“There is a fabulously important role for the hyperbaric nurse to assist with care coordination,” says Nicholas Bird, MD, a physician with Duke Health in Durham, North Carolina, and the former chief medical officer and CEO of Divers Alert Network. “The fact that the patient’s wound exists in the context of underlying chronic disease, diabetes, acute carbon monoxide poisoning, high blood pressure, burns, and other things, necessitates care coordination with the patient’s family. How does that person get the care they need? How do they get transportation to and from? Have they just had a surgical procedure? Have they had an amputation? Have they got a prosthesis? Have they got the ability to ambulate? Have they got home care? Have they got chronic wound care?” asks Bird, who has just described the value and importance of the hyperbaric nurse.
Bird confesses that he’s one of the few people who has made a full-time living as a diving physician consultant in the country. But hyperbaric medicine’s transformation from association with the scuba diving and decompression sickness to oxygen therapy for a range of illnesses has made an appealing opportunity for nurses seeking to work in a very exciting and niche area of health care.
What is Hyperbaric Nursing?
The BNA defines it as “the diagnosis and treatment of human response to actual or potential health problems in the altered environment of the hyperbaric chamber.” The role of hyperbaric nurses is multifunctional, but ultimately, their goal is to provide cost-effective, quality patient care according to established standards. So there is a need for people who are capable of providing dedicated engagement every single day to somebody going through that.
Hyperbarics, as it is often called, is not a mechanism for controlling, for example, diabetes. Rather, it’s the mechanism for minimizing some of the impact of these blood vessel diseases. That is, the downstream effect of long periods (e.g., years) of poor blood sugar control, in the extreme, or just a long-term degree of the disease, which eventually leads to small blood vessel disease. When people get to a certain point where they start having spontaneous tissue breakdown, ulcers, and wounds, those ulcers and wounds won’t heal. Oftentimes, they progress and worsen very rapidly, resulting in people losing toes, feet, even legs. Additionally, Medicare is very specific about the way in which hyperbaric treatment is applied. The patient has to have an ulcer of a certain depth before it is acceptable for hyperbaric treatment.
The History
Initially, many hyperbaric nurses were first experienced in critical care, emergency room, and medical-surgical areas, and they were cross-trained in hyperbaric oxygen therapy. In 1985, the Baromedical Nurses Association (BNA) was founded and hyperbaric nursing became formally recognized. Today, there are over 900 certified hyperbaric nurses and three possible certifications: Certified Hyperbaric Registered Nurse (CHRN), Advanced Certified Hyperbaric Registered Nurse (ACHRN), and Certified Hyperbaric Registered Nurse Clinician (CHRNC). To learn more about becoming certified, visit hyperbaricnurses.org/certification.
Bird believes that the coordination of all of those ancillary services is vital to the success of delivering quality care during or post-hyperbaric care services. “Now, the idea that the care happens magically in this sort of medical bubble here [in the medical facility] and then at home. That home world doesn’t exist and if we’re not successful—because we don’t have adequate care coordination—this is where a nurse comes in to [meet this need] that is so critical,” he comments with much emphasis. What, then, is the role and contribution of the hyperbaric nurse?
Eric Hexdall, RN, ACHRN, the clinical director with Duke Dive Medicine, was a diving officer in the Navy, familiar and competent in dealing with the hyperbaric chamber as applied to diving episodes. He first completed his RN degree and then leveraged his diving experience by obtaining certification as a certified hyperbaric nurse. His entry into hyperbaric medicine followed the typical track. He
worked initially in surgical trauma and the intensive care unit. “So my nursing background is in intensive care, most specifically trauma, but I’ve worked in medical as well,” he explains.
