For New Nurses

When I first went into the cath lab, the nurses scrubbed, monitored and circulated cases.  Of course, techs also scrubbed, monitored and circulated cases.  There was very little difference between the roles and everyone worked as equals.  Over time, some separation was introduced, as nurses claimed the circulator role, as only they were allowed to administer medications.  This made sense, and the nurses continued to scrub and monitor as well.  That made things easy for the scheduler; just put a team into a room with their schedule and leave them alone for the day.  Everyone rotated through the roles, and it was great (until there was only one nurse, who circulated all day).  This worked, as it is easier to perform your role when you know what is happening in the other roles.

As a traveler, I have seen many new nurses come into the lab, trained only as circulators.  That is good, but I sometimes I wish their training included many more things.

Here are the things I wish new cath lab nurses knew:

1. This is a procedure area. The patient comes to the cath lab for the procedure. The nursing care is part of that procedure, but it is not the top priority.  The procedure is the top priority.
2. All cath lab employees are equal. Because it is a procedure area, everyone pulls an equal amount of weight.  If (and it’s a BIG if) anyone is in charge, it is the scrub.  The scrub determines when the procedure is ready to start; when to call the physician; when the procedure ends.  Everyone is equal, but the scrub is the team lead.
3. Understand that everyone in the lab is a professional. The techs are knowledgeable about all aspects of the procedure.  Many nurses have looked at me in amazement when I mention something they didn’t expect me to know, such as a change in the EKG or some other physiologic response.  Cardiac cath lab techs know a great deal about cardiology, and peripheral vascular disease.  Give them the respect they deserve and remember that you might be able to learn from them!  Understand that everyone in the cath lab is an educated professional.
4. Learn how to scrub and monitor. It always amazes me how a new person will try to direct traffic in the lab without knowing what is actually happening.  Learning to scrub and monitor, even if you don’t normally perform those roles, gives you an understanding of the procedure itself; the reason you are here.  Come into the lab and learn to scrub and monitor first.  You can function as a circulator only, but without understanding the procedure, you can’t really be a part of it.  Learn to scrub and monitor.
5. Learn the equipment. There are a lot of sheaths, catheters, and wires, and even more other little things (torquers, tuohys, indeflators to name a few) that we need during a case.  The more you know, the more valuable you are.
6. This is a team effort. While there are a few things that only nurses are allowed to do (administer medications), there is a lot to do.  Please jump in and help get the patient connected to the monitors.  Help us with draping and connecting the manifold to the pressure transducer.  Be a part of the team!
7. Learn cardiology. Learn the anatomy and physiology we are working with.  Learn about the EKG (we never have a “real” EKG in the cath lab).  Learn the difference between PVCs and V-tach…and why we don’t jump when we see either.  Coming into the cath lab is not like going anywhere else.  It isn’t enough to know how to medicate and monitor your patient.  You need to know what we’re doing and why we’re doing it.  Learn cardiology.

It’s a lot.  You will learn these things over time.  That’s how I learned it, but I was surrounded by others who knew…and I was eager to learn.  Any onboarding for new Cath Lab Nurses should include this.  And, it should be included in an annual competency for all cath lab personnel…in my opinion, of course.