The Ten-Minute Interview with… James A. Lincoln, RCIS

I am a cardiovascular technologist who has worked in several cardiovascular/electrophysiology labs since 1997, passing my invasive registry RCIS (Registered Cardiovascular Invasive Specialist) in 2006. Prior to coming to the cardiovascular lab, I held positions in several areas of medicine, including interventional radiology and the emergency department. The first career I had out of high school was in a ski shop and I eventually became the manager of two of them. Supporting me throughout all these career changes has been my wife, two children, and most recently, a set of twin 2-year-old grandchildren. Why did you choose to work in the invasive cardiology field? I enjoy the fast pace and organized chaos in which the cath lab operates. In addition, there is the ongoing challenge to continually learn in order to keep up with the constantly changing technology in the field of invasive cardiology. I like to perform my job well during the critical moments in the lab and have come to appreciate having the high patient turnover, which makes the day go by quickly. I also enjoy the reward of a patient leaving our care feeling, looking, and by and large, doing better than when we started the procedure, which is the case the majority of the time. Finally, with the exception of call, the hours are good and the flexibility in scheduling is accommodating for personal commitments outside of work. Can you describe your role in the cardiovascular lab? I provide care and support to patients having cardiovascular studies and function in many capacities including, but not limited, to: • Primary scrub for diagnostic and interventional cardiac catheterizations, permanent pacemaker, implantable cardioverter defibrillator (ICD) implants, and electrophysiology (EP) ablation procedures. • Monitoring and recording patients’ hemodynamics during procedures. • Second circulate on interventional (percutaneous coronary intervention) cardiac catheterizations • Providing pre and post care for the patients treated in the cardiac cath/EP labs. • Scheduling our annual skills day with outside vendors, vendor lab visits and in-services. • Providing education to our supporting departments; giving presentations at conferences and schools regarding all aspects of the cardiovascular lab. What is the biggest challenge you see regarding your educational role? The biggest challenge is the lack of recognition for the RCIS (Registered Cardiovascular Invasive Specialist) credential. Given our degree of training, we can provide so much valuable support to our patients and the facilities in which we work. However, without national recognition, most hospitals will not allow us to operate to our full potential. The credential is inclusive for all non-physician modalities working in the cardiovascular lab and, when recognized, helps to eliminate a great deal of the inter-disciplinary discrepancies. Work is more evenly shared and it fosters the team in the cath lab to work as a more cohesive group. It has been shown that when this type of atmosphere is created and accepted in the cath lab, personal and job satisfaction is higher, staff turnover is lower and patient outcomes are better. What motivates you to continue your involvement with the cath lab? Professional growth, continued education, and the opportunity to improve patient outcomes in the cardiovascular lab. We do a great job, the work can be very stressful at times, but when the patients and their families say “thank you,” I know I’m making a difference by being part of the team caring for them. What is the most unusual case you have ever been involved with? I was a new staff member in the cath lab with about 10 months experience and was assisting on a patient having a left heart cath with grafts. After visualizing all of the native coronaries and grafts, we hooked up the injector to do a ventriculogram. Apparently, the connection was not tight and the tubing disconnected, spraying contrast all over the room. We reconnected and immediately following the ventriculogram, the patient began to complain of having blurred vision. The patient was assessed on the procedure tab and found to be alert and orientated x3, moved all extremities, grips were equal and questions were answered appropriately. We put in a stat neurology consult and the fellow showed up within minutes. His initial assessment confirmed ours until he took the patient’s glasses off to assess pupils with the room lights on. Immediately the patient was able to see clearly. It turns out that the patient’s glasses were covered with the contrast from when the injector tubing came apart. Yes, we felt very stupid, but the patient was okay and we certainly learned a lesson! When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I am the class clown. Laughter is a very important part of my life, especially when one considers the type of work we do, so I laugh often. I remain thankful for what I have and almost never concentrate on what I do not