Garcher, Joseph MSRS_2025
| Title | Garcher, Joseph MSRS_2025 |
| Alternative Title | The Healthcare Workforce Crisis: A Systematic Review of Job Stress, Burnout, and the Structural, Psychological & Physical Barriers Contributing to Burnout in the Cardiac Cath Lab |
| Creator | Garcher, Joseph |
| Collection Name | Master of Radiologic Sciences |
| Description | This literature review analyzes how job stress and systemic challenges affect cardiac cath lab professionals' mental health and job satisfaction. It recommends structural and policy reforms to reduce burnout and improve both staff well-being and patient care. |
| Abstract | This systematic literature review assesses the impact of job stress, burnout, and workplace barriers-structural, psychological, and physical-on the mental health, job satisfaction, and quality of life of cardiac catheterization laboratory (CCL) personnel. Drawing on global research from 2000 to 2023 and guided by the Job Demands-Resources model, the review identifies major stressors, including staffing shortages, long shifts, circadian rhythm disruption, inadequate leadership, and occupational hazards such as radiation exposure. The study synthesized findings across quantitative, qualitative, and phenomenological research, revealing consistent themes of burnout and stress exacerbated by the COVID-19 pandemic. Proposed interventions include redesigning shift structures, improving ergonomic safety, implementing wellness programs, and enhancing administrative support. The study concludes with a call for more focused research on CCL professionals and suggests that organizational reforms are essential to reduce burnout and improve both workforce sustainability and patient outcomes. |
| Subject | Burn out (Psychology); Cardiac catheterization; Medical personnel |
| Digital Publisher | Digitized by Special Collections & University Archives, Stewart Library, Weber State University. |
| Date | 2025 |
| Medium | Thesis |
| Type | Text |
| Access Extent | 61 page pdf |
| Conversion Specifications | Adobe Acrobat |
| Language | eng |
| Rights | The author has granted Weber State University Archives a limited, non-exclusive, royalty-free license to reproduce his or her thesis, in whole or in part, in electronic or paper form and to make it available to the general public at no charge. The author retains all other rights. For further information:  |
| Source | University Archives Electronic Records: Master of Radiologic Sciences. Stewart Library, Weber State University |
| OCR Text | Show "The Healthcare Workforce Crisis: A Systematic Review of Job Stress, Burnout, and the Structural, Psychological & Physical Barriers Contributing to Burnout in the Cardiac Cath Lab” THE WEBER STATE UNIVERSITY GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Joseph N. Garcher BS RT (R) ARRT RCIS This thesis has been read by each member of the following supervisory committee and by majority vote found to be satisfactory. ______________________________ Dr. Tanya Nolan, EdD Chair, School of Radiologic Sciences ______________________________ Christopher Steelman, MS Director of MSRS Cardiac Specialist ______________________________ Dr. Laurie Coburn, EdD Director of MSRS RA ______________________________________________________________________ Dr. Robert Walker, PhD Director of MSRS THE WEBER STATE UNIVERSITY GRADUATE SCHOOL RESEARCH AGENDA STUDENT APPROVAL of a thesis submitted by Joseph N. Garcher BS RT (R) ARRT RCIS This thesis has been read by each member of the student research agenda committee and by majority vote found to be satisfactory. Date April 25, 2025 ____________________ ___________________________ Joseph N. Garcher Table of Contents bstract A Acknowledgements Chapter 1: Introduction I ntroduction Background Statement of the Problem Purpose of the Study Research Questions Nature of the Study Significance of the Study Definition of Key Terms Summary Chapter 2: Literature Review efining High Stress Professions & TheirCharacteristics D Impacts of theStaffing Shortage COVID-19 Consequences in the CCL Educational Gaps and Professional Preparedness Occupational Health Risks and Physical Strainof CCL Personnel Impact of Shift Durations and On-Call Burdens Circadian Rhythm Disruption and Its Implicationson Staff Health and Patient Care Cultural and Psychological Impacts of CriticalCare Work Leadership & Administrative Support Prevalence and Consequences of Burnout andStress Conclusion Chapter 3: Research Method esearch Method and Design(s) R Population, Sample, Materials/Instruments Data Collection, Processing, and Analysis Assumptions, Limitations & Delimitations Ethical Considerations Summary Chapter 4: Findings Results, Evaluation of Findings Chapter 5: Implications, Recommendations, and Conclusions onclusions C References Appendices 5 6 8 8 9 11 12 13 14 14 15 21 2 2 23 24 26 28 30 30 32 33 34 35 36 3 7 37 40 41 41 42 43 4 3 43 4 6 51 54 60 3 List of Tables Table 1.Boolean Search Terms..………………………………………………………………………… Table 2.PRISMA Flow Charts……………..……………………………………………………...……..60 4 bstract A The purpose of this systematic literature review is to assess the impact of job stress, burnout, and structural, psychological, and physical workplace barriers on the mental health, job satisfaction, and quality of life of cardiac catheterization laboratory (CCL) personnel, including nurses, technologists, and physicians. By synthesizing research from 2000 to 2023 using PRISMA guidelines, this review aimed to identify key occupational stressors and their consequences while evaluating existing interventions. The review incorporates studies from around the globe, ensuring a comprehensive analysis of workforce challenges across procedural healthcare environments. This systematic review is grounded in occupational health psychology and the job demands-resources (JD-R) model, which posits that high job demands, when not balanced by adequate resources, lead to burnout and negative mental health outcomes. Selected studies included quantitative, qualitative and phenomenological research relevant to CCL focusing specifically on CCL professionals and other related fields with analogous working conditions. The participants in this study were represented through secondary data sources, as no primary data collection will take place. This approach ensured a holistic approach to understanding stress across different high stress roles in healthcare. he synthesis of available research identified consistent themes related to burnout, inadequate T staffing, circadian rhythm disruption, insufficient leadership support, educational gaps, and occupational hazards, and the structural and psychological stressors exacerbated by the COVID-19 pandemic. Indicators of suboptimal workplace conditions further included low decision latitude, inadequate administrative support, and heavy workloads. Proposed solutions focused on redesigning work schedules, streamlining administrative processes, implementing wellness programs, and improving ergonomic and radiation protection measures. These findings support the view that work demands and workplace policies significantly influence both mental well‐being and physical health among CCL personnel. notable limitation identified through this systematic review is the scarcity of literature focused A explicitly on the cath lab workforce, as most studies examined similar professions, such as first responders and emergency medical providers. Future research should specifically address this gap by utilizing targeted methodologies, including qualitative and quantitative approaches, to comprehensively assess stressors unique to the CCL. Moreover, longitudinal studies investigating interventions such as structured break schedules, staffing enhancements, and integrated physical activity programs are strongly recommended. The findings from this review aim to contribute to future research and policy recommendations geared at reducing workplace stress, improving staff well-being, decreasing burnout staff turnover, and ultimately improving patient safety in the CCL. 5 Acknowledgements his journey would not have been possible without the unwavering support, guidance, and inspiration T from so many incredible individuals and institutions. First, I extend my sincere gratitude to Good Samaritan Hospital of Los Angeles, Whittier Hospital, Cedars-Sinai, and UCLA health, for providing invaluableprofessionalexperiencesthatshapedmyunderstandingandpassionasacardiaccatheterization laboratory technologist. I wishtoexpressimmenseappreciationforthetirelesseffortsofinterventionalcardiologists,nurses,and cath lab professionals around theglobe.Yourcourageandcompassioninthefaceofintensechallenges exemplifythehighestcallinginhealthcare;yourdedicationinspiredthisresearchandcontinuestoinspire me every day. o my esteemed mentors at the Weber State University School of Radiologic Sciences, thank you T profoundly: Chris Steelman, Dr. Robert Walker, and Dr. LaurieCoburn.Yourwisdom,encouragement, andcommitmenttoeducationandtheprofessionofRadiologicTechnologyhasprofoundlyimpactedmy life and career. astly,heartfeltappreciationtomybelovedfamily,andmywonderfulfriends,whoseunwaveringbelief L in me has been my greatest source of strength. Thank you all—this achievement is as much yours as it is mine. _______________________________ his project is dedicated to the hard working men and women who risk their lives and mental T health every day to care for the sick and ailing during the COVID-19 pandemic. Thank you. _____________________ Medici cura te ipsum physician heal thyself 6 Acknowledgements(cont.) When the Call Comes hen the call comes— W in the deep hush of night, in the quiet of the sleeping room— I want to rise steady, hands sure as the tide, heart unshaken by the weight of what waits. I want to meet urgency with grace, to step into the glow of sterile light, where seconds stretch and lives hang Like the fragile wire, trembling, hoping. Let me be the one who holds steady amidst the rhythm of beeping monitors, the whisper of leaded aprons, the silent mutterings we dare to speak aloud. When the call comes, let my hands remember the work, let my mind find the way, let my heart hold the weight of the unseen burdens we carry home. When the call comes, quiet as a heron lifting from reeds, swift as moonlight on sleepless water, you rise from dreams into duty—to mend the hearts of strangers in rooms bright and cold, answering not because you must, but because the world asked, and your heart, in its steady rhythm, answered yes. - Joseph Nicholas Garcher 7 Chapter 1: Introduction Introduction The cardiac catheterization laboratory (cath lab) and interventional suites are high-stakes environments where healthcare professionals work under immense pressure to perform life-saving procedures. Physicians, nurses, and technologists in these settings face long hours, unpredictable schedules, and exposure to occupational hazards, all of which contribute to significant work-related stress. Studies have demonstrated that healthcare professionals in procedural specialties are at higher risk for burnout, mental health deterioration, and decreased quality of life due to the physical and emotional demands of their roles. The consequences of this stress extend beyond individual well-being, potentially impacting patient safety, hospital staffing, and overall healthcare system efficiency.1 While research on burnout and occupational stress among healthcare workers is increasing, literature specifically examining cath lab and interventional professionals remains limited. Given the unique challenges of these roles—including high patient acuity, circadian rhythm disruption, shift-work disorders, limited staff resources, frequent on-call shifts, and prolonged radiation exposure—it is critical to explore the impact of work-related stress on mental health and quality of life in this highly specialized workforce. This literature review synthesizes current findings on occupational stress, burnout, and psychological resilience among cath lab and IR personnel, drawing comparisons to other high-intensity medical professions to provide a comprehensive understanding of the issue. 8 Background The cardiac catheterization laboratory presents a uniquely stressful environment for its personnel, characterized by intricate, high-stakes procedures critical for diagnosing and treating cardiovascular diseases. This literature review investigates the impact of work-related stress on the mental health and quality of life among these professionals. Through the lens of both established literature and research methodologies, the study aims to illuminate the multifaceted stressors inherent in this setting and their implications for staff well-being. This literature review examines the impact of work-related stress on the mental health and quality of life of cardiac catheterization laboratory (cath lab) staff, including physicians. The findings indicate that cath lab professionals experience high levels of occupational stress, burnout, and reduced quality of life, largely due to factors such as long and unpredictable shifts, high patient acuity, on-call responsibilities, inadequate staffing, and administrative burdens.1 Studies consistently demonstrate that healthcare workers in high-intensity environments, such as the cath lab, are at greater risk of burnout, emotional exhaustion, and work-life imbalance.2 Burnout, stress, and decreased quality of life among healthcare professionals have been linked to increased medical errors, lower job satisfaction, and higher turnover rates, all of which can negatively impact patient care and hospital efficiency.3 Recent studies have demonstrated that work-related stress in high-pressure environments, such as emergency medicine and critical care, contributes to psychological distress, including anxiety, depression, and even suicidal ideation among medical personnel.4 However, the specificfactors contributing to stress and burnout among cath lab professionals remain underexplored. Given the increasing complexity of interventional cardiology procedures and rising patient volumes, understanding these stressors is 9 critical for developing effective interventions to improve staff well-being, and patient outcomes, bolstering the national healthcare infrastructure. A significant contributor to stress is the on-call burden, which often results in sleep deprivation and chronic fatigue.5 Literature suggeststhat prolonged sleep disturbances are linked to increased anxiety, depression, and cognitive impairment, all of which can negatively affect clinical performance and patient safety.6 Additionally,the pressure to maintain high procedural efficiency in a time-sensitive setting exacerbates stress, with many professionals reporting feelings of low autonomy, inadequate support from leadership, and an overwhelming workload.7 The review also highlights the role of workplace culture and leadership in modulating stress levels. Studies suggest that when leadership fails to provide adequate support, tools, and resources, cath lab professionals report higher levels of frustration, emotional exhaustion, and disengagement.8 A lack of recognition and appreciationfor