Issues in Today's EP Lab: Training New Employees

Condensed and Edited by Jodie Miller
Condensed and Edited by Jodie Miller
From 2005, Vol. 5, No. 2: At MUSC Children s Hospital in Charleston, South Carolina, all new employees go through a three-day hospital-wide orientation, followed by department orientation, and finally job specific orientation. Generally, the length of the job-specific training depends on the position and the individual s experience. Because of cross-training for multiple roles in EP and congenital heart caths, "training" can often take well over a year. Given this long process, they work hard to keep their staff who have demonstrated full competencies. From 2005, Vol. 5, No. 1: At Central Baptist Hospital in Lexington, Kentucky, new employees are trained slowly. They focus on tasks and expand when the person is ready. The orientation can last three to six months or longer, until the person is comfortable with each type of procedure. For the nurse, conscious sedation is a major role that is taken seriously and evaluated carefully. From 2004, Vol. 4, No. 12: At United s John Nasseff Heart Hospital in St. Paul, Minnesota, management oversees orientation. They try and place new staff with the same preceptor every day for consistency. Weekly reviews are given during the first 90 days of orientation to identify areas to focus on. From 2004, Vol. 4, No. 11: At Lancaster General Hospital in Lancaster, Pennsylvania, all new employees are brought into the lab through the Electrophysiology Internship Program. The program is 22 weeks of didactic and clinical education in both electrophysiology and devices. The interns are assigned to a mentor, which is a senior staff member, who is responsible for assisting the interns in all aspects of the clinical processes. Their Internship Educator works with the Clinical Educational Coordinator to coordinate the weekly didactic lectures with the EP cases performed in the lab for the week. Their staff and interns are equally important, so all staff members are encouraged to attend outside educational programs, whether they be during the week or weekend, with the expectation that all staff will obtain HRS certification in either Electrophysiology or Pacing, two years from their hire date. From 2004, Vol. 4, No. 10: At Massachusetts General Hospital in Boston, Massachusetts, the training program in Clinical Cardiac Electrophysiology (CCE), which Dr. Ruskin founded in 1978, was among the first EP training programs in the country and has graduated 77 fellows to date. The senior staff of the MGH Cardiac Arrhythmia Service supervises the training of both clinical and research fellows and meets regularly with the fellows for formal clinical teaching rounds and core curriculum conferences. Staff members serve as mentors and advisors to the fellows as they prepare to enter careers in clinical electrophysiology. A majority of fellows who have trained in the MGH CCE program have pursued careers in academic medicine and now include directors of cardiac arrhythmia services and electrophysiology laboratories at more than 30 academic centers worldwide. Nursing orientation is individualized and customized to the needs of the nurse. With exceptional resources and the extensive knowledge base of their current senior nurses, the new orientee receives a well-rounded training in clinical cardiac electrophysiology. From 2004, Vol. 4, No. 9: At Virginia Mason Medical Center in Seattle, Washington, training for new staff is based on their past experience. Typically, training is three to six months. Recently, a new staff position has been developed within the EP and Cath labs to facilitate new staff orientation and continuing education. All mandatory hospital training (BCLS, IVCS, Mock Code, etc.) and competency criteria must be met within a designated time period. Checklists are the major tools used for this process. Training manuals and other resources are readily available to staff. Within six months, all RN staff must be ACLS-certified. From 2004, Vol. 4, No. 8: At the University of Florida, new employees undergo a six-month orientation that includes the cath lab, observation room and EP lab. From 2004, Vol. 4, No. 7: At Lenox Hill Hospital in New York, new employees are trained by the existing staff members. The new nurses are usually placed with one of the more experienced nurses for a few weeks until they are ready to be left on their own. From 2004, Vol. 4, No. 6: At Porter Adventist Hospital in Littleton, Colorado, the turnover in the EP lab has not been an issue. Of the new staff that has arrived, they have come with extensive experience, so there has not been an official orientation developed other than hospital-based orientation. Employees are mentored by another staff member until they are ready to work independently. From 2004, Vol. 4, No. 5: At St. Peter s Hospital in Albany, New York, each new employee is oriented slowly. They focus on the tasks and expand when the person is ready. The orientation can last three to six months or longer, until the person is comfortable with each type of procedure. For the nurse, conscious sedation is a major role that is taken very seriously and evaluated carefully. From 2004, Vol. 4, No. 4: At Medical City Heart in Dallas, Texas, there is a house-wide orientation followed by a department specific orientation. Everyone has a preceptor assigned to him or her. From 2004, Vol. 4, No. 3: At Tufts-New England Medical Center and Cardiac Arrhythmia Center in Boston, Massachusetts, new EP employees undergo a general two-day hospital training, followed by an extensive six-week training orientation role in their lab. From 2004, Vol. 4, No. 2: At St. Luke s-Roosevelt Hospital Center in New York,  they have 12-14 weeks of EP orientation, an additional one-week rotation in the cath lab, and one week in the holding room. All candidates are required to have a critical care and cardiology background before consideration for positions within their laboratory. From 2004, Vol. 4, No. 1: At Parkridge Medical Center in Chattanooga, Tennessee, their standard orientation program lasts an average of six months and consists of both didactic and clinical training. They use the Competency-Based Orientation Program, and each skill mix progresses from station to station once mastery is achieved. RNs are cross-trained to sedate, scrub, stimulate, monitor and map. RTs are trained in all stations with the exception of sedation. The Competency-Based Orientation