Email Discussion Group: October 2006

New Questions: Check-Off List for Non-Medical Staff I would love an outline for non-medical staff skills competency check-off list. More and more across the EP world, line access and catheter placement are being performed by non-medical staff. We have been doing this for 2+ years without one. Peter Uluave, RN/EP tech, Salt Lake Regional Medical Center, Salt Lake City, Utah (To reply to this question, please type Check-Off List in your subject line.) I have a checklist and a policy for sheath insertions, but nothing for catheter insertions and placement since we do not perform catheter insertions. I will send you the files. We felt it important to name the proctoring physician as well as the sizes and numbers of sheaths inserted for procedures. We did this because our department did have one EP doc who did not want the Allied Professionals inserting sheaths. The P and P is 4 pages (sheath implants) long. I developed these documents, and they have not been copyrighted, so they can be adapted with my permission if you so desire. Dana St. John, RN, RCIS Free-standing EP Labs I am trying to find out if there are any free-standing or stand-alone EP labs in the U.S. Does anyone know of any? anonymous by request (To reply to this question, please type Free-standing EP Labs in your subject line.) A Place for the RCIS in the EP Lab? I am a RCIS with 7+ years of cath lab experience, but I am working for the first time at a facility with an EP lab. I would like to transfer into the EP lab to expand my knowledge base, but this is an RN-only department at my facility. What is the trend in staffing ratios across the country for the EP lab? Since the Society for Invasive Cardiovascular Professionals (SICP) includes the EP lab in its scope of practice statement for the RCIS, I was surprised at the resistance to this change from the EP lab staff. How has the addition of RCIS-credentialed technologists been handled in other EP labs? Any insight would be appreciated. anonymous by request (To reply to this question, please type RCIS in the EP Lab in your subject line.) I am sorry you are meeting resistance; however, it is not uncommon to have an all-RN lab. I can only surmise that it is a state/hospital/physician decision, and it may have licensure aspects of the staffing decision. Our lab is both RN and technologist in that our RNs provide moderate sedation, staff our pre-EP clinic, and circulate during cases, which are covered by anesthesia. Our technologists are responsible for all of the other roles in the EP lab. With that said, our technologists are trained in all aspects of EP, and we look for RCIS s in particular because they have had experience at the cath table, are well versed in asepsis, pharmacology, radiology, airway management, general arrhythmia recognition, and emergency procedures. We are particularly interested in RCIS s with interventional experience as they can "hit the ground running" by assisting physicians with the use of interventional equipment for complex BiV implants. This is not to say that we will not hire and train an RN, specifically one with critical care experience, to perform the "tech" responsibilities in our lab, but many CCC nurses enjoy the patient care side rather that the "tech" side of the table. Because our technologists are acting/functioning under direct physician supervision within the EP lab, and most are RCIS, we are able to not only provide excellent patient care, but our RNs are focused on patient needs while the EP technologists are focused on the procedure and physician needs. Although SICP speaks to the EP technologist in the scope of practice, it is unfortunate that some hospitals do not recognize the RCIS as a member of the patient care team in EP as it does in the cath lab. Hopefully the SICP will address this, and will support the need for an EP credential as well as EP education for the RCIS, in order to produce highly skilled EP technologists in our EP labs. Lisha Esbenshade-Smith, Cardiac Electrophysiology Internship Program, Lancaster General Hospital, Lancaster, Pennsylvania Our practice is to orient and utilize all professional designations in the EP and Implant lab. Historically, in our lab, it was and still is difficult to get RCIS s, RNs, and RRTs who wanted to work in the EP/Implant labs, nevermind having previous experience. The complaints were that it's too boring, too technical, too limiting in scope of practice. The job description may have requirements that an RCIS cannot meet. Conscious sedation, in which only a licensed professional can administer sedatives, could be a consideration, but other job duties like scrubbing and recording are not RN-only roles. Maybe there are on-call considerations in which only RNs meet standards and conditions. The medical director and the cath/EP lab director may have considerations for why RNs are only suited for the EP lab.   Every EP/Implant lab I have been to has had both RCIS s and RNs working together. The RNs classically gave the sedation, but all were cross-trained to scrub, run the stimulator, and record the cases. Limited staffing may not permit the experienced professionals to cross-train a new person to the EP lab. Is there a history of attempting and failing to orient RCIS s to the EP lab? Some individuals do not have the ability to retain the technical aspects and perform to an acceptable level on a part-time basis. "Jack of all trades and master of none" does not bode well in medical situations. EP is really a full-time specialty, and professionals who practice it are full-time EP professionals.     I would recommend that you approach the most approachable of the EP RNs and try to find out why you perceive resistance to orienting to the EP lab. Inquiries are usually received and perceived in the manner in which the inquiry is made. If you are serious about learning the EP lab and meeting the team requirements, both spoken and unspoken, I do not see any reason why you would not get serious discussion and an answer to your inquiry. We all start at the bottom, and the only way to get better is with experience. Be warned, though; I have experienced resistance not related to measurable standards and descriptions. Professionals working in the same area can develop a proprietary attitude about their EP lab and their patients. While I suspect the RNs could be testing your desire and commitment to learning EP, I also know RNs have been known to eat their young that is to say, new and inexperienced RNs. I would suspect that new RCIS s would be included.   You want to work in an environment that is supportive and nurturing. Remember, you have your standards and your requirements too, and they are not any less important than the standards and requirements that the EP RNs have or believe they have. I am an RN and an RCIS. Work is a team sport. Good Luck. Dana St. John, RN, RCIS