The Impact of Orientation on Perceived Self-Efficacy of Cardiac Catheterization Lab Staff By Don Bishop Sierra Gibbs Noah Khan Brandon Loveridge Paola Robles Shayla Vornes Jason Witt Linda Zhao A thesis submitted to the School of Radiologic Sciences in collaboration with a research agenda team In partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN RADIOLOGIC SCIENCES (MSRS) WEBER STATE UNIVERSITY Ogden, Utah August 5, 2026 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Don Bishop Sierra Gibbs Noah Khan Brandon Loveridge Paola Robles Shayla Vornes Jason Witt Linda Zhao This thesis has been read by each member of the following supervisory committee and by majority vote found to be satisfactory. ______________________________ Dr. Taylor Ward, PhD MSRS Faculty ______________________________ Dr. Laurie Coburn, EdD MSRS Radiologist Assistant Program Director ______________________________ Dr. Tanya Nolan, EdD MSRS Medical Imaging Leadership Program Director THE WEBER STATE UNIVERSITY GRADUATE SCHOOL RESEARCH AGENDA STUDENT APPROVAL of a thesis submitted by MSRS Students This thesis has been read by each member of the student research agenda committee and by majority vote found to be satisfactory. Date August 5, 2026 August 5, 2026 August 5, 2026 August 5, 2026 August 5, 2026 August 5, 2026 August 5, 2026 August 5, 2026 ____________________________________ Don Bishop ____________________________________ Sierra Gibbs ____________________________________ Noah Khan ____________________________________ Brandon Loveridge ____________________________________ Paola Robles ____________________________________ Shayla Vornes ____________________________________ Jason Witt __________________________________ Linda Zhao 4 Abstract The lack of standardized orientation frameworks in cardiac catheterization laboratories (cath labs) contributes to high burnout rates, transition shock, and unprecedented turnover among non-physician staff (McCoy, 2024). This study aimed to investigate the effectiveness of current orientation practices and their impact on the self-reported self-efficacy of cath lab personnel. A descriptive, cross-sectional, mixed-methods survey was distributed via Qualtrics to nonphysician cath lab professionals across the United States (N = 35). The survey utilized Benner’s Novice to Expert model to quantitatively measure participants' perceived competence and readiness. Statistical analyses revealed that overall clinical experience and time spent working in the cath lab significantly improved self-efficacy scores F(4, 28) = 2.43. In contrast, structural orientation variables, such as the specific length of the orientation period and the configuration or number of assigned preceptors, showed no statistically significant impact on confidence levels. The findings suggest that successful transition into the cath lab relies less on rigid administrative scheduling formulas and more on accumulating mastery experiences over time. Ultimately, evidence-based orientation programs should shift away from arbitrary time-based milestones and focus on cultivating high-quality mentorship, psychological safety, and supportive, competency-based learning environments to foster lasting clinical self-efficacy. 5 Introduction Background The cardiac catheterization laboratory is a high-acuity environment with unique demands. The staff is generally well-compensated, with the average cardiovascular technologist earning $67,260 annually (U.S. Bureau of Labor Statistics, 2024) and catheterization laboratory nurses averaging $94,480. However, the specialty currently struggles with high turnover rates and a distinct lack of standardized training for new personnel (McCoy, 2024). The daily reality of the job involves mastering complex clinical skills and participating in life-saving interventions, but this is often offset by long working hours and mandatory on-call shifts. Staff members must also navigate difficult interdisciplinary team dynamics, inconsistent orientation models, and constant occupational exposure to radiation. When clinicians move to a new facility, they often find that local protocols and training standards vary significantly from their previous workplace, even though the core procedures are identical. This study evaluates how different catheterization laboratories across the United States of America train their personnel and determines which methods best support clinical selfefficacy and confidence. The research specifically examines the effects of cross-training in related areas like electrophysiology and structural heart interventions. It also compares the resulting reports in the form of self-efficacy, from staff who received on-the-job training against those who completed formal cardiovascular technology education. Data was collected through a mixed-methods survey distributed to non-physician staff from cath lab facilities in the United States and across professional networks, including LinkedIn, ARRT, CCI groups, and relevant Facebook communities. 6 Statement of the Problem While current literature covers the on-site training of many healthcare professionals, there is limited research evaluating orientation effectiveness specifically for non-physician personnel in the cardiac catheterization laboratory. These clinical teams consist of professionals from diverse educational and experiential pathways. Some personnel enter the field with specialized degrees in cardiovascular technology, while others transition from nursing or allied health roles. This study assesses the effectiveness of current training models and evaluates staff preparedness for performing independent clinical duties. The research also compares confidence levels across these various professional backgrounds to identify potential disparities in clinical readiness. Significance of the Problem The lack of standardized orientation for non-physician cardiac catheterization laboratory staff represents a critical gap affecting patient safety, healthcare costs, and workforce retention. With over 1.6 million cardiac catheterization procedures performed annually in the United States of America, inadequate staff training has been consistently identified as a contributing factor in sentinel events (The Joint Commission, 2025). Adherence to standardized best practices and protocols, often instilled through structured orientation programs, is crucial for maintaining safety and quality in the cardiac catheterization laboratory (Naidu et al., 2016). The financial impact is substantial, as common procedural sentinel events carry high costs. These events are often linked to failures to follow established protocols and to inadequate team communication or competence, areas directly addressed by staff preparation and training (Rodziewicz et al., 2024). Cath lab staff turnover is notably high, particularly in the first year, and significantly exceeds general nursing averages. This trend aligns with data indicating that factors such as inadequate preparation or challenging transitions into specialty roles contribute heavily to early departures 7 (NSI Nursing Solutions, 2023). Each departing staff member costs approximately $82,000 to replace, and with a projected shortage of qualified cath lab professionals in the coming years, retention of newly trained staff is critical. Addressing this problem through evidence-based research could establish standardized competency frameworks, align educational curricula with practice requirements, and inform regulatory standards, directly impacting the quality of care for millions of Americans requiring cardiac interventions. Purpose of the Study The purpose of this study was to assess the effectiveness of training and preparedness among non-physician healthcare professionals working in the cath lab. This study sought to measure how “ready” individuals feel to perform their roles during invasive procedures and to determine how training influences their confidence. In addition, it compared differences in readiness across professional backgrounds, recognizing that cath lab staff enter from diverse pathways, including invasive cardiovascular technology programs, nursing, and radiologic sciences. By identifying strengths and gaps in current training practices, this study aimed to provide evidence that can guide the development of standardized training models and educational programs. The ultimate goal was to enhance staff performance, foster professional confidence levels, and improve outcomes in the cath lab. 8 Research Questions To identify the value of current training programs in the cath lab specialty across the United States, the following 7 research questions were asked: 1. How do self-reported self-efficacy scores differ among cardiac catheterization laboratory professionals with varying levels of catheterization laboratory experience? 