This is when it all goes right: An 85-year-old woman comes to the cath lab emergently from ICU. She is from Eastern Europe and does not speak English. Her enzymes are elevated, she is having chest pain and appears to be in pulmonary edema. Six people swoop into the room and surround the patient. Someone automatically gathers height, weight, history and lab values from the chart to enter into the computer database. Someone else sets up the scrub table. The remaining four hook her up to our EKG, blood pressure and pulse oximetry. Warm blankets are fetched, both groins shaved, pedal pulses evaluated and caring hands caress her forehead and hair. This is not unlike an Indy 500 pit stop in which all details are rapidly attended to. Often we joke with the patient to acknowledge this hustle-bustle, but with this woman smiles and eye contact were the tools we used for comfort.

Some 10 minutes later, one of us commented on how seamless this setup had been. We had developed a synergy that incorporated each member of the team, the patient and the circumstances. All was accomplished efficiently and smoothly. Later I paused to consider how readily we all had switched hats. The job classifications of RT, CVT, CNA and RN had performed their jobs with a generous sharing of tasks that crossed boundaries without raising hackles. We knew what needed to be done and we simply set about doing it.

The key to this dance was our focus on the patient. First of all, our focus was heightened because of the urgency of the case. We are wired to respond to emergencies and to solve the problems that come our way. When our patient rolled in the door, she was the center of all our attentions. Secondly we responded to her vulnerability. She was someone's grandma. One look into her face was all any of us needed to understand how frightened she was. It is a good thing, this compassion we possess, and another reason we do this work. Our own agendas, issues and conflicts evaporated in the face of her need. Everyone was equal. We served neither ourselves or each other; we served this patient.

Most of the time the above scenario is the norm, but cath labs are not lacking in strong personalities. I can't speak for all cath labs, but the ones I've been involved with are chock full of alpha personalities. No shrinking violets or thin skin. Even though we are bound together by a singular purpose (to stamp out vascular disease wherever it may dwell), we are specialized with different job descriptions. The spectrum of our backgrounds is vast and the paths we have chosen towards angiography are many.

Everyone has worked hard to learn their specific skills and we often have very different perspectives on the work. We also work in a relatively confined area. All of this is a perfect recipe for professions and personalities to collide. I would like to stress that this issue is by no means universal, but we have all seen our fair share of collisions.

With labels and titles, we distinguish ourselves and announce to the world our accomplishments. We are proud of our work and ability to perform. However with these same labels and titles, we can find ourselves confined to invisible boundaries.

Call it what you like: territory, personal space or professional pride, each of us has our field of expertise in which we may become protective. I am not innocent of pointlessly defending my territory. I have felt insecure or threatened in some fashion and have alienated a co-worker by word or deed. I've seen how destructive this behavior is and therefore am searching for solutions to this workplace problem.

The following idea occurred to me at my dentist's office. At this particular office, each employee is not labeled office manager, dental hygienist, dental assistant or even dentist, but as Human Being. For example, a typical name tag will state: Jane Doe, Human Being. Maybe it was just the nitrous, but I was struck by how equalizing this practice was, with its implication that no one is better than anyone else. All tasks are equally valuable and that all are required to accomplish the job. So I got to thinking¦

Imagine a 30-day period in which each member of the lab wears a name badge which contains their name, employer's name and Cath Lab Team Member in place of their job class distinction. RN, CVT, RCIS, RT, CNA, manager, desk manager, physician and whomever else is employed in your lab will perform no differently. (Ideally, the RCIS credential would equalize all medical staff members, but for time purposes, changing staff to Cath Lab Team Member would take only a few minutes, allowing for a faster and more direct impact on the sense of the team.) Job descriptions will not change. Job practices will not change. It shouldn't be confusing for patients because everyone knows who the physician is. Whether physicians would be interested in participating in such an experiment is unclear; however, the purpose of this experiment is that everyone is equal in value, including the physicians.

Let me be clear that no one will be expected to perform outside their skill level. Introduce yourself to the patient as a helper, cath lab team member, caregiver or whatever is agreed upon. Just do the job you normally do. If a patient asks who or what we are, staff should provide that information. I'm most interested in the staff being aware of each other as equal.

I believe that even though everyone in the room knows there are distinct job classifications, there will be a part of our brains that is working on the assumption of equality. Perceiving each other as equal does not mean we are not each valuable. If I role-play as a Cath Lab Team Member and not necessarily a CVT, I can be liberated from any self-imposed boundaries. I foresee a resulting unconscious trend towards co-operation.

Would there be subtle or not so subtle changes in the way you interact with your fellow workers? Maybe you will notice tasks being attended to in a much more universal fashion. What used to be considered the RN's task is taken on by anyone with the time and proximity. Maybe someone else is calling to pre-op the next patient. Perhaps you will find the blanket warmer being restocked by several people. Or equipment and paperwork distributed around the hospital/clinic by whomever has the time. What internal hurdles will you encounter if you are considered a Cath Lab Team Member instead of RT, CVT, RCIS or RN? Will this bother you? How much of your identity is tied up with this label? If you have strong objections to this experiment, ask yourself why. Maybe you will discover that this approach is counter-productive to a smooth-running lab. Perhaps this causes more confusion than it's worth. You may find yourself stumbling over policies and procedures that prevent task-sharing, but policies can be rewritten. Well-meaning people wrote these policies and well-meaning people can update or eliminate them.
After 30 days have passed, revert to your previous name tags. Your lab can meet to discuss this if they want. Undoubtedly, people will discuss this on a formal or informal basis throughout. This experiment may be described as totally stupid and a waste of time, but what harm has it done? No one need be judged or fingers pointed. You don't have to talk about it at all if you don't want. My hope is that thoughts and ideas will spring up.

I mentioned that cath labs are full of strong personalities, but likewise these personalities are progressive and creative. Any group of us could imagine and construct solutions to professional collisions. Tap the rich resource of people with whom you work. My efforts are to learn from others what I don't know or can't conceive of. Let me know what you come up with.

Thanks for listening and floss daily.

Shirly was in ICU and Surgical LPN nursing from 1978 to 1986, and has been a CVT from 1986 to the present. She can be reached at:
SCoffey@peacehealth.org