Cath Lab Digest - September 2007 - (Page 41)

SEPTEMBER 2007 CATH LAB MANAGEMENT 41 A Look at On-the-Job Training: Perceptions, Reality and Our Profession Elisabeth M. Frails, BSRT, RCIS, MSA Harry T. Harper MD School of Cardiac and Vascular Technology University Hospital, Augusta, Georgia The cath lab community has worked very hard to establish credibility regarding its knowledge base, which has paid off in terms of increased responsibility as well as increased expectations. It has a tangible measure, sitting and passing the national registry. but still proved to be a vital part of the team. As the healthcare workforce as a whole experienced a critical shortage, candidates with other experience as well as on-the-job trainees became harder to find. As a result, starting in the early 1990s, specialized cardiovascular education programs evolved. These programs offer a very intense study of cardiovascular technology and supply work-ready technologists. Yet even with these programs available, immediate staffing shortages still exist. This can be attributed to the fact that many labs are doing more cases than ever. Not only cardiac cases, but more peripheral vascular and electrophysiology cases are being performed, all of which require sub-specialty knowledge. This reality has forced some labs to re-invent on-the-job training, involving personnel that did not necessarily have the formal allied health care training or the clinical experience. These employees typically train in the scrub specialty; its repetitiveness makes it relatively easy to learn and is the one role most closely guided by the decisions of the physician. With the increasing duties needing to be done in the cath lab, it is not uncommon to find these techs performing other tasks besides scrubbing, including serving as an additional circulator providing limited patient care, as well as monitoring and at times, other administrative duties. It is at this point that the on-thejob training becomes a source of debate within members of the team that are credentialed. The cath lab community has worked very hard to establish credibility regarding its knowledge base, which has paid off in terms of increased responsibility as well as increased expectations. It has a tangible measure, sitting and passing the national registry. According to the Cardiovascular Credentialing International (CCI) Executive Director Steve Taylor, a little over 500 persons sat for the invasive registry in 2006 and to date, 400 have taken the exam thus far this year, which indicates that by the end of 2007 there will be many more than 500 to take this challenging exam. Most institutional policies outline very clearly the duties of each rotation and who can perform which task. All basically speak to credentialed employees regarding patient care. In order for our profession to avoid a setback in terms of credibility, we need to clearly outline the expectations for those who were not formally trained or hold other credentials, to actively sit and pass the registry. On-the-job trainees should still be expected to “do the time,” but it should be in the form of actively seeking out opportunities in distance and web-based learning. They must build a knowledge base in order to provide accurate patient care. Such opportunities are increasingly more readily available and should be incorporated in many onthe-job training programs. ■ Elisabeth Frails can be contacted at EFrails@uh.org M aintaining an adequate labor pool for the cath lab is a dilemma every manager and supervisor seems to face. Even with the availability of formal, specialized cardiovascular education programs, some labs are turning back to the on-the-job training model in order to keep up with staffing needs. With the increasing need to meet stricter institutional policies and guidelines, as well as meeting compliance with various national accreditation organizations, on-the-job training — including its participants — is not what it used to be. The addition of the modern on-the job trainee adds an interesting mix to the already diverse cath lab work group, which at times can be challenge for all of us. The debate regarding on-the-job versus formal training is longstanding, not just in the cath lab or healthcare in general, but across all jobs that require very specific training. It has been well-documented that hiring a formally-trained employee is most cost-efficient, and certainly safer, because of their entry-level knowledge base; however, when immediate staffing needs to be met, on-the-job training still may be the only option in order to have enough people available to get the cases done. On-the-job training has been the source for staffing in most cath labs before the advent of specialized cardiovascular education programs. The candidates usually consisted of nurses and allied health care specialists formally educated in their profession and with adequate clinical experience, usually already employed by the institution. These candidates were trained on-the-job to perform in any one or all of the three rotations: scrub, monitor and circulate, and performing various duties depending on institution-specific policies. In my own experience, candidates’ competence was not usually questioned. Each individual’s expertise and knowledge base was a welcome addition to each case and the department as a whole. At times, special exceptions were made for candidates that did not necessarily possess the formal training or the clinical experience. These candidates usually trained only for the scrub position and longevity was assured for those who were willing to “do the time.” Ultimately, they would become a respectable member of the team, embraced and appreciated by the existing staff. These scrub techs rarely served in any position other than scrubber and did not perform any of the other two cath lab duties, W hat are your thoughts about on-the-job training? What is the correct balance between formal education and learning from an experienced cath lab professional in the lab? Do you anticipate an increase in cath labs requiring the RCIS credential from staff? Share your thoughts with fellow Cath Lab Digest readers at: rkapur@hmpcommunications.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - September 2007

St. Dominic Hospital The Genous Bio-engineered R Stent Percutaneous Treatment of Peripheral Arterial Chronic Total Occlusions: Device Options and Clinical Outcomes Contents Clinical Editor’s Corner Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How? Myocardial Infarction and Syncope: A Manifestation of the “Raynaud-Prinzmetal Syndrome”? Essential Technical Components of the Transradial Approach If You Build It, Will They Come? Evidence-Based Medicine with Drug-Eluting Stents Back to School: The Value of Education in Cardiovascular Services The ACVP Standards and Competencies: Are You Using Them Effectively? What Do You Think? My Experience with Fibromuscular Dysplasia and Stroke A Brief Review of Fibromuscular Dysplasia Letter to the Editor A Look at On-the-Job Training: Perceptions, Reality and Our Profession Doing the Wave: Inventory Management with RFID The Ten-Minute Interview with… Paul Pinsker, RCIS CLD’s Annual Salary Survey Harrisburg Area Community College Volunteer Survey CEU Education Center SICP* Section Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Clinical & Industry News

Cath Lab Digest - September 2007

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