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A Sustainable Staffing Solution: Interventional Cardiology Rad Tech Transition Program
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EP LAB DIGEST. 2024;24(7):7-8.
In recent years, interventional cardiology has been heavily impacted by the ongoing national shortage of health care professionals. Despite the national shortage of allied health professionals, technological innovations within interventional cardiology are advancing at a remarkable pace. Advancing technology has increased case volumes, and to keep up, the electrophysiology (EP) laboratory at Scripps Memorial Hospital La Jolla has responded to the demand by making plans to expand their department with an additional room. More laboratories and increased case volume require a higher number of experienced staff. EP and cardiac catheterization laboratories struggle to find these experienced candidates to fill highly specialized technologist roles, resulting in high costs spent on travel contracts, burnout of permanent staff, and an inability to meet the increasing demands of the field.
In 2022, several hospitals were forced to reduce or halt their invasive services due to inadequate staffing, prompting an in-depth survey to investigate the full impact of the shortage.1 The results were staggering, revealing that 96% of respondents reported facing challenges in staffing their catheterization laboratory and 85% were currently using travelers or interim staff to supplement their staffing.1 A recent review of the websites of local hospital systems found 16 permanent job openings posted for radiologic or cardiovascular technologists in EP and catheterization laboratories across San Diego County.3-9 Some of these positions have remained vacant after 2 years of open applications. The small pool of qualified applicants fuel competition between employers, with some hospitals offering generous sign-on bonuses in hopes of attracting experienced candidates. Although Scripps has not experienced high turnover rates, this competitive environment lends itself to a candidate’s choice of workplace.
Despite the demand, the career path for radiologic technologists (rad techs) hoping to enter the interventional field can be difficult to navigate. Orientation for rad techs with no prior interventional experience can be long and challenging. The on-the-job training required for this type of orientation is accompanied by a steep learning curve. Unless hospitals provide adequate time and support during training, the new employee risks an unsuccessful orientation period. This often results in the loss of a good candidate and the associated financial investment. To avoid this, some hospitals only hire rad techs with experience working in EP or catheterization laboratories. However, creating a barrier for new rad techs to enter the field further exacerbates the shortage of experienced candidates.
Scripps Memorial Hospital La Jolla is a 426-bed hospital with a large interventional cardiology program consisting of 3 departments: 2 separate catheterization laboratories (totaling 8 rooms, plus 2 hybrid OR suites) and a dedicated 6-room EP laboratory. In response to the shortage of experienced candidates and barriers to new rad techs entering the specialized field, Scripps developed the Interventional Cardiology Rad Tech Transition Program. This pioneering initiative aims to provide a sustainable, long-term solution to the staffing shortage as well as a unique career advancement opportunity for rad techs. The objective of this article is to describe the development, structure, and outcomes of Scripps’ Interventional Cardiology Rad Tech Transition Program, and also consider broader implications for its potential implementation in the interventional cardiology community.
Development
Although the retention rate in the EP laboratory at Scripps was stable, the challenge was in increasing the overall number of rad techs to optimize operational efficiency. The vision for a dedicated program to train inexperienced rad techs began after an extensive search for ones with experience. It was made possible by the existing structure supporting transition programs at Scripps and the capable preceptors in the EP and catheterization laboratories. Beyond orientation, this new 6-month program provides thorough didactic and hands-on skills education. Currently, this is the only hospital-based cardiovascular rad tech transition program of its kind in the San Diego area. It is modeled on concepts of training programs created for other health care professions at Scripps. Over the past 2 decades, transition-to-practice programs for new graduate nurses have been widely adopted by hospital systems in the United States. While some other health care professions such as respiratory therapy have adopted transition programs, in general, they are far less commonly established for allied health professions. The National Council of State Boards of Nursing published results of a large national study examining training and retention of new graduate nurses; this revealed organizations with transition programs not only show improved retention of new nurses, but also lower levels of stress, increased job satisfaction, and improved safety and quality patient outcomes.2 Using the key elements of other program’s success, the Interventional Cardiology Rad Tech Transition Program was designed.
The first step in designing a program was establishing a project timeline and identifying key stakeholders. The program development phase lasted about 9 months and required collaboration between several areas, including legal, human resources (HR), talent development and recruiting, marketing, and the education and training department.
As stakeholder meetings began, required and preferred qualifications for potential candidates were established between the EP and catheterization laboratory leaders and HR. The education department hosted online informational sessions for those interested in applying for the program and collaborated with marketing to promote the career advancement opportunity. As potential candidates were vetted by talent development and recruiting, initial interviews were conducted.
