No Pressure Here - Life as a Hyperbaric Nurse
By Lee Nelson
When registered nurse Annette Gwilliam remarried, she and her new husband found out that they loved scuba diving. That became a huge part of their lives. They even opened up a scuba business in land-locked Utah.
“People that live in a desert like to vacation in water, and we traveled the world taking groups on dive trips,” she says.
When she was visiting the wound care center with one of her home care patients, she learned that they were going to get a hyperbaric chamber.
“It was a match made in heaven. I knew that my love of scuba and wound care would come together and that being the hyperbaric nurse was my dream job,” Gwilliam says.
She now is lead RN at Utah Valley Wound Care and Hyperbaric Medicine Center in Provo, Utah. She also serves as president of the Baromedical Nurses Association.
“I like to say that I am the nurse at our hospital that works under the most ‘pressure.’ You will find that is true in the field of hyperbaric medicine,” she adds.
What is a hyperbaric nurse?
The Undersea and Hyperbaric Medical Society (UHMS) describes hyperbaric oxygen therapy (HBO2) as “an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure.”
“In certain circumstances, hyperbaric oxygen therapy represents the primary treatment modality while in others it is an adjunct to surgical or pharmacologic interventions,” Gwilliam says.
Research is very important in hyperbaric medicine, and many centers are studying the effects of 100% oxygen under pressure on various diagnoses, including traumatic brain injuries.
What is a hyperbaric treatment, and who can it help?
Treatment can be carried out in either a mono- or multi-place chamber. The former accommodates a single patient. The entire chamber is pressurized with near 100% oxygen, and the patient breathes the ambient chamber oxygen directly, Gwilliam explains.
The latter holds two or more people (patients, observers, and/or support personnel); the chamber is pressurized with compressed air while the patients breathe near 100% oxygen via masks, head hoods, or endotracheal tubes.
There is science to prove that the 14 indications recommended by the UHMS (and covered by Medicare and most insurances) are effective and can help heal patients, she says. Those include: air or gas embolism; carbon monoxide poisoning; gas gangrene; crush injury; decompression sickness; arterial insufficiencies and problem wounds; severe anemia; intracranial abscess; necrotizing soft tissue infections; refractory osteomyelitis; delayed radiation injury; compromised grafts and flaps; acute thermal burn injury; and idiopathic sudden sensorineural hearing loss.
Why did you want to be a nurse in the first place?
“I enrolled in nursing school with a goal of becoming a nurse midwife. As happens sometimes in life, my nursing career went in a very different direction,” she says.
Besides hyperbaric nursing, she has spent time on a pediatric office, on the hospital medical and oncology floor, and home care.
What are the day-to-day duties of a hyperbaric nurse?
They include some or all of the following: case managing patients, patient advocate, documentation, insurance authorization, and operating the chambers or working with HBO techs that operate the chamber.
There are always lots of “regular” nursing duties that need to be done: patient assessment and education, wound care, pain management, medication administration including oral meds as well as IV’s, Gwilliam adds.
Some HBO nurses are ICU trained and provide the same care as in the ICU hospital unit, with a twist that the nurse must now meet the needs of the very sick patient through the chamber (for mono-place chambers) or inside a chamber under the same pressure just as the patient is receiving (in multi-place chamber programs).
Some programs around the country are on call 24/7 for emergency cases including for carbon monoxide poisoning and failing plastic surgery grafts or flaps.
How did you get involved in the Baromedical Nurses Association?
As a hyperbaric nurse, Gwilliam attended a UHMS national annual scientific meeting. During the conference, the nurses in attendance had the annual general meeting of the BNA (Baromedical Nurses Association), which she attended.
She volunteered to help on the membership committee and then became chairman. This led to other opportunities to volunteer, and she became vice president, and now serves as its president.
The website has CEU’s free to members as well as other information about HBO nursing, certification and lots of other information including nursing plan of care for HBO patients.
What does it take to become a hyperbaric nurse?
Hyperbaric nursing is a very specialized field, Gwilliam says. As you start working in the field, most nurses take a 40-hour basic course to learn about how pressure affects the body as well how it enhances healing in the 14 diagnoses mentioned above. After this training, you learn from others on the job or through education, either online or through books. This is where the BNA can assist nurses to improve their skills and treat patients safely.
The next step is certification through the National Board of Diving and Hyperbaric Medicine Technology (NBDHMT). After that training course, you apprentice for 480 hours under the direction of the hyperbaric physician or other certified RN’s. You are then eligible to sit for the certification examination. There are three different levels of certification.
Talk about one of the best days you had as a hyperbaric nurse
One of her best days involves the miraculous healing of a patient with CRAO (Central Retinal Arterial Occlusion).
“We received a call from an ophthalmologist who referred a patient to us that had spontaneously lost the vision in one eye. He was a surgeon and could not continue to work without vision in both eyes,” Gwilliam explains.
They administered O2 to him outside the chamber, without any success. He then received a treatment in the multi-place chamber. After he had been compressed the equivalent of being under water about 45 feet on 100% oxygen for about 10 minutes, he started seeing shadows. Before the first treatment was over, he was seeing shapes and color. Throughout the next several days and eight hyperbaric treatments, he received 95% of his vision back.
What is the salary range of a hyperbaric nurse?
The salary range for an HBO nurse is usually higher than floor nursing and as in any nursing job, increases with the amount of experience in the field, she says.
What is the job outlook for these type of nurses?
“There are always RN positions open in the HBO field, and we are always trying to recruit interested nurses willing to be trained,” Gwilliam states. “HBO nurses are found in almost all states as well as around the world, especially in many in areas with scuba diving, such as Cozumel.”