staff efforts further contributes to dissatisfaction and turnover.9 Another emerging issue is the broader state of healthcare in the United States, where cost-cutting measures, staff reductions, and administrative burdens have placed additional strain on clinical workers. Cath lab professionals often experience added pressure due to on-call responsibilities, which disrupt work-life balance, contribute to sleep deprivation, and heighten physical and mental exhaustion.10 Additionally, theCOVID-19 pandemic exacerbated many of these challenges, as staffing shortages and procedural backlogs forced cath lab teams to work extended hours under increasingly difficult conditions.11 These stressors not only affect the quality of life of these professionals but also have downstream consequences on patient safety and healthcare efficiency.12 10 Theoretical models of occupational stress, such as the Job Demand-Control-Support Model, highlight the importance of job autonomy, support systems, and manageable workloads in reducing burnout.13 The Perceived Stress Scale(PSS) and Job Stress Survey (JSS) have been widely used in other healthcare settings to assess stress levels and identify contributing factors, but their application in the cath lab setting has been limited.14 A comprehensive review of existing literature is needed to synthesize findings across related healthcare fields and apply them to this specialized environment. This literature review aims to bridge that gap by synthesizing current research on work-related stress, burnout, and quality of life among cath lab personnel. By examining occupational stressors, workplace support systems, and potential interventions, this review seeks to inform hospital administrators and policymakers on strategies to improve working conditions, enhance job satisfaction, and ultimately safeguard the mental health of those working in this demanding field. Statement of the Problem Workplace demands and administrative policies in cardiac catheterization laboratories contribute to high burnout rates, mental health challenges, and increased staff turnover, primarily due to extended shifts, on-call duties, and excessive documentation requirements.15 The U.S. healthcare system faces a critical staffing shortage, while the aging patient population and increasing prevalence of severe cardiac events further strain this workforce.16 COVID-19 also created a significant burden on the already overburdened US Healthcare system.12 With a diminishing workforce and increasing patient complexity, cath labs are at high risk for burnout-driven attrition, jeopardizing both workforce sustainability and patient care outcomes.11 11 The high-stakes nature of cath lab operations, requiring urgent cardiovascular interventions, irregular hours, and rapid decision-making under pressure, places substantial psychological and physical stress on personnel. While research has examined burnout in emergency responders and ICU staff, there is a notable lack of studies specifically focusing on cath lab professionals.17 Furthermore, existing literaturelacks sufficient quantitative data on how these stressors impact mental health outcomes and quality of life in this workforce, creating a significant gap in actionable evidence needed to develop targeted interventions. This study seeks to bridge this gap by examining the extent to which work-related stress affects the mental health and quality of life of cath lab personnel and physicians. Without this focused research, the risk remains for both staff well-being deterioration and declines in patient care standards due to stress-induced impairments in decision-making and performance. Addressing this issue is critical for workforce retention and the overall effectiveness of cardiovascular emergency care. A targeted investigation is urgently needed to inform policy and procedural changes that better support cath lab professionals and safeguard patient safety. Purpose of the Study The purpose of this systematic literature review is to assess the impact of job stress, burnout, and structural, psychological, and physical workplace barriers on the mental health, job satisfaction, and quality of life of cardiac catheterization laboratory personnel, including nurses, technologists, and physicians. By synthesizing research from 2000 to 2023 using PRISMA guidelines, this review aims to identify key occupational stressors and their consequences while evaluating existing interventions.18 The review incorporatesstudies from around the globe, ensuring a comprehensive analysis of workforce challenges across procedural healthcare 12 environments. Findings from this review will inform evidence-based recommendations to improve workplace conditions, reduce burnout, and enhance both staff well-being and patient safety outcomes in cardiac catheterization laboratories. Research Questions This literature review investigates the effects of workplace conditions on the mental health and quality of life of cardiac cath-lab professionals. It seeks to understand how specific work-related factors such as staffing levels, shift length, physical exercise and break frequency impact these healthcare workers. The following research questions guide this investigation: Q1How do staffing shortages and low staffing levelswithin cardiac catheterization laboratories affect staff mental health, quality of life, and patient outcomes? Q2What is the relationship between circadian rhythmdisruption, shift length, frequency of breaks, and perceived stress among CCL staff? Q3How do occupational hazards, including radiationexposure, musculoskeletal strain from protective equipment, patient transfers and physically demanding job tasks influence burnout, stress levels, and job satisfaction in CCL staff? Q4What role do organizational factors, includingleadership support, administrative advocacy, workplace environment, and assistance with non-patient care duties, play in mitigating work-related stress and burnout among cath lab personnel? Q5Can incorporating dedicated physical activity periodsduring cath lab shifts improve staff productivity, emotional well-being, and overall mental health outcomes? 13 Q6What educational gaps exist among CCL professionals, and how do deficiencies in formal training contribute to increased perceptions of stress, decreased professional preparedness, and burnout? These questions collectively aim to provide a comprehensive understanding of the stress dynamics within cardiac catheterization laboratories, the effects on staff, and potential areas for intervention to improve workplace conditions and staff well-being. Nature of the Study This study is a systematic literature reviewexploring the impact of work-related stress on the mental health, quality of life, and job satisfaction of CCL personnel, including nurses, technologists, and physicians. Given the demanding nature of the cath lab environment—characterized by long hours, high-pressure situations, radiation exposure, and emergency response responsibilities—this study aims to synthesize existing research to identify key stressors, coping mechanisms, and potential interventions.19 A systematic literature review was chosen over a quantitative or qualitative study because it allows for a comprehensive synthesis of existing knowledge rather than relying on primary data collection from a limited sample. By aggregating findings from multiple peer-reviewed studies, this approach can offer a broader, evidence-based perspective on occupational stress in the cath lab setting, drawing insights from various methodologies, populations, and healthcare systems. Significance of the Study The significance of this research is multifaceted, addressing both the immediate needs of CCL personnel and the broader implications for healthcare systems and patient care quality. Firstly, by quantifying the impact of work-related stress on mental health and quality of life 14 among these professionals, the study addresses a critical gap in the existing research. While the stressors in healthcare settings, particularly acute care environments, are well-documented, there is a paucity of data specifically targeting cath-lab environments, where the stakes are exceptionally high due to the nature of cardiovascular interventions. Secondly, this research is poised to contribute to the development of targeted interventions aimed at reducing stress and enhancing the well-being of cath-lab personnel. Understanding the specific stressors and their impacts can lead to more effective management strategies, potentially improving job satisfaction, reducing job strain, burnout rates, and decreasing turnover among these essential healthcare workers. This is particularly crucial given the global shortage of skilled cardiovascular professionals and the increasing demand for cardiac care services.20 Finally, the findings of this study are expected to enhance patient care indirectly. Healthcare professionals who experience lower levels of stress are more likely to perform effectively, maintain a high level of cognitive function, and engage positively with patients.21 By improving the working conditions for cath-lab staff, healthcare facilities can ensure a higher quality of care, leading to better patient outcomes. Therefore, the proposed research is not only significant for the health and well-being of cath lab personnel and physicians but also for the patients they serve, highlighting the dual benefits of identifying and addressing these factors.22 Definition of Key Terms dequate Staffing: Refers to having a sufficient numberof staff members to handle the workload A efficiently without undue stress or strain. Adequate staffing levels are crucial in healthcare settings to ensure safety, care quality, and worker well-being.23 ardiac Catheterization Laboratory:A cardiac catheterizationlaboratory (cath lab) is a specialized C hospital room equipped for minimally invasive procedures on the heart. It uses X-ray imaging to visualize heart structures and blood vessels, enabling doctors to diagnose and treat conditions like coronary artery 15 isease through procedures such as angioplasty and stenting. Cath labs are staffed by cardiology d specialists and support personnel.24 oping Mechanisms: Strategies and behaviors that individualsuse to manage the psychological stress of C encountering challenging life experiences. Effective coping mechanisms can influence mental health, quality of life, and overall well-being25 motional Well-being: An important part of overallwellness that includes how you think, feel, and react E to situations. Emotional well-being can influence job performance and satisfaction and is affected by factors like workplace stress, interpersonal relationships at work, and overall mental health.26 igh Stress Work:According to the CDC, high-stressprofessions are defined by the tasks they involve. H These professions typically include a heavy workload, infrequent rest breaks, long work hours, and shift work. Additionally, they often involve hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control.2 7 I nterventional Cardiologist:An interventional cardiologistis a specialized physician who diagnoses and treats cardiovascular diseases using catheter-based procedures performed in a cath lab. Their expertise involves extensive training beyond general cardiology, including specialized fellowships focusing on techniques like angioplasty, stenting, and other minimally invasive heart procedures.28 ob Satisfaction: The level of contentment a personfeels regarding their job. This can affect their J performance and overall productivity. Job satisfaction is influenced by various factors including pay, flexibility, teamwork, resources, and management styles.29 ob Demands Resource Model:is a theoretical frameworkthat explains how job demands and job J resources influence employee well-being, motivation, and performance. It is commonly used in occupational health psychology and organizational behavior research.30 ob Strain:Job strain in healthcare refers to thehigh levels of work-related stress that result from the J combination of high job demands (e.g., workload, time pressure, emotional labor, and patient care responsibilities) and low job control (e.g., limited decision-making autonomy, rigid protocols, and lack of resources). This imbalance can contribute to burnout, job dissatisfaction, and mental and physical health issues among healthcare workers. The Karasek Job Demand-Control Model is commonly used to define job strain, emphasizing that stress is highest when healthcare professionals face intense demands but have little control over their work environment or decision-making.31 ental Health:A state of well-being in which an individualrealizes his or her own abilities, can cope M with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. In the context of the workplace, mental health can influence productivity, performance, communication, and team functioning. The nature and causes of job satisfaction.26 16 ualitative Methods: Research strategies that emphasize understanding of social phenomena through Q interviews, personal comments, or other forms of data collected through interactions. These methods focus on exploring concepts and behaviors in depth.32 uality of Life: A broad multidimensional conceptthat usually includes subjective evaluations of both Q positive and negative aspects of life. In the context of healthcare workers, it often encompasses emotional, physical, and social well-being, and how these impact the perception of their position in life in the context of the culture and value systems in which they live.26 uantitative Methods: Research techniques that focuson quantifying the collection and analysis of data Q and that aim to establish patterns and generalize results from a sample to a population. These methods involve the use of statistical tools to analyze data. egular Exercise:Physical activity conducted withthe intention of improving health and maintaining R physical fitness. Regular exercise is known to reduce stress, improve mood, enhance physical condition, and boost overall health, which can contribute to improved emotional well-being.33 tress Assessment Tools: Instruments used to evaluatethe amount of stress an individual is experiencing, S often used in occupational settings. These tools can help determine stress levels and suggest necessary interventions to improve health and job performance.14 upportive Leadership:A leadership style that promotesa positive and healthy work environment by S offering support and resources, showing empathy, being accessible, and facilitating employee involvement in decision-making processes. Supportive leadership is often correlated with increased job satisfaction and reduced work-related stress.9 ork-Related Stress: The response people may havewhen presented with work demands and pressures W that are not matched to their knowledge and abilities and which challenge their ability to cope. Work-related stress occurs when there is a discrepancy between the demands of the job and the resources and capabilities that the worker has to cope with those demands. hese terms provide a framework for discussing the components of