The origins of hyperbaric medicine started with diving medicine. Diving meaning scuba divers and dealing with people with decompression sickness, also known as the bends. Its essence is that of enhancing oxygen delivery to tissues that are compromised. To shed light on how hyperbaric medicine transitioned from diving to oxygen therapy, Bird explains it this way: “You and I are breathing 21% oxygen right here in this room. If I put you on 100% oxygen and then increase the pressure at which you are breathing by two to three fold, I could increase your total dose to the equivalent of about 250 to 300% oxygen. That enables oxygen delivery to tissues that are compromised. Now the tissues that benefit from that are the ones that are the most compromised. So diseased states, like burns or primarily diabetes, and people who have had radiation therapy, are those who have blood vessel or vascular supply problems. The principal issue there is microvascular, so the capillaries—the smallest blood vessels—have poor penetration into those tissues.”
“Diseases like diabetes are really diseases of the small capillaries,” Bird continues. “In a diabetic person, for example, they may have windows of hypovascularity, or decreased blood vessel concentration, so hyperbaric treatment enables oxygen to penetrate deeper into tissues to keep them alive in the early phases of treatment. As treatments go on, day by day, you start to enable the building of new blood vessels, and you facilitate healing of tissues that’s sustained. It’s fascinating. There is no other treatment that does that.”
Looking Ahead
A little known fact is this: diving medicine constitutes about 1% of any hyperbaric practice and the treatment of decompression illness. The U.S. Navy and Coast Guard are known for having well-trained and up-to-date facilities by the very nature of their service and work, and events at sea brings them hurrying fast to get the diver to the nearest facility within four minutes. However, most clinicians are providing wound care for people, primarily diabetics and those who have had radiation therapy. A crew of health professionals—including registered nurses—are needed to operate the chambers, which can be found in over 750 hospitals nationwide and require sustained follow-up and treatment oversight. Hyperbaric units may also be staffed by certified hyperbaric technicians, respiratory therapists, physical therapists, or emergency medical technicians.
In recent years, hyperbaric oxygen therapy has been explored as a treatment for individuals with autism spectrum disorders. These studies suggest that a number of children who have been treated by physicians using hyperbaric oxygen therapy may work well at low pressures with varying degrees of oxygen concentrations as well as at varying degrees of high pressures with 100% oxygen on carefully selected children. If this proves appropriate and successful, this will open up a new channel for applying the principles of hyperbaric nursing to this population.
There are three fundamental prerequisites for hiring a coach: 1) make sure that you are ready and willing to be coached; 2) choose one with whom you want to work; and 3) make sure your communication is authentic. Studies show that willingness and good chemistry were the most frequently cited reasons that a coaching relationship was successful.
So, how do you select a coach?
Look for someone who has experience coaching in a similar situation, but hasn’t necessarily been employed doing that job. Organizations should explore whether the coach has a clear methodology because coaching is a way to generate conversations that expand the capacity of people to think and work together. According to survey data, different coaches value different methodologies. Some coaches may begin with 360-degree feedback, while others rely more on psychological feedback and in-depth interviews.
Top business coaches are as clear about what they don’t do as about what they can deliver. For example, a good coach will be able to tell you at the outset whether or not they are willing to serve as a sounding board on strategic matters, such as behavior that may be interfering with your effectiveness in a team setting.
Significantly, coaches are evenly split on the importance of certification. Part of the problem is the number of different certifying organizations that exist so there is, understandably, confusion about which ones are credible. Although experience and clear methodologies are important, the best credential is a satisfied customer. Conversations with coaches indicated that they were selected on the basis of personal references. So, successful coaches engage in meaningful networking to keep their name and reputation before those who might refer them to a prospective client.
Coaching works because it is a targeted, customized, and individualized approach to self-improvement. It is the very opposite of one-size-fits-all training. It is a partnership in which it is possible to realize mutual potential. We know most about the athletic coach, but often times we need to remind ourselves that the coach is not necessarily a better player. Effective coaching requires the suspension of existing assumptions, judgments, and beliefs about the individual coached. This way, the coach can guide you towards your aspirations or the vision of your employer.