2. Does the length of the orientation period impact self-reported self-efficacy? 3. Do participants with prior clinical experience differ from those without prior clinical experience in competence after orientation? 4. Does the type of onboarding (formal orientation versus informal/on-the-job training) relate to self-efficacy after orientation? 5. Are there differences in time-to-confidence across specific background types such as ICU nursing, radiology, and respiratory therapy? 6. Is there a correlation between higher volume cath labs and how long orientation is? 7. Is there a difference between having one versus multiple preceptors during orientation and self-efficacy scores? Limitations The limitations for this study include limited access to participants, time constraints, limited funding, skewed data, surveys lacking depth, and sample limitations. We saw limited participation, with some people unwilling to take the time to complete the survey. This research was about 10 months long, which did cause a time constraint on getting the survey out to as many professionals as possible before the deadline. Given that we were students with other obligations, the funding and time we could devote to the research was limited. The data was possibly skewed by participants that selected the more favorable options rather than trying to 9 make the institution or themselves look bad. The survey did consist only of scale questions and a few open-ended options, which lacked depth or probing. With convenience sampling for the survey, we were not able to say that the research represents the entire population. Delimitations This survey was limited to any cath lab personnel in the United States of America. Participants in this survey were limited to cath lab techs and nurses, excluding cath lab physicians; otherwise, there would be no role-specific restrictions. This survey was only to survey persons over the age of 18. This survey was sent out to assess the on-the-job self-efficacy of cath lab personnel after their orientation period. Summary This study aims to examine staff training in cardiac catheterization laboratories across the United States of America. The lack of standardized protocols nationwide contributes to differences in staff preparedness by location, as well as in how professionals in cardiac catheterization labs perceive their readiness. This also complicates identifying the most effective onboarding approaches for new personnel. Using a mixed-methods survey, data was collected from cardiac catheterization technologists and cardiac catheterization lab nurses nationwide to assess the training outcomes of new personnel, as well as their self-readiness and confidence in performing procedures. The study limitations were sample size, response bias, and time constraints, but the responses were expected to provide valuable insights into improving training for cardiac catheterization programs. It did also provide important insight into how to better staff performance, thus supporting patient safety. The following section will review the relevant literature and lay the foundation for the study. 10 Review of Literature Orientation for new staff in the cardiac catheterization lab can be overwhelming due to emergent myocardial infarctions, complex cases, a multitude of stents and catheters, and the dynamics of a multidisciplinary team. When new staff are introduced to the cath lab, they are expected to learn and master scrubbing techniques while maintaining sterility, monitoring patient vitals and hemodynamics, and recording them throughout the case, circulating and grabbing materials needed, and maintaining radiation safety. Orientees not used to the high-paced environment may feel left behind and struggle (Davis-Arnold, 2022a). This review will look at what the literature says about orientation steps and learning expectations in the cath lab; best practices in teaching new staff that may lack confidence by looking at key themes in learning, such as novice to expert; and clinical implications. After reviewing some of the current research on cath lab staff, two common trends emerged: the need for structured, standardized training across cath labs and how the lack of these standards can cause employees to leave the cath lab at a faster rate. In a study of 48 participants, 33% of cath lab staff experienced burnout, characterized by feeling overwhelmed by work or undervalued by management (Alex et al., 2022). In addition to working regularly scheduled hours, many cath lab staff have on-call hours, which can lead to burnout. A survey sent to 232 Veterans Affairs cath lab employees across multiple hospitals showed that employee satisfaction was lower regarding training and feeling supported by management, but higher when employees felt they had a supportive learning environment (Gilmartin et al., 2022). Another issue that is frequently observed across the cath lab is how inconsistent training affects new staff as they enter the lab. Many people start in this environment feeling like novices, yet they are expected to perform at a much higher level almost right away. Benner’s Novice to 11 Expert model helps explain why this is so overwhelming (Benner, 1982). New staff need time, repetition, and guided support before they can build real confidence and judgment (Dreyfus, 2004; Murray et al., 2019). Employees feel unprepared or unsafe, which increases burnout and makes it harder to stay in a long-term role, something that has been seen in other high acuity areas like ICU nursing (Calamante, 2025). Several cath lab-specific articles stress that orientation is not about what content is truly covered, but how much mentorship is actually present (DavisArnold, 2022a; Davis-Arnold, 2022b). When training is consistent and structured, staff feel more supported and capable of ultimately doing their role, which leads to higher satisfaction and lower turnover. Youmans et al. (2022) presents the point that there are so many differing styles with how the cath lab runs currently when compared to how they were a decade ago. Due to the various ways that they can be structured, it is important to note that orientation can vary greatly not only because of the facility itself, but with what the lab encompasses itself. With the labs that include structural heart procedures within the scope of their practice for example, it is important to note that competency can be lacking for some staff members versus others with how much exposure they have to those cases. Volumetrically, higher-volume labs that rotate all the staff out equivocally for transcatheter aortic valve replacements (TAVR’s) versus lower-volume labs that have a dedicated staff for this specific procedure, can actually benefit the lower-volume lab’s staff as they do not need to constantly be retrained on valve preparation. Under these circumstances having a dedicated team could be more effective rather than extending orientation for all new professionals in the cath lab. Currently, education for new staff entering the cardiac catheterization lab is not standardized in practice. The Bagai et al. (2012) study demonstrates that simulation-based training models have been formally tested to aid training, but as it stands, there have not been 12 any established methods utilized in the catheterization lab (Bagai et al., 2012). According to Gilmartin et al. (2022) one example is the development of a “relational playbook for cardiology teams” as a means to build a supportive learning environment within 81 Veterans Affairs cardiac catheterization labs. Once the playbook was completed, it included resources and interventions, such as means of effective communication, creating a positive culture, and learning environment assessment tool–a survey questionnaire that measured how well of a supportive learning environment the catheterization lab has (Gilmartin et al., 2022). As it stands, this playbook is a good start for identifying the necessary training areas for new staff and for continually fostering a positive environment where they feel confident and comfortable. Embarking on a career in a catheterization lab can feel daunting. The position requires adaptation to high-stress scenarios, complex procedures, and tight-knit teamwork. The lack of a nationwide training framework only adds to the mix, stoking burnout and driving turnover to unprecedented levels. According to the research (Alex et al., 2022), 33% of cath‑lab staff described their workload as exhausting and felt they were not valued. Another study surveying Veterans