I’m currently working on an IR 101 course for new IR techs.  I’ve had to go back to look at a lot of things I haven’t thought about in a long time. But what is the most important part of performing a case?  Is it the knowledge?  The skills?  What is it?

Knowledge of the case is important.  The anatomy, the equipment, and the monitoring of the patient are all important.  The tech must know the disease process, and how the procedure will affect the patient and their diagnosis.  We must be able to watch the patient and ensure their safety.  We must know what the physician wants, and how to use each piece of equipment.  But knowledge is not the most important part of the procedure.

Skills are also important.  A tech must have “muscle memory” of the most common equipment, and be able to manipulate catheters and wires without thinking.  We must also know what the physician will use to treat the disease.  We must be an extension of their hands…and their minds.  In time, we should be able to anticipate the doctor’s needs, and perform the action before he asks for it.  But skills are not the most important part of the procedure.

Regardless of the procedure, whether you are in the cath lab, the EP lab or the IR lab, the most important thing to remember is to keep your head in the game.  Pay attention.  Don’t allow yourself to be distracted by things going on around you.  Paying close attention to each case you are in allows you to see the similarities between different modalities.  It allows you to move from cath to EP to IR seamlessly, even when you have little experience in those modalities.  It will also allow you to work with any physician anywhere…even the first time with a doctor who is extremely particular.  But most importantly, paying close attention will allow you to be ready to react to any situation that arises.  Even the most intense emergency situations.

So, while skills and knowledge are vital, the most important thing you can do during a case is to PAY ATTENTION!  Keep your head in the game.

As a traveler, I usually find there is a reason for travelers; there are situations where people just don’t want to be part of this lab or that lab.  The culprit is usually either the management, the doctors or a small number of staff members who make life miserable for everyone else.  My personal preference is a place where the staff is friendly and the management cares about them.  I can deal with not-so-nice doctors!

However, I am lucky enough to have landed this time in a place that works!  The staff work together well, everyone knows their role, and they help each other to get a large volume of work done.  This is a busy EP lab, with 3 labs and open 12 hours/day.  A lot of wisdom went into making this work. Even now, while they’ve added physicians and are adding and training staff, it works.  Part of it is that the labor is divided along definite lines.  There is the scrub tech, the recorder, and the nurse/circulator.  The scrub tech and recorder are usually interchangeable, although there are times they are not.  However, no one is asked to do anything with which they are uncomfortable.  They seem to have grasped the concept that within the Cath (or EP) lab, there is equality.  Nurses and techs (both RT and RCIS) work side-by-side, with no antipathy for each other.  Sometimes it is an RN recording and an RT/RCIS scrubbing; sometimes it is the RT/RCIS recording and the RN scrubbing.  Of course, due to the medication administration, only an RN is allowed to circulate.  Knowing your role is important to making a department work.

Chance for advancement is also important to employee satisfaction.  In the department where I am now, everyone is receiving training to record and to scrub.  The hospital has brought in travelers to fill in the slots so other employees are trained.  This is amazing.  There are few facilities that will provide this opportunity for their employees.  It satisfies each person’s need to improve themselves, and to advance their careers.  At the same time, it provides the hospital with a larger staff pool from which to draw, easing problems encountered when team members are absent due to vacation or illness.  Cross training creates a win-win situation for facilities.

Last, and probably most important, is the feeling that each person is appreciated.  In other facilities, breaks happen between cases and lunch is a “sometimes” occasion.  At two hospital groups, staff members clock out for lunch, ostensibly to protect the staff.  This keeps management from insisting on “short lunches” and ensures staff members are able to at least stop for 30 minutes.  Or at least, that they get paid for it.  At another hospital, clocking out includes the question “Did you take a 30 minute uninterrupted lunch break away from your workplace?”  These help, but do not really provide the appreciation necessary for employee satisfaction.  At my current position, each staff member is allowed a morning and afternoon break and a full lunch break.  These are rigidly enforced, probably due to a union contract.  However, a union contract shouldn’t be necessary for a facility that is truly interested in staff retention and employee satisfaction.

I worked at a hospital many years ago; a well-known hospital where roles were rigidly enforced, lunches and breaks were prompt, and continuing education was even provided monthly.  However, there was a restlessness among the staff.  I believe that restlessness was caused by the facility’s unwillingness to cross train them.  When people are held back or kept in a position, without the possibility of advancement, there is no satisfaction.  My thought is that the cross training at this hospital, along with fairness and appreciation, is what makes it a good place to work.  And the doctors are pretty good.  Of course, there is always one…