Jean Gingerich is a certified nurse specialist in pediatric electrophysiology at the University of Iowa Children’s Hospital in Iowa. She was recently recognized during the 2009 “100 Great Iowa Nurses” in the state of Iowa. Why did you choose to work in the field of pediatric electrophysiology (EP)? I was working as a nurse specialist in an adult electrophysiology lab and heard about a pediatric electrophysiology nurse position. Our adult lab had participated in the care of many of the older children with arrhythmias, so the opportunity to participate in the expansion of pediatrics sounded like a worthwhile endeavor. After meeting the pediatric electrophysiologists, Dr. Dianne Atkins and Dr. Ian Law, I knew it would be a great opportunity, and I was right. Describe your role in the pediatric EP lab. What is a typical day like for you? I work in the EP lab and the device clinic. For EP procedures, I schedule the patients, provide education, participate in patient prep in the catheterization lab, run the pacing and recording equipment, fill out initial billing paperwork, schedule follow-up, and perform a phone or e-mail follow-up check within a few days of the procedure. My participation in device procedures is very similar, including education, scheduling, and assisting in the EP lab. Post implant, I set up remote monitoring and follow-up on either CareLink (Medtronic, Inc., Minneapolis, MN) or LATITUDE (Boston Scientific, Natick, MA). I schedule their follow-up in clinic, and interrogate devices here and at outreach clinics. We use the Medtronic Paceart® System for device follow-up, and I am primarily responsible for that system as well as CareLink and LATITUDE. What is one of the more unusual EP cases that you have ever been involved with? It is difficult to identify a single patient, but I would have to say performing ablations on infants has been challenging but incredibly rewarding. Our electrophysiology team has been faced with three infants under 5 kg that have had incessant SVT resistant to antiarrhythmic therapy. One patient had complex congenital heart disease, adding another layer of challenge. Fortunately, all the procedures were successful; cryothermal energy was used on every case for safety reasons. Another case that comes to mind is a teenage girl we ablated this past month. She had multiple arrhythmias including AVRT, AVNRT, atrial flutter and an automatic atrial tachycardia. By the way, I should note that everyone who works in our lab is banned from ever saying the words “This case should be fairly straightforward”! What aspects of your work do you find most challenging? Our electrophysiology team takes pride in providing the best care possible. Everyone’s role as a member of the team is crucial; we hold ourselves to a high standard. We face the same constraints of time, money and personnel that every other program faces, but we never want that to stand in the way of our patients feeling that there will always be someone there for them. This personal touch is a key component of our patient care philosophy. It makes a huge difference that patients know my name, especially when they often feel lost in an institution as large as the University of Iowa Hospitals and Clinics. Another challenge I have encountered that I am sure I share with others is keeping up with the technological changes; the amount of current and new devices and technologies is daunting. It is easy to feel overwhelmed. What personality traits do you think are important for a pediatric EP nurse to have? Well, it helps if you like children! I think like most jobs, it is important to be flexible and go with the flow. Day-to-day priorities change, nothing is static. Many times I have gone to work with a list of tasks that I would like to accomplish, only to find a new or established patient that needs immediate attention. I would say it’s important to have a desire to learn, and a curiosity about EP. If you don’t engage in what is happening during an EP study, you will become lost and then lose interest. Ask questions, especially when someone says “that’s interesting,” make them show you what they are talking about. I think you need to buy into the team approach in an EP lab; everyone is important and everyone should be watching. It also helps if you do not mind working in the dark and can skip lunch on occasion! What motivates you to continue your involvement with the EP lab? What motivates me is the desire to give the best care to our patients. As healthcare workers, we are in a powerful position of trust. The parents and patients trust us to do our best. At times we have the unique opportunity to “cure” an arrhythmia, for example, ablating the accessory pathway in a Wolff-Parkinson-White syndrome patient. At other times, our role is to care for patients with significant and sometimes progressive heart disease, such as long QT syndrome or hypertrophic cardiomyopathy. The anti-arrhythmic medication and ICDs can vastly improve the patient’s life, but the disease state remains. The care of these patients requires a diverse approach and skill set, but is incredibly rewarding, What advancements do you hope to see in the field of cardiac electrophysiology in the next five years? Coming from a pediatric perspective, I am hopeful that smaller catheters and curves will become available as well as safer ablation technology. From the device aspect, I would like to see smaller devices and smaller ICD leads, in addition to improved device and lead integrity and longevity. This may be expecting a lot, but our patients deserve it. What advice would you give to EP nurses who are currently at the start of their career? I would advise new nurses and techs to attend HRS. Go to the allied professional sessions and network with others in your field. There is a wealth of knowledge out there, and most everyone is interested in sharing what they have learned. Ask others what books they found helpful to read. I would also encourage them to take the IBHRE certification exam. By studying for that test, you will increase your knowledge base and professionalism, and show you are serious about the world of electrophysiology. EP Lab Digest is also a great professional magazine to read, since you can learn how other labs function and what they have done to troubleshoot common problems. Has anyone in particular been helpful to you in your growth as an EP professional? Yes, I would like to mention Dr. Ian Law (University of Iowa) and Dr. Macdonald Dick (University of Michigan). They are wonderful physicians who love what they do, and want others to understand and love EP too. They go the extra mile every day and set the bar very high. I feel extremely fortunate to have the privilege to work and learn from them. Is there anything else you'd like to add? I feel my role as an EP nurse expands beyond the walls of the hospital, and I am fortunate that I am surrounded by others who share this feeling. Early on, our EP team realized that the care of young ICD patients goes well beyond implanting the device. The psychosocial issues are complex and require a multidisciplinary approach. To better meet the needs of this patient population, we established an annual ICD program, which was recently highlighted in EP Lab Digest. Other programs we have established include the Pediatric Electrophysiology Outreach across Iowa and in South Dakota; it is much easier for our team to travel to a local clinic or hospital than to have all the patients and families come to Iowa City. Dr. Law and I have also partnered with The Children’s Heart Center in Las Vegas, Nevada, to care for their pediatric and congenital heart disease arrhythmia patients. These monthly cooperative efforts include an electrophysiology clinic as well as 6-12 electrophysiology procedures over a three-day time period. On an international level, we have organized and participated in three medical relief trips to the Yucatan Peninsula in Mexico, during which we implant pacemakers and perform ablation procedures (this was also featured in a previous issue of EP Lab Digest).