Rick Luscombe — Vascular Access

In celebration of our Recognition theme on Bloom this month, we'd like to congratulate Rick Luscombe on his Excellence in Nursing Administration Award from the Canadian Association of Nephrology Nurses and Technologists!

How did you end up where you are now?
I attended George Brown College in Ontario for nursing. I first started in renal work at Toronto Western back in 1985 where I was working in peritoneal dialysis and transplants. After a few years I became a hemodialysis nurse and I fell in love with my work.

In 1990 I happened to come to Vancouver on vacation and visited the renal unit at SPH to see how they might be doing things differently from back home. The manager at the time offered me a job and, with the weather being so nice at the time, it was easy to say yes.

I went to UVic to get my BSN in 2002. Part of my project was to develop the role of vascular access nurses in B.C. We didn’t have many at the time, only one at VGH. I wrote up the proposal, created the job description and presented it to my leader who was supportive. I’ve been working as a vascular access nurse at PHC ever since. I’m now a CNL and education has become more of a focus for me.

So what does a vascular access nurse do?
All hemodialysis patients need a vascular access; some way to get blood into and out of the body so it can pass through the dialysis machine. There are three types of access: a fistula, a graft or a central line. I help assess which vascular access would work best for each patient.

I see patients in clinic with the surgeon and nephrologist to consent and triage them for surgery and then I follow them post-surgery to assess for maturation and complications. If complications arise, I organize investigations and interventions. My colleague and I monitor approximately 1,000 patients at any one time between in-patients, in centre hemodialysis, community, kidney care clinics and patients from other parts of the renal program.

What would you like people to know about your job?
It’s a rewarding job but it’s very challenging. You never get to the top of the mountain. We only see the patients who are having problems and in some cases there’s no fixing them. But when we do find a solution and we’re able to give a person an additional one or more years of life, it’s a very rewarding feeling.

What’s the best part of your job?
The best part is my role as an educator. Nurses touch briefly on vascular access in their hemodialysis course but the focus is definitely on operating the dialysis machines and understanding nephrology. To help expand on what they learned, I developed a week long vascular access mentorship program to give our nurses a more well-rounded understanding of vascular access and to introduce new techniques like using ultrasound for cannulation.

What would you change?
I wish we had a better data entry program. Our program is useful but, with the current technology, it crashes frequently and makes extracting the data we need a chore. If we had better access we’d be able to work faster and get more done.

How does your role differ from other health authorities?
We actually work very similarly because we’ve put a lot of effort into standardizing vascular access across the province. B.C. is now a leader on the national scene and other provinces look to us as an example of how they might standardize their policies and procedures.

What attracted you to PHC?
I liked the smaller hospital and the people at SPH. At the time, the renal unit was only 12 beds which I think did a lot to foster camaraderie between the nurses and patients. We’ve now expanded to 40 beds out of necessity and I still love the unit but a bigger unit can make communication more difficult.

What other cool projects are you working on?

I deliver my mentorship program quarterly here in the unit, but I also offer a four hour vascular access workshop to brand new nurses who have only been here for a couple of months.

I recently returned from Calgary where I was assisting them to set up a workshop for their vascular access program.
I’m busy helping plan the national symposium of the “Canadian Association of Nephrology Nurses and Technologists” here at the Hyatt in October.
We’re participating in a research project that is exploring a revolutionary new way of creating fistulas in radiology rather than the OR. We’ve done 25 procedures here at SPH of the 75 done around the world.
Lastly, our unit just won a 3M award for our short stay unit which allows for vascular access procedures and patient education without impacting the rest of the unit. It’s the first of its kind in Canada as far as I know.

Where do you see yourself in a few years?
I love what I’m doing, I have a lot of autonomy in my job and I work with a great group of colleagues. So I’m going to stay right where I am.