How to Find and Train Inexperienced Staff to Work in the Cardiac Cath Lab

Sounds pretty easy, right? In reality, it is a very difficult task to find and train inexperienced staff to work in the cardiac cath lab. If they have some experience, you can ask questions about various scenarios, and what devices and equipment they have used in the past. If they have no experience, then it may seem like pure luck to get a good candidate. Making the most of your interview is very important when hiring new staff (Figures 1-2).   

Following are some key points that can help you select the right candidate. First, try to find someone who is familiar with the general process of the cardiac cath lab. If they cannot tell you about the cardiac cath lab, then you do not want to be the one to tell them. Also, find out their motivation for wanting to come to the cardiac cath lab. Make sure they have a true interest in cardiac cath cases. Weekends and holidays off are not good reasons. Make sure you paint a realistic picture of the department. Be honest about how much call is involved, and be realistic about how often the team gets called in and how much overtime is common. Another tool we use is to invite hospital candidates to observe in the cardiac cath lab for a couple of cases. This helps the candidate decide if the cardiac cath is the right place for them. They can see, first hand, the good and bad of the cardiac cath lab. The last thing you want is for a new staff member to leave after their training because it was not what they were expecting. 

Another important factor when hiring inexperienced cardiac cath staff is to make sure they are familiar with heart pressures, heart/coronary anatomy, and some cardiac pathophysiology. These are some basics that you want them to have already. If you need to teach it in the lab, be prepared for a long orientation and frustrated staff who needs to teach it to them. The idea is to only teach them about the procedures and medications, equipment, supplies, and the flow of the procedure. Anything else and you are setting yourself up for an extended training. 

 Consider utilizing peer interview in the selection process. This is a very useful tool to get your staff’s input on the candidates. Your staff is able to give a true depiction of the lab. They can also help find out if the candidate has the basic knowledge needed to succeed in the cardiac cath lab. One thing to remember if you use peer interviewing is to make sure your staff has some training on what types of questions are permitted. We require peer interview staff to take a class offered by the hospital.  

One way to find good staff is to let your current staff do some recruiting in the hospital. Many of our newer staff members were interviewed because our older staff members were impressed with their skills in another department. Cath lab staff will talk about our department and sometimes other hospital staff are interested. Let your staff be your ambassador. We also post our job listing on the hospital website. [Editor’s note: Don’t forget the wide reach of CLD classified ads as well!].

I have found that emergency room registered nurses (RNs) usually are a good fit in the cath lab. These RNs are used to a fast pace and are able to adapt to different situations. Intensive care unit (ICU) RNs are great, too. They have all the knowledge needed to be a good cath lab RN.  The only issue I have found is that in the ICU, it is usually a controlled chaos and it takes these RNs a little getting used to the fast pace of the cardiac cath lab and the quick transition from routine PCI to a full-blown code. Weekly goals are important to make sure that the orienting RN is getting the exposure to different types of cases, understands the cases, and understands documentation. Use of a case log can help pinpoint what type of cases they are seeing.

With an inexperienced technologist, first make sure they have graduated from an accredited school and have their CCT certification (certified cardiac technician) from Cardiovascular Credentialing International ([CCI] cci-online.org). It is also extremely important to have a very structured orientation with weekly goals. Start with the basics and slowly work your way forward. Remember to include in your weekly goals an understanding of hemodynamics, coronary anatomy, and sterile technique. Also, include radiographic views, catheter shapes, wire management, and manifold prepping in your goals. Try not to overwhelm your new staff member all at once. Start with diagnostic cardiac caths and then, once mastered, start with simple percutaneous coronary interventions (PCI) and progress from there. Also, you may want to consider giving them a deadline to pass the RCIS (registered cardiovascular invasive specialist) exam from CCI. With cardiac cath labs looking for cath lab accreditation, this is an important consideration.

Whether it is a RN or a tech in training, it is important to get your physicians’ feedback during the training process. Having the physicians buy in on the training can help them feel that they are a part of the training process. We currently utilize a physician feedback form (Figure 3) that the physician will fill out before we sign off any new staff. This works well, and gives management and educators a way to make sure the physicians are ready to work with this employee independently.  

No matter how hard you try, be prepared to have some failures along the way.  Some people are just not meant to work in the cardiac cath lab. Having weekly goals can help you indentify these problems early. Then you can work on correcting them.  If they consistently fail to meet goals, then you must make the difficult decision to end the training.

Michael Robbins, BSN, RN-BC, can be contacted at michaelri@baptisthealth.net.