Affairs personnel working in cath labs found a decline in satisfaction, particularly with the quality of training and the support they received from management (Gilmartin et al., 2023). Those results highlight the need for an orientation program to help build competence and confidence in cardiac catheterization labs. 13 METHODS Introduction The purpose of this study was to investigate the effectiveness of orientation training and the perceived readiness of non-physician staff working in cardiac catheterization laboratories across the United States. This research employed a cross-sectional, comparative descriptive survey design using a mixed-methods approach. A quantitative framework serves as the primary methodology, using Likert-scale items to measure perceived competence and readiness, while open-ended qualitative questions enabled deeper exploration of participants' training experiences. The survey instrument consisted of two components. The first section gathered demographic information from participants, including educational background, years of experience, and the orientation structure received. The second section utilized Benner's Novice to Expert model to gauge the confidence level of participants in performing cath lab procedures (Benner, 1982; Dreyfus, 2004)(see the Appendix). This framework categorized skill acquisition into five stages—novice, advanced beginner, competent, proficient, and expert—providing a structured method for participants to self-assess their current level of confidence and selfefficacy within the cardiac catheterization environment (Murray et al., 2019). A survey design was selected because it allows for efficient data collection from a geographically diverse population while enabling comparison across professional backgrounds, including those who completed formal invasive cardiovascular technology programs and those who received on-thejob training from nursing, radiologic sciences, or other healthcare disciplines. 14 Before this research study was conducted, the researchers first obtained Institutional Review Board (IRB) approval (see Appendix A). Participant consent was obtained prior to survey completion (see Appendix B). Target Population The target population for this study was non-physician personnel who currently work or have recently worked in a cardiac catheterization laboratory in the United States. This includes cardiac catheterization technologists and nurses who function in roles such as scrubbing, circulating, and monitoring during invasive cardiovascular procedures. Additionally, cath lab staff enter from diverse educational pathways—including formal invasive cardiovascular technology programs, nursing programs, radiologic sciences, respiratory therapy, and other pathways making this population ideal for comparing training outcomes across different backgrounds. Sampling Strategy This study utilized convenience sampling with snowball recruitment. Convenience sampling was selected due to the specialized nature of the target population and the lack of a centralized registry of cath lab personnel in the United States. Participants were recruited through multiple channels to maximize geographic and institutional diversity: ● Professional social media platforms including LinkedIn groups dedicated to cardiac catheterization and interventional cardiology professionals. ● Facebook groups for cath lab technologists and cardiovascular nurses. ● Cardiovascular Credentialing International (CCI) affiliated groups and forums. ● American Society Radiologic Technologists (ASRT) community pages. 15 ● Word-of-mouth referrals from initial participants. Inclusion criteria: ● Currently employed or previously employed within a U.S. cardiac catheterization laboratory. ● Function in a non-physician clinical role (technologist, nurse, or allied health professional). ● Age 18 years or older. ● Have functioned independently in a clinical role in a U.S cardiac catheterization lab, with either formal education or on the job training. Exclusion criteria: ● Physicians, fellows, or medical residents. ● Individuals under 18 years of age. ● Personnel who work haven’t worked in a cardiac cath lab (e.g., echocardiography, stress testing). ● International cath lab personnel working outside the United States of America. Instrumentation To ensure that the survey accurately measured the constructs of the effectiveness of orientation training and the perceived readiness of non-physician staff working in cardiac catheterization laboratories across the United States, a survey was deployed consisting of a demographic portion, which included 11 multiple-choice questions and 1 open-ended question, and a Beginners to Expert portion that includes 8 multiple-choice questions and 4 open-ended questions. These questions were based on an extensive literature review of orientation, training, and learning models for healthcare professionals and cardiac catheterization staff. 16 The primary data collection process was a structured survey designed to capture quantitative and qualitative data from the participants. The survey process is widely used for gathering research because it allows us to standardize information from large groups in a costeffective and timely manner (Creswell & Cresswell, 2018). The survey was designed according to Dillman's Taylor Design Method, which emphasizes brevity and clarity to improve response quality and completion rates; this allowed for the survey to have maximized the information gathered and minimized the time required to participate (Dillman et al., 2014). The first section of the survey was designed to collect demographic information such as age, locations worked, educational or training background, and professional role. According to Fowler (2014), survey errors most often result from non-sampling errors due to poor design, failure to minimize respondent burden, ambiguous language, and open-ended questions that lead to varied interpretation. The survey questions were designed to be closed-ended to ensure consistency and ease of analysis. To gauge participants' confidence levels, the survey included items from Benner’s Novice to Expert model. Benner’s model has been widely used as a framework for nursing and other health professions to develop clinical competencies and the developmental progression of confidence. According to Thomas and Kellgren (2017), the novice-to-expert model has been successfully adapted in numerous studies to assess clinical staff confidence, growth, and skill development. There were also open-ended questions, so participants could input their own thoughts outside the scale, and any apparent trends can be extracted for further analysis alongside the scale. 17 The survey was administered through Qualtrics, a secure web-based data collection platform widely used in academic and healthcare research. It was chosen because this platform supports customizable question formats, complex surveys, and integration of both quantitative and open-ended responses. Its interface is user-friendly and it allowed researchers to minimize respondent burden while maximizing data. Qualtrics is recognized for its data security features, including compliance with institutional privacy standards such as FERPA and HIPAA, safeguarding participants' information (Qualtrics, 2023). Validity Content validity was established through expert review. We presented the questions to subject matter experts, experienced cardiac cath lab professionals, who reviewed the orientation curriculum and assessment tools. These questions were reviewed for clarity and relevance and then revised based on the feedback received. Face validity was established through a pilot test with individuals familiar with the cardiac catheterization lab and the orientation process. These individuals were not part of the final survey. These individuals were asked to comment on the readability, clarity, and relevance of the questions, as well as provide any other feedback to improve the survey questions. Reliability Reliability of the survey was assessed using the Likert scale in conjunction with Cronbach’s alpha. To quantitatively measure participants' perceived readiness and confidence, a composite variable for "self-efficacy" was computed prior to hypothesis testing. This continuous variable was created by calculating the mean score of the eight Likert-scale items adapted from Benner’s Novice to Expert model within the survey instrument. To ensure that these combined items reliably measured the same underlying construct, an internal consistency reliability 18 analysis was conducted. The results yielded a Cronbach's alpha of .80 across the eight items. This value exceeds the generally accepted