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My Life as a Thrombosis Clinical Nurse Specialist

I am Ediscyll, also known as ‘Edi’ to my London colleagues. Just like most of us, after years of working in the Philippines, I decided to spread my wings and work abroad. In 2000, I relocated to London. It was a massive decision for me and I am glad I took the plunge. I started working in the ward as a staff nurse for a few months to obtain my PIN and then moved to Coronary Care Unit (CCU). After 10 years in CCU, I transferred to Haematology and worked my way up. Currently I am working as a Senior Thrombosis Clinical Nurse Specialist in St George’s Hospital, the home of British documentary programme ‘24 hours in A&E.’ I also cover Queen Mary Hospital in Roehampton which is also run by St Georges Hospital.

Being a previous cardiac nurse, I used to look after patients with pulmonary embolism, atrial fibrillation, mechanical valves-- most of which require anticoagulation. The clotting cascade fascinates me. This motivated to move to a role where I can practice in a dynamic, autonomous & patient-centred service role. I chose this field of nursing because I can utilise and develop my clinical skills including my clinical reasoning and treatment options with back-up from my team.

As a Thrombosis Clinical Nurse Specialist, I act as an education and advisory resource for other healthcare professionals in all areas of anticoagulation treatment and venous thrombosis management. Besides directly taking care of my patients, being a thrombosis Clinical Nurse Specialist often involves research projects. My consultant colleagues often encourage me to come up with innovative ideas to deliver high quality patient outcomes.

I handle patients who are referred for either confirmed deep vein thrombosis (DVT) or Pulmonary Embolism (PE). I will initiate their treatment and see them in my clinic until the time they are discharged. Nurses in this field often build long-term relationships with the patients and their families. I also enjoy the patient interaction and the variety of cases that I see. Every day presents a new challenge or a new learning experience.

My Typical Day

In my job, every day is different. My day could be exhausting, momentous, depressing or sometimes, it can be all of the above. I arrive at work just before 7am. I will first check my emails to see if I have urgent meetings, referrals or patients to see that day. Thursday is usually my busiest day because I run the Joint Specialist Thrombosis Nurse and Midwife Clinic. Here we see pregnant patients who are at risk of blood clot. We review their Venous Thrombo Embolism (VTE) risk assessments and if they are deemed intermediate and high risk, we start them on thromboprophylaxis during pregnancy and until six weeks post-partum. Our clinic usually finishes at around 2pm.

On other days, I could be attending meetings, sorting out referrals, seeing patients in the wards, collecting DVT/PE data for the Trust or conducting teaching sessions for nurses, midwives or pre-registered doctors. I can also be in other trust teaching or conducting audit on VTE.

When I do my ward rounds, I can be seen in the adult or paediatric ward checking if VTE risk assessment were carried out properly, in a timely manner and the right medications were prescribed. I also do ad-hoc on-the-spot teaching sessions to student nurses who might need help on medicine administration such as low molecular weight heparin injections. Just before 5pm, I need to ensure that all my documentations are up-to-date especially for the patients referred to me or I have seen for that day. Then I will change to my normal clothes, travel home and put my “ mummy “ hat. What a day!

Challenges of a Thrombosis Nurse Specialist

Being a Thrombosis Nurse Specialist is not easy. I am constantly on my feet checking scan results, VTE risk assessments and initiating treatment. You need to have a strong presence of mind and attention to detail. I always think that every step is crucial and can have grave consequences, especially when it comes to patient care. This is why I pay careful attention when I am reading scan results, interpreting investigations and preparing prescription to my patients to ensure that I do not miss anything.

My role can be mentally and physically exhausting. As a Thrombosis Nurse Specialist, flexibility and strong stamina are essential. Aside from running my own clinic & managing VTE Assessments, I can be running to several wards to see patients or do teaching sessions or performing an audit.

Because of the criticality of our roles, our team has to ensure that we are continuously updated in VTE prevention and treatment. Despite our busy schedule, we need to ensure that we make time for training and skills development.

Benefits of my role

My job personally gives me a sense of satisfaction. I feel that through the service we provide, we are helping in reducing hospital admissions. My role as a Nurse Specialist also enhances my career prospects. Being surrounded with colleagues who are practicing at an advanced level is amazing. I am constantly learning from them every day.

With this post, I also have the opportunity to attend annually the All Party Parliamentary Thrombosis Group (APPTG) in the House of Commons. I started attending this meeting since 2010 and I am able to meet the exemplary people in anticoagulation and thrombosis services across UK.

As a thrombosis nurse, I am also able to take part in service evaluation and quality improvement in the Trust. I have made guidelines, audit tools and leaflets that are now being used in the hospital. Since September 2020, I have been approached to co- Chair our Trust’s Hospital Thrombosis Group together with a Consultant Haematologist. This committee plays a key part in a wider concerted effort to reduce the incidence of deaths related to thrombosis. This is a massive responsibility for me but I accepted the challenge.

Skills Needed to be a Successful Thrombosis Specialist

I run my own clinic each week and part of thrombosis service is delivered by clinical nurse specialist therefore it is essential that one is able to exercise sound clinical judgement and capable of working with minimal supervision. I encourage anyone who would like to be a nurse specialist to take the physical assessment and clinical reasoning course. This course helped me a lot when I am taking full history review, physical examination, performing and interpreting investigations and liaising with ultrasound for scans. Also, having a non-medical prescribing qualification would be an advantage.

Excellent teaching skill is an advantage too as my role involves introduction of the new oral anticoagulants and educating other health care professionals on thrombosis and anticoagulation.

Advice to my fellow Nurses

Coming from a different background and learning to adjust in a new work environment does not always come easy. If you like working autonomously, enjoy teaching and looking for a challenge and chance to shine, I encourage you all try this part of nursing. Being a thrombosis nurse is like a superglue in the middle- someone who can pick up patient concerns and act on those concerns but can also provide empathy, support and health promoter type of role.

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