Edinburgh Napier University

  Background/aims
The cardiac catheter laboratory offers services to patients with a variety of conditions. These may include coronary heart disease, structural heart disorders and cardiac electrophysiological syndromes. Owing to the complex nature of an evolving health service and the increasing demands placed on healthcare workers, it is essential that innovative paradigms of service delivery are identified. This scoping review examines the state of knowledge regarding the rationale for change, solutions and potential consequences of expanding the roles of nurses in the cardiac catheter lab.

Methods
An exploratory scoping study approach was employed, using an established framework. Databases searched included the Cumulative Index to Nursing and Allied Health Literature, Medline and Google Scholar. A systematic search strategy spanning a date range from 1988–2018 was formulated. Titles and abstracts of 172 papers were screened; a total of 20 papers were identified for full review, including 16 from the UK, one from the United States, two from Europe and one from Australia.

Results
Literature to date concentrated on seven key areas: (1) drivers for change, (2) principles underpinning change, (3) ways of developing the workforce, (4) appropriate change management, (5) recommendations for practice, (6) barriers and facilitators, and (7) outcomes.

Conclusions
The cardiac catheter lab is under pressure to meet the variable demands placed upon it. There is documented evidence of a shortage of cardiac physiologists, which has a direct and measurable impact on operational efficiency and patient care. The concept of expanding the nurse's role to incorporate aspects of the cardiac physiologist's role has been explored and could be a potential solution. Role expansion and advanced practice is a well-explored model in nursing. There are many themes associated with this issue, which are outlined in this paper. There needs to be more evidence surrounding the patient's perceptions in relation to professional roles in the workplace. An economic evaluation of the costs and benefits of a multiskilled workforce would be a challenging but worthwhile endeavour.