Three years ago, at the cath lab at Poudre Valley Hospital in Fort Collins, Colorado, the word was spreading that the hospital and cardiologists were going to open a joint venture outpatient cath lab, to be called Heart Center of the Rockies Cardiac Catheterization Lab (HCOR). The venture would take place between the Heart and Vascular Clinic of Northern Colorado and Poudre Valley Health Systems (PVHS). The staff in the cath lab were skeptical that it would work, and most employees showed no interest in the new endeavor. Because of this there was difficulty in hiring a manager. The Medical Director asked Denise and I if we would start putting it together until they could hire a manager.

Job-sharing Nurse Managers Carol Mackes, RN and Denise McCutchan, RN

       We agreed, as we were both part time, and thought the extra cash would be nice. I had expertise with the equipment side, including networked systems and the cath database. Denise knew the supplies and purchasing side inside out. Between the two of us, there was over 20 years of cath lab experience. After working on this project for a couple of months, we began taking ownership, and the thought of turning it over to someone else was not very appetizing. After much discussion, we put together a proposal to job-share the position. Our first proposal was turned down flat, with the reason given that they only wanted one person to manage the cath lab. After another month, they were still having no luck finding a manager, we tried again, going directly to the Medical Director. Our proposal was immediately accepted. We continued to work part-time in the hospital cath lab another three months until June of 2000, when we started job-sharing the management position at HCOR.

Creating a Schedule
       During the previous six months, we had gotten the equipment ordered, policies written, staff hired, lists of supplies completed, and visited the site on numerous occasions. We had negotiated our jobs so that I worked two 10-hour shifts a week and Denise three 10-hour shifts. Since we were going to be salaried, we built in an extra 4 hours a week into my position so I could cover Denise’s vacations and other emergent staffing needs. Denise had 2 hours extra a week built in for the same reason. The total hours and cost came to a 1.3 FTE, but because we were also staffing in the cath lab, it decreased other staff needs. We would cover each other and perform the administrative duties with the extra time we got by working the 10-hour days.

HCOR Staff. (L to R — back row) Julie Weimer, RN, Mark Tegtman, Unit Assistant, (L to R — front row) Angela Jones, RN, Kathy Wilson, RN

HCOR Facilities & Daily Life
       HCOR facilities are a joy to work in — we have 13 bays, which we use for patient prep and recovery, a small kitchen area, and a procedure room where we perform DSEs, TEEs, and cardioversions. The cath lab is large and has a storeroom. There is also a dictation/viewing room for the physicians. Denise and I have a large built-in desk in the break room, which has worked out, as the staff are usually only in the break room for lunch, during which time we are relieving them. The best part of our break room office is the windows on both sides of our desk, which look out onto the majestic Rocky Mountains.
       We do 60–75 angiographic procedures a month, and 15–20 procedures in the procedure room. We staff daily with 2 RNs and one unit assistant in addition to Denise or myself. On most days, the cases are done by 10 A.M. and the patients gone by 3 P.M. at the latest. The last staff member leaves by 3 P.M. or when the last patient is able to leave. If we do more then 4 patients on a day, we have relief people that we can call to help out. The physician’s office is in the same building, so there is always a doctor close by.
       Our documentation is paperless, as most of our charting is done on a computer. The few papers we do have to fill out are scanned into the system. We hope to be completely paperless in another year. HCOR is linked by a fiber network to the hospital, and we continue to communicate frequently. Though we work for the joint venture cath lab and are under the physician’s administrative control, we are still employees of the hospital, which bills the joint venture.

Our Job Sharing Preparations & Maintenance
       A key point in putting our job-sharing position together was sorting out the expectations of the other person. Denise and I had many discussions about how we would handle various things. One big issue was the schedule.

       Scheduling. Though I can see how this could be a major stumbling block in the job sharing situation, for us, it has not been so. We usually do 2–3 months of our schedule at a time, both agreeing that if something comes up, we would be willing to flex. If we schedule appointments on our days off, we try to do it in the afternoons, so if needed we could work the busy times in the mornings. We both realized from the beginning that there would be times when we would both have to attend important meetings. Thus far, we feel being salaried is an advantage in flexing our time for meetings, staff coverage, etc.

       Sharing Information. Communication was going to be our biggest issue, as we would see each other infrequently. We solved this by having a filing system where we can track items, such as what has been ordered, leaving notes, and talking on the phone frequently, either during the day, or in the evenings or on weekends. To keep communication going, email is sent to a cath lab manager address that includes both our names. Our system has worked out well, and we have not had any complaints from physicians, staff, or vendors. Knowing there is a potential for problems in this area, we are very diligent about checking our email.

Figure 1. HCOR floor plan

       Duties. Each of us continue to have areas where we are taking more responsibility. I do more of the equipment work, such as service contracts, keeping up on the changes and updates, the network and our database, statistical reporting, and QA. Denise has done most of the vendor work, ordering, bill-paying, contracts, and product tracking. In a pinch, we both know enough about what the other does to accomplish what is needed.
At first, for any decisions we would communicate with the other; but now, after two years, we fill in for each other, move forward with decisions, and communicate these decisions to the other.

       Preparing to Hire Staff. When we were getting ready to start hiring our staff, we had to sit down together and talk about what each of us considered were the most important qualities we wanted in our staff at HCOR. The priority, it was decided, was having staff that were very team-oriented and portrayed a positive attitude. We decided we could work with less experienced staff if they came with the right attitudes.
       After interviewing, we compared our notes and impressions of the person and were able to agree quite easily on the same individuals. We haven’t been disappointed. I do feel we had an advantage in coming into the situation fresh, without previous problems and personalities. Having a small group to work with is also a plus. From a human resources standpoint, Denise and I usually handle evaluations, pay adjustments, leave of absences, etc., together.

Considerations to Keep in Mind for Job Sharing
       I feel like my job couldn’t be any better. The biggest reason for our satisfaction is the fact that we are both working toward the same goal, and have maintained the lines of communication for every aspect of the job.
       Finding a negative about our job sharing is hard to do. The key points to our success would be our communication, flexibility, and willingness to compromise. As we look to the future and our department becomes busier, we know our roles will change, but we are confident we can adjust. Job-sharing is something I highly recommend, though the biggest priority would be to really come to know the person with whom you will be working. Discuss the areas mentioned here prior to making a commitment. Since we work part-time, job-sharing has also left us free to pursue other areas of interest in the cardiology field, which has been beneficial, both increasing our enjoyment of our careers and bringing added knowledge to our venture.