Integrating Education into a Clinical Ladder for Cardiac Catheterization Clinical Professionals

Continuing education is vital to not only the success of a service line program, but to the clinician(s) providing care. Many cardiovascular programs across the United States have either considered or implemented a tiered approach through a clinical ladder. More often than not, cardiovascular service line staff is on the front lines of care, putting out fires throughout the day that require clinical and operational skills, as well as the ability to remain composed and confident about the care they are providing. Cardiac cath lab staff is the ambassador for this key service line. Staff is faced daily with demanding colleagues, cardiologists, and complex patients, as well as new procedures and technological advancements. The expectation is that staff will perform their roles, responsibilities, and tasks at their highest skill set. This can be especially difficult in the ever-changing work environment of the cardiac cath lab, as technologies continue to evolve rapidly, and the expectations are that staff obtains the education necessary to perform their duties and maintain competencies in this environment. In Corazon’s experience, we have found that many programs across the United States are beginning to utilize clinical educators and preceptors to implement and monitor the performance of the clinical staff (nurses and technologists). Educators and preceptors provide the necessary competency testing that is required, and remain the backbone of many clinical ladders in place today. The clinical educator and preceptors are the coaches; they design and develop programs to improve staff knowledge, in order to allow them to provide the highest level of care. Many clinical educators will embrace and utilize role playing to prepare the staff for complex clinical situations and how to manage these situations, be it a complex patient or tough personalities. They also are effective in helping newly hired staff adjust to this complex cultural environment. The preceptors also provide oversight on how the clinical staff is performing, as well as guidance on how to adjust their bedside manner to improve patient satisfaction. The preceptor monitors deficiencies identified through quality and peer review in an appropriate teaching environment. In order to provide the most appropriate recommendations, this review environment must not be punitive, but facilitated as an education session. If need be, a necessary performance improvement plan is then identified, with solid goals and assigned accountabilities. A clinical ladder should be designed to recognize and reward the cardiovascular clinical staff not only for clinical expertise, but for a commitment to continuing education and independent expertise in delivering direct care to patients. Clinical ladder programs are developed in collaboration with the cardiovascular service line administrators, department director(s), educators, and human resources, in order to evaluate appropriate compensation for each tier of the ladder. In the development of a clinical ladder, there are many levels of expertise or activities that are evaluated. Some of these may include, but are not limited to the following:

• Serving on a specific cath lab quality or performance improvement committee;
• Demonstrating excellent patient care in complex situations;
• Providing education to other healthcare providers;
• Precepting other staff members as new hires or as new technologies are purchased;
• Obtaining continuing education credits for professional license as required by the state governing board;
• Evaluating and utilizing nurse and technologist research;
• Achievement of professional designation through cardiovascular societies.

Typically, a clinician interested in advancement up a clinical ladder may need to submit a formal application for promotion, accompanied by a notebook documenting all activities and competencies completed. It may also involve the submission of a professional resume and a past performance review assessment. In addition, multiple interviews with appointed clinical ladder review panels composed of managers, experienced peers, educators, physicians, and preceptors may be facilitated. The applicant must also identify peers who may be interviewed regarding the applicant’s performance and effectiveness in the clinical setting. The clinical ladder for advancement is based upon the unique skill sets for both nurses and technologists. An example of this methodology is reflected in Figure 1. A clinical ladder is just not about the clinical staff obtaining advanced certifications or degrees as much as it is about listening to what employees need beyond an annual performance review and salary increases. It is often about the organization’s ability within the service line to empower their clinical staff to achieve and maintain “best practice” and great success, both personally and professionally. Some health systems utilize a shared governance model that empowers staff to take the lead on issues such as patient safety, clinical practice, professional development, and education. Clinical ladders or clinical advancement programs have been active in the United States for more than 30 years. It comes as no surprise that those health systems achieving a best-practice approach and providing the highest quality of care to their patients are supported by a clinical ladder that empowers and invests in clinical staff. ——————————————— Corazon recommends that those cardiovascular programs that do not currently support a clinical ladder evaluate their needs, and consider the appropriateness and feasibility of implementing one. It is also recommended that a cardiovascular program’s internal expertise be assessed to determine how it can assist with formalizing a solid educational plan, advanced competencies, and training to propel the program to the next level. If your organization has a clinical ladder for the cath lab, and you are willing to share your model and experiences, we would like to interview you and your team. The information gathered from such interviews can help the Corazon team learn more about other cath lab programs and provide valuable knowledge that will be incorporated into subsequent articles. Please email us at corazon@corazoninc.com to schedule a time to discuss. Ron is a Vice President at Corazon, Inc., offering the full continuum of services in the heart, vascular, and neuro specialties, including consulting, recruitment, and interim management. To learn more, visit www.corazoninc.com, or call (412) 364-8200. To reach Ron, email rschmidt@corazoninc.com