The Ten-Minute Interview with George Fichter, BS, CVT, RCIS, MS, FSICP

Why did you choose to work in the invasive cardiology field? It should be made clear to every new employee this job is not for everyone. However, it certainly does excite me. Having the mental toughness to overcome the daily obstacles of invasive cardiology is challenging, yet rewarding. Personally, I always take pride in knowing that I did my best and satisfaction in a job well done. I try to encourage this behavior in others as well. There are plenty of opportunities to gain a sense of accomplishment in the cath lab. I particularly like unique cases that require a little more thought such as aneurysms, valves and congenital anomalies. Acute procedures fuel my interest and excitement level. The energy, focus, and urgency are all contagious, but short-lived. In short, I am eager to work on the difficult procedures. Can you describe your role in the CV lab? I currently work in a lab where I am required to scrub for diagnostic and interventional cardiac catheterization procedures and for electrophysiology studies/device implants with rotating charge responsibilities. I have worked in various states where my role has been vastly different. I trained at Inova Heart and Vascular Institute and have formal training in all three operational positions in the cath lab. However, every new facility I join, the role is different. I have found that my role is dictated more by the individual lab’s culture, which derives, from hospital policy, rather than from State rules and regulations. As a result, I gained several years of experience administering medications at one institution, while at the next, I was not allowed to touch medications other than for sterile tray set-up (lidocaine and nitroglycerin). I have always fit into the role of expanding the realm of possibility for cath lab staff. Because I am a CVT by education and credentialed as an RCIS, I have always been an independent being the only, or one of few credentialed staff. I believe in staff cross training, yearly competency evaluations and continuing education. Also, I believe that an appropriately cross-trained staff can administer medications, gain arterial and venous access and deploy closure devices with skill. Several studies, in fact, have suggested that in many cases, technologists who deploy closure devices have fewer patient complications than the physicians due to the fact that the technologists deploy more devices than the physicians. What is the biggest challenge you see regarding your role in the CV lab? Recognition, in my view, is the biggest challenge. Having obtained a degree in Healthcare Management, I am aware of the past and current limitations posed by the different hospital administrations, and I have debated representatives from human resource departments about this topic. There seems to be a breakdown in communication regarding the hiring needs and the minimal job requirements for employment in the cath lab. I personally have fallen victim to human resource departments kicking out my application for employment because I didn’t meet the minimal job requirements as posted by the cardiovascular department managers and administrators. I recently had a large healthcare organization in Pittsburgh receive my resume through one of their current employees. The hospital called me in for an interview and essentially asked me, Where have you been? The truth is that I had tried several times to inquire about a job through the official channels, but was always refused an interview. I would like the SICP as an organization to address this need by making a type of human resource reference guide a document that the average cardiovascular administrator and human resource representative could use to: a. Simply explain the various types of staff members who are qualified to work in the cath lab. b. Create job description templates that incorporate the RCIS credential. c. Provide sample clinical ladders that incorporate credentials, time of service, and tangible, cath lab-specific knowledge. d. Explore the various hiring possibilities to help guide administrators to hire the best candidate for the job. e. Outline a more adequate system to determine appropriate compensation. What motivates you to continue working in the CV lab? I look at every procedure as a new learning experience. Obviously, each patient is different both anatomically and in terms of presentation to the lab. It is important to maintain a teaching atmosphere among the staff and physicians in order to foster interest and growth for the individual and the team. Questions can easily lead to lengthy discussions about the patient and most appropriate treatment strategy. I enjoy teaching by freely sharing my knowledge and hope that others view me as a resource when they have questions. Furthermore, by opening up discussion with your patients, you put their mind at ease, answer any questions they may have, and make the procedure a little more personal. This helps me evaluate the patient and is also a vital component of conscious sedation. What is the most bizarre case you have ever been involved with? The most fascinating case I was ever involved in was an elective diagnostic cardiac catheterization of a 41-year-old man. A nonselective shot of the left system revealed a 95%+ left main stenosis. Our one designated CVOR had a scheduled surgery, and the lab typically did not start an intervention without on-site O.R. clearance. By the second picture, a slow flow state was created and may have even disrupted the plaque enough to induce fibrillation. A cath lab team of four and a back-up O.R. team coded the patient for only twenty-five minutes before Dr. Paul Uhlig, cardiac surgeon, turned our resuscitation efforts into a perfusion effort. Dr. Uhlig was leading the team on his drive into the facility via cell phone and the cardiopulmonary bypass machine was ready and primed upon arrival. Dr. Uhlig cut down to the femoral arteries bilaterally and inserted 20 Fr cannula. Once on bypass, the patient was transported to a multipurpose O.R. suite and the bypass operation followed. The patient was walking the halls within a week. The cath lab team’s efforts were really terrific; likewise, the back-up O.R. team was second-to-none and the progressive thinking of Dr. Uhlig likely saved the life of this young man. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? The better part of valor is discretion. Shakespeare. I am an introvert by nature, so there are internal motivating factors that keep me driven. Introverts have a bad habit of disengaging and not expressing feelings or emotions. I tend to use discretion when involved with an emotional situation. I feel it is better to revisit things at a later time when emotions are not so high or so low. I have found that it’s necessary to understand that low moments do inevitably occur and they affect the work environment. I have worked in cath labs where the morale was frequently low, which tended to be contagious. Negative people sometimes compound problems. Obviously, it is impossible to avoid negative influences and negative people because of the need to work as a team, but you shouldn’t become part of the problem either. You spend too many of your waking hours at work not to enjoy it. I like to smile a lot and use humor at appropriate times to lighten the mood. It is my belief that your colleagues make you stronger. At my facility, everyone from the ladies in the lunch room, the environment aids, to the nurses on the floors, know me by name because it is important to me to get to know the people I work with. I work hard to ensure my legacy as the guy from the cath lab who smiles a lot. This leaves a good image with your coworkers and builds a positive public image of your department. Are you involved with the SICP or other cardiovascular societies? I am currently only involved with the SICP. I would like to become more involved with the SICP and pursue the launching of a local chapter for the organization because there is an overwhelming need for staff training and cooperation in the Pittsburgh area. I would also like to get involved with the SICP’s clinical training workshops and Registry Review Courses. I recently attended the Registry Review for ASOCC 2005 this past June in Las Vegas, Nevada and was extremely impressed with the knowledgeable faculty and the vast knowledge based covered by the course. I would recommend this to all newcomers to the field and those looking to take the Invasive Registry exam. I was recently appointed fellowship status with the SICP. This is a significant personal accomplishment and something that gives me great satisfaction. Some may consider this honor as vindication for my convictions. In my mind, if I make it easier for the next new professional to succeed in the cath lab, then I have succeeded. If I create a positive working environment, which raises the standard of care, then I am vindicated. I would like to invite anyone with cooperative interests of improving the cath lab environment, continuing education and networking cath labs together, to join the SICP organization and help with the establishment of local chapters. Are there websites that you would recommend to other CV labs? I highly recommend: www.sicp.com. You really can’t go wrong with this website. If you have any questions about the RCIS credential and where a credentialed staff member may fit into your invasive cath lab, the Scope of Practice is easily accessible. I also recommend: www.cathlab.com. I love the chat rooms and end up doing much more observing than participating. There is so much to learn from the other labs and networked staff. Suggested texts: Managing Influence Situation Management Systems, Inc. www.smsinc.com. For putting things into perspective: A Short History of Nearly Everything by Bill Bryson. For personal development: The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change by Stephen Covey. Do you remember participating in your first invasive procedure? I was a student at Inova Heart and Vascular Institute, Fairfax Hospital, Falls Church, Virginia in 1994. I recall that I was scrubbed with my proctor, Rob Anderson, RCIS, in the old lab 3 (back when there were only 4 labs!). Rob was very patient and offered many helpful tips. He realized there was more than one way to do things and always taught according to the way he thought was easiest. I was impressed with Rob’s demeanor and how the physician valued his opinion. Rob and all of my instructors inspired me to become respected as a knowledgeable resource to the physicians and to be an asset to the team. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? a. I would warn myself about how my lifestyle would change with on-call responsibilities. It would have been nice to understand at the start that I would only be able to make about 50% of my family functions! b. It would have been beneficial for me to be more assertive and become more involved with process improvement upfront instead of continually waiting for change to happen. c. Invest in yourself. Put forth the time and effort early in your career to gain the credentials and degrees that will help you along the way. Professional advancement and job satisfaction will come easier with due diligence. d. Have patience and enjoy the ride! Obtaining more credentials and degrees does not happen overnight, and there are many things to be learned through experience. Where do you hope to be in your career when it is time to retire? If you’re never scared or embarrassed or hurt, it means you never take any chances. Julia Sorel If you’ve ever been to a retirement dinner, then you’ve heard all the stories about how a particular person touched the lives of so many. Over time, I hope to make a difference in the lives of my patients and coworkers. I hope to grow into a management role as a cath lab director and to become known as an established educator. Another area I would like to pursue further that of maximizing cath lab policy and procedures to make the cath lab an easier and more enjoyable place to work. I also would like to become involved with legislation, which supports health care workers and ensures quality for our patients. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Invasive Supervisors Mark McDowell, Russell D’Sa, RCIS, Rob Anderson, and Clinical Instructor, Marty Breads, RCIS, were the primary professionals involved in my instruction at Inova Fairfax Hospital. The entire staff of the cath lab generously shared their knowledge and contributed to the fantastic clinical education I received while there. It has been said many times before, but it is worth saying again: You can’t achieve very much in life without the support of the people around you. I appreciate the contributions of all of former teammates at The Western Pennsylvania Hospital and Jefferson Regional Medical Center in Pittsburgh, Pennsylvania, Concord Hospital in Concord, New Hampshire, and Trinity Medical Center West in Steubenville, Ohio. A sincere THANK YOU! for making me who I am today. Where do you think the invasive cardiology field is headed in the future? The future, I believe, lies in DNA and stem cell research. There will be many doors opening in these areas, and the possibilities are presently difficult to fathom. I can only hope that there is more good than bad that comes from it and that we will be able to differentiate between the two. JCAHO will strive for credentialing and continuing education for staff in every specialty in the cath lab. The RCIS credential should lead the way for cath lab professionals, but it is by no means the only credential.

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