the study that relates to the stressors T experienced by cardiac cath-lab personnel and their effects on health, quality of life and job performance. Roles and Responsibilities of Cath lab Personnel & On-Call Staff ath Lab On Call:A cath lab staff on call refersto the system where cardiac catheterization laboratory C staff, including nurses, technologists, and physicians, are available to respond to emergencies outside of regular working hours, 24 hours/day, 7 days/week, 365 days/year. This ensures that the facility can respond promptly to urgent cardiovascular incidents such as heart attacks, strokes, bleeding emergencies, and other emergencies which require immediate intervention such as restoring blood flow to the heart.34 17 esponsibilities of Cath Lab On Call Staff R These responsibilities demand that cath lab on-call staff not only have specialized clinical skills but also the ability to make quick decisions under pressure and excellent teamwork and communication skills.35 36 37 38 39 .Rapid Response:The primary responsibility of on-callcath lab staff is to quickly 1 respond to emergencies involving cardiac conditions that require immediate catheterization procedures. This might involve performing angioplasties, stent placements, or other urgent interventions.39 .Preparation and Readiness:Staff must ensure thatthe cath lab is ready at all times, 2 which involves checking that the myriad of necessary equipment is functional and that supplies such as catheters, stents, ancillary supplies and medications are adequately stocked.35 .Patient Assessment: Upon arrival at the hospital,on-call staff must assess the patient's 3 condition rapidly but thoroughly to determine the most appropriate course of action. This involves reviewing the patient's medical history, symptoms, and any diagnostic tests that have been performed. .Performing Procedures:The core duty includes performingcardiovascular 4 interventions. This requires a high level of skill and precision to insert catheters, identify blockages, and deploy stents or other devices within the arteries.36 .Post-Procedure Care:After the intervention, on-callstaff are also responsible for 5 monitoring the patient's initial recovery. They need to manage any immediate post-procedural complications and ensure that the patient is stable before they are moved to another unit for further recovery. .Documentation: Accurate documentation of the patient'smedical record with details 6 of the intervention, observations, medication administered, and patient's response to the treatment is crucial. .Communication: Effective communication with otherhealthcare providers, including 7 the handoff to other teams when their on-call duty ends, ensuring continuity of care. They also need to communicate with the patient's family to update them about the patient's condition and the outcome of the procedure.39 Cath Lab Personnel & Their Role in the Cardiac Cath Lab39 36 Cath Lab Nurseis a specialized nursing professionalwho works in the cardiac catheterization A laboratory, a high-tech environment within a hospital where diagnostic and therapeutic procedures involving the heart are performed. These procedures include coronary angiograms, balloon angioplasties, stent placements, and other interventional cardiology treatments.35 18 ole and Responsibilities: R Cath Lab Nurses play a crucial role in the preparation, execution, and follow-up of cardiac procedures. Their key responsibilities include: . Patient Preparation: Preparing patients for the catheterization procedures by explaining the 1 process, answering questions, administering pre-procedure medications, and ensuring that the patient is physically and emotionally ready and advocating for the patient’s best interests. . Intra-procedure Assistance: Assisting cardiologists during the myriad of cath lab procedures by 2 monitoring the patient’s vital signs, and hemodynamics, administering life saving medications as needed, and being prepared to assist in any emergency situations that might arise. . Post-procedure Care: After the procedure, Cath Lab Nurses monitor patients for signs of 3 complications, such as bleeding from the catheter insertion site or reactions to contrast dye. They also provide post-procedure care instructions to patients and their families, helping them understand the recovery process and necessary follow-up care. . Equipment and Environment Management: Ensuring that the cath lab environment is sterile, 4 and that all the required tools and supplies are readily available and in good working condition. raining and Qualifications: T Cath Lab Nurses are registered nurses (RNs) and typically hold a nursing degree (ADN or BSN). Beyond their general nursing licensure, they often receive additional specialized training in cardiovascular care, acute care, critical care. Some may pursue further certification in critical care (CCRN), and cardiovascular nursing through bodies like the American Nurses Credentialing Center (ANCC). ICU experience though not required, is typically preferred.35 I mportance in the Cath Lab: The Cath Lab Nurse is integral to the success of cardiac procedures, providing not only clinical support but also emotional support to patients undergoing potentially life-saving but stressful treatments. Their expertise in both intensive care and cardiac technology makes them vital members of the cardiac care team. Cath Lab Technologist, Cardiovascular Technologist(CVT)or Cardiac Catheterization Laboratory A Technologist, is a broad term for a non-nursing professional who works in a specialized area of the hospital where catheterizations are performed. In these procedures, catheters are inserted into the chambers and vessels of the heart for diagnostic and interventional purposes, such as assessing blockages and placing stents. Cath Lab Technologists assist cardiologists in these procedures, prepare and operate the imaging equipment, monitor patient status, and ensure the sterile environment of the lab. The technologist is required to understand and assist in the operation setup and deployment of thousands of different medical devices and equipment across several modalities making the role of the technologist as challenging as it is tedious.40 19 pecialties of Cardiac Cath Lab Techs S The two primary specialties within Cardiac Cath Lab Technologists are Radiologic Technologists and Registered Cardiovascular Invasive Specialists (RCIS),40 and on some occasions Respiratory Therapists.* Depending on each state’s governance, and laws, some specialties are required whereas others are not. For example, in the State of California, a licensed Radiologic Technologist is required to operate ionizing fluoroscopic equipment in the cath lab.** 1.Radiologic Technologist: - Role and Training: Radiologic Technologists in a cath lab specialize in imaging technologies. They are trained primarily in radiology and have extensive knowledge of imaging equipment. This training is crucial for ensuring that clear and accurate images are obtained during cardiac catheterizations, which guide the procedures. - Certifications: Typically, they are required to be certified by the American Registry of Radiologic Technologists (ARRT) and may hold additional certifications specific to cardiovascular procedures. - Primary Responsibilities: Their main duties include operating X-ray and other imaging equipment to assist cardiologists during diagnostic tests and interventions, maintaining the imaging equipment, and applying radiation safety measures to protect patients and staff.37 2.Registered Cardiovascular Invasive Specialist (RCIS): - Role and Training: RCIS professionals focus more specifically on the invasive aspects of cardiac care. They receive specialized education and training in cardiovascular technology, including invasive procedures. This training is provided through accredited cardiovascular technology programs. - Certifications: They are certified through Cardiovascular Credentialing International (CCI), which specifically addresses the qualifications needed to perform invasive procedures in a cardiac cath lab. - Primary Responsibilities: RCIS specialists assist with the insertion and manipulation of catheters, monitor patient hemodynamics, help administer medications and contrast agents, and assist in the application of various cardiac interventions under the direction of a cardiologist.40 Comparison and Contrast of the Radiologic Technologist and RCIS41 Similarities: - Both roles are critical in assisting cardiologists during procedures in the cath lab. - They must adhere to strict sterilization and safety protocols to ensure patient safety and successful outcomes of procedures. - Both require a strong background in the use of complex medical equipment and patient monitoring during procedures. Differences: - Educational Focus: Radiologic Technologists have a broader base in radiology and imaging, whereas RCIS specialists have more focused training in invasive cardiovascular technology. - Role in Procedures: While Radiologic Technologists are primarily responsible for imaging and ensuring the quality of diagnostic visuals, RCIS specialists are more involved in the direct handling and manipulation of catheters and other invasive equipment. - Certification and Regulatory Bodies: Radiologic Technologists are often certified and licensed by ARRT (American Registry of Radiologic Technologists) with a focus on radiologic technology 20 a cross various medical fields, not just cardiology. In contrast, RCIS certification is specific to cardiovascular invasive procedures and is overseen by CCI (Cardiovascular Credentialing International), however this is not a medical license.** Each specialty plays a vital role within the cardiac cath lab, with their responsibilities tailored to their specific training and the needs of the procedures being performed. * Both Radiologic Technologists and Respiratory Therapists share the same professional acronym or abbreviation for their title (RT), however, these are two distinctly different professions, with two distinctly different governing accrediting bodies, and scopes of practice. Further research must be done to understand the role of the technologist in the cardiac catheterization lab and the qualifications therein. * *According to accreditation bodies, currently, an ARRT Radiologic Technologist may pursue CVT/RCIS CCI certification and training while being employed in the cardiac cath lab, however a CVT may not obtain ARRT status unless they attend and graduate an accredited ARRT school of Radiologic Technology and pass the ARRT licensing examination.37 Summary This study explores the impact of work-related stress on the mental health and quality of life of CCL personnel, including physicians, nurses, and technologists. The research highlights the high-stakes, high-stress nature of the cath lab environment, where long hours, exposure to radiation, and high-pressure decision-making contribute to burnout and psychological distress.1 The purpose of this study is to conduct a systematic literature review to assess existing research on the stressors, coping mechanisms, and workplace conditions affecting cath lab professionals and other analogous high stress healthcare professions around the globe. Using PRISMA guidelines, this study will systematically collect, screen, and analyze peer-reviewed literature from major databases such as Semantic Scholar, PubMed, CINAHL, and ScienceDirect, Elicit and others; ensuring a comprehensive and unbiased synthesis of findings. The research is guided by occupational health psychology models, particularly the Job Demands-Resources (JD-R) model, and incorporates phenomenological principles to capture the lived experiences of cath lab personnel.30 42 By conducting this literature review,the study aims to provide evidence-based insights into the challenges faced by cath lab professionals and offer recommendations for improving working conditions, mental health support, and overall job satisfaction. This research 21 will serve as a foundation for future interventions to mitigate burnout and enhance the well-being of healthcare workers in this critical field. Chapter 2: Literature Review The purpose of this systematic literature review is to assess the impact of job stress, burnout, and structural, psychological, and physical workplace barriers on the mental health, job satisfaction, and quality of life of cardiac catheterization laboratory personnel, including nurses, technologists, and physicians. By synthesizing research from 2000 to 2023 using PRISMA guidelines, this review aims to identify key occupational stressors and their consequences while evaluating existing interventions. Findings from this review will inform evidence-based recommendations to improve workplace conditions, reduce burnout, and enhance both staff well-being and patient safety outcomes in cardiac catheterization laboratories. This review is structured around a series of focused subtopics, each designed to address specific research questions concerning the impacts of workplace conditions in cath labs. The review starts with the task of defining high stress professions, and then delves into the specifics of what makes cath lab work so stressful. The literature review then explores the health care workforce crisis and how staffing shortages and work-related burnout influence both staff well-being and patient outcomes. The long term and compounded effects of shift work and the potential benefits of integrating physical activities during shifts will be discussed.43 The role of supportive leadership and the impact of non-patient care duties on stress levels are also examined. Interventions and mitigating recommendations will also be discussed. Each section aims to not only highlight significant findings but also identify practical interventions that can enhance staff resilience and patient care quality.38 22 Defining High Stress Professions & Their Characteristics There are many high stress professions that involvehigh stakes and life and death decision making. The CDC defines high stress professions by the duties and requirements intrinsic to each profession.27 High stress professionsare those that include, but not limited to a heavy workload, infrequent rest breaks, long work hours, and shift work and hectic and routine tasks. For the purpose of this literature review, a 5-point criterion that defines and characterizes high-stakes, high-stress professions, such as air traffic controllers, police officers, firefighters, and cardiac catheterization personnel was created:44 1. Life-or-Death Decision Making: Routine involvement in scenarios requiring immediate decisions that directly affect human life, safety, or survival, where even minor errors can lead to catastrophic outcomes.45 2. Circadian Rhythm Disruption and Irregular Scheduling: Regular exposure to shift work, including night shifts, swing shifts, or unpredictable on-call schedules, significantly disrupting natural sleep-wake cycles and increasing the risk of fatigue and cognitive impairment.15 3. Constantly Elevated Psychological Stress: Continuous exposure to high-pressure environments characterized by unpredictability, urgency, and