Meet Jan Revella, an arthritis specialist and the Director of Research and Education at the Sonoran Spine Center in Phoenix, Arizona. Here’s what she has to say about being a rheumatology nurse.
MP3 Audio Podcast
Jamie Davis: Jan, welcome Nursing Notes Live. It’s great to have you on the show here. I always like to start off with my first question to the nurses that I have on the show and ask if you could tell us a little bit about why you decided to become a nurse and maybe give us a picture of your path through nursing school and through your nursing career.
Jan Revella: Well, basically, I’ve been in the medical field for many years from the very get-go. And my family is very medically-oriented as well. And I came from a background, a very unexciting actually that my mother was a nurse and that was why I chose nursing. I felt that I didn’t know much about nursing at the time but she seemed very happy and seemed very satisfied with her career so I kind of just stepped into her shoes and did the same thing. Went to nursing school from 20 to 23 and graduated and immediately went into orthopedics because it was a day position, funny thing. And fell in love with orthopedics and in that orthopedics hospital, basically, it came down to me taking care of many, many people that had arthritis and that’s where my rheumatology career started. Knee joint replacement is done for arthritis as most nurses know and because of that I started learning about joint replacement and then I started looking at the patients themselves and what they needed to know and that’s really how my career took off.
Jamie: You know, it’s interesting. I talked to nurses in many specialties in the course of doing this program and rheumatology is one of the specialties that I’m more familiar with simply because both my mother and mother-in-law have rheumatoid arthritis and one of my daughters has rheumatoid arthritis. So I’m very familiar. And I have to say rheumatology nurses have really touched us in many special ways as a family and I wonder what your thoughts are about how important it is to connect, not just with the individual, but with their family members as well.
Jan: I think it’s really important and I think rheumatology is really unique, orthopedics as well, because there has to be a lot of education and that education has to be applied to the patient and also to the family many times because that rheumatology patient may be not feeling well. They have a lot of stress around them. They may have lost some of their independence due to the disease process itself. And because of that, the family has an integral part play in helping this patient feel better and become better and did them the encouragement to become independent as they try to recover either from an orthopedic procedure due to their rheumatologic condition or simply because they need the education so that they can learn to get well.
Jamie: Do you see other nurses seeing the specialty and moving into it? Is it something that you see nurses choosing as a specialty?
Jan: No, I don’t. I don’t see a lot at all. In fact, nurses are amazed at my interest in this. And I think the reason why it’s seemed important for me is because I learned early on in my career to work hard as a nurse. And that to me is critical in this field because you have to be able to understand the diagnosis process. It gives you the knowledge. It gives you this platform so that you can be effective at providing that education. So I don’t see a lot of nurses doing it and I think there’s a couple of reasons. I happen to be unique in that years ago when I started my career, I did work for a group of orthopedic surgeons and rheumatologists that thought RNs were very critical. But in today’s world, that’s not necessarily the case unless you become a nurse practitioner and that obviously requires more scrutiny. So I see in orthopedics a lot of people having an interest in rheumatology but as a specialty in itself I don’t see a lot. I wish they did because I think that it’s a necessary component and I think rheumatologists would appreciate that level of education to their patients. But it just doesn’t happen as often as I would like to see it. When I started my career and just kind of evolved into the nurse that I am today, I went through 14 years or 15 years of working as a head nurse in the orthopedic office which gave me access to the rheumatology aspect of this. Then from there, I ended up as an orthopedic administrator for a hospital that specializes in orthopedics and rheumatology. I’ve always taught patients to be the head of their healthcare team, not the doctor. In other words, the doctor is part of the team but the patient’s in charge. And so with that kind of empowerment, they tend to research on their own. They tend to look at the options they have. They tend to understand them better. And they tend to do better in regards to either a treatment or their recovery program from a surgical procedure due to arthritis.
Jamie: And it’s interesting you say that because I found that to be true as well that the people that I know with rheumatoid arthritis and rheumatological diseases are very active in like online communities, talking to other patients about, “Hey, what’s working with you?” and I think that’s an important component of this, is giving them the ability and the empowerment to go out there and share their experiences and learn from other’s experiences.
Jan: Exactly. Well, and I also – because I’m the director of research right now for a spine center, and I see a lot of people with arthritis. It affects the spine as well as it affects the other joints. And because I’m the director of research, we’re always studying the clinical outcomes of patients. Whether they had surgery or whether they haven’t is not really that important but what is important is to watch that process so that we can share the information that we learned with other patients so that they feel more certain about the treatment that they’re going to get and that to me is really exciting.