A survey of coaches by Harvard Business Review found that respondents acknowledged that confidentiality was central to successful coaching and that, in most cases, they gave updates on their coachees’ progress to other stakeholders in the organization. If your employer is underwriting the cost of the coach, then you may expect that this will happen. If, however, this is your personal initiative and there is agreement that coaching will occur during the work-day, then the contract must be iron clad on this issue. No information to your employer.
In the days of long ago, the interaction between the interviewer and the candidate was designed to see whether the candidate could impress the interviewer with their technical knowledge first and foremost. It placed the candidate’s competencies against a very specific job description. Not entirely so much today. The engagement is intended to uncover the real person, assessing your character without being taken in by the “tuxedo effect.”
As a candidate, you should be prepared to be assessed on the following abilities: articulating well; sharing the conversation across an observance of your capacity to reason; displaying good judgment, ethical stamina, and analytical processes; and adapting to a wide array of interactions in a diverse employment dimension. And yes, your technical competency will inevitably be investigated.
Andrew Proffer, PhD, a psychologist with health care IT recruiting firm, CompassPoints Consulting, says: “Candidates should be prepared to speak to their professional values and accomplishments in a way that is positive, accurate, and not self-aggrandizing.” He suggests that candidates should research the prospective employer on Glassdoor.com as well as through professional circles in order to ask questions that will provide meaningful information and demonstrate that they’ve done their homework. “Be prepared,” he adds, “to turn the interview into a discovery process about the company, the culture, and the individual interviewing you.”
Keep the Focus on Your Strengths
First, acknowledge that pursuing your career interests is work. Examine your areas of strength and areas still needing development. Never use the word “weakness.” If it is used by the interviewer, gently reconstruct it as areas needing further development and demonstrate how you are actively engaged in moving that forward.
Be prepared to identify what has given you the greatest satisfaction and has led to your career selection as well as the decision to continue on in your chosen specialty. This should be aligned against your knowledge that there is a match between your chosen specialty and the functional area of the prospective employer. Never blindly cast your choice before the employer without knowing that there is a related function in the organization.
For example, you know that there is an ongoing effort by the health care provider to encourage nurses to improve their knowledge and skills in the area of evidence-based nursing. It’s a tool to strengthen your ability to engage patients and provide quality care with factual information regarding the patient’s illness. Now is the time to convey that your academic preparation or your prior work experience has equipped you to serve well in such a culture.
Remember, you need to get past the HR representative before you get to visit with the hiring manager and the screening committee(s) that will follow a successful first interview. In that encounter, be prepared to respond to “Tell me about a time when….” questions. Share your in-depth knowledge in the areas where you are strongest, and probe the committee to uncover what is expected of the person they seek to hire as it impacts the specialty areas where you believe you are strong.
The Scenario Interview Challenge
This is another aspect of the behavioral interview. Here’s an example:
Bertha is a petite woman who looks younger than her 67 years, but she has a failing heart. Even the smallest amount of physical exertion causes shortness of breath and other symptoms such as arm pain, so her cardiologists brought in the palliative care team and you are a member. Bertha could go home on her intravenous medication, but neither her son nor her daughter is going to be able to accommodate her needs. This is a common situation in today’s families. What might you do that would help the family decide what to do?
Belinda Jennette, who was recently hired by the largest privately held analytics firm as a project manager, says she was given a typical set of events made by management that had produced some unforeseen outcomes and asked how she as project manager would resolve the situation. “While the specific scenario was not unusual for the company,” she explains, “its purpose was to see how I would develop clarity regarding what was described, and how I would use my probative skills to produce a recommendation that could be defended. It was not designed to judge whether I had had experience handling that specific scenario.”
Beware the fishing questions. These might include: “When or how might you use humor as part of your bedside manner?” or “How many times does an inappropriate act by your coworker have to occur before you report it to the provider’s management?”
The point is: you should spend preparation time thinking about how you might demonstrate that you are very committed to delivering care consistent with the provider’s vision and sensitive to the competitive nature of the industry. Figure out how to sufficiently respond to questions in the interview without excessively overstating things. You should have some sense of when the fish is in the boat!