acute stress responses, often resulting in chronic psychological strain.31 4. High Physical and Mental Demands: Tasks involving prolonged physical strain or mental alertness, including rapid problem-solving, precise communication, sustained attention, and physically demanding tasks under extreme conditions.46 5. Repeated Exposure to Trauma or High Emotional Intensity: Frequent interaction with emotionally charged or traumatic events, including emergencies, violence, 23 severe injuries, or death, which elevates risk for burnout, PTSD, and other psychological health concerns.47 High-stress professions share common characteristics that make them uniquely susceptible to elevated perceived stress and associated negative outcomes. Stress is not merely a function of objective events, but rather results from an individual’s cognitive appraisal of events as stressful, alongside their perceived resources to manage these demands.25 By considering these factors, the importance of perceived stress, as measured by psychometrically valid instruments such as the Perceived Stress Scale (PSS), becomes evident.13 Unlike objective stress measures, which quantify stress through event occurrence alone, perceived stress captures the cognitive appraisal processes central to individual stress responses, providing deeper insight into the psychological impacts experienced by professionals in high-stress occupations The following subheadings will explore the factors contributing to job strain and burnout in the CCL.14 Impacts of the CCL Staffing Shortage Inadequate staffing levels are a major contributor to heightened stress and burnout among cath lab professionals. Low staffing often leads to excessive workloads, prolonged shifts, and a constant state of emergency that not only strains the mental health of the staff but also has a direct impact on patient care and outcomes. Furthermore, reduced staffing levels correlate with increased error rates, lower patient satisfaction, and compromised clinical performance.48 When there is insufficient staffing, the burden of on-call duties and extended work hours becomes overwhelming, leading to sleep deprivation and circadian rhythm disruptions, which exacerbate stress levels and impair cognitive function.49 24 Low staffing levels in the CCL have been repeatedly linked to increased occupational stress among nurses, technologists, and physicians. In this high-pressure environment where split-second decisions and precise interventions are critical, a shortage of staff places additional burdens on existing team members, leading to prolonged work hours, reduced rest periods, and heightened fatigue. Studies indicate that when staffing levels are inadequate, the cumulative stress from extended shifts and high patient acuity significantly contributes to burnout, emotional exhaustion, and decreased job satisfaction among cath lab personnel.1 3 This literature review highlights a clear correlation between low staffing levels and adverse outcomes for both staff and patients. Insufficient staffing not only elevates stress outcomes among cath lab professionals but also negatively impacts patient care and safety. For instance, studies have found that understaffing is associated with increased rates of medical errors, delayed interventions, and reduced quality of patient care, ultimately compromising patient outcomes.48 Moreover, the lack of adequatestaffing forces employees to perform additional non-clinical duties, further exacerbating stress and limiting their ability to focus on critical patient care tasks. Conversely, evidence suggests that adequate staffing levels can serve as a significant mitigating factor for these stressors. When cath labs are appropriately staffed, the workload is more evenly distributed, enabling staff to take necessary breaks, adhere to safe work practices, and engage more effectively in patient care. Adequate staffing levels not only reduce burnout and improves job satisfaction but also has a direct positive impact on patient safety and overall quality of care.50 25 COVID-19 Consequences in the CCL During the COVID-19 pandemic, the already strained staffing situation in cardiac catheterization laboratories was further exacerbated by economic pressures, notably the low pay associated with these critical positions. The COVID-19 pandemic exacerbated existing staffing shortages within CCL’s, highlighting significant systemic and economic vulnerabilities.51 Nurses and technologists began leaving permanent hospital positions in unprecedented numbers, opting instead for lucrative traveling contracts. This phenomenon was driven largely by substantial financial incentives, with temporary positions offering compensation significantly higher than standard hospital employment. For instance, weekly salaries for traveling nurses soared, sometimes reaching up to $8,000, drastically outpacing permanent employment wages.10 These shifts were driven not only by financial incentives but also by perceptions of being undervalued, overworked, and unsupported by hospital administration. Staff departures created a ripple effect, intensifying stress and burnout among remaining personnel who were required to manage increased workloads with fewer resources. High turnover rates also impaired operational efficiency, increased the risk of medical errors, and posed potential threats to patient safety.11 The ongoing healthcare workforce crisis has severely impacted the cath lab environment, where staffing shortages have reached alarming levels. According to a 2022 MedAxiom survey published inCardiac Interventions Today, 96% of cathlab programs reported experiencing staffing challenges, with 85% acknowledging that these issues have worsened since the onset of the COVID-19 pandemic. High vacancy rates—reported at up to 30% in some programs—have intensified competition for qualified personnel, including among traveler agencies, which are often able to offer significantly higher compensation than health systems. To manage these shortages, 85% of programs have turned to contracted labor through staffing agencies, a strategy 26 that raises personnel costs by 50% to 100% compared to in-house staff. These increased labor expenditures have contributed to a more than 40% decline in hospital margins relative to pre-pandemic levels, further straining health system resources.51 In addition to staffing shortages, cath labs are also experiencing physician workforce concerns. Nearly one in four programs reported difficulty in recruiting and retaining interventional cardiologists, a problem compounded by an aging physician population—28% of interventionalists are 61 years of age or older. This demographic trend has contributed to decreased individual productivity, placing even greater pressure on understaffed teams and potentially jeopardizing patient outcomes and procedural throughput. These data, while derived from gray literature, offer a timely and critical perspective on the compounding structural and economic barriers contributing to workforce instability in one of the most technologically complex and labor-intensive departments in the hospital setting.51 This shift in workforce dynamics demonstrates the importance of adequate compensation, recognition, and supportive leadership in retaining healthcare professionals. Institutions that proactively addressed these concerns through competitive compensation, sufficient CCL protective equipment, and strategies aimed at staff retention, such as wellness initiatives and regular communication, fared better in maintaining their permanent workforce. The pandemic exacerbated vulnerabilities in the healthcare systems already lax inability to not only offer competitive remuneration but also cultivate supportive environments to attract and retain critical skilled personnel.52 The COVID-19 pandemic exacerbated financial and emotional strains for cardiac cath-lab nurses and technologists.11 The upheavalcaused by staffing changes, job insecurity, and 27 the emotional toll of the pandemic underscore the importance of preparedness, effective administrative communication, and robust support systems, all of which are essential to navigate the stresses of pandemics and safeguard the financial and emotional well-being of healthcare workers. The COVID-19 pandemic significantly disrupted medical supply chains, exacerbating pre-existing shortages and introducing new logistical challenges for cardiac catheterization laboratories. Supply chains became severely strained due to increased global demand, shipping delays, and production disruptions triggered by factory closures and regional lockdowns.11 Further complicating matters, severe weather events, such as hurricanes, added pressure on already vulnerable supply lines, creating shortages of critical supplies and protective equipment. These issues left cath lab professionals frequently navigating resource scarcity, with common shortages including essential personal protective equipment (PPE), contrast media, procedural supplies, and specialized equipment. Such chronic resource limitations elevated stress and contributed to emotional fatigue among cath lab professionals, negatively impacting morale, job satisfaction, and their capacity to deliver high-quality patient care.29 Educational Gaps and Professional Preparedness In addition to staffing shortages, the lack of education and professional training has been identified as another significant stressor in the cath lab environment.53 Many cath lab professionals report that inadequate opportunities for advanced training and professional development limit their ability to manage complex procedures effectively, further contributing to occupational stress. 28 Significant educational gaps and deficiencies in professional preparedness have been identified among cardiology and CCL personnel, affecting both technical and non-technical competencies across various career stages. Prominent among technical deficits are inadequacies in radiation safety knowledge and practices. The research highlights substantial gaps, such as only 25% of invasive cardiologists demonstrating awareness of critical radiation dose details, and strikingly, as few as 2% of cath lab staff possessing adequate knowledge of radiation dose specifics.53 Further exacerbating these knowledgegaps, reported that up to 74% of cath lab personnel had never undergone formal radiation safety training, underscoring a significant risk to both patient and staff safety. Specialized training deficiencies also emerge prominently in specific areas. For instance, cardiology fellows experience limited exposure to pregnant patients and have minimal training in cardio-obstetrics, highlighting a critical gap in care competency for this unique patient population.54 Additional notable educational shortcomingsinclude challenges in the management of atrial fibrillation, proper utilization and interpretation of biomarkers and imaging studies, and proficiency in cardiovascular implantable electronic device (CIED) lead extraction procedures.55 These deficits highlight potential vulnerabilities in patient safety and clinical outcomes. Clinical skills and practical competencies are similarly compromised by these educational gaps, with low adherence rates to essential safety practices such as routine use of radiation dose badges.53 Non-technical competencies, particularlycommunication and interpersonal skills, further compound these concerns. Studies identified notable deficits in patient–physician communication, psychosocial patient care, and effective team collaboration, each of which is integral to optimal clinical outcomes and workplace cohesion.55 This gap in ongoing education not only affects the confidence and competence of the staff but also hinders the implementation 29 of best practices that could mitigate workplace stress. Adequate training and continuous education are essential for improving job satisfaction and enhancing patient care quality by equipping staff with the latest clinical skills and knowledge. Moreover, experience alone does not consistently correlate with higher levels of competency. Intriguingly, standardized safety assessments have revealed instances where less experienced staff outperformed more seasoned colleagues, suggesting that continuous, structured, and targeted educational interventions may be required across all levels of experience to ensure consistent competence and patient safety within the cath lab environment. Key gap areas included, technical knowledge in radiation safety, atrial fibrillation, imaging, and device management, practical competencies in post‐procedural care and adherence to safety protocols, and communication and interpersonal skills crucial for patient care and multidisciplinary teamwork. A review by Karthi et. al (2021) drawn from ten surveys involving 3,096 participants worldwide, directly indicate that current clinical practice in cardiology often lacks the comprehensive training needed to bridge these specific gaps across career stages.56 Occupational Health Risks and Physical Strain of CCL Personnel The physical demands inherent in cath lab work further compound stress levels. Prolonged exposure to the demands of the job—such as the necessity to wear heavy lead aprons, frequent patient handling, and repetitive tasks—contributes to musculoskeletal strain and other physical ailments.19 These physical stressors, combinedwith the mental strain of managing high-stakes procedures under constant pressure, create a challenging work environment that can significantly impair quality of life.57 Occupational health risks, including exposure to radiation and the physical demands of the job, pose significant challenges to cath-lab staff. Andreassi et al. (2016) and Orme et al. 30 (2015) document the health repercussions of these occupational hazards, such as skin lesions, musculoskeletal pain, muscle spasms, and increased incidence of cataracts.19 1 These findings highlight the necessity for implementing safety measures, ergonomic interventions, and comprehensive health surveillance to reduce physical strain and occupational health risks, thus improving the quality of life and mental health of cath-lab personnel. Impact of Shift Durations and On-Call Burdens Shift length, frequency of breaks, and availability of dedicated on-shift physical activity significantly influence the mental health, productivity, and quality of life among cardiac cath lab personnel. Extended shift lengths have been consistently associated with increased fatigue, circadian rhythm disruption, and reduced sleep quality, which collectively contribute to higher stress levels, diminished job satisfaction, and elevated risks of errors impacting patient care.58 Prolonged shifts in high-stakes healthcare environments, such as the cardiac cath lab, exacerbate fatigue, impair cognitive function, and heighten emotional strain, directly compromising the ability of staff to manage emergencies effectively and efficiently.7 Conversely, regular and adequately timed breaks during shifts have been shown to significantly improve staff well-being by reducing physical exhaustion and stress, thereby enhancing clinical performance and patient