threshold of .70, demonstrating a high level of internal consistency and confirming that the calculated self-efficacy variable is highly reliable for statistical evaluation. This allowed us to demonstrate that the survey question responses were related to orientation and training. Data Collection To collect data, we used a mixed-methods research design, consisting of a survey with multiple-choice and open-ended questions. This survey consisted of a demographic portion, which included 11 multiple-choice questions and 1 open-ended question, and a Beginners to Expert portion that included 8 multiple-choice questions and 4 open-ended questions (see Appendix A and B). The survey was distributed in April 2026 and remained open until June 2026, as IRB approval was received. The survey was distributed through outlets such as the Cath Lab LinkedIn group and the Cath Lab Lounge Facebook page. It was posted to these groups via a URL link that any cath lab professional can access and take the survey. The survey was open to any cath lab staff, excluding physicians and minors. It was estimated that the survey will take approximately five minutes to complete. Ethical concerns that were considered included participants being worried about their survey responses not being anonymous. Steps were taken to ensure that all participants remained anonymous promoting voluntary participation, and preventing bias. The names of the participants and which facility they are employed at was not asked on the survey to ensure anonymity. 19 Voluntary participation was completed through public distribution of the survey and participants had to complete the survey on their own, without any incentives or coercion. We prevented bias in participants' answers by not including leading questions, so the results were not skewed. See Appendix A for Demographic Survey. See Appendix B for Confidence Assessment (Benner’s Novice to Expert Model). Data Analysis To address each research question, specific statistical procedures were selected based on the type of variables involved and the relationships being examined. Research Question 1 examined how self‑reported self‑efficacy scores differ among cardiac catheterization laboratory professionals with varying levels of cath lab experience. The dependent variable was the composite self‑efficacy score, and the independent variable was time spent working in the cath lab. A one‑way ANOVA was planned because this question compares self‑efficacy across multiple experience‑level groups. Research Question 2 evaluated whether the length of the orientation period impacts self‑reported self‑efficacy. The dependent variable was the composite self‑efficacy score, and the independent variable was orientation length. A one‑way ANOVA was selected to compare self‑efficacy across different orientation‑length categories. Research Question 3 explored whether participants with prior clinical experience differ from those without prior experience in competence after orientation. Competence (dependent variable) was measured using the Benner composite score, and prior experience (independent variable) was categorized by background type (e.g., RCIS, RTR, RN). Because this question compares competence across multiple background categories, a one‑way ANOVA was planned. 20 Research Question 4 assessed whether the type of onboarding (formal orientation vs. informal/on‑the‑job training) relates to self‑efficacy after orientation. The dependent variable was the composite self‑efficacy score, and the independent variable was onboarding type. Because the onboarding type has two categories, an independent-samples t‑test was selected. Research Question 5 investigated whether time‑to‑confidence differs across specific background types such as ICU nursing, radiology, and respiratory therapy. Both variables were categorical, so a chi‑square test of independence was planned to determine whether the distribution of time‑to‑confidence varies by background. Research Question 6 examined whether there is a correlation between cath lab case volume and orientation length. Orientation length was treated as the dependent variable, and case volume as the independent variable. A Pearson correlation was selected to evaluate the linear relationship between these two continuous variables. Research Question 7 evaluated whether having one versus multiple preceptors during orientation relates to self‑efficacy scores. The dependent variable was the composite self‑efficacy score, and the independent variable was preceptor configuration. Because this question compares self‑efficacy between two groups, an independent sample t test was planned. Ethical Considerations The primary ethical consideration for the study was ensuring participation is fully voluntary and based on informed consent. At the start of the online survey, participants were presented with an information statement describing the purpose of the study, procedures involved, the voluntary nature of participation, risks and benefits, and contact information for the research team. Participants were then asked to indicate whether they consent to participate by 21 selecting yes to proceed or no to terminate the survey. Participants were free to exit the survey at any time without penalty, and incomplete responses were not used. To ensure participants' anonymity, no names, email addresses, or other direct personal identifiers were collected within the survey. Demographic and professional background information were limited to the minimum necessary to address the research questions. All data collected was stored on secure, password-protected systems accessible only by the research team. Any potentially identifying free text responses were reviewed and, if necessary, de-identified prior to analysis or dissemination. All results were presented in group form only, and no individual participant or institution will be identified in any reports, presentations, or publications arising from the study. Results Introduction The purpose of this study was to examine the orientation experiences, preparedness, and perceived confidence of cardiac catheterization laboratory professionals across the United States. Orientation quality, team culture, and learning environment are known to influence clinical performance, safety outcomes, and staff well‑being in high‑acuity procedural areas such as the cath lab (Alex et al., 2022; Davis‑Arnold, 2022a, 2022b; Gilmartin et al., 2022, 2023). Because cath lab work requires rapid decision making, technical proficiency, and interdisciplinary communication, understanding how new staff transition into this environment is essential for improving training structures and reducing preventable errors (Rodziewicz et al., 2024; The Joint Commission, 2025). The conceptual foundation for this analysis draws on Benner’s (1982) Novice to Expert model, the Dreyfus model of skill acquisition (Dreyfus, 2004), and transition‑to‑practice 22 literature describing the challenges faced by clinicians entering specialty practice (Murray et al., 2019). Bandura’s (1977) theory of self‑efficacy further supports the examination of how confidence develops through mastery experiences, social support, and feedback. Survey Design and Analytic Approach A descriptive, cross‑sectional survey design was used to collect quantitative and qualitative data from practicing cardiac catheterization laboratory professionals. The survey instrument was administered electronically using Qualtrics, a secure, web‑based platform commonly used in academic and healthcare research. The survey included categorical items, Likert‑scale measures, and open‑ended questions. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize quantitative responses. Qualitative responses were reviewed for recurring themes related to orientation challenges, preparedness, and confidence development. Survey Outreach and Sample Size The survey received 55 total submissions through Qualtrics. After data cleaning procedures, including removal of incomplete responses, responses that completed the survey in under 150 seconds (2.5 Minutes), unnecessary extra data, and variable name cleanup, 35 completed responses remained and were included in the final analysis. All included respondents completed the full survey and met the inclusion criteria. This approach aligns with recommended practices for survey‑based research, which emphasize analyzing only complete and valid cases to ensure accuracy and reliability (Dillman et al.,2014). 