Competency Check List

Have you ever asked:

How do I assess for competency in the cath lab?

How and when do I check off a new technologist or nurse in the cath lab?

What should a cath lab orientation checklist include (tools, sterile skills, imaging review, monitoring skills)?

What is the role of the circulating nurse or tech in the cath lab and how do I build a checklist for that role?

What are best practices for onboarding new staff in the cath lab from diverse backgrounds (RT, radiologic tech, EMS, sonography, nursing)?

These are exactly the questions I hear from preceptors, educators, directors and managers in the field so no, you’re not alone. No one knows where to start until they try.

The Challenge of Teaching in the Cath Lab

Teaching in the cath lab is not easy. Often you're asked (or “volun­told”) to be a preceptor without formal training or a structured process. Meanwhile, new staff enter the cath lab from very different backgrounds (respiratory therapy, radiologic technology, paramedic/EMS, sonography, nursing, cardiovascular technology) and each brings a different skill-set. The onboarding of one will not be the same as the next. The question becomes: How do you assess and certify competency fairly and effectively?

Here is an example of a structured checklist to kick off some ideas for onboarding:

Why a Structured Check-Off and Assessment Process Matters

A structured process ensures consistent standards and expectations where usually, we feel tossed in and overwhelmed. 

It provides clarity for the new staff: they know what is expected, when they are “checked off,” and what their progression looks like.

It helps preceptors/educators stay consistent and fair (they're overwhelmed and tired too!)

It allows for documented tracking: which you’ll need if you’re ever audited, credentialed or doing performance reviews. Or even just to pull aside an overwhelmed new hire and go 'see, look how much you have learned already!'.

When Should You Check Them Off?

Here are some guidelines:

Initial orientation phase: During onboarding, after foundational training (e.g., sterile technique, monitoring, equipment familiarity).

After supervised practice: Once the new staff has completed a set number of supervised cases (you decide the number). See one (or two or three), do one.

Milestone check-points: After they fully front scrubbed a diagnostic left heart catheter without you having to jump in. After they circulated an intervention by themselves without pulling you in. But check in: DID they understand what they were doing? Were there moments they just 'did it' but were not use if they did it correctly?

Periodic review: Even after initial check-off, periodically revisit skills (annually or when new equipment/procedure introduced).

Event-driven: When things change: new device, new imaging system, new protocol you want to re-check or validate competency. We all forget!

What About the Circulating Role?

Here are some examples of topics to include in a checklist: 

Pre Procedure Participation: Verification of patient identity, allergies, pertinent labs and non invasive testing, checking what equipment is in the room based on the case.

Scrub Support: How to set up the Manifold lines or Acist, Transducer and zeroing. 

Preparing Medication: Reviewing the common medications based on the case (diagnostic or intervention) show them how to prep it, allow them to prep and pull it and verbally ask to review 'what to watch out for'. 

Patient Monitoring: Sedation, monitoring vitals, abnormal hemodynamics and when to intervene.

Equipment and Supplies: Anticipation of needs. "X is occurring, what do we need?"

Post Procedure Care: Transferring the patient to the bed, hooking up to the portable monitor, giving report, assessing the access site.

Communication: How to verbalize and collaborate with the physician/scrub/monitor to achieve closed loop communication.

See how much you can dissect out?

Final Thoughts

As an educator or preceptor in the lab, you are doing important work. Setting up a clear, structured, visible process for check-offs and competencies not only benefits your new staff, it protects your lab, your patients, and your own professional progress. This framework helps you move from uncertainty (“When do we check this?”) to clarity (“Here’s exactly what we check, when, and how.”).