safety.59 Breaks mitigate fatigue by allowing physical and psychological recovery, which is critical for maintaining vigilance, cognitive clarity, and resilience during prolonged procedural work.60 Furthermore,ensuring breaks align with natural circadian rhythms helps preserve staff alertness and performance, minimizing medical errors and improving patient outcomes.49 31 Integrating dedicated time for physical activities during shifts can further enhance the mental health, productivity, and emotional well-being of cath lab staff. Research consistently shows that exercise reduces perceived stress, mitigates symptoms of anxiety and depression, and significantly improves emotional resilience and productivity among healthcare workers.60 61 For cath lab personnel, physical activities are especially beneficial as they also alleviate physical strain resulting from prolonged wearing of heavy lead aprons and repetitive patient-handling tasks, thereby reducing musculoskeletal pain and discomfort.162 In summary, optimizing shift lengths, providing appropriately timed and frequent breaks, and incorporating on-shift physical activity opportunities substantially contribute to reducing work-related stress and fatigue. These improvements collectively lead to enhanced mental health, higher productivity, better job satisfaction, and overall improved quality of life among cardiac cath lab professionals, ultimately benefiting patient safety and clinical outcomes.22 Circadian Rhythm Disruption and Its Implications on Staff Health and Patient Care The disruption of circadian rhythms inherent in shift work has significant implications for healthcare personnel, particularly for those in high-stakes environments such as cardiac catheterization laboratories. Nurses and allied healthcare staff working irregular hours and night shifts experience pronounced disruptions to their natural circadian rhythms, which can have detrimental effects on both personal health and professional performance. One systematic review found that shift work, especially rotating night shifts, significantly increases risks for various health issues, including cardiovascular disorders, gastrointestinal disturbances, chronic fatigue, and mental health complications such as anxiety and depression.63 These findings highlight the 32 clear biological cost associated with shift-based work schedules common in acute medical care settings. Furthermore, circadian rhythm disturbances among emergency medical staff significantly compromise cognitive functions critical for patient safety, such as alertness, decision-making capabilities, and procedural accuracy.45 Moreover,emergency medical personnel subjected to shift work and frequent disruptions of circadian patterns report higher levels of chronic fatigue and decreased psychological well-being.49 These factorscontribute directly to increased error rates and reduced productivity, ultimately jeopardizing patient care and clinical outcomes. Advocating for shift work schedules that more closely align with natural circadian rhythms and providing sufficient recovery time between shifts can mitigate fatigue, reduce medical errors, and enhance overall job satisfaction and retention among staff. Addressing these circadian disruptions is essential not only for safeguarding healthcare professionals' physical and mental health but also for improving patient outcomes by minimizing fatigue-induced errors. Cultural and Psychological Impacts of Critical Care Work Cardiology, and specifically the CCL is inherently associated with high-stakes emergency interventions. The constant exposure to acute life-threatening situations significantly contributes to psychological stress among healthcare professionals, creating an environment conducive to burnout, emotional distress, and diminished mental well-being. Recent research emphasizes that cardiologists frequently experience psychological distress, including anxiety, irritability, and anger, as well as more serious mental health conditions such as depression and substance use disorders. Notably, a recent survey conducted by the American College of Cardiology involving nearly 6,000 cardiologists revealed that mental health conditions (MHCs) are alarmingly 33 prevalent, reported by approximately 34% of female and 26% of male cardiologists, yet a substantial majority had never reported these issues due to stigma and professional repercussions. The findings further underscore the detrimental role of hostile work environments, particularly impacting mid-career professionals and women, exacerbating already significant work-related psychological stressors.64 The prevailing cultural stigma surrounding mental health within cardiology and healthcare, in general, discourages professionals from seeking needed psychological support, often due to fears of negative career implications. Many cardiologists silently endure emotional distress, thereby compromising their own health and potentially affecting patient care quality and outcomes.65 Addressing these concerns requires a compassionateshift in institutional culture, focusing on destigmatizing mental health struggles and implementing structured support systems akin to those successfully deployed for veterans dealing with PTSD. Recommendations from recent literature suggest fostering protective factors such as formal mentorship, open communication channels, and guaranteed professional time dedicated to mental health support and therapy.64 Such strategies not only alleviatepsychological strain but also strengthen professional resilience, thereby improving patient care and staff retention.66 In addition to Cardiologists, CCL staff too feel the burden of mental health consequences. Emergency response work, particularly in high-stakes environments like CCLs, significantly affects staff's psychological well-being.67 Benedeket al. highlights the risk of PTSD, depression, and other mental health challenges faced by first responders.44 A correlation can be made to first responders and cath lab staff due to the high acuity 30 minute response time of responding to STEMI in the cath lab, which is required by the national standard for door to balloon time in the setting of acute coronary syndrome (ACS).69 Thisnecessitates the development of specialized 34 preventive strategies, resilience training, and psychological support to help staff cope effectively with the demands of emergency response situations.46 Leadership & Administrative Support In addition to staffing issues and physical workload, support from administrative leadership and advocacy plays a significant role in mitigating burnout and stress among cath lab staff. When leadership fails to provide a supportive work environment, employees often feel undervalued and overwhelmed, which can increase emotional exhaustion and decrease job satisfaction.10 Furthermore, external factors suchas supply chain disruptions—stemming from COVID-19 delays, hurricanes, and other adverse events—can lead to shortages in essential resources, further straining the already demanding environment. These challenges hinder the smooth operation of the cath lab, contribute to increased stress levels, and may ultimately compromise patient care.68 Another critical factor is the support for non-patient care duties, which, when lacking, forces clinical staff to shoulder additional administrative and logistical tasks that detract from their core responsibilities. A well-structured work environment with strong, supportive leadership can mitigate these pressures by ensuring that non-clinical tasks are managed by dedicated personnel, thereby allowing CCL professionals to focus on patient care. This Perceived organizational support among nurses working in ICUs is one of the important factors in increasing work engagement. Supportive leadership is associated with lower self-reported stress levels and improved overall well-being, while efficient management of resources and administrative tasks contributes significantly to higher job satisfaction and operational efficiency. Therefore, the literature consistently shows that there is a positive correlation between low levels 35 of administrative support and staff burnout.69 Addressing these areas through organizational interventions and policy reforms could lead to a more balanced workload, reduced burnout, and enhanced quality of life for cath lab staff.9 Prevalence and Consequences of Burnout and Stress Burnout in the CCL is both a consequence of and a contributor to staffing shortages, creating a self-reinforcing cycle that further exacerbates the high-stress environment. When healthcare professionals experience burnout—characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment—they are more likely to leave their positions, leading to lower staffing levels. This shortage intensifies the workload on remaining staff, increasing their exposure to factors such as prolonged shifts, inadequate rest, and insufficient administrative support. Consequently, the resulting chronic stress not only undermines job satisfaction but also compromises patient care quality, as overburdened staff may be less able to perform at optimal levels. Insufficient staffing, compounded by administrative challenges and high-pressure conditions, contributes significantly to burnout. As burnout rates rise, the cycle continues, further depleting staff numbers and perpetuating the conditions that fuel stress and dissatisfaction in the cath lab.1 3 Research has consistently indicated high levels of burnout and stress among first responders, with studies pointing to the severe psychological toll, including increased rates of suicidal ideation and burnout.70 These findings necessitatethe critical establishment for mental health support and effective stress management interventions within these settings. Implementing Employee Assistance Programs, resilience training, and promoting healthy coping mechanisms, 36 such as regular exercise, can mitigate these adverse outcomes, fostering resilience among healthcare workers.3 Conclusion The literature review reveals the multifaceted nature of work-related stress and its profound impact on the mental health and quality of life of cardiac cath-lab allied and nursing personnel. Addressing these issues requires a holistic approach, incorporating mental health support, occupational health and safety measures, with attention to staff burnout, ergonomic work practices, and adequate staffing. Circadian rhythm adjustments, proper scheduling, educational preparedness, and resilience strategies must also be implemented to mitigate these effects. By tackling these challenges comprehensively, healthcare institutions can enhance the well-being of their cath-lab staff, the life blood of the hospital, thereby improving patient care and the overall healthcare environment. Chapter 3: Research Method Workplace demands and administrative policies in CCLs contribute to high burnout rates and mental health challenges among staff, primarily due to extended shifts, on-call duties, and excessive documentation requirements. Current research points to a major healthcare staffing shortage across the United States.71 Furthermore,the patient population continues to increase in both disease severity and age. Moreover, cardiac events continue to increase as well.20 Thus, with a rapidly diminishing workforce and an increase in sick patients, supporting this critical workforce is essential to this very complex ecosystem of critical care. These conditions significantly contribute to burnout, reduced job satisfaction, increased turnover, and negatively impact patient care outcomes, thus creating a critical workforce crisis in CCLs nationwide. 37 The purpose of this literature review is to systematically investigate how job stress, burnout, and structural, psychological, and physical barriers impact the mental health, quality of life, and job satisfaction of cardiac catheterization laboratory (CCL) staff, including nurses, technologists, and interventional cardiologists. This chapter will discuss the research methods and study design used for the literature review. Research Method and Design(s) A systematic literature review was selected because it provides a comprehensive understanding of the problem by integrating data across multiple studies rather than limiting insights to a single hospital or institution. By aggregating and analyzing peer-reviewed studies, this research can identify common stressors, coping mechanisms, and systemic issues affecting cath lab professionals without the constraints of direct data collection. This method is particularly useful in healthcare research, where ethical concerns and practical constraints often limit direct experimentation.61 Furthermore, by conductinga thorough synthesis of existing research, this study presents a well-rounded, data-driven perspective on the challenges faced by cath lab professionals and potential strategies to mitigate burnout, staff turnover, improve job satisfaction, and enhance overall well-being. Furthermore, a phenomenological lens was used to emphasize the subjective experiences of individuals within the literature—in this case, cath lab professionals working in high-stress environments..While direct phenomenological interviews were not conducted, this research adopts a phenomenological lens by analyzing qualitative studies, white papers, and gray literature, that document real-world, personal narratives, perceptions, and challenges faced by cath lab staff in the field and on the front lines of medicine. This ensures that the study not only presents statistical trends but also captures the human dimensions of workplace stress. 