23 Demographics The reported mean age was between 26 and 35 years old (M = 2.77, SD = 0.97). The reported gender distribution indicated most respondents identified as female ( M = 1.80, SD = 0.41). Professional Characteristics The primary position that was reported indicated that technologists represented the largest group (M = 1.66, SD = 0.48), followed by nurses. Primary roles reported by respondents included scrubbing (28 respondents), monitoring (21 respondents), and circulating (17 respondents), with an additional three respondents selecting “other.” These findings indicate that cross‑training is common in cardiac catheterization laboratories, as many professionals perform multiple roles depending on procedural needs. Then most respondents indicated that they had 1 to 3 years of experience (M = 3.11, SD = 1.13). Prior Clinical Experience As part of the demographic analysis, respondents also reported a wide range of professional backgrounds before entering the cardiac catheterization laboratory. The most common entry pathways were radiologic technology (RTR; 14 respondents) and registered nursing (RN; 11 respondents), followed by cardiovascular technologist (CVT; 4 respondents), registered cardiovascular invasive specialist certification (RCIS; 3 respondents), emergency medical technician–paramedic (EMT‑P; 1 respondent), and respiratory therapy (RRT; 1 respondent). An additional four respondents selected “other” as their background. These distributions indicate that RTR and RN remain the predominant feeder professions into the cath 24 lab workforce, aligning with national workforce patterns reported by the U.S. Bureau of Labor Statistics (2024). Case Volume of First Cath Lab The mean case‑volume category was 2.71 (SD = 0.93), with a mode of 3, indicating that most respondents were trained in moderate‑ to high‑volume labs. Orientation Structure Introduction to the Cath Lab The mean introduction type was 1.14 (SD = .36), with a mode of 1, indicating that most respondents received on‑the‑job training rather than structured classroom instruction. Role Structure in the Lab Respondents reported the following staffing models: Only nurses can circulate: 6 respondents Cross‑trained to all roles: 12 respondents This reflects the national variability in cath lab staffing models and supports the need for standardized orientation frameworks. Competency and Confidence Scales The survey included eight Likert‑scale measures assessing competencies such as prioritization, adaptability, mentoring, patient assessment, managing multiple demands, experience level, communication, and outcome evaluation. These variables were used to 25 calculate the self-efficacy variable score. The descriptive statistics for these scales were added since analysis of the remaining SPSS output is complete. Summary Overall, the descriptive results indicate that the sample consisted primarily of early‑career cath lab professionals, most of whom were technologists or nurses with prior clinical experience in ICU, ER, or radiology. Respondents commonly performed multiple roles in the cath lab and typically received on‑the‑job training rather than structured classroom‑based orientation. These findings align with national reports describing variability in cath lab staffing, training, and workflow (Davis‑Arnold, 2022a, 2022b; Gilmartin et al., 2022). Research Question 1 - How do self-reported self-efficacy scores differ among cardiac catheterization laboratory professionals with varying levels of catheterization laboratory experience? A one-way analysis of variance (ANOVA) was conducted to examine whether selfreported self-efficacy scores differed by length of time working in the cardiac catheterization laboratory. Mean self-efficacy scores were compared across the time-in-lab groups to determine whether statistically significant differences existed among participants with varying levels of experience in the cardiac catheterization laboratory. Mean self-efficacy scores increased across experience groups. Participants with less than 6 months of experience reported the lowest mean self-efficacy score (M = 4.13). In contrast, higher means were observed among more experienced groups (1-3 years: M = 4.59, SD = 0.37; 20+ years: M = 4.94, SD = 0.15). The total sample mean was 4.71 (SD = 0.38). See Table 1 for descriptive statistics. The one-way ANOVA showed a 26 statistically significant difference in self-efficacy scores across experience groups. F(4, 28) = 2.43, 𝜔𝜔2 = .041 (see Table 2). Table 1 Descriptive Statistics by Experience Group Length of Experience N M SD SE in Cath Lab 95% CI 95% CI Lower Upper Less than 6 months 1 4.13 1–3 years 8 4.59 0.37 0.13 4.28 4.90 4–10 years 14 4.71 0.35 0.09 4.51 4.92 11–20 years 4 4.94 0.13 0.06 4.74 5.14 20+ years 6 4.94 0.15 0.06 4.78 5.10 Total 33 4.74 0.34 0.06 4.62 4.86 27 Table 2 One-Way ANOVA for Self-Efficacy Scores Between Experience Levels SS df MS F p Between Groups .95 4 .24 2.43 .071 Within Groups 2.73 28 .098 Total 3.68 32 Research Question 2 - Does the length of the orientation period impact self-reported selfefficacy? A one-way analysis of variance (ANOVA) was conducted to examine whether selfreported self-efficacy metrics differed based on the length of the orientation period (df = 3, 29) (see Table 3). Based on the one-way analysis of variance (ANOVA), there was no significant difference in self-efficacy levels across participants' orientation lengths, F(3, 29) = 0.934, p = .437, ω² = -.006. See Table 3 for descriptive statistics. The mean self-efficacy scores ranged from M = 5.00 with no variance for less than 2 weeks, M = 4.46 (SD = 0.51) for 2 weeks to 1 month , M = 4.77 (SD = 0.34) for 1 month to 3 months, and M = 4.74 (SD = 0.28) for 3 months or more . The overall mean and standard deviation of self-reported self-efficacy scores were M = 4.73 and SD = .34. 28 Table 3 One-Way ANOVA for Self-Efficacy by Orientation Length Orientation Length N Mean (M) Std. Deviation (SD) Less than 2 weeks 1 5.00 - 2 weeks - 1 month 3 4.46 0.51 1 - 3 months 20 4.77 0.34 3+ months 9 4.74 0.28 Total 35 4.73 0.34 Research Question 3 - Do participants with prior clinical experience differ from those without prior clinical experience in competence after orientation? The planned one-way analysis of variance (ANOVA) was intended to examine whether self-reported competence after orientation differed between participants with and without prior clinical experience. However, descriptive analysis revealed that only one participant reported having no prior clinical experience, whereas the remaining participants reported at least one type of prior clinical experience. Because the "no prior experience" group consisted of a single 29 participant (N = 1), the assumptions necessary for a meaningful one-way ANOVA were not met. Specifically, the extremely unequal group sizes prevented a reliable estimate of within-group variability and substantially reduced the validity of any statistical comparison. Consequently, the planned ANOVA comparing participants with and without prior clinical experience was deemed inappropriate for interpretation. Research Question 4 - Does the type of onboarding (formal orientation versus informal/onthe-job training) relate to self-efficacy after orientation? An independent-samples t-test was performed to determine whether self-efficacy scores differed between staff with informal on-the-job training and those with formal education. The assumption of homogeneity was not met, as there were only 5 responses that chose the formal education option as opposed to the 30 responses that chose on-the-job training, as seen in Levene’s Test (p = .042). There was not a statistically significant difference (t = .893, p = .148) in self-efficacy scores between staff who received on-the-job training (M = 4.77, SD = 0.50) and those who received formal education (M = 4.40, SD = .89) (see Table 4). This may be due to the sample size of the formal education group (N = 5). Table 4 Descriptive Statistics and t test Results for Onboarding Type 30 Research Question 5 - Are there differences in time-to-confidence across specific background types such as ICU nursing, radiology, and respiratory therapy? A Chi-Square Test of Independence was conducted to examine the relationship between specific prior clinical backgrounds and the time required for participants to feel confident performing their roles independently after cath lab orientation. To facilitate the analysis, time-toconfidence was collapsed into two categorical milestones: "Fast Adapters" (0 to 6 months) and "Slower Adapters" (greater than 6 months). The assumption of expected frequencies was violated, with 75.0% of cells having an expected count of less than 5 (minimum expected count = .44) due to the limited overall sample size (N = 34) and the distribution across six distinct clinical backgrounds. While the statistical output indicates a significant