Curran HeelBy Laura Van Heel RN, BSN, CCDS

It is difficult justifying a new hire without explaining how the added personnel will either decrease costs or increase revenue. After all, you must pay for their salaries, tools, and space for them to work. This seems to be the nature of medicine these days. “Doing more with less.”

I supervise a Cardiac Implanted Electronic Device (CIED) clinic, and one of the difficulties in hiring personnel is being able to quantify the level of staff needed for the job. The CIED clinic is a specialized area of Cardiology with its unique language, a multitude of devices, and several ways to evaluate device functionality. The specialized nature of this clinic makes the hiring process even more complicated. We need our employees to provide a service that is safe and protects our patients with their devices.

Clinic Needs

Our clinic needs staff who are appropriately trained with a thorough understanding of device therapy and the ability to expertly monitor those devices. Such skills like these are invaluable when communicating with our customers. So, we employ and train technicians to answer the phone, troubleshoot remote monitoring, update our device database, order supplies, schedule appointments in adherence with insurance guidelines, manage disconnected monitor lists, submit billing, send result letters, and follow up with non-compliant patients. Technicians that obtain a cardiac certification also handle our implanted cardiac monitors (ICM’s).

A Technician’s pay range is lower than a registered nurse, and therefore, the institution saves money, but these technicians are trained and have the skills appropriate for the job.

Our registered nurses are trained and ultimately certified, thereby becoming skilled in the nuances of device therapy. They are the assistant to the physician, aiding in troubleshooting, reprogramming, and triaging patient concerns. Additionally, they perform all evaluations in-clinic and read all therapy device remotes. We choose to invest time and extensive education into these specialized nurses because their critical thinking skills and use of evidence-based medicine ensure high-quality patient care. Our physicians have confidence in their abilities and consider them experts in device therapy.

Our Heart Center CIED staff provide support to 5600 CIED patients, five implanting Electrophysiologists, twenty-one cardiologists, and nineteen advanced practice providers, along with delivering daytime coverage to the 487-bed hospital. To ensure this coverage and prevent burn out, we have embraced a strategy for knowing when we need to hire more staff.

Current Formula

For many years now, we have subscribed to a formula that for every 700 patients, we need one registered nurse, and for every 1000 patients, we require one technician. As our clinic grows, having this formula allows us to predict when to start recruiting new staff. Because CIED registered nurse training is lengthy—8-12 months to be fully competent in device therapy—the ability to forecast the need for a new hire is critical.
Embracing this staffing formula has been successful in several ways: we have high patient satisfaction scores, top staff satisfaction scores, minimal to no turnover in staff and our clinic is a financial asset to the Heart Center, we consider these successes and have maintained them for several years.

Why the Right Staffing Mix Matters

Making sure you have the right staffing mix is essential! The last thing you want to do is have nurses be glorified secretaries or technicians working outside their scope of practice. Both scenarios can lead to staff turnover, which puts patients at risk and adds chaos to an already busy clinic.

We calculated our formula based on the principle that patient encounters occur every one to three months depending on the device and patient needs. This calculation takes into account the responsibilities required in providing those visits, plus enrollment, education, and troubleshooting needed to care for the CIED patient. Determining your patient to staff mix is the foundation you build your clinic on; using it to predict when to hire is crucial.

For many, this level of staffing just isn’t an option. Administrative buy-in, finances, and appropriately trained technicians and nurses are not always available. For others (even when staffing ratios are appropriate) staff resignations, transfers, retirements, and illnesses can quickly leave gaps in your ability to provide care. What other options exist?

Partnering With Us!

A partnership with CV Remote Solutions can be an excellent solution for many clinics. CV Remote Solutions specializes in providing a high level of technical support for device clinics. CVRS uses only IHBRE certified RNs for technical device support. They are flexible to allow quick integration into your current workflow, using your current device database and integrating with your EMR. This flexibility will enable them to provide the solution that you need for your clinic quickly but also allows you to retain control over your device clinic patients and resume follow-up yourself when your staffing issues are resolved. In addition, CVRS provides device clinic consultative services which can allow for assistance with training your device clinic staff and establishing workflows and protocols that will allow you to realize the highest level of care that you desire for your patients.

Laura Van Heel RN, BSN, CCDS

Laura Van Heel RN, BSN, CCDS is the Supervisor of Clinic Cardiology at Centracare Heart & Vascular Center (CCHVC) in St. Cloud Minnesota. She Supervises the Pacemaker/ICD Clinic, the CCHVC Heart Failure clinic, CCHVC Electrophysiology, and Atrial fibrillation clinic scheduling. She has been a Cardiac Implanted electronic device nurse for 27 years. Van Heel is also collaborating with peers from around the country to bring remote monitoring service to clinics without resources to manage the growing device patient population through CV Remote Solutions PC.

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