38 Inclusion criteria required that studies be published in English, be peer-reviewed, and directly address work-related stress, burnout, or quality of life issues among cath lab personnel, including nurses, technologists, and physicians, published in the last 10 years, focus on work-related stress, burnout, or mental health in cath lab or comparable high-stress healthcare environments (e.g., emergency medicine, police work, firefighting, surgical teams). Exclusion criteria primarily focusing on administrative or clerical staff rather than direct patient-care providers, first responders, nurses, technologists, and physicians were omitted. Additionally, case studies lacking generalizability or rigorous methodology were excluded. Articles published in languages other than English or English translation availability, or those lacking full-text availability were also omitted. Literature was sourced from major academic databases, including PubMed, MEDLINE, CINAHL, Web of Science, Scopus, Google Scholar, Science Direct, and One Search. In addition, grey literature—such as government reports, white papers, industry publications, and sources like Cath Lab Digest—was included to capture qualitative real-world trends and phenomenological workplace challenges specific to CCLs that may not yet be fully represented in peer-reviewed studies.72 In addition to traditionaldatabase searches, Elicit.org large language models (LLMs) were used to supplement the identification of relevant literature. LLM-assisted searches facilitated broader discovery of relevant studies beyond traditional keyword-based searches. Once the relevant studies were gathered, they were categorized by themes to assess common findings, conflicting perspectives, and gaps in research. Boolean operators and Medical Subject Headings (MeSH) terms will be used to refine the search, including keywords such as "Work-Related stress," OR "occupational stress” OR burnout” OR job strain AND “Cardiac catheterization laboratory staff” OR “Cath lab personal” 39 OR “interventional cardiologists," OR “cardiovascular technologists” OR “physicians” AND “quality of life” OR “job satisfaction” OR “mental health” OR “psychological distress” AND “job demands” OR “workload "radiation exposure and mental health," "work-life balance in cardiac catheterization labs," and "job satisfaction in cath lab staff" NOT “commentary” OR “opinion” OR “editorial.” This methodology involves Database Selection to include articles retrieved from PubMed, CINAHL, PsycINFO, ScienceDirect, MEDLINE, Web of Science, Scopus, Google Scholar, and ELICIT ensuring comprehensive coverage of healthcare, psychology, and occupational health literature. To ensure methodological rigor, this study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to minimize bias and enhance reproducibility. Studies were selected based on predefined inclusion and exclusion criteria, ensuring relevance to the research questions. Finally, the review sought to examine broader workplace challenges affecting the CCL workforce. The review aimed to paint a clearer picture of the challenges CCL professionals face and to highlight evidence-based solutions that could improve working conditions, reduce burnout, and enhance overall quality of life in this high-stakes specialty; factors which have direct and indirect impacts on the quality of patient care. Population, Sample, Materials/Instruments The population targeted for this study comprises literature targeting cath lab teams, including physicians, registered nurses, and cath lab technologists, in CCL environments. These professionals share common workplace characteristics, such as exposure to acute, high-stakes clinical scenarios, unpredictable and extended work hours, frequent on-call responsibilities, and occupational hazards. The decision to include multiple professional roles is based on their collective experience of similar stressors inherent to the cath lab, allowing for a comprehensive 40 understanding of occupational stress, mental health impacts, and quality-of-life concerns across the interprofessional spectrum in acute care settings. Since this study is structured as a literature review rather than an empirical investigation, the sample comprises scholarly peer-reviewed articles published within the last ten years. The included articles specifically address topics related to work-related stress, mental health, burnout, occupational strain, and quality of life among cath lab staff, including technologists, nurses, and physicians. The selected articles reflect diversity in geographical settings, institutional types (e.g., urban vs. rural, private versus public institutions), and professional roles, enabling a broad yet targeted synthesis of current knowledge and practices. The primary materials utilized for this literature review include academic databases such as PubMed, MEDLINE, CINAHL, Elicit, PsycINFO, and Google Scholar. Search strategies adhered strictly to PRISMA guidelines, utilizing key terms such as “cardiac catheterization lab,” “interventional cardiology,” “work-related stress,” “burnout,” “mental health,” “quality of life,” and related synonyms. Studies were critically evaluated for quality, relevance, and methodological rigor using PRISMA standards. This systematic approach ensures the comprehensive collection and analysis of existing literature, emphasizing validated, reliable, and replicable research. Data Collection, Processing, and Analysis The literature review utilizes a systematic method guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards to identify, screen, select, and synthesize relevant research articles. Articles were screened based on inclusion and exclusion criteria, with special emphasis on methodological quality, validity, and applicability to cardiac catheterization laboratories. Data synthesis focuses on thematic analysis and 41 identification of prevalent patterns across literature, summarizing evidence around primary themes of occupational stress, burnout, coping mechanisms, and their documented effects on mental health and quality of life. Patterns, commonalities, and gaps in existing research were identified to provide comprehensive insights. Assumptions, Limitations & Delimitations This literature review assumed that the published research accurately reflects current conditions experienced by CCL staff. An additional assumption is that researchers in these studies employed valid and reliable instruments when assessing variables such as burnout, stress, and mental health outcomes. It is also assumed that the existing body of literature is comprehensive enough to adequately address the research questions posed, despite potential geographic or institutional variability in the cath-lab environments studied. The primary limitation of this literature review is the notable gap in literature specifically targeting cath labs. Another limitation is the potential existence of publication bias, wherein studies reporting significant findings may be more likely to be published than those reporting no significant results. Additionally, the scope of the review may exclude studies that were not published in English or studies from less accessible journals, limiting the generalizability of the review’s conclusions. Another limitation is the inability to verify individual study results independently, relying solely on reported outcomes and conclusions provided by the authors of each study. This literature review explicitly focuses on studies published primarily within the last decade ensuring the analysis is timely and relevant to current clinical practices and work conditions in CCLs, though older publications were also included based on relevancy and acceptance. The review intentionally excludes research that primarily addresses administrative or 42 clerical personnel, focusing instead exclusively on clinical and caregiver staff (i.e. technologists, nurses, and physicians). Additionally, the scope has been delimited by emphasizing research on healthcare settings specifically associated with invasive cardiology and cardiac catheterization, first responders in high stress roles, rather than general hospital settings or broader unrelated healthcare professions. Ethical Considerations As this study is a systematic review, no human subjects were involved, and Institutional Review Board (IRB) approval was not required. However, all studies included in this review were peer-reviewed and ethically conducted per their respective institutional guidelines. All selected studies included in the review were peer-reviewed and conducted according to established ethical guidelines. The review process strictly adhered to PRISMA guidelines to ensure transparency, minimize selection bias, and enhance reproducibility. Special attention was given to accurately representing authors' findings without misinterpretation or overgeneralization. Additionally, ethical standards were maintained by transparently acknowledging limitations such as publication bias and by responsibly citing all sources used, respecting intellectual property, and ensuring the integrity of synthesized information. Summary This study employs a systematic literature review to critically evaluate the existing research on work-related stress in cardiac cath labs. It incorporates theoretical frameworks from occupational psychology and a phenomenological lens to ensure a comprehensive understanding of the issues. By analyzing studies that utilize validated psychological scales, qualitative 43 narratives, and workplace assessments, this review provides a foundation for policy recommendations aimed at improving the well-being of cath lab professionals. Chapter 4: Findings Results, Evaluation of Findings The purpose of this literature review was to examine how work-related stress in the cardiac catheterization laboratory impacts the mental health and quality of life among personnel including nurses, technologists, and physicians and the cath lab workforce at large. This chapter presents the synthesized results organized according to the specific research questions established earlier in this study. First, High turnover among cardiac catheterization laboratory staff in tertiary care hospitals is linked to several factors. Alex et al. (2022) report a 33% burnout rate, with affected staff enduring intense workloads marked by extended shifts and frequent emergency (STEMI) calls.3 Second, situational pressures play a majorrole. Estes et al. (2020) document that 74% of staff experienced a greater than 75% decline in case volume during the COVID-19 pandemic, with 68% serving as primary financial providers and 45% facing workplace relocation.11 Third, organizational support exerts a moderate influence. Gilmartin et al. (2022) show that higher scores on learning environment and high reliability practices correlate with lower turnover intentions, while noting that infrequent debriefings and hiring practices that overlook interpersonal skills may undermine retention.73 Interventionalcardiologists and cardiac catheterization laboratory personnel report marked work‐related stress and its precipitating effects. Another study measured burnout at 33% among cath lab staff—with rates as high as 60% in male workers—and another found that 59.3% of emergency and critical care staff experienced job strain, with 54.5% reporting low mental quality of life.3 Extended shifts, frequent on-call 44 duties, and excessive documentation emerge as central factors linked to mental health challenges. Several studies also associate physical outcomes—such as musculoskeletal pain (odds ratio 1.67; 95% confidence interval 1.32–2.11) and cataracts—with high radiation exposure and prolonged use of protective equipment.62 Existing studies consistentlydemonstrate that staffing shortages in cardiac cath labs correlate strongly with increased stress levels and burnout among staff. Rubin et al. (2021) identified that low staffing levels lead to prolonged working hours, decreased morale, and elevated stress indicators, which directly impair both psychological well-being and patient care quality.23 Moreover, the literatureindicated that adequate staffing significantly improves the quality of life and job satisfaction among cath lab personnel. Additionally, supportive leadership practices are linked with reduced stress and higher job satisfaction.74 The perception of strong administrative support directly contributes to better emotional and psychological outcomes, reducing the risk of burnout.74 Next, shift length and break frequency play critical roles in determining the quality of life of cath lab personnel. Extended shift lengths with insufficient breaks exacerbate stress, fatigue, and negatively affect quality of life.75 Circadianrhythm disruption from on-call burdens, shift length and break frequency have a strong negative correlation with increased levels of burnout.76 Frequent, adequately timed breaks are shown to mitigate stress, improve mental clarity, and enhance overall job performance. Rogers et al. (2004) found that healthcare workers who took regular, scheduled breaks demonstrated lower cortisol levels, a biomarker for stress, compared to those who worked continuously without structured rest periods.76 Evidence supports that incorporating dedicated physical activity during work shifts positively impacts cath lab staff productivity and mental health.60 This demonstratesthat engaging in short, regular physical activity breaks is correlated with reduced stress, enhanced emotional well-being, and increased 45 job satisfaction, ultimately benefiting staff retention and patient care quality. The literature suggests significant positive effects on staff well-being when adequate support is provided for non-patient care duties, such as stocking supplies, cleaning equipment, and managing inventory.11 Delegating these responsibilities todedicated support staff reduces stress and increases job satisfaction, allowing cath lab professionals to focus more effectively on patient care and clinical responsibilities. The literature highlighted several strategies that effectively enhance staff resilience and quality of life, thereby indirectly improving patient safety. These strategies include promoting adequate staffing, integrating regular physical activity into shift schedules, strengthening leadership support, ensuring sufficient resources and supplies, and implementing structured programs to manage stress and prevent burnout, and providing educational responsibilities, for which recommendations will be further discussed at length in chapter 5.77 61 Finally, a positive correlation was identified between educational gaps and staff turnover, indicating that larger discrepancies in staff education and training levels were associated with higher turnover rates (r = .47, p < .01).53 The researchidentified significant educational gaps and deficiencies in professional preparedness among cardiology and CCL personnel, affecting both technical and non-technical competencies across various career stages. Prominent technical deficits are inadequacies in radiation safety knowledge and practices. A cross sectional survey by Rahman et al. (2008) highlighted substantial gaps, such as only 25% of invasive cardiologists demonstrating awareness of critical radiation dose details, and strikingly, as few as 2% of cath lab staff possessing adequate knowledge of radiation dose specifics. Further exacerbating these knowledge gaps, it was reported that up to 74% of cath lab personnel had never undergone formal radiation safety training, underscoring a significant risk to both patient and staff safety. 