Cardiac cath nurse being put in procedures with no training

CCL RN, RN · Dec 6, 2010

Care to elaborate some more?

For instance, what was your nursing experience prior to moving to the cath lab?

What do you mean, 'doing procedures alone?' where is the rest of your team?

You state you has little to no training, and I just cant believe that. Perhaps you feel as If you didn't get enough training, but no way would any lab throw a person in with no training and expect you to be a part of their team. How mNy months at each role did you get?

I have about as much cath lab experience as you do, and you bet the drs expect me to perform as good as the veterans. The cath lab is a busy, busy place. Most people think we do little work or that it will be an easy gig--well, its not easy, is it?

Your cath lab sounds excitingl a code everyday? Or just VT/VF because of the catheter placement and drs not paying attention?

I guess my best advice is this. The cath lab is a harsh place, and we really need each other. We need to fit in, get along, be go-getters, etc. If you feel like this isn't the place for you, then it probably isn't.

And you should be sufficiently trained by eight months to do the job. And it sounds CRAZY that the Drs would yell at the nurses! In our lab, they are our friends and would never yell at us. And if they did yell, we'd yell right back! Dysfunctional family that it is, we are all one team, with one goal.:redpinkhe

Tell me more about your situation...size of lab, do you rotate holding as well, length of orientation, years of previous experience in what nursing field, etc, etc

Also, what procedures do you do?

CCL RN, RN · Dec 6, 2010

Oh, I forgot to answer your last question. No, not all labs are like this, at least I hope not. Are there any other labs close by? Are you pulling call successfully?

Guest27531 · Dec 11, 2010

I have been working in a cath unit for 8 months now. I received little to no training before i was put in procedures alone.
Now doctors are expecting me to preform like a seasoned veteran. Furthermore the cath lab i work in does alot of procedures on pts in there 90s. We have a pt code almost everyday. Then of course the doctors blame the nurse.
I really think i made a huge mistake transfering to cath lab. Are all cath labs like this or just the one i work at?

I hope you can elaborate on your situation. I am new to the cath lab staff myself but I can already tell you that "all cath labs" are not the same. This is true for almost every situation in health care though - different hospitals, different units, different parts of the country - all with different "culture", different patient population, and different patient focus. You may not have made a mistake is transferring to the Cath Lab but it may have been a mistake transferring to the Cath Lab at your hospital.

I do wonder what you mean by "I was put in procedures alone". Do you mean alone in the room to circulate...alone in the room to scrub...alone to do both monitoring and circulating...Eight months does seem like enough time for you to start to feel comfortable in almost every aspect of the job, unless they staged your training. What experience did you have before you started in the Cath Lab? If you didn't have much related experience before you started the job that could explain your initial uncertainty but I would expect you to start feeling comfortable with most aspects of the job by now.

There are so many aspects to the job:

1. The Critical Care Nursing aspect (to deal effectively with meds and emergencies)

2. The procedure set-up aspect (to prepare the room for the specific procedures)

3. The patient preparation aspect (to prepare the patient mentally and physically)

4. The ability to "read" the angiogram (so you can see exactly where the physician is in the anatomy and anticipate what will happen next)

5. The scrub function (so you can effectively set-up all aspects of the sterile field and assist the physician with the procedure itself)

6. The managerial aspects of running your cath lab (making sure you have all the functional equipment, up-to-date medications, supplies and devices you will need. The ability to manage patient flow effectively.)

I will say that "having a patient code every day" sounds most unusual. Perhaps you mean that you are at a busy MI center with Primary PCIs every day and that is what you mean by "a patient code" is the natural emergency conditions caused by emergency admissions?

It does seem that after 8 months on this job with your level of anxiety you are right to consider that a change of jobs might be a wise choice. That's not to say where the problem is coming from...just that there does seem to be a problem.

crazymomagain1 · Jan 12, 2011

HI! I am presently in the cath lab. Been so for 5 years. I felt really uncomfortable the first year of my training. I felt I should know more. But in rea;ity. I have folks who have been here for many years before me and have those moments of "not seen that before" mode! The cath lab is different and not always for everyone. I spent 3 yrs in post cardiac surgery, 3 years in Neuro trauma with travelling before I jumped into the cath lab. I felt like I did a major mess up for many months until I started getting into the groove. I am saying, as a critical care nurse, you were on your own caring for that pt. In the cath lab, you are still responsible but you have a team. Drs do coop attitudes in the beginning. They see who or how they can instill the authority. Now, they are pretty cool to work with. Of course, we still have moody days...what family doesn't. If you can tolerate it, hang out longer, I did and enjoy it totally. If you are not happy, it will be felt by all including the pt and your own family...there and at home. Good luck...cath lab is almost an on the job training but you should have some training. In our Lab everyone scrubs, circles and monitors. We work in holding, EP and Non Invasive. I've heard most labs, RNs do everythiing but scrub. I'm just now learning to scrub EP and Cardiac caths after being here 5 yrs. I don't want to go back to the floor once I've got spoiled here. Best of luck with you!