and strong relationship between prior clinical experience and time-to-confidence, (χ2(5) = 15.589, p = .008, Cramer’s V = .677), Registered Nurses and Cardiovascular Technologists achieve role confidence faster (0– 6 months) than imaging-centric specialists like Radiologic Technologists, see Table 5. These inferential results must be interpreted with extreme caution. The low number of participants in several specific background categories limits the statistical power of the test. 31 Table 5 Crosstabulation of Prior Clinical Background by Time to Confidence Fast Adapters Slower Adapters (0–6 months) (>6 months) Radiologic Technologist (RTR) 3 11 14 Registered Nurse (RN) 8 3 11 Prior Clinical Background Total (Table 5 continues) (Table 5 continued) Prior Clinical Background Cardiovascular Technologist Fast Adapters Slower Adapters (0–6 months) (>6 months) 4 0 4 3 0 3 Total (CVT) Reg. Cardiovascular Invasive Spec. (RCIS) 32 Paramedic (EMT-P) 0 1 1 Respiratory Therapist (RRT) 1 0 1 Total 19 15 34 Note. Fast Adapters = 0 to 6 months to feel confident; Slower Adapters = greater than 6 months. χ2(5, N = 34) = 15.59, p = .008, Cramer's V = .68. The assumption of expected frequencies was violated due to limited sample sizes in several subgroups. Research Question 6 - Is there a correlation between higher-volume cath labs and the duration of orientation? The Pearson correlation coefficient was used to determine whether there was a correlation between higher-volume catheterization labs and orientation duration. Pearson correlation analysis revealed no statistically significant relationship between annual cath lab case volume and the duration of the orientation period (r = –.72, p = .681) (see Table 6). Table 6 Pearson Correlation Between Orientation Length and Annual Case Volume Variable r p N Orientation Length -.72 .681 35 33 Research Question 7 - Is there a difference between having one versus multiple preceptors during orientation and self-efficacy scores? A one-way analysis of variance (ANOVA) was conducted to examine whether selfefficacy metrics differed based on the preceptor assignment structure designated during the initial training phase. The analysis revealed no statistically significant difference in self-efficacy scores across the four preceptor cohorts, F(3, 29) = 1.30, p = .294. The effect size indicated that approximately 11.8% of the variance in self-efficacy scores was accounted for by the preceptor arrangement (η² = .118). As shown in Table 7, respondents who trained under one consistent preceptor exhibited the highest mean self-efficacy score (M = 4.86, SD = 0.19). In contrast, those with no assigned preceptor reported the lowest mean score (M = 4.56, SD = 0.62). These findings suggest that while a consistent preceptor may slightly elevate self-reported confidence, the overall number of instructors designated during orientation did not significantly impact overall self-efficacy levels among the sample. 34 Table 7 Self-Efficacy Scores by Preceptor Configuration Preceptor Configuration n M SD I had one consistent preceptor 15 4.86 0.19 I had 2-3 preceptors who rotated 7 4.66 0.27 I had multiple preceptors (little 9 4.63 0.49 I did not have an assigned preceptor 2 4.56 0.62 Total 33 4.73 0.34 consistency) 35 Discussion and Conclusion Discussion The primary objective of this study was to assess the effectiveness of orientation training and perceived clinical readiness among non-physician professionals in the cardiac catheterization laboratory. By analyzing various onboarding structures, clinical backgrounds, and mentorship models, several distinct themes emerged regarding how these clinicians develop self-efficacy in a highly acute environment. The Impact of Prior Clinical Experience and Time A major finding of this study relates to how prior clinical backgrounds dictate the speed at which new staff adapt to the catheterization laboratory. While the research initially sought to compare post-orientation competence between clinicians with and without prior clinical experience, the overwhelming majority of the sample entered the specialty already possessing a robust clinical background. Although this demographic distribution prevented a direct statistical comparison between true novices and experienced clinicians, the data did reveal a statistically significant, strong association between a clinician's specific type of prior background and their overall adaptation speed (Cramer’s V = .68). Professionals with heavy emphasis on critical care, invasive procedures, and direct acute patient care, specifically Registered Nurses and Cardiovascular Technologists, achieved role confidence significantly faster than imaging-centric specialists like Radiologic Technologists. This suggests that foundational skills in hemodynamic monitoring and acute patient assessment provide a distinct advantage during the initial transition period. 36 Furthermore, while statistical significance was not reached across all experience groups, overall self-efficacy scores consistently increased the longer an employee worked in the laboratory. This observed trend aligns with Bandura’s (1997) Social Cognitive Theory, which identifies mastery experiences as the primary source of self-efficacy. As staff gain hands-on experience managing complex clinical scenarios over time, their clinical confidence naturally strengthens. These insights highlight the value of shifting away from universal orientation timelines and moving toward tailored, background-specific training pathways that accommodate distinct learning curves. Orientation Structure, Duration, and Training Pathways When examining the administrative structure of orientation, the data suggests that rigid metrics like duration and facility volume do not inherently dictate staff readiness. There was no statistically significant relationship between annual case volume and the length of a facility's orientation period. As noted by Youmans et al. (2022), modern catheterization laboratories have evolved into highly complex, variable environments, sometimes incorporating electrophysiology or interventional radiology. Because of this variety, higher-volume labs may rotate staff evenly across complex cases, while lower-volume labs might rely on dedicated specialty teams. Consequently, an orientation's length is highly dependent on a facility's specific scope of practice rather than its overall volume. Similarly, the study found no statistically significant difference in self-efficacy scores based on the specific duration of the orientation period or whether the onboarding pathway was formal versus informal. The lack of statistical difference suggests that the clinical learning environment carries significantly more weight than an administrative timeline. Current literature 37 heavily supports prioritizing program quality over length. Weise and Bennett (2022) demonstrated that programs emphasizing personalized feedback and ongoing direct observation are highly successful at preparing new employees to integrate into clinical environments. This reinforces the survey findings that clinical self-efficacy is driven by the actual orientation experience rather than an arbitrary duration. Mentorship and the Learning Environment The structural approach to preceptorship further reinforces the importance of environmental quality over administrative formulas. The analysis indicated no statistically significant difference in overall self-efficacy scores based on whether a new hire was assigned a single, consistent preceptor or rotated among multiple educators. While descriptive statistics showed a slight trend favoring a consistent preceptor, the inferential results demonstrate that administrators have the flexibility to utilize multi-preceptor models without compromising a new hire's final clinical confidence. These findings suggest that successful orientation relies less on preceptor headcounts and more on the collective culture of the department. This aligns directly with Gilmartin et al. (2022), who demonstrated that supportive learning environments within Veterans Affairs facilities yielded significantly higher rates of job satisfaction. Rather than isolating new staff to a single mentor, departments can maintain adaptable staffing schedules provided that the entire training team fosters psychological safety and provides consistent, targeted feedback (Davis-Arnold, 2022a). 