What do you like most about working as a CRNA?
When I decided to go into anesthesia, I feared losing the special time I had talking and getting to know my patients. But as a CRNA, you don’t lose that bond. The reward you feel when you care for patients during their most vulnerable and scariest times still exists.
Interested in getting a job s a CRNA? Then check out the Daily Nurse Career Center to begin building your nursing career.