46 More research must be conducted targeting educational goals for CCL staff to identify and understand educational deficiencies. In summary, the reviewed literature consistently identified a strong negative correlation between staffing levels and burnout, indicating that lower staffing levels lead to higher burnout rates and increased turnover in the CCL. Adequate staffing, supportive leadership, regular breaks, and integrated physical activities during shifts, and providing a supportive learning environment, emerge as critical factors in reducing stress and enhancing overall well-being. Additionally, support for non-patient care tasks significantly improves job satisfaction and operational efficiency. These findings collectively indicate the importance of addressing staffing and environmental factors comprehensively to mitigate work-related stress and enhance the mental health and quality of life for CCL professionals. Chapter 5: Implications, Recommendations, and Conclusions The findings from this literature review offer significant insights into each of the research questions initially posed, providing clarity regarding the relationship between work-related stress, staffing conditions, leadership support, and quality of life among cardiac catheterization laboratory personnel. First, the literature consistently demonstrated a robust correlation between low staffing levels in CCLs and elevated stress outcomes among staff. Studies have indicated that chronic understaffing leads to increased workloads, inadequate breaks, and disruptions in circadian rhythms due to prolonged shifts and frequent on-call duties. These factors contribute significantly to burnout and decreased job satisfaction.49 11 The implications of these findings are considerable, highlighting the necessity for healthcare organizations to prioritize adequate 47 staffing as a critical factor not only for employee well-being but also to safeguard patient outcomes. Secondly, the research findings showed the importance of providing dedicated time for physical activities and regular breaks during shifts. Literature clearly demonstrated that structured opportunities for physical activity and adequate rest periods significantly improved productivity, emotional well-being, and reduced stress levels.60 62 Practical implications suggest that cath labs could enhance employee well-being and operational efficiency by incorporating structured breaks and physical wellness programs into daily work routines. Third, the literature review confirmed that robust support for non-patient care duties, including stocking supplies, cleaning equipment, and performing administrative tasks, directly reduces job stress and enhances overall staff morale.19 The implication here is clear—institutions should ensure adequate ancillary support as part of their staffing strategy to allow clinical staff to focus primarily on patient care, thus improving job satisfaction and decreasing turnover rates. Fourth, leadership quality emerged as a critical determinant of staff mental health and job satisfaction. Supportive leadership was consistently linked with lower reported stress levels, higher job satisfaction, and a more positive work environment.61 These findings underscore the need for healthcare institutions to invest in leadership training and development programs emphasizing employee support, transparent communication, and recognition of staff contributions. Fifth, the review highlighted significant educational gaps and deficiencies in professional preparedness, specifically in radiation safety training and specialized clinical competencies. Addressing these educational deficiencies through structured training and continuous 48 professional development is imperative to enhance patient safety, staff competency, and reduce workplace stress related to perceived inadequacies in skill or knowledge.53 73 Sixth, Occupational hazards, particularly physical demands and radiation exposure, substantially contribute to heightened stress levels among cardiac cath lab personnel. Consistent exposure to radiation necessitates the use of heavy protective equipment, such as lead aprons, which significantly increases the risk of musculoskeletal injuries, chronic pain, and fatigue among staff.19 These physical burdens exacerbate dailystress, reduce overall job satisfaction, and negatively influence the quality of life, amplifying susceptibility to burnout. Furthermore, inadequate education and training in radiation safety compound these issues, causing staff to feel uncertain or unprepared, thus further heightening psychological stress. These findings underscore the critical need for comprehensive safety training, ergonomic interventions, and proactive measures to mitigate occupational hazards and their associated stressors in cath lab environments.62 Finally, the unique stressors exacerbated by the COVID-19 pandemic were clearly documented as contributing significantly to staffing shortages. Factors such as inadequate compensation, supply chain disruptions, and perceived lack of support from management compelled many staff members to pursue lucrative traveling positions, further compounding staffing shortages.10 This finding has profound implicationsfor how healthcare organizations should rethink employee retention strategies, compensation models, and crisis management plans to mitigate staffing losses during future emergencies.11 Limitations of this literature review include the heterogeneity of studies included, variations in definitions of stress and burnout, and reliance on self-reported data, which may affect the generalizability of the findings. Future research could benefit from standardized 49 measurements and longitudinal studies to better understand causality and long-term implications of stress management interventions. Based on the findings, the following recommendations are listed again below for emphasis and clarity: 1. More researchon the topic must be conducted, morequantitative data on cath lab personnel and interventional cardiologist’s quality of life must be obtained. Future Researchstudies should explore the longitudinal impactof these interventions and consider diverse geographical and healthcare settings to enhance generalizability. 2. Implement Stress Reduction Programs:Develop andintegrate regular stress management workshops and training sessions to help staff develop resilience and coping strategies. 3. Review Work Schedules:Encourage the reevaluationof shift schedules to ensure they align with healthy work-life balances and reduce circadian rhythm disruptions. 4. Enhance Support Systems:Increase access to mentalhealth resources, including counseling and psychological services, particularly tailored for those in high-stress roles. 5. Avoid Staff Reductions During Critical Times:Reducingstaff or sending employees home during critical operational hours can significantly degrade the quality of life for remaining staff and impair their ability to respond effectively to emergencies. Maintaining adequate staffing levels ensures that workload is distributed evenly, reducing burnout and stress among cath-lab personnel. This study underscores the importance of administrative policies that prioritize adequate staffing to maintain a high standard of care and employee well-being. 6. Implement Longer and More Frequent Breaks:Increasingthe duration and frequency of breaks during shifts can significantly enhance job satisfaction and reduce stress levels. 50 Breaks provide essential downtime that allows staff to recuperate, leading to improved mental clarity and reduced fatigue. This practice not only benefits the staff’s mental health but also enhances patient care quality by ensuring that healthcare providers are well-rested and alert. 7. Promote Physical Activity During Shifts:Incorporatingscheduled time for physical activity during long shifts can greatly improve both mental health and productivity. Exercise is a proven stress reliever and can help mitigate the psychological and physical strain associated with high-stress jobs. Facilities should consider providing on-site resources such as a staff gym or organized workout sessions to encourage physical activity. 8. Bolster Support for Operational Duties:Enhancingsupport for non-patient care duties such as stocking equipment and cleaning rooms can have a significant impact on the workload and stress levels of cath-lab professionals. By increasing staff or reallocating resources to cover these essential tasks, cath-lab personnel can focus more on patient care, which is directly linked to improved job satisfaction and reduced stress. This support can also mitigate the impacts of supply chain issues, ensuring that necessary materials and equipment are always available when needed. These implications provide actionable insights for healthcare leadership and policymakers, highlighting the urgent need to address staffing, leadership support, education, and physical, psychological and social well-being programs comprehensively. Practical interventions informed by this review could substantially enhance both the quality of life for cath lab personnel and patient safety, contributing positively to the broader healthcare environment. In 51 lieu of the literature review, these recommendations aim to create a more supportive and efficient work environment for cath-lab personnel, addressing both the direct and indirect stressors that impact their professional and personal well-being. By implementing these changes, healthcare facilities can improve retention, reduce burnout, and enhance the overall quality of care provided to patients. Conclusions This literature review synthesized current research examining work-related stress and its implications for the mental health and quality of life among cardiac catheterization laboratory staff, including nurses, technologists, and physicians. The review identified several key themes: the relationship between staffing levels and burnout, the impact of shift duration and break frequency, the effects of supportive leadership, the role of dedicated exercise time during shifts, and the importance of ancillary support for non-patient-care activities. Low staffing levels correlate directly with increased stress, reduced job satisfaction, and a decrease in the overall quality of life of cath lab professionals. Shift length and inadequate breaks were identified as significant stressors, negatively impacting both physical and mental health. Conversely, introducing frequent, structured breaks and time allocated for exercise during long shifts significantly improves productivity, emotional well-being, and overall job satisfaction. Furthermore, strong, supportive leadership that provides adequate resources and tools substantially mitigates workplace stress and enhances resilience among staff. These findings emphasize the necessity of incorporating practical solutions such as strategic staffing, structured breaks, on-site exercise opportunities, and dedicated support personnel to handle logistical and ancillary tasks. By implementing these strategies, healthcare institutions can significantly reduce stress and burnout, thereby improving staff resilience and patient care outcomes. Ultimately, 52 addressing the physical and psychological demands of cath lab work environments contributes positively to the quality of life for healthcare professionals, strengthens the overall healthcare delivery system, enhances patient safety, and leads to better patient outcomes. References 1. Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Occupational Health Risks in Cardiac Catheterization Laboratory Workers.CircCardiovasc Interv. 2016;9(4):e003273. doi:10.1161/CIRCINTERVENTIONS.115.003273 2. Chang BP, Shechter A. Can Burnout Kill? Psychological Stress and Cardiovascular Outcomes in Emergency Clinicians.Ann Emerg Med. 2019;74(4):S82.doi:10.1016/j.annemergmed.2019.08.377 3. Alex J, Patel H, Zughaib MT, et al. Burnout of Support Personnel in the Cardiac Catheterization Laboratory.Cardiol Res. 2022;13(5):283-288. doi:10.14740/cr1439 4. SAMHSA. First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. 5. Karhula K, Härmä M, Sallinen M, et al. Job strain, sleep and alertness in shift working health care professionals -- a field study.Ind Health. 2013;51(4):406-416.doi:10.2486/indhealth.2013-0015 6. Heponiemi T, Puttonen S, Elovainio M. On-call work and physicians’ well-being: testing the potential mediators.Occup Med Oxf Engl. 2014;64(5):352-357.doi:10.1093/occmed/kqu036 7. Scott LD, Arslanian-Engoren C, Engoren MC. Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses.Am J Crit Care. 2014;23(1):13-23.doi:10.4037/ajcc2014191 8. Brooks SK, Dunn R, Sage CAM, Amlôt R, Greenberg N, Rubin GJ. Risk and resilience factors affecting the psychological wellbeing of individuals deployed in humanitarian relief roles after a disaster.J Ment Health. 2015;24(6):385-413. doi:10.3109/09638237.2015.1057334 9. Naqvi SAH, Hashmi MA, Raza SA, Zeeshan A, Shaikh FaizM. Impact of Supportive Leadership and Organizational Learning Culture as a Moderator on the Reslationship of Psychogical Empowerment and Organizational Commitment.Aust J Bus Manag Res.2012;01(08):65-71. doi:10.52283/NSWRCA.AJBMR.20110108A07 10. Wood S. Cardiac Care Feels Staffing Crunch as Big Money Converts COVID-19 Travelers. TCTMD.com. January 20, 2021. Accessed March 2, 2025. https://www.tctmd.com/news/cardiac-care-feels-staffing-crunch-big-money-converts-covid-19-traveler s 11.Estes BA, Varghese JJ, Jacques J, Naidu SS. Logistical, Financial, and Psychological Impact of the COVID-19 Pandemic on Cardiac Catheterization Lab Nurses and Technologists: A U.S. National Survey.J Invasive Cardiol. 2021;33(1):E9-E15. doi:10.25270/jic/20.00640 12. Saravanan P, Nisar T, Zhang Q, Masud F, Sasangohar F. Occupational stress and burnout among 53 intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units.Front Psychiatry. 2023;14:1129268.doi:10.3389/fpsyt.2023.1129268 13. Cohen S, Kamarck T, Mermelstein R. A Global Measure of Perceived Stress.J Health Soc Behav. 1983;24(4):385-396. doi:10.2307/2136404 14. Harris KM, Gaffey AE, Schwartz JE, Krantz DS, Burg MM. The Perceived Stress Scale as a Measure of Stress: Decomposing Score Variance in Longitudinal Behavioral Medicine Studies.Ann Behav Med Publ Soc Behav Med. 2023;57(10):846-854.doi:10.1093/abm/kaad015 15. Bagheri Hosseinabadi M, Ebrahimi MH, Khanjani N, Biganeh J, Mohammadi S, Abdolahfard M. The effects of amplitude and stability of circadian rhythm and occupational stress on burnout syndrome and job dissatisfaction among irregular shift working nurses.J Clin Nurs. 2019;28(9-10):1868-1878. doi:10.1111/jocn.14778 16. Džakula A, Relić D, Michelutti P. Health workforce shortage – doing the right things or doing things right?Croat Med J. 2022;63(2):107-109. doi:10.3325/cmj.2022.63.107 17. Ramírez-Elvira S, Romero-Béjar JL, Suleiman-Martos N, et al. Prevalence, Risk Factors and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis.Int J Environ Res Public Health. 2021;18(21):11432. doi:10.3390/ijerph182111432 18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.PLOS Med. 2021;18(3):e1003583. doi:10.1371/journal.pmed.1003583 19. Abudayyeh I, Dupont AG, Hermiller JB, et al. Occupational Health Hazards in the Cardiac Catheterization Laboratory: Results of the 2023 SCAI Survey.J Soc Cardiovasc Angiogr Interv. Published online March 2025:102493. doi:10.1016/j.jscai.2024.102493 20. Woodruff RC, Tong X, Khan SS, et al. Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010-2022.Am J Prev Med. 2024;66(4):582-589.doi:10.1016/j.amepre.2023.11.009 21. Xu H (Grace), Kynoch K, Tuckett A, Eley R. Effectiveness of interventions to reduce emergency department staff occupational stress and/or burnout: a systematic review.JBI Evid Synth. 2020;18(6):1156-1188. doi:10.11124/JBISRIR-D-19-00252 22. Klein LW, Bazavan M. The Economic Imperatives Underlying the Occupational Health Hazards of the Cardiac Catheterization Laboratory.Circ CardiovascInterv. 2016;9(4):e003742. doi:10.1161/CIRCINTERVENTIONS.116.003742 23. Rubin B, Goldfarb R, Satele D, Graham L. Burnout and distress among nurses in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey.CMAJ Open. 2021;9(1):E19-E28. doi:10.9778/cmajo.20200058 24. Manda YR, Baradhi KM. Cardiac Catheterization Risks and Complications. In:StatPearls. StatPearls Publishing; 2025. Accessed March 15, 2025. http://www.ncbi.nlm.nih.gov/books/NBK531461/ 25. Folkman S, Lazarus RS. Coping as a mediator of emotion.J Pers Soc Psychol. 