During the first round, candidates sat for a panel interview with the leaders of the 3 laboratories. Then, the final candidates were invited back for an “observational interview” during which time they had the opportunity to spend an hour observing and talking to staff in each of the 3 laboratories. Current and predicted staffing needs were used to determine the number of candidates invited to begin the program. Upon accepting their offers, the new program trainees were placed in one of the 3 laboratories, where they would remain for the program’s duration. This was done with the goal of a seamless transition into a permanent position in that laboratory after successful program completion. During the program, the trainees’ compensation comes from a dedicated “training” cost center that has been set up for Scripps’ transition programs. After completion of the program, the program graduate is transferred to the cost center of the laboratory where they have accepted an employment offer.
The program’s design provides 3 key components for a successful transition: adequate time, ample support, and structured education. Didactic content and a program syllabus were developed between the education department and the EP and catheterization laboratory leaders. Throughout the 24-week program, biweekly check-ins occur between the supervisor, preceptor, and trainee to assess progress towards the outlined learning milestones and ensure proper progression through the program.
Through months of meetings and collaboration, the idea for the program evolved from its infancy to an implementation-ready Interventional Cardiology Rad Tech Transition Program. Before implementation, the EP and catheterization laboratory leaders gained a final seal of approval from legal, HR, and senior leadership.
Educational Structure and Program Content
Scripps’ EP and catheterization laboratory leadership collaborated with the education department to develop the program’s two 24-week curriculum pathways, one of which is dedicated towards EP and the other specific to the catheterization laboratory. Education includes online learning modules, in-person classes or lectures, and hands-on training in the laboratory. The educational content and learning objectives were collaboratively developed between the education department and local EP and catheterization laboratory clinical experts, expanding upon current departmental onboarding criteria. The content is divided into weekly areas of focus. The trainees begin with learning the most basic concepts and increase in complexity as they progress through the program. Weekly online learning modules are scheduled to coincide with the area of focus for that week, complimenting the trainees’ hands-on learning and creating clear learning milestones. The program content includes concepts such as sterility and cardiac rhythm interpretation. An example of the first 7 weeks of a curriculum pathway is shown in the Figure.
Outcomes and the Future of the Program at Scripps
Since Scripps implemented this transition program 2 years ago, 5 trainees have successfully completed the program. The retention rate of these rad techs since program completion is 100%. All program graduates have proven to be valuable additions to the team. The transition program has also resulted in improved staffing across the 3 laboratories at Scripps Memorial La Jolla.
Positive outcomes from the implementation have prompted the program’s expansion to other sites within the Scripps system. Recruitment is currently underway for the first cohort of rad techs at Scripps Mercy Hospital San Diego, who will begin the program this June. To accommodate the hybrid structure of this laboratory, the catheterization lab clinical mentor of Scripps Mercy Hospital San Diego, Diana Spokas, BSN, RN, CCRN, CV-BC, is working to develop a combined EP/catheterization laboratory curriculum pathway in anticipation of the incoming cohort. In the future, the goal is to expand structured career pathways at Scripps by implementing a transition program for nurses entering the catheterization laboratory from other specialties.
Implications for the Community
The implication of this type of program extends beyond the profession of nursing. The ongoing advancements in interventional cardiology and EP will continue to aggravate the staffing shortage. The utilization of transition programs for specialized allied health professionals with difficult on-the-job training, such as EP and catheterization laboratory technologists, could help usher new talent into the specialty and strengthen the workforce across the greater EP and catheterization laboratory communities.
Conclusion
As interventional programs continue to expand and staffing needs increase, there is a call to action for hospitals to put structures in place to support an adequate inflow of allied health professionals into the EP and catheterization laboratory workforce. Through sharing the details and successful outcomes of the Interventional Cardiology Rad Tech Transition Program, Scripps hopes to provide valuable insight to the community regarding the utilization of transition programs as a sustainable, evidence-based solution to staffing challenges faced by EP and catheterization laboratories across the nation.
Acknowledgments
Andrew (Andy) Feltgen, RT(R), the supervisor of the EP laboratory, was the first to recognize the potential benefits of bringing new rad techs into the interventional specialties with the support of a structured transition program at Scripps Memorial Hospital La Jolla. He advocated for a program shortly after stepping into his current leadership role. Having first-hand experience of this challenging transition, he empathized with rad techs facing the learning curve associated with entering the EP laboratory. The mammoth amount of knowledge that the techs are required to know is daunting for those with no experience in the position. Adapting to these requirements takes self-motivation, commitment, and above all else, aptitude. Andy believes creating a transition program, as opposed to traditional onboarding, provides an opportunity to assess the aptitude and commitment required to learn new skills in a moderate- to high-stress environment while reducing the risks associated with hiring a rad tech with no prior interventional experience. Additionally, Whitney Sitter, RCES, is acknowledged for her invaluable contribution as a content expert to the EP curriculum.
Sarah Vanderhoff, MSN, RN, Procedural Advanced Practice Nurse, and Andrew Feltgen, RT(R), Electrophysiology Imaging Supervisor
Scripps Memorial Hospital La Jolla, San Diego, California
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest, and report no conflicts of interest regarding the content herein.
References
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