As I See It

Out of the Darkness and Into the Light

Warren Grand, RN, York, Pennsylvania
Warren Grand, RN, York, Pennsylvania
For those of us who have been working the cath lab circuit for several years, you may have noticed that we no longer operate in a cave. Some may liken this to “flying above the radar.” Whatever the metaphor, the cath lab, like all other departments, has come under intense scrutiny for several reasons. Chief among these is finances. As dollars dwindle, hospital finance departments are looking very closely at departments that have, until recently, operated in a vacuum of sorts. Administrators rarely came to the cath lab except for Joint Commission inspections or the occasional “feces hitting the oscillator” scenario. And that was okay with the cath lab staff. “They just don’t understand what we do,” is a commonly heard complaint. This was usually muttered after a new form or procedure was enacted to keep the department in compliance with the rest of the hospital. I can totally understand this type of response, as I had a Joint Commission inspector once ask me, “With all this paperwork, when do you have time to care for the patient?” I wanted to scream at him for the obvious reason that we are doing all this paperwork to comply with Joint Commission standards! To add insult to injury, this happened before we were expected to fill out the ACC form on every patient. As a travel nurse, I hear this and other complaints so often, that I’m positive these must be some quasi-universal issues. One of the things I’m consistently asked is, “What do they do for [this or that] at other places you’ve worked?” I always pause before answering, because it can so easily turn into ammunition for someone to use when making their case. I will say this, however; the only consistent thing between cath labs is the patient and their heart disease. The funny thing is, many cath labs would have you believe they invented the whole thing, and their way must be the only way. For instance, how many ways can the transducer and manifold system be set up? Let me tell you, many. And it puzzles me why a cath lab will dismiss a labor-saving or cost-saving idea out of hand, almost as a reflex action. One of the other things I have noticed is the growing trend of putting administrators who don’t know the cath lab business in a position to impede operations. There is an old saying that a good manager or director can manage any department. That may be true, and I have certainly had the pleasure of working for some of these individuals. However, these same leaders, who were so skilled, obviously headed the advice of Lee Iacocca, “Lead, follow, or get out of the way.” On a recent assignment, I worked for a director who failed to head this advice. The department remains rudderless and adrift without clear-cut goals and very little chance for success in a competitive environment. Let there be no mistake. Every hospital within a stone’s throw of each other is vying for those same patients. There is no faster way to destroy morale, chase away skilled employees or sour a department’s name than to disregard Mr. Iacocca’s words of wisdom. Maybe Chrysler wouldn’t be in the jam it is today if it had continued to pay heed to these words. The lesson here is, let the managers manage, the charge nurses charge and the…well, you get the idea. Internal strife in the cath lab remains eternal. One of the mysteries I find myself pondering is, why do we permit bullies in our department? Why do we get all upset when a physician chews our butt off, but we just take it, when it’s a fellow staff member? Why do individuals believe that because they have more experience, they are somehow elevated to a higher level of intolerance of others? It shouldn’t be a right of passage that new people to the cath lab, or any department, endure those who are rude, crude and abrasive. It’s a mistake to believe the “good ones” will endure this mental hazing. I have found just the opposite to be true. The “good ones” will say “@#*% it, I’m too good to put up with this.” I believe this will ring true with many readers. I hope I’m wrong, but in my experience it seems to be the case in many places. We roll on. Despite ourselves and the many hurdles we face, we make it happen. Countless people owe their lives to the folks who help open those occluded arteries during busy times and in the wee hours of the night. I constantly remind my workmates that things have a way of working out, and they usually do. I also remind them that many of us spend a third of our life working side by side, so it’s a lot better and easier if we get along. Some bullet points: • Get the curmudgeons out of the cath lab. I’d rather work short than listen to their rants. • Form Cath Lab Improvement Committees. So as to improve things. • Don’t complain about management, step up to the plate and replace them when the opportunity comes along. • Accept the new standards coming our way. If you can’t beat them, join them. • Never settle for the status quo. Always be looking to improve on an old theme. • Remove the following statement from your memory banks: “Well, that’s the way we’ve always done it.” That single statement has done more to impede progress then all the product recalls combined. • Quit paying dues to the BMW club, aka, B*tch, Moan and Whine. It should only exist as a guide wire and German automobile. • Obey the Golden Rule. Do I really need to define this one? As I was putting the finishing touches on this article, I was hired as an interim manager at a busy cath lab. When I reported to work on Monday, I was surprised to learn that no one was expecting me. Not the secretaries, assistant managers or any of the staff members, not to mention the medical director of the cath lab. I was doomed from the start for someone’s failure to uphold a common sense rule, communicate with your staff. Warren Grand can be contacted at