The Role of the RN in Hyperbaric Medicine

Background
Hyperbaric oxygen therapy relies on a chamber operator as well as a supervising provider. The generally accepted industry standard is one chamber operator for every two hyperbaric chambers. Many programs train and develop chamber operators from a variety of clinical backgrounds including:

• EMTs
• Paramedics
• Respiratory Therapists
• LPNs/LVNs
• RNs

With such a variety of clinical backgrounds in the HBO field, then what (exactly) is the role of the Registered Nurse in hyperbaric medicine? We find that the role of the hyperbaric RN can vary dramatically depending on the needs and acuity level of the unit where they are working.

History
Hyperbaric nursing first originated in Europe in the 1950s. More formal training for hyperbaric nurses was established in the 1960s, and the Baromedical Nurses Association was formed in 1985. The first set of nursing certification questions was written in the 1990s, and the nursing certification exam was established in 1995.

Historically, staff nurses assessed patients prior to (and during) each hyperbaric oxygen treatment. They also accompanied patients into multiplace chambers and operated monoplace hyperbaric delivery systems.

Today, we find hyperbaric nurses holding key roles in research, education, consulting, surveying, and leadership. There are three levels of hyperbaric registered nurse certification including…

1. Certified Hyperbaric Registered Nurse (CHRN)
2. Advanced Certified Hyperbaric Registered Nurse (ACHRN)
3. Certified Hyperbaric Registered Nurse Clinician (CHRNC)

Administrative certification recognition (-ADM) is also available for each of the above certifications when a hyperbaric RN is working in an administrative HBO₂ role and no longer directly involved in patient care.

The first textbook in hyperbaric nursing was published in 2002. Today, there are over 1,000 certified hyperbaric registered nurses (and many more non-certified RNs working in HBO2 roles) found all over the world. The Baromedical Nurses Association has also established a set of nursing guidelines which can be downloaded directly from the BNA website at https://hyperbaricnurses.org.

Present Day
Today, we find registered nurses in a variety of roles in (and around) hyperbaric oxygen therapy programs. Outpatient/low-acuity HBO2 programs may not employ an RN as a chamber operator; however, the program director or nurse manager is usually an RN who is responsible for direct oversight and management of the program. In other situations, RN oversight may be provided by a wound care RN who also has HBO2 training and supervises the hyperbaric technician/care plan from the adjacent wound care center. We also see RNs who become Nurse Practitioners and then continue their HBO2 work as supervising providers in collaborative relationships with trained hyperbaric physicians.

Arguably, full-body assessment is part of an RN’s scope. For this reason, many hospitals allow RNs to assess patient’s tympanic membranes and other parts of the body (as they relate to HBO2) in partnership with the supervising provider. Patient education has always been an important part of the Registered Nurse’s role. In the hyperbaric setting, RNs may be responsible for educating the patient around a number of key HBO issues:

• Knowledge deficits about the procedure
• Confinement anxiety
• Potential for injury
• Management of expected & potential side effects
• Pain & discomfort management
• Nutrition
• Appropriate aspects of self-care and wound healing (as they relate to the HBO2 therapy)

Emergency HBO₂ units will often choose to employ RNs in direct chamber operation/patient care roles. These units may be called on to manage intravenous infusion, hemodynamic monitoring, airway control, and other advanced medical practices which require an RN scope.

Documentation
Documentation is a critical aspect of the nursing process (and not just in hyperbaric medicine). Nurses are called on to manage the patient’s interdisciplinary team plan while recording the care (and progression of that care) towards the specific goals. In today’s era of electronic medical records, it is not uncommon for the nurse’s documentation to interweave with the provider and other care team members, especially if the RN is in a supervisory or assessment-based role instead of directly operating the chamber(s).

Conclusion
In summary, registered nurses have a well established presence in hyperbaric medicine, but not necessarily a one-size-fits-all traditional role that works for every center type. Depending on acuity level and unit needs, RNs may (or may not) be directly employed as chamber operators. They are also often utilized for nursing oversight of hyperbaric staff with lesser clinical qualifications or as program managers. A variety of nursing certifications can be pursued through the Baromedical Nurses Association, and the nature of RN scope (including teaching ability & patient assessment) means that they are a critical and irreplaceable part of any hyperbaric program.