is evaluated at the six-month completion period, and goals are set for the next year. From 2003, Vol. 3, No. 9: At Emory Crawford Long Hospital in Atlanta, Georgia, all new employees are brought in through the preceptor program where they receive on-the-job training by their staff. They provide direct training in areas of EP, and also use industry as a valuable source of training on specific equipment and devices. From 2003, Vol. 3, No. 8: At St. John Hospital and Medical Center in Detroit, Michigan, all new employees undergo an intense, three-month long training under the direction of the lab s charge nurse, in addition to close monitoring for up to 12 months. From 2003, Vol. 3, No. 7: At the UCLA Cardiac Arrhythmia Center in Los Angeles, their manager has a comprehensive program for orientation, and they provide clinical updates to their staff as well. From 2003, Vol. 3, No. 5: At the University of Iowa Hospitals in Iowa City, Iowa, they have a strong commitment to education in the electrophysiology lab on all levels. All faculty members and their trained nursing staff provide didactic teaching and "on-the-job training" in the laboratory. They have several weekly conferences to review cases on all levels. These include conferences for the fellows, for the faculty and for the nurses and radiographers. From 2003, Vol. 3, No. 4: At the University of California - San Diego in California, new employees spend up to six months in a probationary training status. They are trained by existing senior staff members and EP program faculty. From 2003, Vol. 3, No. 3: At the University of Rochester Medical Center at Strong Memorial Hospital in New York, they utilize a comprehensive training orientation for new hires consisting of 1:1 preceptorship and six weeks of hands-on training. If hires are new to the University of Rochester, their nursing practice has an orientation to complete in addition to training in the EP lab. Nursing staff are often broken in by the attendings who try to make the work day pleasurable by infecting us with their sometimes corny senses of humor. From 2003, Vol. 3, No. 2: At Advocate Illinois Masonic Medical Center in Chicago, Illinois, their new staff members are precepted and mentored by their current staff and clinical coordinator. They have an orientation and competency book, which they fill out as they achieve goals and master skills. They attend classes and inservices offered by the vendors for both EP and devices. However, the majority of their education comes from hands-on experience and the expertise of their physicians who patiently answer questions and often provide one-on-one EP study or ECG analysis after the case is over or in down time. Because their program involves teaching and training fellows, they all benefit from the knowledge and dialogue shared by their physicians, fellows, and nurses during live cases. They also have a weekly journal club and EP conference that they all try to attend to go over cases, clinical and research issues and analysis of electrograms and journal articles pursuant to their practice. From 2003, Vol. 3, No. 1: At the Carle Heart Center in Urbana, Illinois, training is primarily on the job. Cath lab training can take two to four months, depending on previous experience. All staff are required to complete ACLS training. Both nurses in the electrophysiology lab are PALS-certified as well. The physicians teach during electrophysiology lab cases. The vendors have also been a valuable source of teaching. From 2002, Vol. 2, No. 6: At Mercy General Hospital in Sacramento, California, orientation and training is individualized to match the employees experience level. They require RNs to have ICU experience and techs to have cardiovascular knowledge. Each employee is paired with a preceptor; the orientation checklist guides the process with follow-up from the Clinical Nurse Specialist. Their approach is very hands-on, providing the orientee the opportunity to see one, do one and teach one. The electrophysiologists play an active role by providing learning experiences, explanations, and feedback. From 2002, Vol. 2, No. 5: At the Einstein Heart Institute in Philadelphia, Pennsylvania, their new employees undergo a preceptorship training program. Their physicians and nurse manager evaluate the progress of new employees and determine areas in which additional training may be required. Their physicians are excellent educators and will take time to teach during or after cases. A review of the case and electrograms are usually done with staff at the end of ablations and EP studies. In addition, Einstein holds a two-day annual Electrophysiology Symposium, during which topics in basic and advanced EP are discussed. From 2002, Vol. 2, No. 3: At Riverside Methodist Hospital in Columbus, Ohio, all new personnel at Riverside receive general hospital orientation. The RNs in the electrophysiology lab receive an eight to twelve week orientation with another EP nurse. They are taught to know all procedures, equipment and computer systems. They are also taught surgical scrub techniques for device implants. From 2002, Vol. 2, No. 2: At Saint Vincent Heart Center in Erie, Pennsylvania, all of the new employees receive a general orientation to the Heart Center, where they are introduced to the flow of a typical day. New staff members to the EP lab will be teamed up with a preceptor to learn the specific duties expected of them. Weekly evaluations are performed for three months to identify areas of improvement and mutual goals for the next week. All candidates for positions in the electrophysiology lab must have previous cardiology experience. From 2002, Vol. 2, No. 1: At the EMH Regional Healthcare System, which has campuses in Elyria and Amherst, Ohio, new employees are given a 90-day or more orientation into the lab. From 2001, Vol. 1, No. 2: At Walter Reed Army Medical Center in Washington D.C., all new personnel at WRAMC receive a general orientation to the facility. Employees assigned to the cath lab are given a unit-specific orientation, which includes a familiarization with all procedures and equipment. From 2001, Vol. 1, No. 1: At Morristown Memorial Hospital in Morristown, New Jersey, new employees all participate in a formal orientation program. Furthermore, newer staff members who may be very experienced in other aspects of cardiac care, but who are new to the electrophysiology service, undergo extensive training before being asked to work independently.