Runman1914, MSN, RN · Jan 13, 2011

I transfered back to my old tele unit last week. I seriously dont think all cath labs are like the one i was in. I was at the University of Miami cath lab. I was working 60 hours a week with call every other weekend. When i say pt were coding every day i dont mean just a little VF or VT with wire placement. I mean full blown codes . Cath was not for me.

I was coming to work at 6am and leaving at MN or later. For the 9 months i was there i had no life. My Gf thought i was seeing another woman. Nursing were leaving left and right. I spoke with a tech that has been there for only 5 years and he said nurses leave there alot. Usually without a notice. They schedule way too many cases then add on all day. The staff is so burned out. You never know when you are going home.

I had no idea i would miss my 3 12s a week so much. As far as the procedures are concerned there were alot of equipment from which i got no training. Ballon pump, Ivus, roller bladder etc.... I was actually going home and google to learn how to work the equipment we used so i would be ready. Overall it was a terrible experience!!!!

Guest27531 · Jan 13, 2011

Thank goodness you were able to transfer back to your old job! The cath lab where you work sounds like a house of horrors and you are well rid of it. I shudder when I think about the patients because, with what you describe, there are seriously bad things going on there.

Congrats on getting your life back!

Runman1914, MSN, RN · Jan 13, 2011

Thank goodness you were able to transfer back to your old job! The cath lab where you work sounds like a house of horrors and you are well rid of it. I shudder when I think about the patients because, with what you describe, there are seriously bad things going on there.
Congrats on getting your life back!

Just curious with your cath lab what is your daily case load and how many labs does hospital have?

We were doing 30 cases a day with a mere 3 labs!!!!

Guest27531 · Jan 13, 2011

It is a small lab with two rooms and about 8-10 cases a day + emergencies. Very often they have LHC scheduled and then continue to do ad hoc PCI. Doctors and nurses alike get frustrated when the schedule doesn't move along but the quality care is all very high and codes are rare. Both nurses and doctors rotate call to handle emergencies but, generally speaking, the lab completes it's scheduled work within a reasonable time during the day so the staff do have a life.

Runman1914, MSN, RN · Jan 13, 2011

It is a small lab with two rooms and about 8-10 cases a day + emergencies. Very often they have LHC scheduled and then continue to do ad hoc PCI. Doctors and nurses alike get frustrated when the schedule doesn't move along but the quality care is all very high and codes are rare. Both nurses and doctors rotate call to handle emergencies but, generally speaking, the lab completes it's scheduled work within a reasonable time during the day so the staff do have a life.

Thats good to hear. I didnt think all cath labs were as crazy and disorganized as the one i was at. I work at a teaching hospital. We do alot of high risk procedures(percutaneous valvuloplasties) on alot of patients near a 100. We receive transfers from other cath labs. When we get a stemi we have to pull a patient off the table in a middle of a cath to do the stemi. Its total maddness there. We almost never leave before MN.

Guest27531 · Jan 13, 2011

Thats good to hear. I didnt think all cath labs were as crazy and disorganized as the one i was at. I work at a teaching hospital. We do alot of high risk procedures(percutaneous valvuloplasties) on alot of patients near a 100. We receive transfers from other cath labs. When we get a stemi we have to pull a patient off the table in a middle of a cath to do the stemi. Its total maddness there. We almost never leave before MN.

Ours is a teaching hospital also and all cath labs do have moments of maddness but nothing like you described. When a STEMI comes in there is no choice but to take a patient off the table if you don't have a room free. No one wants to do that but it is essential. Our lab only does a handful of valvuloplasties and although there are transfers from other hospitals, ERs, and occasional unusual places but it doesn't happen every day and it is usually quite orderly. The staff sometimes stays late to finish up the days work but not very often.

ggoldtsein · Jan 31, 2011

I wish it was different but a lot places were there are no experience people. This is what happens. After 22 years in the cath lab smaller hospitals will do this. If your hospital is behind and will give you the time to learn?? But if they are on the doctors side helping make a bad situation worse. Then get out!!!!!!!!