Email Discussion Group

Topic Under Discussion: For Larger Labs I have a question that is specific to the larger labs (3+ rooms or >25 staff members).

a) How is the leadership designed in your lab? b) Is there a manager, director, or other? c) Who negotiates contracts? d) Who runs day-to-day operations? e) Who hires and manages staff? f) Who writes the budget and variances? g) Who handles payroll issues? h) Who does PI? i) Who writes policies? j) How long have you had this management style? k) Are there any plans to change your unit specific organizational chart?

Thank you very much, Anna, RN, RCIS, Clinical Educator CCL/CCPR annasmith@chi-east.org Group Members’ Responses… Lone RCIS in Large Lab I am presently the only RCIS on staff at my facility. There are 4 labs (1 EP; 3 cardiac cath, with one capable of performing peripheral interventions). The 5th lab is in the planning stages. RNs, myself as RCIS, paramedics (3), and 2 RTRs staff the labs. Unfortunately, there is no requirement for taking the (RCIS) Registry in our lab. The hospital will pay for staff to attend seminars for CEUs Leadership is under the RNs. My job description falls under the techs; although I am able to perform all tasks with only one exception administration of medications. Three staff a procedural room, one member must be an RN or I must have an RN available for delivering medication when I’m circulating. Our lab is presently designing a position for a director of operations, who will be over 2 hospitals. I'm not sure of the position held by my manager’s boss (newly hired) whose background I believe is in economics. She presently is reviewing policies and procedures, JCAHO requirements, etc. The actual policies are written by RNs and RCIS in the lab. Presently we have a manager (RN) of the lab who performs the day-to-day operations, hires and manages staff, (staff member responsible for scheduling staff assignments), participates in the purchasing decisions, budgets, payroll issues (staff member provides daily input), and delegates assignments to her staff members. I’m responsible for daily charges along with another RN. The manager has been in this leadership role since 1997. I believe contracts are negotiated through the administration, since often we are told what equipment is to be used. In the past we (staff) have had some input in the decision process. Recently they tried to replace the Medrad injector with the L-F injector. A few of us had previous experiences with its use and it was not purchased. An RN was recently hired to manage the ACC Registry for the lab. Christine, RCIS reochris2000@comcast.net Director out of touch Our leadership has failed, in my opinion. We have a clinical team leader, a director, and a VP of cardiology. Human resources does the contracts, the clinical team leader runs day-to-day things, the director hires, the director does the budget, the director and the clinical team leader handle the payroll, and the director and the clinical team leader do PI. We have an individual who has been in the lab for about 10 years who writes the policies. This style of management has been in place for about 10 years with no plans for change. We have a lot of problems because our director does not know or care what goes on in the lab from day-to-day. This person was based out of cardiac surgery and manages them as well unfortunately focusing primarily on them. Anonymous Mgmt strategies in place for 7 years thus far We currently operate 7 cath labs. Two of these labs have been open since 9/2003. We incorporate team leader positions in each of the procedure rooms to provide direction to staff regarding patient flow, staff assignments, breaks, etc. for the staff in their room. The patient flow for the entire department is handled at the communications board by a team leader. The next level on the chain of command is the supervisors. We have 3 in our department, (which also includes 2 additional EP labs). The supervisors are responsible for the daily operations of the labs, for hiring and managing staff, handling payroll issues, and writing policies. The manager is responsible for the budget and variances, and provides direction to the supervisors. We operate under the direction of a CV Division director. Our Procurement Department is responsible for negotiating contracts. We have a departmental PI committee that tracks special operational PI projects for our department. Our facility's Clinical Analysis Department tracks ACC data. We also have an Invasive Cardiology Committee that consists of management and cardiologists to address operational issues. We have had this type of management for at least 7 years, and there are no current plans to revamp it. Sheila DeBastiani, R.T(R), Supervisor/Educator WakeMed Invasive Cardiology sdebastiani@wakemed.org No plans to change; Hiring assistant RN manager a) How is the leadership designed in your lab? Currently we are looking for an assistant nurse manager. We also have a lead worker in EP, Echo, ECG, and a vascular specialist. b) Is there a manager, director, or other? We have an operations manager, with a director above her and then the VP c) Who negotiates contracts? The operations manager d) Who runs day-to-day operations? Presently a charge person (RN) with the assistant nurse manager (once the position is filled) to do 80% eventually. e) Who hires and manages staff? The Operations manager f) Who writes the budget and variances? The Operations manager and director, with limited information from the lead positions and assistant nurse manager. g) Who handles payroll issues? Operations manager and Director. The payroll is done by one of the unit coordinators h) Who does PI? Everyone is responsible. We do have a clinical nurse specialist that does do most of the work. i) Who writes policies? The lead workers are responsible for the policies with the operations manager and the director to oversee. j) How long have you had this management style? Many years k) Are there any plans to change your unit specific organizational chart? At the present time, no. Connie csgehin@yahoo.com

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