Cath Lab Management: Short- and Long-Term Strategies to Address Cardiovascular Staff Shortages

In cardiovascular care, the staff shortage is real, with emergency care, critical care (i.e., cath lab, telemetry, and intensive care), and surgery being the hardest hit and the most difficult areas to fill. This critical shortage will have a profound effect on all areas of the healthcare system over the next five to ten years. The greatest impact will be felt in the shortage of Registered Nurses, as this group makes up the largest component of direct patient-care providers. There has been an overabundance of studies on the healthcare staff shortage and its causes. Current trends in staff shortages are shown in Figures 1 and 2. However, there are many other factors contributing to the cardiovascular staff shortage, including: Aging of the population; Aging of the workforce the average age of nurses is currently 44 years, with only 10% of the workforce under the age of 30; A competitive hiring environment (e.g., wages, benefits, hours, etc.); Increased opportunities outside of the hospital setting; Managed care influences; Financial pressure on employers; Work environments; Negative image of healthcare-related professions; Reduced enrollment in educational programs. We must act proactively and develop realistic solutions to combat cardiovascular staff shortages. Responsibility for change must be borne by the healthcare industry, hospitals, government, and individual providers. Many hospitals and cath labs have attempted to resolve the shortage issue by focusing on a short-term band-aid namely, recruiting. The result is a revolving door of new staff and increasing dissatisfaction for current staff. Until internal changes are made, the staff revolving door will be occurring at many facilities. Alongside the internal changes of individual facilities, there must also be long-term plans initiated by the healthcare industry, hospitals, government, and individual providers at large for the education and recruitment of various healthcare professionals. Planning to address cardiovascular staff shortages must take place at both local and national levels. The most successful programs in retaining, retraining and recruiting staff have a cardiovascular strategic plan and a vision of the future that can be shared with both current and new team members. If a facility s strategic plan is based solely on the historical growth of the program, the needs and resource requirements of the institution s program will be underestimated. A historical growth-oriented plan does not consider the aging of the population and the resulting increase in demand for cardiovascular services. As a result, strategic plan development should be based both on market needs and the future demands of the community. Once a strategic plan is in place, resource requirements can be developed appropriately.

Local Level

At the local level, the individual cardiac catheterization lab is a critical access point to the cardiovascular program for patients. However, simply staffing the cath lab will not meet the needs of the entire program. There must be a specific cardiovascular strategic plan that drives a staffing plan for retention, retraining, and recruitment to address facility needs. This plan should then be integrated into the overall hospital program. The facilities most successful in recruiting staff have a specific plan and a vision of the future that can be shared with both current and new team members.

National Level

A long-term effort for healthcare recruitment planning must take place at a national level. As healthcare professionals, we must take some individual responsibility for recruitment by participating in mentoring programs, providing a positive work environment and creating on-the-job experiences for new and potential healthcare workers. Without these efforts and support, training of team members cannot be accomplished and future healthcare workers will continue to decrease in number. Coupled with the need for individual recruitment efforts is the need to reduce the costs and time of educational healthcare programs. This can be accomplished by increasing the number of available programs and online training. There must be government support for foreign graduates, i.e., tax credits. Hospital systems must provide clinical rotations and support educators who teach future healthcare professionals. Men and minorities are an untapped market. The image of healthcare as a profession for women must change to the image of a high-tech, high education/knowledge-based profession that is rewarding both financially and personally. If there is a revolving door of staff at your facility, the issues driving it should be addressed. In order to retain current staff, several key areas should be reviewed: Quality of work life Salary and benefits Efficiencies and technology

Quality of Work Life

Gone are the days of loyalty to employers by employees. How a position will affect one s personal life, family considerations, and the facility work environment have all become strong influencing factors in job choice, sometimes even before salaries are considered. Hospital administrators need to develop policies that address issues of overtime and inappropriate behavior by staff and physicians, yet are flexible enough to meet employee needs. At a personal level, the most successful programs have developed very flexible schedules. One program has 4, 6, 8, 12, and 16-hour shifts coupled with weekday and weekend-only rotations. This has encouraged part-time workers to reenter the workforce. Other programs have allowed for more self-governance with regards to scheduling. Also helpful are efforts at many facilities to create a team atmosphere and respect between physicians and other healthcare professionals. Salary and benefits are a critical consideration when choosing a potential employer or deciding to change jobs. If salaries and benefits for current staff are not at or above market levels, the institution or facility will not be able to keep existing staff or recruit new staff. Many cardiac cath labs and hospitals have lost professionals for as little as a 25 cents per hour differential. As the shortage of healthcare professionals expands, salaries and benefits must keep pace to remain competitive in the market. Sample salary ranges for cardiac cath lab personnel are shown in Table 1. Additional elements that should be considered are efficiency and technology. Does the cath lab run efficiently and is it appropriately outfitted? Some key elements that help make cath labs and support services efficient are: Block scheduling of physicians; Limiting the number of vendors; Effective staff mix for cases; An adequate number of labs; Sufficient equipment. Equipment should be state-of-the-art and/or upgraded regularly to minimize breakdown and improve efficiency. The healthcare profession in general is lagging far behind in the use of technology to make our jobs easier. Computer systems have become mirror images of the already existing mountain of paperwork rather than streamlining efforts. Internal telephone systems should reduce the number of steps that the staff must take, and give independence to staff and physicians. Hospitals must invest in the future of technology to maximize the effectiveness of limited staff in the future. I can t find experienced staff. This cry is being heard throughout the country. The most effective source of new staff is within your existing program. The willingness of the management to allow current staff to advance professionally and learn new jobs is directly tied to the level of staffing and staff satisfaction. A training program should be formal and not entirely on-the-job, or frustration will arise for the manager, coworkers, and trainee. If you do not train current staff, open positions may remain unfilled for as long as six months or a competitor may recruit your staff. Once changes have been made in your department culture and positions have been filled from within, you can determine where true position needs exist and the actual level of staffing that you require. Management and administration cannot bear the full burden of recruitment. Staff must be receptive enough to work with and accept the new person into the group. Without the participation of the existing staff, turnover will continue. Many hospitals involve current staff in the recruitment process. Efforts include bonuses, referral fees, internships, recruiting students, and involvement in the interview process. There are many creative ideas for recruitment. One state is offering low-cost home and educational loans. For nursing, obtaining Magnet Status (endorsed by the American Nurses Association) has been a strong draw, particularly in larger cities. Other recruitment efforts involve the usual activities, such as a job fair to attract the top fifty nurses, recruitment of foreign graduates, and/or involvement in the local community college. One idea alone will not work, so all options must be tried to determine what works best in your part of the country. The cardiovascular staff shortage is not only real, but will increase over the next ten years as the demand for healthcare grows along with the aging of the population and the retirement of current healthcare providers. The image and salaries of healthcare workers must change for the better. Men and minorities, a frequently overlooked pool of potential professionals, must be recruited. Critical to recruitment is the long-range planning and revision of your facility s strategic plan, the development of efforts to address the needs of current staff, allowing existing staff to develop professionally, and recruiting appropriate staff to fill vacancies. If you are in a situation where not enough professional staff exist, rethink the staff mix. Cardiac cath labs have added clerical and housekeeping staff to their staffing mix. Intensive Care Units have developed care partnerships with Respiratory Therapy or Intensive Care Technicians. Solutions are not easy. The performance program in the market will be most effective in long-term recruitment. It will take real effort on the part of government, hospitals, management, individual healthcare workers and the public to ensure that the healthcare needs of the future are met.