10-Minute Interview: Diane D. Sheffield, RN, BSN

Why did you choose to work in the field of electrophysiology? I have always been interested in the area of cardiology. I began working as a nurse in the ICU, Open Heart Recovery, and the cardiac cath lab prior to my working in electrophysiology. Approximately three years ago, the Medical College of Georgia brought in an electrophysiologist to begin a new EP program, allowing me the opportunity to join the team at the beginning of its inception. I found the area of electrophysiology very challenging, and decided to continue to stay in EP. Describe your role as an EP nurse. What is a typical day like for you? Originally, our EP lab staff was small, consisting of two RNs and one RCIS. We alternated between circulating, scrubbing and nursing/conscious sedation for each case. The EP lab has been growing rapidly over the past three years, so we now have a staff of two RCIS s, three RNs, two patient care techs and two nurse clinicians, along with two electrophysiologists. With the increase in staff and patients, I have moved out of the lab and into the clinic and hospital settings. The physician and I see approximately 12 to 16 patients (sometimes as many as 20 to 22 patients) in the clinic, two mornings per week. My job consists of scheduling patients for pending procedures, performing pre- and post-procedure teaching on inpatients and outpatients, performing device interrogations in the clinic and hospital, and doing telephone triage for patients with complaints or problems. I am also responsible for the device interrogations through telephonic monitoring programs that we ve recently started for our ICD patients. What is the most memorable case you have ever been involved with? We had a patient present to our EP clinic with a history of dextrocardia with situs solitus, sick sinus syndrome status post dual chamber pacemaker implantation, and paroxysmal atrial fibrillation (AF) and atrial flutter. She had been having symptomatic AF with a rapid ventricular response for approximately two years, and continued to have the arrhythmia despite trials of propafenone, sotolol, and two failed pulmonary vein ablations at another hospital prior coming to our service at the Medical College of Georgia. She had been reluctant to have an AV nodal ablation in the past due to her fear of pacemaker dependency, so we tried dofetilide and then amiodarone without success. She again was in atrial fibrillation with a rapid ventricular response having respiratory failure and congestive heart failure when she finally agreed to have the AV nodal ablation, after which she had a rapid recovery. Since her ablation procedure, she reports feeling better than she had in years and was sorry that she waited so long to have the procedure done. She has since lost weight and is very active. She is back at work and very appreciative of all that was done for her. What aspects of your work do you find most rewarding and/or challenging? I find it very rewarding when a patient comes to me after a procedure and says, I feel better already. I didn t realize that I felt so bad before. Or when a patient who just received a new pacemaker comes to the clinic and his spouse says, I can t keep up with him! Another rewarding feeling is when a patient comes in for a routine device interrogation and I find that the patient received a shock or ATP therapy for ventricular tachycardia (VT) or ventricular fibrillation without knowing, most likely while sleeping, that may have resulted in saving their life. Some of the most challenging aspects of my job are dealing with non-compliant patients. Are you or is your EP lab currently involved in any EP-related research projects? Our EP lab is actively involved in studies involving VT ablations, CRT devices, AF ablations, and lately some ablation research involving animals. We recently finished testing a detection algorithm for a potentially new subcutaneous defibrillator as part of a multi-center study. What specific areas of EP and/or patient care need more attention? In the area of patient care, I feel that medical insurance coverage for patients needs more attention. Patients are unable to have procedures or receive needed devices because of lack of medical coverage, or they may not be able to obtain medications that are needed because they are not covered or have high deductibles or co-pays and cannot afford them. Are there any particular websites or texts you would recommend to others in the field of EP? We have a very informative website at www.epmcg.net that I would recommend for patients and EP staff. I would also recommend the Heart Rhythm Society website at www.hrsonline.org. As for books, I would recommend Cardiac Pacing and Defibrillation: A Clinical Approach by Drs. David Hayes, Margaret Lloyd and Paul Friedman for pacemaker and ICD information, and Handbook of Cardiac Electrophysiology: A Practical Guide to Invasive EP Studies and Catheter Ablation by Drs. Francis Murgatroyd and Andrew Krahn et al, for EP studies and ablations. What advice would you give to EP professionals who are currently at the start of their career? EP is not an area for people who are afraid to be challenged or who are intimidated by technology, because EP is so technologically dependent. Having a background in cardiology is helpful and gives a good basic knowledge to build on. Be prepared for the many challenges ahead and wear comfortable shoes. Has anyone in particular been helpful to you in your growth as a nurse? My husband, Steve, has been a big influence on my nursing career. He also works in cardiology, and I find I can bounce questions or ideas off him. Dr. Robert Sorrentino has taught me everything I know about devices and electrophysiology, and continues to encourage me to grow in this field. Dr. Adam Berman has been helpful with expanding my knowledge in the areas of arrhythmias and complex ablation procedures. Is there anything else you'd like to add? Electrophysiology is a rapidly growing area of cardiology. I really love my job and find it both challenging and rewarding. I work with a great team of EP physicians and staff. I can t picture myself doing anything else.