Recruitment and Retention: A Cath Lab Perspective

What worked for me is not necessarily what will work for everyone, but I believe my experiences could be a base with which to start. In my current position as Director of Diagnostic Cardiovascular Services at Bay Medical Center in Panama City, Florida, I am privileged to manage a department of cardiovascular professionals who define the word team, professionalism and excellence. What is the common denominator of all cath labs? Obtaining and maintaining exceptional clinical professionals who perform invasive coronary, peripheral and EP procedures in the most rewarding and critical specialty in medicine today, and decreasing high staff turnover rates and increasing staff satisfaction. What are the issues that all employees face? Competitive salaries, territorial boundaries, lack of involvement, communication, support from management, support from physicians, desire for added responsibilities, respect, trust, training, education, tools to do their job, team work and a place that they would like to come work everyday. So many issues, so few answers. How do we as managers resolve these issues, or can we? Can we satisfy everyone 100% of the time? Where do we begin? To look at these challenges as a whole is overwhelming. Putting them into perspective will allow them to become more manageable. Not all issues need to be addressed individually, because there are some that will fall in line or fix themselves if a related issue is first improved. Communicate Communication is by far the number one problem area. By increasing communication, other areas could improve along with it. Regular staff meetings are a great forum. Some facilities hold monthly staff meetings. Although this is a minimum requirement, I have found weekly meetings to be much more beneficial. We hold cath lab staff meetings each Tuesday at 6:30 am. We have found this time to work well for the staff and the schedule. A Communication Book is also a useful tool for those who could not make it to the staff meetings, i.e., PDO, Sick, Education meetings, etc. The book also serves as a method to verify if certain topics have been discussed in the event of a question. Having a Read and Initial form for the staff meeting minutes in the book is also a good idea to ensure that all staff have read them. Communication goes in all directions. The pipeline of communication from senior management to employees relies on the department manager’s and/or direct supervisor’s communication to the staff. This is also true in the reverse. One way the employee can communicate back to a manager is through the same pipeline. As department managers (supervisors, managers, directors) we are, on many occasions, the voice and spirit of those we supervise. The more direct communication we have, the less the confusion there will be, and fewer rumors as well. Involve the staff Staff members want to feel that they are a part of the business. Decisions are being made about their job duties and responsibilities, their daily work and/or call schedules, and their chosen profession. Cath lab staff are very proud people. They want to do the best job possible and provide exceptional patient care. If a method or system needs to be changed or adjusted, get their input. Pose the problem or issue to them directly. For example: We need to decrease the room turnaround times by 5 or 10 minutes. How can we as a team accomplish that? Many suggestions could be brought up at this meeting. You could ask some of the staff to form a committee to obtain suggestions or possible solutions and bring them to the next meeting for discussion. I have found that more than enough staff will volunteer for these committees (this is an area where added responsibilities are brought into the mix). The committee’s purpose is to present viable plans or solutions to the staff and management. In most cases, there is more than one reasonable presentation. It is the group’s task at this time to select one and put that plan into motion. This action is usually performed as a trial or pilot, with staff understanding that small adjustments may be necessary along the way. Ask for help As managers, we can’t do it all. There is too much to do. We must rely on our support group, the staff. Ask the staff for help. Look for volunteers. I was once asked by another manager, How did you get that person to do that without having to pay her more money? What that manager didn’t understand was that while compensation is certainly important, it’s not always about the money. I had asked if someone would be interested in taking on the responsibility of being our educator. Right away, one of the cath lab nurses took on this challenge, and she has done a remarkable job. In addition to her normal duties as a procedure nurse, she finds the time (somehow) to work on all the educational requirements of this department. Not only did she achieve exceptional results, but the program and design she came up with have also served as a model for other departments. We (the cath lab supervisor and I) also asked for volunteers for an Interview Committee, an Operational Committee, a Value Analysis Committee and a Cath Lab Committee. We had overwhelming responses from staff members for each of these committees. Our lab’s committee members take great pride in their committee duties. In order to get trust and respect, you have to earn it first When I first arrived here a little over a year ago, I knew the staff was nervous. What will he do? What will he change? Will things get better or worse? How will he receive us? The list of apprehensive questions could go on and on. One of the best things I changed was being a manager who could lead by example, listen, communicate, support and work side-by-side with my staff. Aside from the administrative aspects of this position, I must possess the qualifications and expertise that meet those of my staff. How else can a manager relate to his/her employees? Within my first week here, I stepped into the cath lab, met the team assigned to that room, scrubbed up and began working with the staff and physicians performing procedures. This seemed to be a rare event for my new staff. The control room filled up pretty quickly with spectators. By doing this, I began the process of gaining the trust and respect not only of the staff, but of the physicians as well. Is this something that everyone should do? No. There is always more than one way to accomplish a task and achieve the same results, but this was the process that worked for me. The staff needs to trust us (managers) to be there for them, support their ideas and remain open-minded. We need to remember that none of us were born into this