38 Limitations These findings must be interpreted with caution due to several methodological constraints. The most significant limitation is the small sample size (N = 35), which severely restricted statistical power. In the analysis of prior clinical backgrounds, the limited sample caused a severe violation of the Chi-Square assumption of expected cell frequencies, elevating the risk of inferential error. Additionally, calculating correlations related to orientation length and facility volume proved difficult due to recall bias, as many actively working participants struggled to accurately remember the specific annual case volume from their initial training period years prior. Furthermore, the study intended to compare outcomes between clinicians with and without prior clinical experience; however, the highly skewed demographic distribution, where nearly all respondents possessed prior clinical backgrounds, prevented reliable comparative analysis on this specific variable. Conclusion Ultimately, this study demonstrates that building clinical confidence in the cardiac catheterization laboratory is a multifaceted process driven by prior acute care experience and continuous mastery rather than rigid administrative schedules. Exposure to multiple educators or informal training pathways does not statistically hinder a clinician's final self-efficacy, allowing departments vital flexibility during the onboarding process. Future Research Future research must prioritize expanded recruitment timelines to obtain more participants to take the survey for a more accurate representation, with greater transparency 39 about what can be considered outliers. Specifying and rewording some questions will also be beneficial for gaining more insight and obtaining more accurate data. There were also some questions left unanswered in some survey responses, leading to incomplete data that cannot be fully extrapolated. Researchers should also ask additional questions about other factors that may affect selfefficacy after orientation, such as the quality of orientation, preceptorship effectiveness, and organizational support. An important area for future study involves exploring how academic preparation influences readiness for practice in cardiac catheterization laboratories. Given that participants in this study entered the field through different educational routes, it would be beneficial to examine whether graduates of programs offering Registered Cardiovascular Invasive Specialist education demonstrate greater initial confidence or faster adaptation compared to those transitioning from radiography or nursing backgrounds. Because RCIS programs vary widely in curriculum structure, clinical hours, and simulation exposure, evaluating these differences may help identify which educational models best support early competence (Calamante, 2025). Another important direction is to examine academic pathways that prepare learners for the ARRT Cardiovascular Interventional credential. These programs often include coursework and clinical rotations focused on sterile technique, hemodynamics, and interventional workflows. Future studies should compare graduates of ARRT CVI-aligned programs with those who enter the cardiac catheterization laboratory without formal cardiovascular training to determine whether structured CVI preparation reduces early confidence gaps or improves procedural readiness. Future research should also investigate how partnerships between academic institutions 40 and clinical sites influence learner development. Collaborative models that integrate simulation, competency-based curricula, and early exposure to invasive procedures may help bridge the gap between classroom learning and real-world practice. Mixed-methods designs that incorporate interviews with educators, preceptors, and new graduates could provide deeper insight into how academic preparation shapes early confidence and performance (Gilmartin et al., 2023). Additional research should examine how credentialing pathways influence retention, psychological safety, and long-term career development. Because self-efficacy is linked to burnout and turnover, studies that evaluate whether CCI or ARRT preparation improves workforce stability would provide valuable information for administrators and educators. This aligns with findings from Alex et al. (2022), who reported that 33% of cardiac catheterization staff experienced burnout related to workload and inadequate support. Future studies may also benefit from longitudinal designs that follow learners from academic programs through their first year of practice. Tracking the development of confidence over time would help identify the point at which learners transition from novice to advanced beginner, consistent with Benner’s (1982) model of skill progression. These designs could also clarify how academic preparation interacts with the structure of orientation, mentorship quality, and clinical exposure. These directions for future research will help clarify how educational pathways, credentialing preparation, and academic-clinical partnerships contribute to the development of confident and competent cardiac catheterization professionals. 41 References Alex, J., Wang, S., & Naidu, S. S. (2022). Burnout of support personnel in the cardiac catheterization laboratory. Cardiology Research, 13(5), 263–270. https://doi.org/10.14740/cr1419 Bagai, A., O’Brien, S., Al Lawati, H., Goyal, P., Ball, W., Grantcharov, T., & Fam, N. (2012). Mentored simulation training improves procedural skills in cardiac catheterization. Circulation: Cardiovascular Interventions, 5(5), 672–679. https://doi.org/10.1161/circinterventions.112.970772 Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Advances in Behaviour Research and Therapy, 1(4), 139–161. https://doi.org/10.1016/01466402(78)90002-4 Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman. Benner, P. (1982). From novice to expert. The American Journal of Nursing, 82(3), 402–407. https://doi.org/10.2307/3462928 Calamante, Z. (2025). Exploring the lived experience of intensive care unit nurses in their first year post training: A qualitative inquiry into knowledge gaps and educational needs (Doctoral dissertation, Charleston Southern University). ProQuest Dissertations and Theses Global. (Publication No. 3192209947). Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications. 42 Davis-Arnold, S. (2022a, January). We need to start an educational conversation: Frameworks for orientation success in the cardiac catheterization lab (Part I). Cath Lab Digest, 30(1), 22. Davis-Arnold, S. (2022b, February). Continuing an educational conversation: Functionality and implementation for orientation success in the cardiac catheterization lab (Part II). Cath Lab Digest, 30(2), 26–28. Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed.). John Wiley & Sons. Dreyfus, S. E. (2004). The five-stage model of adult skill acquisition. Bulletin of Science, Technology & Society, 24(3), 177–181. https://doi.org/10.1177/0270467604264992 Fowler, F. J. (2014). Survey research methods (5th ed.). SAGE Publications. Gilmartin, H. M., Connelly, B., Hess, E., Mueller, C., Plomondon, M. E., Waldo, S. W., & Battaglia, C. (2023). Developing a relational playbook for cardiology teams to cultivate supportive learning environments, enhance clinician well being, and veteran care. Learning Health Systems, 8(2), Article e10383. https://doi.org/10.1002/lrh2.10383 Gilmartin, H. M., Hess, E., Mueller, C., Connelly, B., Plomondon, M. E., Waldo, S. W., & Battaglia, C. (2022). Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories. Health Services Research, 57(2), 385–391. https://doi.org/10.1111/1475-6773.13907 Gilmartin, H. M., Hess, E., Mueller, C., Plomondon, M. E., Waldo, S. W., & Battaglia, C. (2020). A pilot study to assess the learning environment and use of reliability enhancing work practices in VHA cardiac catheterization laboratories. Learning Health Systems, 5(2), Article e10227. https://doi.org/10.1002/lrh2.10227 43 Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover—a 10-element onboarding program intervention. SAGE Open Nursing, 3, 1–13. https://doi.org/10.1177/2377960817697712 Leonardsen, A.-C. L., Husebø, S. E., Hall-Lord, M. L., & Friberg, F. (2023). The impact of clinical experience in advanced practice nursing education: A cross-sectional study of Norwegian advanced practice nurses’ perspectives. Nursing Reports, 13(3), 1304–1317. https://doi.org/10.3390/nursrep13030113 McCoy, A. (2024, November 4). How much do cardiac catheterization laboratory nurses make? NursingEducation. https://nursingeducation.org/careers/cardiac-catheterizationlaboratory-nurse/salary/ Murray, M., Sundin, D., & Cope, V. (2019). Benner’s model and Duchscher’s theory: Providing the framework for understanding new graduate nurses’ transition to practice. Nurse Education in Practice, 34, 199–203. https://doi.org/10.1016/j.nepr.2018.12.003 Naidu, S. S., Aronow, H. D., Box, L. C., Duffy, P. L., Kolansky, D. M., Kupfer, J. M., Latif, F., Moulton, M. J., Rao, S. V., Swaminathan, R. V., & Wenger, N. K. (2016). SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory. Catheterization and Cardiovascular Interventions, 88(3), 407–423. https://doi.org/10.1002/ccd.26551 NSI Nursing Solutions. (2023). 