Developing the Cardiac Catheterization Lab and Cardiac Preparation and Recovery Unit Cross - Training Program: Case Report
Presented By:
Donna Calfin, MHL, BSN, RN; Andrea Steele, BSN, RN; Mary Pretsch, MSN, RN, CPN; Lauren Stahl, BSN, RN, CPN; Edie Ryan, BSN, RN; Brittany Fearon, BSN, RN, CPN; Kathleen Andruszko, BSN, RN; Lisa Brogan, BSN, RN, CPN
Children's Hospital of Philadelphia
Calfin@chop.eduOverview:
Introduction: The Cardiac Prep and Recovery Unit (CPRU) and the Cardiac Catheterization Lab (CCL) are highly specialized areas requiring patient care to be provided by nurses with cardiac inpatient or Intensive Care Unit (ICU) experience. These nurses receive a specialized orientation to procedural and/or pre-post anesthesia care. All non-ICU patients come to the CPRU pre-procedure and recover in the CPRU unless an ICU recovery is warranted. Pre-pandemic, leaders proposed cross-training between the units to increase staff satisfaction, fiscal responsibility, and awareness of the full patient experience. At that time, due to staffing constraints, the program was not able to be implemented.
Case Description: Decreased volumes during the pandemic lead to redeployment of staff to multiple support roles throughout the organization. Postponement of elective cases left the CPRU overstaffed and at risk of losing positions. The CCL had vacancies and was opening a fourth lab, leaving them understaffed. To preserve skill mix in the CPRU for when volumes returned and to support the CCL with their vacancy, the CPRU and CCL leaders proposed to have some CPRU nurses cross-train to the CCL. Interested nurses completed a shadow experience to provide input into what elements of the circulator role they could be quickly trained in.
Discussion: Two nurses volunteered to cross-train between the units for one year. The original plan consisted of a task-oriented approach, however; feedback from staff who shadowed informed the leaders’ decision to pivot from that plan and to fully train the nurses to the circulator role. Orientation went well, the first nurse quickly learned to circulate. The second nurse became restricted from radiation exposure and was trained to record. Her success in learning to record encouraged leaders to have the first nurse orient to this role as well. Phase 2, training CCL nurses to the CPRU, to improve the ability to flex in both directions, began this summer. Two nurses have successfully oriented to care for pre and post procedural patients. Other CCL nurses have expressed interest in cross-training. In addition, a few other CPRU nurses have inquired about cross-training to the CCL. Challenges remain with scheduling. CPRU and CCL have different staffing models and hours of operation. Both units being fully staffed will provide more opportunities to cross-train additional nurses and flex between the units, to provide the best nursing care for our patients.
Conclusion: Nearly 2 years after the beginning of the Covid-19 pandemic, the CCL is fully hired and the CPRU has not lost any budgeted positions. The flexible staffing program allows cross-trained nurses to split or transfer a shift entirely to the area with greater need. This flexibility improves staffing without added cost. Understanding the roles and responsibilities in both units improves communication related to patient flow, patient care, and staffing needs. All cross-trained staff have expressed satisfaction working in both areas. As a result, they have been recruiting others to take advantage of this opportunity for professional development. Next steps include applying the knowledge and experience of the cross-trained staff to improve the patient experience and staff education. The shared experience on the “inside” of both units allows the teams to break down communication barriers, improve knowledge of the systems both areas use, and build competency and consistency.
Case Description: Decreased volumes during the pandemic lead to redeployment of staff to multiple support roles throughout the organization. Postponement of elective cases left the CPRU overstaffed and at risk of losing positions. The CCL had vacancies and was opening a fourth lab, leaving them understaffed. To preserve skill mix in the CPRU for when volumes returned and to support the CCL with their vacancy, the CPRU and CCL leaders proposed to have some CPRU nurses cross-train to the CCL. Interested nurses completed a shadow experience to provide input into what elements of the circulator role they could be quickly trained in.
Discussion: Two nurses volunteered to cross-train between the units for one year. The original plan consisted of a task-oriented approach, however; feedback from staff who shadowed informed the leaders’ decision to pivot from that plan and to fully train the nurses to the circulator role. Orientation went well, the first nurse quickly learned to circulate. The second nurse became restricted from radiation exposure and was trained to record. Her success in learning to record encouraged leaders to have the first nurse orient to this role as well. Phase 2, training CCL nurses to the CPRU, to improve the ability to flex in both directions, began this summer. Two nurses have successfully oriented to care for pre and post procedural patients. Other CCL nurses have expressed interest in cross-training. In addition, a few other CPRU nurses have inquired about cross-training to the CCL. Challenges remain with scheduling. CPRU and CCL have different staffing models and hours of operation. Both units being fully staffed will provide more opportunities to cross-train additional nurses and flex between the units, to provide the best nursing care for our patients.
Conclusion: Nearly 2 years after the beginning of the Covid-19 pandemic, the CCL is fully hired and the CPRU has not lost any budgeted positions. The flexible staffing program allows cross-trained nurses to split or transfer a shift entirely to the area with greater need. This flexibility improves staffing without added cost. Understanding the roles and responsibilities in both units improves communication related to patient flow, patient care, and staffing needs. All cross-trained staff have expressed satisfaction working in both areas. As a result, they have been recruiting others to take advantage of this opportunity for professional development. Next steps include applying the knowledge and experience of the cross-trained staff to improve the patient experience and staff education. The shared experience on the “inside” of both units allows the teams to break down communication barriers, improve knowledge of the systems both areas use, and build competency and consistency.