position. We went through the same growing pains as everyone else. It is especially something we should not forget when one of our employees comes to us with a concern that may seem trivial, but is important to that employee. It is also our responsibility to teach others. Have you ever had someone who was very knowledgeable, but would not pass on their knowledge for fear that someone else may become more valuable? We all have. Education should be another top priority. We need to ensure that in-services and continuing education are ongoing. Staff are eager to learn and they thirst for knowledge. I have found great personal satisfaction in being able to pass on what I have learned and teach others. By continually educating staff and staying abreast of the latest technologies and procedures, the physician/staff relationship also grows. The more confident the physicians are with the staff, the better the working relationship and mutual trust will be. Retention By gaining the staff’s trust and respect, a manager is likely to increase retention with that accomplishment alone, but what else can be done? There are many ideas floating around out there that have been very successful. Any success I achieved in retaining staff I attribute to treating them as adults and as highly intelligent medical professionals. As a manager, we must trust our staff and give them the opportunities to perform their duties without direct supervision, looking over their shoulders, micro-managing their day, or even getting in their way. My management style is to give staff the tools, education, training and support they need to do their job. In other words, they know what to do, let them do it. Cath lab staff are very proud individuals who like to show off their talents, their lab and their profession. Being territorial, cath lab staff are very protective of their patients. They treat each patient as if he or she were one of their loved ones. Professionalism knows no prejudice. All patients are treated and cared for equally. Rewards What about rewards? Rewards don’t have to be monetary, but some certainly are. If a person obtains his bachelor’s degree or becomes registered, there should be some kind of compensation and/or recognition. Send staff to conferences, seminars, or professional symposia. I don’t know of any staff member who doesn’t like to attend these meetings. Recognition is a big reward. Staff like to know they are being recognized not only by their direct supervisors, but by upper management and administration as well. Recommend stellar performers at your center for Employee of the Month. Say thank you! two easy words to say that mean so much. Acknowledge staff and let them know how much they are appreciated and how important it is to have them there. Without physicians, there are no patients; without staff, there are no procedures. Both generate revenue and without the revenue cath labs generate, most facilities could not exist. Recruitment Recruitment is a difficult process. Finding nurses and technologists for a specialty area is extremely difficult, especially in the cath lab environment. Most employees who are hired into these positions do not have a background in the cath lab. In many cases, we must train our own. Outside of the cardiopulmonary technology (CPT) schools located throughout the country, there is no specific school that teaches this specialty. Utilizing search firms (headhunters) though the result will be a fully-qualified professional candidate is extremely expensive. Recruitment processes must be aggressive and outside the box. Posting positions in the typical places, such as monster.com, hotjobs.com, Cath Lab Digest, careerbuilder.com, EP Lab Digest, and many others, are great places to start, but we need to go even further. Contact technical schools, particularly radiology and surgical tech schools. Offer to give talks about your profession and facility. If possible, invite schools to come to your facility for their clinical rotations. Some facilities provide internship programs. Although most cath labs will not recruit newly graduated nurses, it is still beneficial to have nursing rotations in the labs. The rotation may spark an interest in those nurses and encourage them to gain the experience needed as critical care nurses to eventually work in the the cath lab. This has actually proven to work out in this manner several times in my career. Most medical professionals don’t really know what goes on in a cath lab. In every interview I have with a prospective candidate, I ask, What do you know about cath labs and what is done? Most will say that they have had a one- or two-day rotation or that they know nothing at all about cath lab procedures and processes. Occasionally, medical professionals who work at the hospital will stop by and ask about the cath lab. Invite them to come and observe for a day. One final important recruitment tool is your staff! Staff who are satisfied and happy with their place of business make the best recruitment tools possible. Through networking, they get the word out that their lab is the place to be. This has been a plus for our lab many times over. When our cath lab expanded and added more rooms, there was also a need to add more staff. We were inundated with phone calls from professionals interested in interviewing for positions. One good means of measuring this interest were the amount of calls and transfer requests we received from within the hospital. All positions were filled quickly and there is now a waiting list. The thoughts and ideas presented in this article are but the tip of an iceberg. We all know that it is very expensive to continue to hire new personnel and put them through orientation, just to lose them within a short period of time. Retention of staff needs to be one of your main focuses. It’s all part of a manager’s multitasking abilities. Keeping good staff is not easy, but it can be done. You may never achieve 100% consistent retention (although I believe there are those out there who have), but you can achieve high ratings. This past fiscal year, I have been fortunate to achieve a 96% retention rating, and the most recent Employee Survey rating of 91%. This was a significant increase from the last survey in 2003 of 54%. I attribute this success to my staff. They are the key. They have the knowledge, skills, loyalty and dedication it takes for a manager to succeed. I was once asked, What is your reward? My answer was, To have staff members who are so self-sufficient, that if I’m not here, it doesn’t matter. They will continue at the same level and be the best. Dennis Holloway can be contacted at denniswh1951@yahoo.com

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