have. In the summer months, I spend a lot of time camping, sitting around a fire and reading. It seems to be the only time I truly relax. In the winter, I love skiing. Before deciding on a career in healthcare, I was a ski shop manager, which afforded me the ability to ski some 40+ days a year (for free). I can only ski about 6 days a year now (having to pay for everything) and I think I am still going through withdrawal, even after 13 years. Are you involved with the SICP or any other cardiovascular societies? Yes, I have been a member of the SICP since 2005 and recently accepted the position as Advocacy Committee Chair. There are several members on this committee currently, and with their support and dedication, within a couple of months, the committee has accomplished some of the goals it set. I look forward to working with the committee this upcoming year and have great hopes of accomplishing even more. Are there websites or texts that you would recommend to other cardiovascular labs? I am always referencing the following books: 1. The Cardiac Catheterization Handbook by Morton J. Kern, MD 2. Grossman’s Cardiac Cathet-erization, Angiography, and Intervention. I frequently visit the following websites: 1. www.cathlab.com 2. www.sicp.com Do you remember participating in your first invasive procedure? Yes, I remember it well. I was nervous, sweating and my hands would not stop shaking. The physician I was working with looked at me, put his hand on top of mine and held it down on the table (it was a bit awkward). Fearing the worst, I braced for a comment that would shatter what little confidence I had, but then he said, “Relax, it’s fine.” He made light of the situation with a little humor, then continued with the procedure. At the end of that case, I felt confident that I had the skill necessary to continue and improve, and have not stopped to this day. It was one of the defining moments for me in my career. This is an example of how one individual has the ability to impact another person’s life with just a couple of words and a subtle gesture. If you could send a message back to yourself at the beginning of your cardiovascular career, what advice would you give? I would tell myself to: • Be patient. • Be prepared to have your career become part of who you are. • Be open to and willing to change (it occurs frequently). • Be in the frame of mind to continuously seek education. • Find a way to convert frustration into a challenge. • Make sure that you want to return to work each day. If not, the cardiovascular lab is not for you. Where do you hope to be in your career when it is time to retire? I would like to be in some type of educational role and feel satisfied that I was able to contribute in a constructive way to the manner in which cardiovascular patients receive care. Hopefully, the RCIS credential will be recognized and, through our combined efforts in its advancement, will have improved job satisfaction for everyone working in the field of invasive cardiology and improve patient outcomes. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Yes. Dr. Peter Cohn is the cardiologist I described earlier. He is an extraordinary teacher. Also, the cath lab director, Laurie Mulgrew RT(R)CV, for providing me with opportunity, challenge and support to grow professionally. Where do you think the invasive cardiovascular field is headed in the future? Today’s trend of hybrid cardiac catheterization labs seems to be one of consolidating and adding services. The cardiac cath lab has been a melting pot of non-physician allied healthcare providers since the beginning and now, because of the growing acceptance of the cross-training of staff and the specialty training of the cardiologist during fellowships, we are going to see procedures done in the cath lab that have been traditionally offered in such places as the operating room and interventional radiology. Many of the interventional cardiologists are completing their fellowships with training in peripheral procedures. We are seeing a rapid growth in cath labs offering diagnostic and interventional angiography for carotid, renal, aorto-iliac and other peripheral arterial disease. There will be a steady growth in the percutaneously-replaced heart valves, in conjunction with atrial septal defect (ASD)/ventricular septal defect (VSD) closures being performed, as well as the continued integration of electrophysiology and pacemaker/ICD implants. Cardiac cath labs have been largely unregulated to date, and with the new Medicare guidelines and other legislation such as the CARE bill being re-introduced in the 111th Congress, it will be very interesting to see how cath labs around the country enact new policies in order to be in compliance. If we stay involved now, we can help guide our workplaces in the direction that will afford us job satisfaction, security, advancement and better the outcomes for our patients. James Lincoln can be contacted at jlinc915@yahoo.com

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