May I have your retention, please?

 Have you ever contemplated leaving your job in the EP lab? Maybe you enjoy the nature of your work, but something just feels like it’s missing. As a lab manager, what lengths would you go to improve employee retention? There are many factors to job satisfaction. Education will not only improve contentment but also boost fulfillment at a relatively low cost. Instead of having one foot out the door, a new passion for your career may ignite. 

 Retention is extremely important for employers, especially in the healthcare setting. Losing an employee costs approximately 33% of the annual salary to hire a replacement. In addition, there is a significant cost of hiring traveling employees while bridging the gap until the position is filled. We know that not anyone can just walk into the EP or Cath lab and be able to function independently. There is a large learning curve in order to provide the best care to the patient, and this is not a place to cut corners. 

 There are various factors in which an employee may leave, but job satisfaction is a largely controllable factor. Career development is a common reason for dissatisfaction with the job. For some individuals, this may be receiving recognition for a job well done or being part of a committee. For myself and many others, it is the feeling that you are an active participant. I want to know that I helped make the case successful and that I was a valued team member. 

 When an employee is trained to perform a task without the additional knowledge of in-depth education, electrophysiology can become very monotonous. However, with education, the employee now can explore all the different nuances, understand why something is performed, make informed suggestions, and be engaged. The understanding is what transforms the “job” to a passion. 

 Employees who have had a formal in-depth training experience, whether in the classroom or online, have a better perspective about the theories behind why they are performing certain tasks. Those that are trained on the job are good at the tasks but do not really understand why they are performing them or what to do in unexpected situations. Though this is not true for all on the job training (OJT), it is what is most commonly observed. Often, there is not time in-between cases where you may review electrograms with your preceptor, and not all physicians have the time (or desire) to teach. With OTJ training, the employee has to rely on the experience and knowledge of the person instructing them. If their preceptor has very little experience in the line of work, they can only bring the pupil to their level.

 I earned a cardiovascular technology degree from Southeast Technical Institute in Sioux Falls, SD and then had the pleasure to work with Dr. Scott Pham and Dr. Chris Stanton at Sanford Health. They both encouraged me to learn electrophysiology and would help me understand the many concepts. Due to my educated experience, I have been in the field for almost 20 years and I’m passionate about my career. 

 Knowledgeable staff will not only be more satisfied in their chosen career but will aid in increasing patient safety while decreasing case times. In both the Cath lab an EP lab setting, the physician is monitoring many concurrent elements of the procedure. For example, an EP physician will be simultaneously observing the x-ray, 3D mapping system, ablation display, patient vitals, and live electrograms. Heart block may happen quickly in which the physician needs to immediately stop delivering therapy and possibly pace the heart. With an educated staff, the physician is still monitoring these items, but now there are extra sets of eyes watching to help prevent complications and aid in the procedure. 

 When the staff has this heightened level of expertise, they are able to anticipate the next steps. In an EP procedure, a knowledgeable staff member may observe a left-sided pathway with catheter insertion, allowing them to have the left-sided equipment ready before the physician completes the study. In many labs, the physician has to break scrub to perform the EP study or have to walk the staff through where to pace and what to do next. In other labs with highly trained individuals, the staff knows not just the appropriate pacing site, but they are able to recognize activation changes, block, and understand what to do if tachycardia is induced. This will assist in cutting down procedural times. 

 There are many training options available for both Cath and EP. In the electrophysiology field, there are various books and classroom or online training. When I was learning electrophysiology, the benefit of formal training was not yet available. Therefore, I have spent years compiling education, electrograms, and case studies to help others. Along with Dr. Paul Haas and Scot Felton, we (EP Essentials) published a unique EP book Understanding EP: A Comprehensive Guide and an online EP program. This textbook is filled with colored illustrations, 3D maps, and many electrograms. We cover everything from cardiac anatomy to complex ablation strategies and more. A separate workbook is included to practice new skills as they are introduced. It contains over 200 electrograms to interpret and corresponding labeled electrograms and explanations. Our self-guided online electrophysiology program includes reading material, presentations, assessments, live electrograms, case studies, review games, and continuing education credits. The learner is able to complete the courses in any order. Therefore, if there is a WPW scheduled for the next day, the learner may skip forward and study AVRT without having to complete the other courses first. 


 Which every route or education company is chosen, know that a good decision has been made. Learning more will help you appreciate and gain that passion for your chosen field, increasing your job satisfaction, and ensuring patient safety.  

 VIVA EP,

 April Felton

This week’s EP question:

This is often seen before complete heart block during RF ablation. 

  1. Accelerated Junctional Rhythm
  2. Ventricular Tachycardia
  3. Atrial Tachycardia
  4. Sinus Bradycardia
Answer

Accelerated Junctional Rhythm

 During an AV node ablation notice that just before CHB and backup pacing are observed, there will be accelerated junctional rhythm. This is a good time to learn what damage to the normal conduction system looks like; therefore, when CHB is meant to be prevented you know the tell-tale signs. For example, during the ablation of AVNRT, slow junctional rhythm is a good indication of a successful ablation site, but accelerating junctional rhythm is a sign of damage to the fast pathway. The fast pathway is the normal conduction system; therefore, if an accelerated junctional rhythm is observed, ablation must immediately be terminated. 

 

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 For more information:  EP Essentials – Understanding EP: A Comprehensive Approach section on AVNRT Treatment Strategies.