By Hannah Fullerton – Dental Implant Nurse at Dawood and Tanner Specialist Academy.
On being asked to write an extract detailing my typical working day as an implant dental nurse, everyone knew straight away there isn't a structured routine so to list my day hour by hour just wouldn’t work.
I generally start my day by arriving an hour before any patient is scheduled to be seen. This time allows me to go through my day, seeing if there have been any changes from the evening before, and I prepare myself mentally for the stage of treatment each patient is in for. I see multiple patients each hour so it would be impractical to set up the surgery for every patient but I can prepare a set amount of treatments up across the three rooms I may be working between. I am in charge of one room so each morning I ensure it is fully stocked and all equipment is working to prevent any unwanted delay in the day. My colleagues will open up and stock their rooms and before the first patient arrives we get together to all look at the day ahead updating each other of different stages of treatment or flagging up potential areas of priority.
The first patient will arrive and this is when the fun begins.
My first patient could be having multiple implant placements which may involve me being surgically scrubbed up and nursing chair side though equally I may be the runner. This is just as important and involved as I might be manipulating the scan software for the dentist to view through treatment, opening up implant components, taking clinical photographs and selecting and preparing relevant impression copings. Familiarising myself with the case ahead of surgery allows me to anticipate the clinician’s requirements and needs. It is important to know the cases, treatment stages, what’s next and be fully engaged at all times whether as scrub nurse or runner.
My first patient could have also been a review follow up appointment with a patient post-surgery. They may be coming to have their sutures removed. This appointment would be considerably shorter than a surgical procedure nursing chair side but it is still an opportunity when the dental nurse can be actively involved. It is crucial to check in verbally with the patient and discuss how they have been, answer often many inquisitive questions they have been thinking of and also to ensure the correct oral hygiene routine is being followed encouraging the surgical site to be healing well. After approval from the clinician and patient, the nurse may get more involved and even remove the sutures-sometimes hard to resist if they are flapping in the breeze!
It might not always be possible but I try to keep consistency with patients and if I nursed for them surgically I will try to be the one to make a post-operative courtesy call and subsequently see them again for future removals. Nursing is an interactive job, can cover a very wide spectrum of roles, and I fully believe it is what you make it.
Some days I am performing the surgical hand washing technique each hour and surgical procedures are back to back though other days I am meeting and greeting new patients for their first consultation; their first step in the implant journey. Although surgical procedures are my first love, these consultants-meeting a new patient for the first time- comes close! First impressions really do count and it is vital I am on the ball and confident to what I am explaining. Every patient is different and most have lots of questions, chatting away, and I get to discuss teeth to my heart’s content but equally some patients prefer to sit and wait for the dentist, which is something I do always point out; though I have taken the time to research independently and study my profession and yes, I am now familiar with a whole range of panoramic radiographs I am presented with; still, my eyes and knowledge are trained differently to that of a dentist. However, the nurse is still a significant part of that appointment. Before the clinician comes in I take time to get to know the patient individually and in a somewhat casual discussion, I will be gathering information such as medical issues, patient concerns and patient priorities so that I can be the ‘middleman’ and provide an accurate handover to the clinician when he enters the room. I guess this is an efficient routine the clinician and nurses now have down to a fine art!
First patients of the day could be an emergency and at which point there is often little planning or preparation that can be done-I enjoy these patients as they keep me on my toes because I have to think quickly piecing together information they give me so I can relay the situation to the clinician, identify what materials or equipment we may require and thus work efficiently with the time we have.
My first patient may be at the impression stage of their treatment; the morning preparation really pays off in an appointment like this as I would have already known the components required for the impression or even, something really exciting, it may be a digital impression. Both versions allow the nurse to be actively involve. Either conventionally taking the opposing impression or digitally scanning the patient. My favourite has to be the digital as I can stop, show the patient what I am doing and they can follow the process with me. There’s something rather fantastic about seeing patients eyes light up whilst they see an exact replica of their teeth appear on the screen before them. For me I have a particular love for dental technical advances (technical advances which Dawood and Tanner are at the forefront of using and have access to at their fingertips) so I have begun to be involved in the digital planning and set up; or rather the next stage of these scans. Working on the dental software’s I mostly do after hours as I get unpressured time to experiment and teach myself extra steps in setting up for example; an edentulous patient for implant planning using their CT scans and digital scans combined. I am still in the early process of learning this path, but ask me in a year and let’s see where it has taken me!
At the practice, I may even see my first patient off site, in the hospital for an oncology rehabilitation case, which brings out a whole different kind of day all together but that day deserves its own report alone!
I may seem like I’m working alone most of the time but far from it. Yes, I do get a lot of one on one patient time which I really try to use efficiently but I always keep in constant communication with my team; where I am and where they are so we can sync together the patients and smooth running of our day. I definitely couldn’t do my day without them! Together we flow through the morning to afternoon, assisting each other chair side (working 6 handed), turning around rooms quickly (ensuring correct cross infection control at all times) and making sure the clinician goes to the right room first!
Now some people do get teeth in a day and so that same patient may be my first and last patient of a day. This treatment is something very exciting for the patient and too for the team, often seeing an almost instant transformation. Planning, communication and preparation of the whole team together allows this treatment to be carried out.
Back on track-My first patient could equally be someone having their later stage of treatment and finally getting their implant supported definitive prosthetic work. I use the beginning of the treatment appointment to show the patient their new crowns or bridgework and we look together at the artistry the technician has put into making the material come to life and appear as tailor-made teeth! I also use this time, with the aid of the 3D printed model, to demonstrate to the patient the correct maintenance technique. I explain carefully the different anatomical structure of a tooth and an implant and the different cleaning techniques.
Notice how every patient could be my first patient? Well that’s because I try to make every patient feel like they are my first patient of day and are greeted with the same fresh enthusiasm I have at 9am in the morning even at 5pm in the evening.
So, before I realise it, the days appointments are complete-and I want more! But luckily there are still a few tasks to wrap up before I call it a day. I once again I gather with the team and go through the day passing on relevant information (Lab work, Letters, reviews of X-rays) for the other nurses or clinician. I then individually go through the diary and go into every patient I have seen and check my notes for accuracy (which I would have recorded at the time of the appointment) then I take the time to go through the next day and prepare the radiograph request forms for patients who will require imaging tomorrow. Going through to identify if a patient requires a CBCT or OPG is a good way to familiarise myself with what to expect the following day.
So, all in one day the variety of my role could take me from impression taking, to suture removing, to oral hygiene communication, to digital scanning, to radiographic scanning, to surgically assisting or prosthetically assisting. Implant nursing isn’t just A to B but instead it goes through a whole journey (C,D,E, all the way through to Z!) of unique treatment for a patient and every step of the way is just as important as the last-but also an opportunity for the nurse to be involved in thoroughly. No matter what the treatment- and I sure haven't been able to write about them all- as a nurse I strive to always be reassuring and caring, putting the individual patient first. So a typical day?- I might be buzzing around the practice or sitting down chair side for an hour but I am always active and even when I do stop and sit still at lunch time I get itchy feet quickly!