Cath Lab orientation length

[CRC12]

Hi everyone,

I am an RN with 5 years of experience in critical care (ICU and CCU). I just recently got a job in Interventional Cath Lab at Level 1 trauma hospital. It’s a very busy lab. I am currently in orientation. They give us 1 month in scrubbing, 1 month in circulating, and 1 month in monitoring. I finished my scrubbing orientation, and I was started on “buddy call” after 1.5 months in the lab. I am still in orientation and I am learning to circulate, but during calls I only scrub. The other day one of the doctors told me that they are advancing me too fast, and I am doing a good job for such a short period of time but still it’s way too soon to start scrubbing during calls and that I am slowing him down during calls. I didn’t do anything unsafe during scrubbing like pulling the wire or anything. I am just not fast. I spoke to my leader and she said that everybody starts buddy call after 1.5 months. She said that it was the best way to learn by doing it. I wonder what other labs do as far as length of orientation. Please please help and share. I love the job but I wonder if I am being set up for failure. 

[NedRN]

I float sometimes to the cath lab from OR. That doc was a total jerk and his remark non-constructive. Every doc wants the scrub and everyone else on the team to anticipate his every need. That is big in many OR procedures and in some specialties the surgeons can really get nervous with new staff no matter how experienced.

You were right to ask for staff input. Frankly, zero tolerance for such comments should be universal. Sadly, not all facilities manage physician's passive aggressive traits, or explicit anger events. I do travel open heart scrub and circulate and these surgeons have perhaps the worst reputations of any service. I've seen much worse behavior than the comment you got, but unlike staff, I don't have to live with them for my career, just 3 months or so at a time.

They (the lab and the docs) are lucky to have you. Cath labs are begging for staff. Pretty burn out specialty with the amount of call usually required. Congrats on choosing the cath lab. I have cath lab friends that describe it as ICU on steroids (in a good way - a critical care career upgrade).

[CRC12]

NedRN,

Thank you so much for your comment. Well, before this comment was made, he actually raised his voice at me during the call. This comment was made to me in my director’s office after I told her that he mistreated me. He refused to talk to me one on one, so my director was involved. That’s not the point though. I really wonder if my length of orientation is too short and they are advancing me too fast. 

[NedRN]

Orientation speeds vary. As a new grad, I benefited from a long orientation of 8 or 9 months (which is probably optimal for OR) rotating circ/scrub through all the services. Your facility may believe a short orientation works best overall in their experience, but you do have to adjust to the individual. Additionally, they may simply be looking at cost benefit factors, less orientation means more productive time from new nurses.

So you may be right, or the faster orientation could be better for you. Hard to say. Hang in there for a while longer and see if the cath lab is a good fit for you generally, or this one specifically. Unlike ICU, one bad doc could make a cath lab career unpleasant depending on his volume versus other physicians at the same lab.

There is also the possibility that you are slow! Some certainly are. I have the idea though that in the cath lab, RNs spend far more time circulating/monitoring than scrubbing. That is the best use of your skills. So even if you are truly slow and will stay there when scrubbing, it may not matter too much. But the ability to scrub makes staff and call scheduling much easier for the hospital, so even if scrubbing ends up being rare, having that skill even if slow is valuable to your facility.

[CRC12]

NedRN,

Thank you so much for your responses. It feels very therapeutic to read them. Honestly, I feel that 6-9 months of orientation is more appropriate for such a high skill. I learned the basics of scrubbing but the skills are not automated yet after 1 month. I still have to think before I do them. In the end, it is all muscle memory and practice, and I am just not there yet. My leaders have a full belief that I have a great potential in Cath Lab, but I do not know if they are just being nice to me. If anybody else is working in Cath Lab, please share how your orientation was. I know it is very individual, but I would love to hear how other facilities do it. I do tend to believe that they are advancing everybody too fast. In my first week, I was already standing next to the doctor without any idea of what we are doing. I am learning how to do things without knowing why we are doing it. I have to come home and Google what the hell we just did today.

[NedRN]

You might a search here. There isn’t a sub forum for the cath lab, but there are relevant threads in Cardiac and CCU. Posting in Cardiac may get you some  colleague responses.