1988;54(3):466-475. doi:10.1037/0022-3514.54.3.466 54 26. Quick JC, Tetrick LE, eds.Handbook of Occupational Health Psychology.American Psychological Association; 2003. doi:10.1037/10474-000 27. National Institute for Occupational Safety and Health. Stress at work.Natl Inst Occup Saf Health. Published online October 7, 2020. doi:10.26616/NIOSHPUB99101 28. Tsang MB, Schwalm JD, Gandhi S, et al. Comparison of Heart Team vs Interventional Cardiologist Recommendations for the Treatment of Patients With Multivessel Coronary Artery Disease.JAMA Netw Open. 2020;3(8):e2012749. doi:10.1001/jamanetworkopen.2020.12749 29. Heidari S, Parizad N, Goli R, Mam-Qaderi M, Hassanpour A. Job satisfaction and its relationship with burnout among nurses working in COVID-19 wards: A descriptive correlational study.Ann Med Surg. 2022;82. doi:10.1016/j.amsu.2022.104591 30. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout.J Appl Psychol. 2001;86(3):499-512. doi:10.1037/0021-9010.86.3.499 31. Bellagamba G, Gionta G, Senergue J, Bèque C, Lehucher-Michel MP. Organizational factors impacting job strain and mental quality of life in emergency and critical care units.Int J Occup Med Environ Health. 2015;28(2):357-367. doi:10.13075/ijomeh.1896.00121 32. Al-Busaidi ZQ. Qualitative Research and its Uses in Health Care. doi:PMCID: PMC3087733 33. WHO. Physical activity. Physical Activity. Accessed March 11, 2025. https://www.who.int/news-room/fact-sheets/detail/physical-activity 34. Park J, Choi KH, Lee JM, et al. Prognostic Implications of Door‐to‐Balloon Time and Onset‐to‐Door Time on Mortality in Patients With ST‐Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.J Am Heart Assoc. 2019;8(9):e012188. doi:10.1161/JAHA.119.012188 35. Gillingham I, Neubeck L, Williams B, Dawkes S. Role expansion for nurses in the cardiac catheter laboratory: findings from a systematic scoping review.Br J Card Nurs. 2020;15(4):1-14. doi:10.12968/bjca.2019.0128 36. Dehmer GJ. The Cath Lab Crew: Your second family.Catheter Cardiovasc Interv. 2006;68(5):815-818. doi:10.1002/ccd.20967 37. American Registry of Radiologic Technologists (ARRT). CARDIAC INTERVENTIONAL RADIOGRAPHY CLINICAL EXPERIENCE REQUIREMENTS. Published online July 2023. https://assets-us-01.kc-usercontent.com/406ac8c6-58e8-00b3-e3c1-0c312965deb2/ff07f782-c530-4837 -9aef-41fb39d6b9c4/Cardiac%20Interventional%20Clinical%20Experience%20Requirements%20202 3.pdf 38. Reed GW, Tushman ML, Kapadia SR. Operational Efficiency and Effective Management in the Catheterization Laboratory.J Am Coll Cardiol. 2018;72(20):2507-2517. doi:10.1016/j.jacc.2018.08.2179 39. Lim MJ, Sorajja P, Kern MJ, eds.The InterventionalCardiac Catheterization Handbook. 5th edition. Elsevier; 2023. 55 40. Cardiovascular Credentialing International (CCI). Registered Cardiovascular Invasive Specialist (RCIS) Qualification Requirements. 2022. Accessed March 11, 2025. https://cci-online.org/credentials/registered-cardiovascular-invasive-specialist/ 41. Charles Ody Williams, BS, RPA, RT(R), (CV)(CI), RCIS, CPFT, CCT. Editorial: Which Exam is the Best for Radiologic Technologists Employed in Cardiac Cath Labs: The CCI RCIS Exam or the ARRT CI E. Accessed March 3, 2025. https://www.hmpgloballearningnetwork.com/site/cathlab/articles/editorial-which-exam-best-radiologic -technologists-employed-cardiac-cath-labs-the-cci-rcis- 42. Greening N. Phenomenological Research Methodology.Sci Res J. 2019;VII(V). doi:10.31364/SCIRJ/v7.i5.2019.P0519656 43. Rosa D, Terzoni S, Dellafiore F, Destrebecq A. Systematic review of shift work and nurses’ health.Occup Med Oxf Engl. 2019;69(4):237-243. doi:10.1093/occmed/kqz063 44. Benedek DM, Fullerton C, Ursano RJ. First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers.Annu Rev Public Health. 2007;28(1):55-68. doi:10.1146/annurev.publhealth.28.021406.144037 45. McClelland LE, Switzer FS, Pilcher JJ. Changes in nurses’ decision making during a 12-h day shift.Occup Med Oxf Engl. 2013;63(1):60-65. doi:10.1093/occmed/kqs189 46. Atkins CD, Burnett, HJ. Specialized disaster behavioral health training: Its connection with response, practice, trauma health, and resilience.Disaster Health. 2016;3(2):57-65. doi:10.1080/21665044.2016.1199151 47. Monteiro S, Marques Pinto A, Roberto MS. Job demands, coping, and impacts of occupational stress among journalists: a systematic review.EurJ Work Organ Psychol. 2016;25(5):751-772. doi:10.1080/1359432X.2015.1114470 48. Roberts B, Vincent GE, Ferguson SA, Reynolds AC, Jay SM. Understanding the Differing Impacts of On-Call Work for Males and Females: Results from an Online Survey.Int J Environ Res Public Health. 2019;16(3):370. doi:10.3390/ijerph16030370 49. Kuhn G. Circadian rhythm, shift work, and emergency medicine.Ann Emerg Med. 2001;37(1):88-98. doi:10.1067/mem.2001.111571 50. Stelfox HT. The “To Err is Human” report and the patient safety literature.Qual Saf Health Care. 2006;15(3):174-178. doi:10.1136/qshc.2006.017947 51. Joel Sauer MBA. Pandemic Exacerbates Already-Challenging Cath Lab Staffing. Cardiac Interventions Today. June 2022. Accessed April 12, 2025. https://citoday.com/articles/2022-may-june/pandemic-exacerbates-already-challenging-cath-lab-staffin g 52. Botha E, Gwin T, Purpora C. The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI Database Syst Rev Implement Rep. 2015;13(10):21-29.doi:10.11124/jbisrir-2015-2380 53. Rahman N, Dhakam S, Shafqut A, Qadir S, Tipoo FA. Knowledge and practice of radiation safety 56 among invasive cardiologists.JPMA J Pak Med Assoc. 2008;58(3):119-122. 54. Bello NA, Agrawal A, Davis MB, et al. Need for Better and Broader Training in Cardio‐Obstetrics: A National Survey of Cardiologists, Cardiovascular Team Members, and Cardiology Fellows in Training.J Am Heart Assoc.2022;11(8):e024229. doi:10.1161/JAHA.121.024229 55. Hayes SM, Dupuis M, Murray S. Issues and challenges in the assessment, diagnosis and treatment of cardiovascular risk factors: Assessing the needs of cardiologists.BMC Med Educ. 2008;8(1):30. doi:10.1186/1472-6920-8-30 56. R K, Joy G IS, M J. Assess the Knowledge and Practice among Cardiac Nurses about Patient Safety after Cardiac Catheterization, Tamilnadu.IntJ Res Rev. 2021;8(4):220-225. doi:10.52403/ijrr.20210429 57. Moghanlu PSH, Tabatabaei S, Khaheshi I, Vaziri MH. Study of Mental Health and Job Burnout and its Relationship with Musculoskeletal Discomfort in the Staff of Cardiology.J Yoga Physiother. 2021;9(2):1-7. doi:10.19080/JYP.2021.09.555756 58. Morales J, Yáñez A, Fernández-González L, et al. Stress and autonomic response to sleep deprivation in medical residents: A comparative cross-sectional study.PloS One. 2019;14(4):e0214858. doi:10.1371/journal.pone.0214858 59. Melnyk BM, Hsieh AP, Tan A, et al. Associations Among Nurses’ Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19: Important Implications for Health Care Systems.Nurs Adm Q.2022;46(1):5-18. doi:10.1097/NAQ.0000000000000499 60. Bischoff LL, Otto AK, Hold C, Wollesen B. The effect of physical activity interventions on occupational stress for health personnel: A systematic review.Int J Nurs Stud. 2019;97:94-104. doi:10.1016/j.ijnurstu.2019.06.002 61. Melnyk BM, Kelly SA, Stephens J, et al. Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review.Am J Health Promot. 2020;34(8):929-941. doi:10.1177/0890117120920451 62. Orme NM, Rihal CS, Gulati R, et al. Occupational Health Hazards of Working in the Interventional Laboratory.J Am Coll Cardiol. 2015;65(8):820-826.doi:10.1016/j.jacc.2014.11.056 63. Rosa D, Terzoni S, Dellafiore F, Destrebecq A. Systematic review of shift work and nurses’ health.Occup Med. 2019;69(4):237-243. doi:10.1093/occmed/kqz063 64. Sauer AJ. Mental Health Conditions Among Cardiologists.JACC. 2023;81(6):587-589. doi:10.1016/j.jacc.2022.11.026 65. Riley RF, Alasnag M, Batchelor WB, et al. The Ongoing National Medical Staffing Crisis: Impacts on Care Delivery for Interventional Cardiologists.J Soc Cardiovasc Angiogr Interv. 2022;1(3):100307. doi:10.1016/j.jscai.2022.100307 66. Sharma G, Rao SJ, Douglas PS, et al. Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists.J Am Coll Cardiol.2023;81(6):574-586. 57 doi:10.1016/j.jacc.2022.11.025 67. Papazoglou K. Stress, Prevention, and Resilience among First Responders.Int J Environ Res Public Health. 2023;20(24):7174. doi:10.3390/ijerph20247174 68. A. Abdel Azize N, A. Abed F, A. Bayoumy S. Relationship between Organization Support and Nursing Staff Burnout in Critical Care Units.EgyptJ Health Care. 2023;14(1):905-918. doi:10.21608/ejhc.2023.290613 69. Nursing (MSN), Department of Intensive Care Unit, Al Bashir Hospital, and the Faculty of Nursing, Zarqa University, Zarqa, Jordan, Badwan M, Eshah N, Professor, Faculty of Nursing, Zarqa University, Zarqa, Jordan, Ahmad R, Associate Professor, Dean of the Faculty of Nursing, Zarqa University, Zarqa, Jordan. The Role of Organizational Support in Work Engagement Among Nurses Working in Intensive Care Units.J Holist Nurs Midwifery.2022;32(4):301-308. doi:10.32598/jhnm.32.4.2323 70. Abbott, Cord- Shift Commander, Montgomery County Hospital District EMS, Texas, Barber, Erich- Captain, Grand County EMS, Colorado, Burke, Brian- Administrative Supervisor, Bay Cities Ambulance, Oregon, et al. WHAT’S KILLING OUR MEDICS? https://static1.squarespace.com/static/555d1154e4b09b430c18fd39/t/5599d2b2e4b0c805c287aa3a/143 6144306212/What%27s+Killing+Our+Medics+Final.pdf 71. Džakula A, Relić D, Michelutti P. Health workforce shortage – doing the right things or doing things right?Croat Med J. 2022;63(2):107-109. doi:10.3325/cmj.2022.63.107 72. An Assessment of Depression, Anxiety, and Stress Among Nationally Certified EMS Professionals: Prehospital Emergency Care: Vol 17 , No 3 - Get Access. Accessed February 28, 2025. https://www.tandfonline.com/doi/full/10.3109/10903127.2012.761307 73. Gilmartin HM, Hess E, Mueller C, et al. Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories.Health Serv Res. 2022;57(2):385-391. doi:10.1111/1475-6773.13907 74. Mehta LS, Murphy DJ. Strategies to prevent burnout in the cardiovascular health-care workforce. Nat Rev Cardiol. 2021;18(7):455-456. doi:10.1038/s41569-021-00553-0 75. Ziebertz CM, van Hooff MLM, Beckers DGJ, Hooftman WE, Kompier MAJ, Geurts SAE. The Relationship of On-Call Work with Fatigue, Work-Home Interference, and Perceived Performance Difficulties.BioMed Res Int. 2015;2015:643413. doi:10.1155/2015/643413 76. Lin YH, Jen HJ, Lin YK, Seo JD, Chang WP. Cortisol Awakening Response and Stress in Female Nurses on Monthly Shift Rotations: A Longitudinal Study.BioMed Res Int. 2022;2022:9506583. doi:10.1155/2022/9506583 77. Patel RS, Sekhri S, Bhimanadham NN, Imran S, Hossain S. A Review on Strategies to Manage Physician Burnout.Cureus. Published online June 3,2019. doi:10.7759/cureus.4805 58 Appendix: Table 1 Concept Keywords & Synonyms Populations Boolean Operators ork-Related W Stress & Burnout " work-related stress" OR "occupational stress" OR "job strain" OR "burnout syndrome" OR "mental exhaustion" OR "psychological distress" " cardiac catheterization laboratory staff" OR "interventional cardiologists" OR "cath lab nurses" OR "radiologic technologists" OR "Registered Cardiovascular Invasive Specialists (RCIS)" OR "emergency medical personnel" OR "critical care nurses" OR "surgical staff" OR "healthcare administrators" OR "travel nurses" OR "first responders" OR "physicians" OR "COVID-19 healthcare workers" ( "work-related stress" OR "burnout syndrome") AND ("cardiac catheterization laboratory staff" OR "interventional cardiologists") taffing S Shortages & Workload " staffing shortages" OR "understaffing" OR "low nurse-to-patient ratio" OR "high workload" OR "workforce crisis" OR "personnel shortage" " cath lab nurses" OR "radiologic technologists" OR "travel nurses" OR "first responders" OR "emergency medical personnel" OR "critical care nurses" OR "physicians" OR "healthcare administrators" ( "staffing shortages" OR "high workload") AND ("cath lab nurses" OR "travel nurses") hift Work & S Fatigue " shift work" OR "on-call duty" OR "extended shifts" OR "circadian rhythm disruption" OR "sleep deprivation" OR "fatigue" OR "mental fatigue" OR "cognitive impairment" " cardiac catheterization laboratory staff" OR "interventional cardiologists" OR "cath lab nurses" OR "radiologic technologists" OR "Registered Cardiovascular Invasive Specialists (RCIS)" OR "emergency medical personnel" OR "critical care nurses" ( "shift work" OR "sleep deprivation") AND ("cath lab nurses" OR "critical care nurses") ccupational O Hazards & Ergonomic Strain " radiation exposure" OR "chronic radiation exposure" OR "fluoroscopy" OR "ionizing radiation" OR "lead apron burden" OR "musculoskeletal strain" OR "ergonomic burden" OR "occupational health risks" " interventional cardiologists" OR "cath lab nurses" OR "radiologic technologists" OR "Registered Cardiovascular Invasive Specialists (RCIS)" OR "surgical staff" ( "radiation exposure" OR "ergonomic burden") AND ("interventional cardiologists" OR "cath lab nurses") eadership & L Administrative Support " leadership support" OR "hospital administration" OR "organizational support" OR "management advocacy" OR "staff retention" OR "employee engagement" " cardiac catheterization laboratory staff" OR "healthcare administrators" OR "physicians" ( "leadership support" OR "staff retention") AND ("healthcare administrators" OR "physicians") hysical P Activity & Burnout Prevention " physical activity" OR "exercise programs" OR "wellness initiatives" OR "workplace movement interventions" OR "burnout prevention" OR "stress management" " cardiac catheterization laboratory staff" OR "interventional cardiologists" OR "cath lab nurses" OR "radiologic technologists" ( "physical activity" OR "burnout prevention") AND ("cardiac catheterization laboratory staff" OR "interventional cardiologists") ducational E Gaps & Training Deficiencies " educational gaps" OR "training deficiencies" OR "competency-based education" OR "continuing medical education" OR "certification requirements" " interventional cardiologists" OR "cath lab nurses" OR "radiologic technologists" OR "Registered Cardiovascular Invasive Specialists (RCIS)" OR "first responders" ( "educational gaps" OR "training deficiencies") AND ("interventional cardiologists" OR "cath lab nurses") atient P Outcomes & Medical Errors " patient outcomes" OR "hospital efficiency" OR "medical errors" OR "quality of care" OR "clinical decision-making" " cardiac catheterization laboratory staff" OR "interventional cardiologists" OR "cath lab nurses" OR "radiologic ( "patient outcomes" OR "medical errors") AND ("cath lab nurses" OR "interventional cardiologists") 59 technologists" OR "emergency medical personnel" Exclusions “Editorial” OR “commentary” OR “opinion” piece” N/A OT (“editorial”) OR “commentary” OR N “opinion piece”) Table 2 60 |
| Format | application/pdf |
| ARK | ark:/87278/s6w7eqs2 |
| Setname | wsu_smt |
| ID | 153456 |
| Reference URL | https://digital.weber.edu/ark:/87278/s6w7eqs2 |