Discussion group members responded to the questions below, and emails are included for any questions readers may have regarding a particular lab™s policies. If you™d like to join our group, please send an email to:
cathlabdigest@hotmail.com

Topics Under Discussion:

Who is Responsible for Prescription Lead Eyewear?
During an education session on radiation exposure, the question arose on whose responsibility it is to provide prescription eyewear for staff members? Standard lead glasses are provided by the hospital, but many of us need our prescription eyewear (some require bifocals) to see! Any feedback would be appreciated on how other institutions address this issue.     
Chris Reoch, RCIS
reochris2000@comcast.net

Clinical Ladders
We are in the process of designing a clinical ladder within the cath lab for both the nurses and techs. Would anyone be willing to fax their clinical ladder layout or provide input into the design?
Odediah Skolnick, RN, BSN,
akhot2345@earthlink.net

RCIS: Continuing Discussion
There seems to be a lot of suggestion for RNs  and RTRs to test within the cardiac interventional arena to benefit our knowledge within the cardiac field. Although I condone continuing education, I'm slightly confused as to  the benefit a RCIS certification would hold for nurses or radiologic technologists. Currently Illinois does not recognize RCIS as a license.

My question or concern is this: my state requires RNs to be present during all patients undergoing conscious sedation for monitoring reasons. They also mandate that a radiologic technologist  be present for QA during radiation emission. So what benefit is there for the hospital to hire a RCIS? They don't provide any coverage for state requirements or JCAHO.

Am I missing some component? Do other states allow a RCIS to substitute as a RTR or RN because of their testing? Although the exam for RCIS may benefit individuals¦
A CLD reader

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Group Members Respond to ¦ Prescription Lead Eyewear Who is Responsible?

Bulk ordering good option
At our cath lab, we purchase eyewear for staff and physicians. We also look at a bulk order in order to get a discount price.
Thomas Gaylets, t9261@epix.net

1X only
We came across this one too, as well as the vision loops for the surgical nurses. Did we buy them? Yes, however, we also felt it was part of the tools of their trade. They also take better care when they put out the $$. In the future, I do not intend to buy them.
Judith Filthaut, JudithF@mcgh.org

Fit-over frames
At my facility, the Cleveland Clinic, the department pays for staff physicians only; however, with a large cardiovascular fellowship program, there is little opportunity for our nurses and CVTs to be the primary scrub assistant, thus little need for lead eyeware. One very economic alternative to prescription lead glasses are fit-over frames. These are conventional 0.5mm lead equivalant lenses and 0.25mm sideshields in a conventional tortoise-shell frames with a plastic space bar at the top to allow them to fit on top of the majority of prescription glasses. I purchase the RayShield Fit-Over Model #LG-190 from Aadco Medical, but other manufacturers/distributors sell similar products.
Kenneth A. Gorski, RN, RCIS, FSICP
Assistant Manager
Sones Cardiac Catheterization Laboratories
The Cleveland Clinic Foundation, Cleveland, OH
gorskik@ccf.org

Price determines decision
We do not have anyone using prescription lead glasses. If we were to need this, I would get a price, then, depending on cost, decide about purchasing them.
Cindy Porterfield
cporterfield@cmhhospital.org

Hospital responsible
The hospital organization has the responsibility to protect their employees in a safety issue. I know the glasses are costly but feel the hospital should provide them or at least pay half. There are clip-on lead glasses that don™t have to be prescription.
Suggested company name: Pacific Northwest X-Ray Inc., P.O.Box 625, Gresham, OR 97030. (Sorry I don™t have the phone number, but we found it on the web.)
Larry Sneed, BS, RCP
Manager, Cath Lab
Alamance Regional Medical Ctr.
sneelarr@armc.com

If requested
We provide both the physicians and the staff with prescription lead glasses if they are requested.
Sheila DeBastiani, RT(R),
Supervisor/Educator
Sdebastiani@wakemed.org

At 2 facilities, yes
I™ve worked for two facilities in the last 10 years and both have provided prescription lead glasses to the staff and the physicians.
Charlene Houston, NCMC, Greeley, CO, c6009@hotmail.com