Jamie: There’s a lot of going on with new treatments, new medications, new things on the horizon to treat these types of disorders. What do you see is the future of managing a rheumatological patient?
Jan: Well, I think the treatment has gotten a quantum leap better than it was 30 years or 35 years ago when I entered the field. I saw very poor outcomes then. I saw lack of treatment. I saw crippling patients. I saw all kinds of things that could make people really sad and give up on life. Now I see, particularly in rheumatoid arthritis and the inflammatory types of arthritis, I see a lot of treatment that has huge promise and literally halting the disease and stopping the damage before it’s there.
Jamie: What do you see as the key component for a nurse to have as they maybe look at a career in rheumatology?
Jan: I think if you’re going to go into this field, I think the most important thing is that you have the passion to do it. In other words, this is not a rewarding field without that passion in my opinion because that’s what drives me to be excited about what I do every day. You also have to be passionate that you want to help people with a chronic disease because sometimes they get better, sometimes they don’t, sometimes the progress is slow, sometimes there’s mental and emotional issues that accompany the physical pain of arthritis. So they have to really be passion-oriented and passionate. They have to have a love for educating people and making sure that they understand what they’re hearing. I think that that’s an important part of it because then you understand the disease process, you understand the diagnosis and the path that that takes you, understand the imaging that goes with what is needed, the blood work that might be needed. You understand the treatment and the options and the outcomes. All of that is something that I think a nurse needs to be passionate about to be good at this. Then obviously you want to be able to be an advocate for that patient and develop the patient-doctor relationship and encourage that so that they feel safe wherever they’re receiving that treatment. Then finally, I think, that like I had stated before, I think it’s important that a patient be encouraged to be the leader of their healthcare team rather than walk in and when the doctor says, “How are you?” you tell him you’re fine when you’re really not and learn to communicate honestly, openly and specifically about those things that really bothered them. I find so often patients don’t get good treatment because they don’t tell the doctor what they’re really thinking. That’s a problem because doctors just go with what they’re told many times and if you say you’re fine, you’re fine, that’s it and then I’m done. So that’s a big problem for me. So all of those things together I think it would make that nurse very effective in the role as you play with this field.
Jamie: It really is looking at the whole patient. I know we say that all the time in nursing, looking at the whole patient in all of their aspects. But when someone’s living with a chronic illness, it affects so many aspects of their life that you really need to almost be a little bit of a detective to determine – “Hey, there’s something else going on under the surface here even though the patient says, ‘I’m fine.’”
Jan: Exactly. Many times patients don’t realize that doctors don’t have a lot of time. One of the things that I stress when I’m trying to teach patients how to behave with a doctor is to cut through the chase, be specific, talk about pain and how specifically it affects them, the type of pain that they’re having and so forth. Because a lot of times they’re so general and they have so many stories that are attached to their chronic illness that they get sidetracked. So I always tell patients, “You might have two minutes to really state your case before you guys start having an interaction about where this is going to go.” Most patients are pretty surprised.
Jamie: Do you have any, as we close out here, final pieces of advice for nurses in other specialties that might encounter a patient with a rheumatology illness? Something that you could share about managing these patients better.
Jan: It gathers a very frustrating aspect of what I do when I’m out there in the field of, let’s say, cardiology or respiratory illness or something like that. Because a lot of times they really don’t know very much and, you’re right. I think that because we have an aging population, we have a full gamut of types of arthritis that affect everybody from a child to old age but most of the arthritis and most of the chronicness of it becomes more problematic as they get older in general. Because of that, if you’re going to be in the field where you’re going to take care of older patients even like what I just mentioned, I think it’s important that they do study up on arthritis. The internet is loaded with good information but it’s also loaded with not-so-good information. So you want to make sure that the information you get is either from a Mayo Clinic or Cleveland Clinic or a reputable website or something like that because that’s where you’re really going to learn the most. And I think that nurses has to have the commitment to continue to learn and not say, “Well, this is where I am and I’ve already graduated, so therefore here I am.” I think we go to strive to become better all the time. My career has really kind of evolved into what it is naturally because of the passion I have to learn. I’m always moving forward. I never stay stuck. It’s kind of a fun thing for me to be a nurse because everything’s evolved very, very naturally for me.
Make sure you check out the entire January, 2014 issue of Nursing Notes, where we look at the career specialty of Rheumatology Nursing. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month featuring our Rheumatology Nurse panel discussion with Vicky Ruffing, nurse manager at the Johns Hopkins Arthritis Center and former president and founder of the Rheumatology Nurses Society, and Sheree Carter, current president of the Rheumatology Nurse Society and clinical assistant professor at the University of Alabama in Huntsville College of Nursing.. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.