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“I felt like the angel of death”: role conflicts and moral distress among allied professionals employed by the US cardiovascular implantable electronic device industry

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Abstract

Purpose

This study aimed to identify themes associated with role conflicts and moral distress experienced by cardiovascular implantable electronic device (CIED) industry-employed allied professionals (IEAPs) in the clinical setting.

Methods

Focus groups were used to elicit perspectives from IEAPs who had deactivated a CIED.

Results

Seventeen IEAPs (five women) reported increased clinical presence and work-related role conflicts and moral distress along several themes: (1) relationships with patients, (2) relationships with clinicians, (3) role ambiguity, (4) customer service to clinicians, and (5) CIED deactivation. Patients often misperceived IEAPs as physicians or nurses. Many physicians expected IEAPs to perform clinical duties. Customer service obligations exacerbated IEAP role conflicts and moral distress because of dual agency. IEAPs commonly received and carried out requests to deactivate CIEDs; doing so, however, generated considerable distress—particularly deactivations of pacemakers in pacemaker-dependent patients. Several described themselves as “angels of death.” IEAPs had recommendations for mitigating role conflicts and moral distress, including improving the deactivation process.

Conclusions

IEAPs experienced role conflicts and moral distress regarding their activities in the clinical setting and customer service obligations. Health care institutions should develop and enforce clear boundaries between IEAPs and clinicians in the clinical setting. Clinicians and IEAPs should adhere to these boundaries.

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Abbreviations

CIED:

Cardiovascular implantable electronic device

FG:

Focus group

HRS:

Heart Rhythm Society

ICD:

Implantable cardioverter-defibrillator

IEAP:

Industry-employed allied professional

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The study was funded by a grant received by Dr Mueller, the Mayo Clinic Scholarly Opportunity Award.

Conflict of interest

Dr Mueller is a member of the Boston Scientific Patient Safety Advisory Board. He lectures for the Boston Scientific Education Services, and he is an Associate Editor for Journal Watch General Medicine.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Paul S. Mueller, Abigale L. Ottenberg & Barbara A. Koenig

  2. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

    David L. Hayes

  3. Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA

    Barbara A. Koenig

Authors
  1. Paul S. Mueller
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  2. Abigale L. Ottenberg
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  3. David L. Hayes
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  4. Barbara A. Koenig
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Corresponding author

Correspondence to Paul S. Mueller.

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Mueller, P.S., Ottenberg, A.L., Hayes, D.L. et al. “I felt like the angel of death”: role conflicts and moral distress among allied professionals employed by the US cardiovascular implantable electronic device industry. J Interv Card Electrophysiol 32, 253–261 (2011). https://doi.org/10.1007/s10840-011-9607-8

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  • DOI: https://doi.org/10.1007/s10840-011-9607-8

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