Suggested company
I™ve not encountered a request for lead glasses from any of my staff. But I have recently found a company that makes lead eyewear that fits over any prescriptive glasses. They can also be worn alone. The glasses are lightweight and affordable. The company is Alliance X-Ray. You can contact Charlie Miller at (866) 311-9729 or email at alliance.xray@my2way.com
Tracijo Capua, CCL Coordinator, Tracy.Capua@flaglerhospital.org

Union and OSHA say yes
The management facility is responsible for prescription lead eyewear protection in our cath lab. This is a union hospital and we are covered according to OSHA standards.
M. Bolla RT(R)
Santa Teresa Hospital, San Jose, California
msmarlenerose@yahoo.com

Wear-overs comfortable
If you look at the right vendor, there are lead goggles that can be worn over your own personal glasses. They are comfortable, shaped like goggles so they protect against splashes, and do not have to be replaced every time your prescription changes.
Anna Smith BSN, RN, RCIS
Clinical Educator: Orientation, Ambulatory
Services, Center for Clinical Excellence
St. Joseph Medical Center, Towson, MD
annasmith@chi-east.org

Employees purchase
My hospital provides generic lead glasses. If an employee wants prescription glasses, they purchase those themselves, since they would not be of any use for anyone else. If they leave our facility, the glasses belong to them and they take the glasses with them. We do provide the same glasses for our doctors.
Gloria Nolan
Gloria.Nolan@HCAHealthcare.com

Should be supplied
We currently supply lead glasses for the staff but prescription eyewear for the physicians is to be purchased by them. I have also seen facilities that purchase the prescription eyewear for the physicians. I would think that it is the facilities™ responsibility to purchase it for the staff in the lab, prescription or not just a personal opinion.
Connie Gehin RTR, RCIS
Meriter Hospital, Madison, WI
csgehin@yahoo.com

Suggestions for tint, plastic
Prescription glasses with bifocals and trifocals that have the photo-gray tint or the photo-brown tint remove about 92% of the radiation to the eyes. The darker the tint, the better. A former student of mine did a thesis on eye glasses and radiation exposure. The plastic grade lens are just as good and not as breakable.
Prescription lead glasses are not usually handled by their employers. If a staff member needs them, I feel the employer should handle the expense of the initial pair. The problem with lead glasses is easy breakage if dropped. These shield the eyes by absorbing 92“94%.
Chuck Williams BS, RPA, RT, RCIS, CPFT
CCT, Cardiac Cath Lab, Emory University
Hospital, Atlanta, GA, codywms@msn.com

2nd Email Discussion Topic: Clinical Ladders

Based on RCIS is best
From my experience over the past 3 decades, the best clinical ladder that functions the best is writing one job description for a registered cardiovascular invasive specialist (RCIS) and then have all nurses and technologist take the RCIS exam through CCI. This removes any turf issues between this the RN™s responsibility and this is the tech™s responsibility. Have all personnel ACLS certified and trained in moderate conscious sedation.
The manager and assistant managers should be CCI-certified to make the team uniform.
Then adjust the salary levels of the new credentialed staff to one level with the understanding that some longer on staff employees may exceed the new levels. Once the salaries are parallel, then their annual evaluation of work performances will determine their annual increases beyond cost-of-living adjustments made by employers. The result creates how far the person wishes to advance based on daily motivation to provide excellent teamwork and most importantly excellent patient care.

This concept is very parallel to the Deming approach of providing quality work with quality performance.
Do NOT be surprised if HR and the administration view the idea as strange and very bizarre.
Chuck Williams BS, RPA, RT, RCIS, CPFT
CCT, Cardiac Cath Lab, Emory University
Hospital, Atlanta, GA, codywms@msn.com

Non-nursing clinical ladder
We have one for non-nursing positions (the surrounding 3 pages are a descriptive cheat sheet).
Jim Wade
JWade@ecommunity.com

