Cath Lab Digest

The appropriateness of staffing a cardiac cath lab with diversified specialties is an issue that has been debated and continues to be widely so. A diversified team, made up of various credentials but united through the Registered Cardiovascular Invasive Specialist (RCIS) credential and thus, fully cross-trained, is a good idea for cath labs that respect a wide knowledge base. However, it has been increasingly difficult to create a culture of mutual respect as cath lab teams become more diversified in facilities without professional integration (i.e., cross-training and/or mandating achievement of the RCIS credential). What does this mean for facilities on both sides of the issue?

Cath labs are filling staff positions with registered nurses, radiology technologists, and cardiovascular technologists and technicians with varying experience levels and clinical skills. Mixing all three specialties can create a cohesive team with many intellectual resources from which to draw. Specialties such as interventional radiology, hemodynamic and ECG monitoring, and critical care or step-down nursing, are very valuable to any cath lab team. The value of such a team cannot be stressed enough, but problems may arise in attempting to integrate such specialties.

Interdependence is and ought to be as much the ideal of man as self-sufficiency.
Mahatma Gandhi ¹

Maybe the worst thing a manager can do is to hire personnel without regard to professional background and institutional or department culture, and hope to make a tasty cath lab stew. The policies of your department must first mandate specific practice stipulations for your cath lab professionals, before considering whether or not to provide special consideration for the RCIS credential. This may require some research not just in your local area, but statewide or even nationwide.

For example, one popular dispute among cath lab professionals is whether non-nurses may administer medication. In western Pennsylvania, there aren’t any institutions, with the exception of a few trained individuals, committed to this practice. Yet, if you look deeper into the issue, you will find that there are institutions in the state of Pennsylvania which routinely allow non-nurses to administer medication. What causes this variation within the same state? It is the interpretation of the law, the hiring practices within individual institutions, and the culture and traditions of each cath lab.

Cultural Diversity and Task-Specific Teams
Are there institutions that refuse to hire cardiovascular technologists? The answer is yes, and there may be a legitimate reason why it may not fit the culture of the department or institution. Cath labs are comprised of a closely bound group of people with their own unifying traditions and practices. These traditions and practices are incredibly diverse, even within close geographic regions.

Radiology technologist schools, nursing schools, and their graduates are more prevalent in the marketplace, and thus have obtained more widespread cultural acceptance. If a particular hospital traditionally hired all registered nurses, all radiation technologists, or a mixture of both, then their policies and procedures may not accommodate the cardiovascular technologist. Are staff members in your lab allowed to perform certain nontraditional tasks or favorably compensated for having the RCIS credential? If not, the policy, procedures, and culture of your institution may not support the RCIS and the credential’s benefits will be minimized.

The CVT profession itself is still considered a new way of doing things because it is a crossbreed between traditional backgrounds. For many, accepting the CVT or RCIS is congruent to accepting an outsider. Change does not happen easily, or overnight.

Nurses and radiology technologists have traditionally worked in task-specific roles in the cath lab environment. The advantage of task-specific roles is that they are well-defined and performed to encourage proficiency at a specific set of tasks. Theoretically, a task-specific team member can perform his or her defined role better than cross-trained personnel at the same task, who may not perform a particular task often enough to gain time-won efficiency and effectiveness.

Two common examples of task-specific efficiency are gaining arterial access and closure of arterial access. The more one does, the better one becomes.

Task-specific teams also can:

Save time through faster room turnover times everyone has his or her own role.

Save money through less waste in equipment only staff who know the technical aspects of products open equipment.

Have better quality due to higher quantity of specific tasks i.e., those who use the most closure devices have less complications.
Quality is a measure that is tracked effortlessly and continuously in today’s healthcare settings. A quality product is a sum of the individual performances in a cath lab. If the culture of your facility cannot accept diversification, you may create an unstable (quality-adverse) work environment by not specifically delineating individual tasks in the cath lab. Can task-specific labs produce the quality of fully integrated (i.e., cross-trained) labs? They will say yes, but I do not believe that to be true. However, if your environment is fundamentally task-specific, it is important to acknowledge your culture and focus on efficiency and effectiveness through specifically delineated tasks.