GI Nursing: Does it Make Your Ears Wiggle?

Can you remember why you became a gastrointestinal (GI) nurse? Close your eyes and recall the moment you chose to enter GI nursing. Was it the tales of a respected colleague or friend who was a GI nurse? An opportunity to escape "the floor" or the daily psychic trauma of the emergency room (ER)? Can you remember how excited and thrilled you were your first week in endoscopy, exploring strange new worlds?

I decided to become a gastroenterologist after such a moment as an intern. I assisted in a post-midnight endoscopy on my old veteran patient, a variceal bleeder. After hours at the bedside applying a useless ice-water lavage, I was fascinated by the ease and grace with which the GI fellow stopped the life-threatening bleed with endoscopy.

On my return home, I rushed to call my parents about what I had decided to become when I grew up. My mother was perplexed but supportive. Her response to a daughter who would wish to do such a weird, distasteful, unusual profession as endoscopy was, "Honey, as long as it makes your ears wiggle."

It's been more than a decade and my ears still wiggle when I get a great case or an interesting patient; however, it seems there is a lot of "physician stuff" conspiring against the vibrations of my ears: long hours, heavy patient loads and malpractice concerns.

Those in GI nursing have similar problems. I have been privileged to speak with many of you about your profession, and find similar concerns worldwide, including:

• Hospital administration's lack of effort to retain good nurses, as in "any ol" nurse can do GI, can't they?"

One of our local hospitals pays one GI nurse to be on-call nights and weekends. If there is an unruly bleeder or a tough foreign-body extraction in the wee hours, the endonurse gets a nurse covering the operating room (OR) or the nurse administrator to monitor the patient while he or she does the procedure -- really untrained care for our sickest patients.

At this same hospital, if a weekend or night endoscopic retrograde cholangiopancreatography (ERCP) is needed, the GI nurse needs to call on the endo suite, hoping to find someone available to assist in the procedure.

What's wrong with this picture?

• Lack of respect and appreciation and the incivility of doctors.

The rampant incivility of our generation is alive and well in the hospital, where it can have disastrous effects. Poor communication and collaboration have actually been shown to increase death rates for similar patients in the intensive care unit (ICU). If you don't like your colleagues or physicians, you may not communicate with them fully about a patient. It's not just an issue of seeking a pleasant workplace, but of the very nature of what we are sworn to do. Our nastiness is harming our patients.

• Increased workload with shortened room times for procedures

Faster, faster, faster ... are we taking as much care as we used to?

• Rewarding the incompetence of your less capable colleagues with less work.

You know who they are.

• Difficulty in maintaining competency in new or rare procedures.

There's not enough APC, PDT and laser work to go around, and who wants all the late afternoon and evening ERCPs?

• Irregular hours with mandatory overtime and on-call requirements.

Very tough on family life and a strain on many nurses, weird hours in medicine make it tough to fulfill other responsibilities. It has been said that medicine is the only socially acceptable reason to abandon one's family!

• Lack of professional growth opportunities.

There is only one unit director, so where do you go from here?

• Occupational risks: infectious, chemical, environmental and radiation exposures.

Although available, many choose not to wear protective devices or to report on-the-job injuries. Rates of wearing gluteraldehyde or radiation badges are low, as are eye protection rates. Protect yourself first!

• Low pay.

Need I explain? All of this is piled up on top of insufficient time to take care of yourself.

What is the answer? We need to reconnect with those parts of our profession that thrill us and discard the parts that don't. We must demand appropriate compensation for our work, via unionization if necessary. We need to seek protection from occupational hazards, and request such protective devices as appropriate. We should support the use of certified endoscopy nurses as nurse endoscopists, rather than underqualified primary-care physicians, nurse practitioners or physicians' assistants. We will insist that the endoscopy suite become a civil workplace.

Most importantly, continue your efforts through your professional affiliation and credentialing to be recognized as certified experts in your field. You are a rare and talented group.

Let's get your ears wiggling again.

Patricia Raymond, MD, FACG, a practicing gastroenterologist, helps nurses and physicians first "Turn Care Inward," having presented this topic at the 2001 Tampa SGNA, regional SGNA meetings, and to the Fall 2001 GESA meeting in Sydney, Australia. She will return for the 2002 Phoenix SGNA with "The Civility Project: Civility, Collaboration and Cooperation in the Endoscopy Suite." She can be contacted at PLRaymond@RxForSanity.com.

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