3rd Email Discussion Topic: RCIS: Continuing Discussion

In field since 1972
Some hospitals have tried to place a bandage on the critical shortage of RNs and RTRs by allowing RCIS credentialed folk to do their work. Some thought that hiring an RCIS would even save them some money. What I see is that some good RCIS people are making the same amount of money as the RNs and RTRs, and they are in fact doing the same work. Hospitals need to realize that their real savings will come by hiring and retaining good professionals. Retaining will happen through fair pay; professional respect and recognition; and affording on-going education, both on and off premises. If any organization is seeking to do something important, they should offer grandfathering of RCIS, RTRs and RNs into a professional organization where the people would possess the title: Registered CardioVascular Interventional Specialist (for those who do NOT scrub in) and Registered CardioVascular Interventional Practioner (for those who do scrub in). I have seen growth in our field, and having too many splinter groups will dilute our ability to lobby on behalf of the professional RNs, RTRs and RCISs who dedicate themselves to ongoing education in their effort to make a difference. These are my thoughts, after being in the field since 1972.
Robert J Basile, RTR, PBI Regional Medical
Center, Passaic, NJ, bobstero@ptd.net

I™m a Registered nurse and I™m eager to take that next step to be an RCIS. Having that after your name just proves that we know what we are doing. For me, I think the interventional cardiologist, when working with an RCIS, feels more secure. It™s more of the individual benefit.
George Robert I. Victoriano III BSN, RN, Clinical Coordinator,
Cardiac Cath Lab, Heart Hospital, Mc Allen, Texas
grvictoriano@hotmail.com

Wear initials proudly
Granted, the RCIS is not a recognized degree. What it DOES do, however, is validate one's knowledge in the cardiac cath arena. I took the RCVT (now the RCIS) exam 10 years or so ago, and when I received my study material, I was shocked to learn how much I DIDN'T know about cardiac cath. Many long hours studying at the local medical school doing research, and attending a review course, allowed me to blow away the exam on my first try. I was even invited to proofread an upcoming (at that time) RCVT review book. At the review course, however, I met RNs, RTs and RRTs who were attempting the exam for as many as 7 times, as was the case for one RN. This alone validated the degree for me. So, while the RCIS is not recognized, it is still a wonderful accomplishment, for which all who pass the exam should be proud. Wear those initials well!!! Also, anyone wishing to request my sources for study materials is welcome to email me.
Alex Holmes
alex.holmes@tenethealth.com

Not only how, but WHY
The RCIS certification is actually many fold. For those who have gone to CVT school it is their credential, i.e., an equivalent to RN boards. For others, RN/RTs, the RCIS is a credential similar to the CCRN, AORN, etc.
I can understand your concern. In many states SICP is making progress in getting legal recognition and have been given limited licensure that is limited to the cath lab and specials. What benefits would you get from an RCIS? You would get a highly trained indiviual who not only knows how to do a procedure but UNDERSTANDS why the procedure is being done from an A&P standpoint. This benefits not only the person who has their RCIS but also the physcian, patient and the lab in which they work. They can scrub diagnostic, interventions, pacers/defibrillators and monitor, and in some labs give medications. Yes, they have to go through a pharmacology course during their CVT training and it is on the CCI/RCIS test. (I am one who firmly believes that a cath lab should be seamless; everyone has an important factors to bring to the table, and everyone should be cross-trained for a lab to run smoothly.)

On a personal note, when I first starting working in the cath lab several years ago, I thought, what do I need an RCIS for? I won™t see a benefit for me or my career as an RN. As I worked with several RCISs I developed a respect for their knowledge and skills. I began to research the possibilities of taking the RCIS myself. While at the hospital I was working for full-time would not recognize the RCIS (they didn't recognize the CCRN, AORN either) I felt it would be a good a development tool for me.

Little did I realize that my knowlege of the vascular system was so lacking. I studied for nearly a year and passed the CCI exam. Many of the doctors I work with slowly began to ask me questions like, What was the shunt formula again? or I have this case, can you do my calculations for me? Then my peers began to ask me questions on why something may be important and it gave me a chance to educate them on the importance of certain criteria needed for the physician for the patient™s care. I have since changed hospitals and at this hospital they reconize my RCIS and I get a pay differtial to my hourly wage.
I have just been appointed to the newly organized membership committee for the SICP. Why would I want to promote the SICP? I strongly feel those with this credential are a VITAL part of the cath lab.
Kevin Rich, BS, RN, RCIS, ldrich3@comcast.net