Being a Team in the Cath Lab

Definitions: Team\ tem \ n 1: two or more draft animals harnessed to the same vehicle or implement (OK, we all work in healthcare; please disregard THIS definition, especially anyone who is an administrator!) 2: two or more individuals associated in work or activity (that’s better) vb 1: to join forces to work toward completing a common goal (now we’re talking) The management team of the Department of Cardiovascular Medicine at The Cleveland Clinic recently attended a four-hour developmental retreat/seminar. The seminar leader was Christine Holton Cashen (www.adynamicspeaker.com). Not being an individual who enjoys managerial seminars, retreats, role-playing exercises, etc., I just kept praying Lord, help me not to embarrass myself by snoring too loudly when I fall asleep. To my pleasant surprise, Christine was very animated, and has a gift for interjecting humor with creative thinking (and thankfully, she did not subject me to role-playing). Christine touched on a number of topics, the most timely of which was what makes up a true team? She gave a list of ten items that are essential to true teams. Four of these items stand out in my mind more than the rest: Help each other to be right, not wrong; Treat each other with respect; Speak positively about each other and your organization at every opportunity; and, Make have fun the rule. Traditionally, cardiac catheterization laboratory staffing consists of a multi-disciplinary lineup of professionals. At various institutions, cardiologists may work with a group that can be comprised of RNs, Licensed Practical Nurses (LPNs), Radiologic Technologists (RT(R)s), Cardiovascular Technologists (CVTs), Emergency Medical Technicians (EMTs or Paramedics), and Respiratory Therapists (RTs). How do all of these different individuals, with varying personalities, levels of education and credentials, work together? If only half of your staff worked while the other half stood by and did nothing, would your cases be completed as safely and efficiently as possible? Is your cath lab cross-trained, or are the duties of each staff member so spread out and separated that if one staff member is missing, another cannot move in and effectively perform? Over the years, I have come to notice a rather large roadblock to becoming an effective team: seasoned veterans are often very unwelcoming, cold, and downright unkind to the new kids on the block. While I was in nursing school, one of my instructors made the statement that nurses eat their young. Some time ago, a friend of mine forwarded an excerpt from an article in the job section of his local newspaper. Part of the article stated, People very seldom leave their jobs anymore for salary issues and retirement programs; they leave because of how they are treated. This refers not only to how management treats them, but also to how they are treated by co-workers. More and more each day, it seems as if hospitals are becoming large intensive care units. The population of America is aging, and there is a nationwide shortage of nurses and other healthcare professionals. Yet instead of being greeted with open arms, rookies are often made to prove their worth before being accepted. Now I realize this is not the case at every facility; however, I have personally experienced it enough over the years to expect it to be the norm, not the exception. Sad, but unfortunately true. A recent topical discussion on the www.cathlab.com bulletin board touched on this very subject. The topic, posted under the Administration/Management thread, began with a question about new graduate nurses working in the cath lab. Most replies were in agreement that only nurses with years of critical care/ICU experience were equipped with the skills necessary to work in the lab. One respondent, who identified himself as coupdfem, relayed his unfortunate cath lab experience. In his first posting, coupdfem stated that he was an RN with 8 years CCU experience who had just been on the job at a busy cath lab for the past four months, and still felt like he was floundering. When I began my career in the cath lab at the University of Michigan some 15+ years ago, I felt the same way. I had an Associates Degree in Cardiovascular Technology, and had been working previously at a community hospital performing ECGs, stress testing, holters, and EEGs. My first week at the University of Michigan, I felt as if I had made the biggest mistake of my life. Coupdfem worked in a cross-trained lab, and the expectation was to be able to be proficient in all roles, including scrubbing and monitoring, in 60 days. Coupdfem eventually decided that it was not worth the sign-on bonus, nor the retention bonus coupdfem would have received had he or she remained employed until January of next year. One of coupdfem‘s final statements was a plea: reexamine your orientation expectations and follow-up; make sure the people you have are given a chance to be successful. Some of the comments that followed revealed the cold, harsh attitude in healthcare I previously mentioned. One respondent in particular made these statements: Since when was any part of the tasks in the cath lab part of an RN’s education, training, or scope of practice? ¦ALL of the nurses that I have worked with since 1987 have been deficient¦ if it weren’t for their license to administer medications, they would not be in the lab. This person then went on to describe various situations in which the respondent, a mere tech, had to come to the rescue and bail out the nursing staff. It is true that many tasks in the cath lab are not part of an RN’s education and training. However, my nursing education did a very good job of covering critical care. It is also true that most patient care aspects are not part of the training and education of Radiology Techs. However, RT programs do a fabulous job of covering radiographic anatomy and disease of the entire body. Paramedical and Respiratory Therapy educations are also geared differently. Herein lies the strength of the cath lab multidisciplinary staffing, from which our patients benefit. Being a resource in the cath lab can only come with experience, not professional background. I have seen both nurses and techs excel, and I have seen both nurses and techs sink. Unless you are a graduate of an accredited Cardiovascular Technology Program (of which there are so few across the country) and this program includes a full year of invasive cardiology, no one can be prepared to work in the cardiac cath lab right out of school, regardless of your educational background. A proper orientation and mentoring from senior staff are the keys to success for new cath lab employees. I strongly advocate that the Registered Cardiovascular Invasive Specialist (RCIS) be the specialty credential exam of choice for all cath lab professionals.* Whether you are an RN, CVT, RT, RRT, or EMT-P, (etc.), we have all experienced issues related to scope of practice. However, we need to put aside our differences and work together as a team. Experienced cath lab professionals also need to nurture new employees. Fifteen years ago, if it wasn’t for the help of co-workers like Paul Eby, Henry Hawker, and George Davis, I would have left the cath lab at University of Michigan. These professionals not only helped me out as I learned how to do things, they took time out to have fun as well. If someone does not know something, don’t cop an attitude and do it yourself. Take the time to explain what is going on and instruct them how to do it. Be an advocate for your teammate, especially if they are new to the environment. You may have to stop and tell the physician, Nurse/Tech Doe is new/hasn’t been oriented to this, so it will take a few more minutes. Yes, I know the physician may get impatient, even angry, but you know what? Ultimately, they will respect your experience and knowledge more when you take the time to properly train others. The water in the healthcare resource pool is getting more and more shallow with each passing day. The reality is that we no longer have the luxury of hiring only staff with years of critical care experience. We have to give staff a reason to want to stay in the cath lab. Let’s stop eating our young.

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