2023 NSI national health care retention & RN staffing report. Workplace Change. https://www.wpchange.org/resources/2023-nsi-national-health-careretention-rn-staffing-report 44 Orientation of medical trainees to a new clinical environment (the Ready-Steady-Go model): A constructivist grounded theory study. (n.d.). PubMed Central. Retrieved July 5, 2026, from https://www.ncbi.nlm.nih.gov/pmc/ Qualtrics. (2023, March 2). XM for strategy and research. https://www.qualtrics.com/strategy/ Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2024). Medical error reduction and prevention. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK592394/ The Joint Commission. (2025). Sentinel event data 2024 annual review. https://digitalassets.jointcommission.org/api/public/content/eac7511986c0442a9c1ae04b1 aa02cc0?v=ad34daa0 Thomas, C. M., & Kellgren, M. (2017). Benner’s novice to expert model: An application for simulation facilitators. Nursing Science Quarterly, 30(3), 227–234. https://doi.org/10.1177/0894318417708410 U.S. Bureau of Labor Statistics. (2024). Cardiovascular technologists and technicians. Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/cardiovasculartechnologists-and-technicians.htm Youmans et al., (2022, April). Turnover of cath lab staff: Is complexity to blame? Cath Lab Digest, 30(4). https://www.hmpgloballearningnetwork.com/site/cathlab/ 45 Appendices Appendix A - Demographic Survey 1. Age: ○ 18-25 ○ 25-35 ○ 35-45 ○ 45-55 ○ 55-65 2. Prior experience before being employed in the Cath Lab: (select all that apply) ○ RN, ○ RTR, ○ RRT, ○ EMT-P, ○ RCIS, ○ CVS, ○ Other (please explain) 3. Which States have you practiced in while working in the Cath Lab (Select all that apply) 4. How would you describe your introduction to Cath Lab? ○ Formal education in Cath Lab (CVT, MSRS, etc) ○ On-the-job training ○ Primarily-self directing learning ○ Other 46 5. Which of the following describes the Cath Labs you have been employed in regarding staff roles? ○ Staff are cross-trained to all roles regardless of discipline, ○ only nurses can give medications, 6. How would you describe orientation to the Cath Lab as a new employee at the facilities where you have been employed? ○ Strictly on-the-job training while doing cases, ○ Formal classroom time to introduce basic concepts followed by practice with a preceptor during cases, 7. When you found yourself in a situation where you weren’t prepared after orientation, what resources did you have to help you get through the situation? ○ Preceptor/Mentor as a guide ○ Referenced books/online 8. How long was your orientation period when you first started working in the Cath Lab? ○ Less than 2 weeks ○ 2–4 weeks ○ 1–3 months ○ 3–6 months ○ More than 6 months 9. During your orientation, how would you describe your preceptor assignment? ○ I had one consistent preceptor throughout orientation ○ I had 2–3 preceptors who rotated ○ I had multiple preceptors with little consistency 47 ○ I did not have an assigned preceptor 10. What is the approximate annual case volume of the Cath Lab where you currently or most recently worked? ○ Low volume (fewer than 500 cases/year) ○ Moderate volume (500–1,000 cases/year) ○ High volume (1,000–2,000 cases/year) ○ Very high volume (more than 2,000 cases/year) ○ Unsure 11. After completing orientation, how long did it take before you felt confident performing your role independently without regular assistance? ○ Immediately after orientation ○ 1–3 months ○ 3–6 months ○ 6–12 months ○ More than 1 year ○ I still do not feel fully confident 12. If you could change one thing about your Cath Lab orientation experience, what would it be? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 48 Appendix B - Confidence Assessment (Benner’s Novice to Expert Model) Likert scale: 1 = Strongly Disagree, 5 = Strongly Agree ● I feel confident in my ability to prioritize tasks effectively. I can independently make clinical decisions in complex situations. ● I feel comfortable adapting to unexpected changes in patient needs. I can anticipate potential complications before they occur. ● I feel confident mentoring or guiding less experienced colleagues. ● I can recognize subtle changes in patient conditions without prompting. ● I feel confident managing multiple competing demands simultaneously. ● I can apply past experiences to inform current clinical decisions. ● I feel confident communicating effectively with interdisciplinary teams. ● I can evaluate the outcomes of my decisions and adjust accordingly. Open ended questions (Benner’s Novice to Expert Model) ● During orientation, please describe what was most difficult to grasp. (Case sequence, instrumentation, patient preparation, etc.) ● Immediately after orientation, what did you feel least prepared for? (Codes, medications, panning, etc.) ● What factors most influence your confidence level in your current role? ● If you could change one thing about your Cath Lab orientation experience, what would it be? 49 Appendix C - Qualtrics Link: To edit: Edit Survey | Qualtrics Experience Management To respond to: https://qualtricsxm2rh7vrlr3.qualtrics.com/jfe/form/SV_en6LYQkMXtgwDk2 50 Appendix D - Survey Information Letter Subject: Invitation to Participate in a Cardiac Catheterization Lab Training Study Dear Prospective Participant, You are invited to participate in a research study examining orientation training and perceived readiness among non‑physician staff working in cardiac catheterization laboratories across the United States. The purpose of this study is to explore how different training pathways influence confidence and competence among professionals working in the Cath lab environment. This study uses a cross-sectional, comparative descriptive survey design with a mixed‑methods approach. Participants will complete a brief online survey containing both multiple‑choice questions and optional open‑ended responses. The survey includes two sections: 1. Demographic and professional background information, such as education, years of experience, and the type of orientation or training received; and 2. Self‑assessment of perceived competence and readiness, based on Benner’s Novice to Expert framework for skill acquisition. Your participation will help researchers better understand nationwide training practices and identify opportunities to improve orientation processes for staff entering the cardiac catheterization laboratory. The survey is expected to take approximately 10–15 minutes to complete. Eligibility 51 You may be eligible to participate if you currently work, or have worked within the past 12 months, in a cardiac catheterization laboratory in a non‑physician role (e.g., cardiovascular technologist, registered nurse, radiologic technologist, or other allied health professional). Voluntary Participation Participation in this study is entirely voluntary, you may choose to withdraw from the survey at any time by exiting the survey without submitting, or by closing the internet browser. There will be no repercussions for choosing to withdraw from the study and will not jeopardize your future relations with Weber State University, the Dumke College of Health Professions, or the School of Radiologic Science. Once the data is submitted, the data cannot be withdrawn as it will be unidentifiable. Data obtained through your participation may be used in the publication of a thesis for an educational requirement, published in a professional journal, and/or presented at a professional conference. Confidentiality All responses will be kept confidential to the extent allowed by law. No identifying information will be included in any reports, publications, or presentations resulting from the study. How to Participate If you would like to take part in this study, please click the link below to review the informed consent and begin the survey: https://qualtricsxm2rh7vrlr3.qualtrics.com/jfe/form/SV_en6LYQkMXtgwDk2 52 Contact Information If you have questions about the study, please contact: Sierra Gibbs sierra.gibbs@mail.weber.edu Dr. Taylor Ward Taylorward2@weber.edu The Weber State University Institutional Review Board has approved this document for use on ___4/19/2026___ Protocol # __IRB-AY25-26-266__. Thank you for considering participation in this important study. Your experience and perspective are greatly valued. Sincerely, MSRS Students, 2027 cohort Weber State University School of Radiologic Sciences