RCES – Can ‘WE’ Raise the Bar Even Higher?

Joe Giron, RN, RT, RCIS, RCES, CEPS, FSICP, Co-Founder of the CEPT Program at Loma Linda University, Director of Clinical Education for
SpringBoard Healthcare
Gavin Hays, CEO of SpringBoard Healthcare. www.springboardhealthcare.com

The field of cardiac electrophysiology (EP) in the last decade has been
blessed with explosive growth and development, that has included both
challenges and successes. This expansion isn’t showing any signs of
slowing down anytime soon. Clinical advances have included increased
patient access and procedure indications, improved 3D mapping technologies,
and the birth of formal allied EP education and additional EP
credentialing options. Now, a question for the EP field is – what impact
and opportunity will increasing secondary allied EP credentialing and
training create?
The International Board of Heart Rhythm Examiners (IBHRE), beginning
in the late 1980’s, began offering the advance credential of Certified
Electrophysiology Specialist (CEPS). In 2007 Cardiovascular Credentialing
International (CCI) developed and launched the Registered Cardiac
Electrophysiology Specialist (RCES) credentialing exam. Both of these
credentials are great in their own light, collectively raising the standard
of care in EP. Each exam has also developed its own niche to a certain
degree. The CEPS credential is becoming considered a more advanced
EP credential among clinical-industry-education circles, while the RCES
credential is taking deeper roots in the hospital clinical setting for the
allied professional (RNs, RTs, CVTs).
We would like to see an open forum focus on the RCES credential and
round off the topic by considering the question, “Can we raise the bar of
the RCES even higher?”
Currently, there are 609 RCES credentialed registrants, serving a total of
2,000 EP labs, of which 1,200 provide ablative therapies in the United
States. Based upon averages, that translates to less than one RCES credentialed
person per EP lab in the U.S. If credentialing is meant to raise the
standard of care, then there is a great opportunity to do so by getting
more RCES credential holders into EP labs.
Historically, RNs have enjoyed great levels of participation in EP development
and procedures during the formative periods in the 1980’s and
1990’s, when the vast majority of EP was developed and practiced at
distinguished university-based medical centers. As the practice of EP
expanded its borders, so did the allied contributors, i.e. RTs and CVTs.
As EP indications and procedures expanded, amid shortages in formally
trained EP professionals, large contingents of RNs found themselves
working more on the circulation and patient aspects of cases, whereas
the more technically inclined RT and CVT cohorts began to gravitate
towards the technical and equipment based aspects of EP procedures.
Amid any given EP lab in any given state, you will most likely see a
diverse cohort of allied professionals tending to EP procedures, which
include RNs, RTs and CVTs alike. This is a great thing. The not-so-greatthing
is that nursing administration folks at large do not recognize the
RCES credential with educational and credentialing reimbursements,
pay or ladder advancement, professional promotion and support as the

RT/CVT cohorts receive. The RT/CVT cohorts may not always be broadly
endorsed and supported 100% of the time, on all these levels in 100% of
all hospitals, however RTs/CVTs receive far greater support and recognition
of their RCES credential than the RN cohorts.
There are many issues to examine in an RCES RN/tech discussion, however
the bottom line is patient care, which is the most important point
of discussion, in our opinion. A study which illustrates this is in an EP
development consulting project SpringBoard recently concluded, which
demonstrated through various assessments and testing, that RNs and
techs (RT/CVT) roles were 90 percent similar in all aspects in job performance
and expectations in the EP lab setting, however the RNs without
RCES credentialing scored 30% lower on average compared to RNs with
the RCES credential. We can go on and on with the data analysis, however
the great thing about the RCES exam is that it accounts for ALL allied
professionals in the EP Lab setting, testing on knowledge and skill from
technical EP aspects, principles and fundamentals to patient care and
therapeutic issues. The issue really isn’t should RNs be specifically EP
credentialed in the EP lab setting, that answer is a resounding ‘yes’, not
just to RNs, but all allied professionals in the EP lab. The issues are team
cohesion, minimum standards, outcomes and patient care.
The question should not be whether or not RNs need to obtain RCES credentialing,
or whether or not the RN accrediting bodies should or should
not recognize the RCES credential. No, the far better question(s) are can
WE raise the bar of the RCES credential even higher, can WE finally push
for a minimal-national standard for EP allied credentialing, can WE work
together in maximizing the highest level of outcomes and care to OUR
patients?
What if RN’s societies and organizations recognized the RCES credential?
If that were the case, would more RNs be supported and seek the credential?
If we had a national minimal standard for allied EP credentialing,
would patient care and outcomes increase? If ALL allied professionals
had greater access to formal EP education or RCES/CEPS exam prep,
would more allied professionals (RN, RT, CVT) seek the EP education
and credentials to advance their careers? What if RNs, RTs and CVTs
worked and supported each other in EP specific credentialing? What if…
What if we start with your thoughts, and your ideas, based on your
perspective and work experience? We invite you to join in on our online
survey, to capture your thoughts on various aspect of the RCES credential,
which we would love to report on with a follow-up article. Please go
to https://www.surveymonkey.com/r/rcescredential to contribute your
thoughts. Look forward to changing the EP world with you. Viva EP!