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My Story as a Lead Cardiac Advanced Nurse Practitioner

I am Dennis, Lead Nurse for the Advanced Nurse Practitioners (ANP) in Cardiac Surgery at one of the NHS Trusts in England.

I am an alumnus of Saint Louis University, College of Nursing in Baguio City, Philippines and continued post graduate studies in one of the universities in England. I moved to the United Kingdom back in 2002 and was one of the Filipinos who were on the Adaptation Programme for the NHS. Started as a Band 4 Nurse in the cardiac surgery ward and worked my way up to a senior nurse in the ward, then transferred to the Cardiac Surgery Pre-Operative Assessment Unit as a senior/charge nurse. After few years, I moved to an ANP role and now, as we speak, I am working as a Lead Cardiac ANP.

How did you get this job?

Our trust is one of the first hospitals who had Advanced Nurse Practitioners in the country. It was created in May 2011 after the introduction of the European Working Time Directive (EWTD), New Deal and Modernising Medical Careers (MMC) which reduced the working hours of Junior Doctors. Because of this, there has been a decline of available junior doctors or surgical house officers in cardiac surgery who can provide clinical support. To address these challenges, Advanced Nurse Practitioner roles were created to fill in these gaps and to ensure that adequate clinical expertise are still provided.

In 2013, the ANP team was expanding and as I was at peak of being a pre-operative nurse plus with a lot of encouragement from our cardiology nurse consultant, I applied to be an ANP and was successful. It was in 2015, when I was interviewed and got the role as a Lead Practitioner.

What is a Cardiac Advanced Nurse Practitioner? What is your typical day like?

Cardiac Advanced Nursing Practitioners (ANP) are fully trained nurse practitioners who work closely with the medical team undertaking some of the roles previously performed solely by junior doctors, in the care and management of cardiac surgery patients from admission to discharge.

These would include skilled assessments of patients on admission, attending medical ward rounds, planning of ongoing care, ordering of appropriate tests, prescribing and discharge planning.

As a Lead Cardiac ANP, my role is very varied and it is mainly divided to 2 areas. First, I look into the clinical demands across the cardiac wards and the high dependency unit, including pre and post cardiac surgery patients.

A typical day begins with rounds with surgical consultants and registrars.

It involves identifying patient issues, physical assessment, reviewing diagnostics tests, making differential diagnosis, reviewing and prescribing medications, making clinical decisions and summarising a plan of day for our patients.

We would also attend to the clinical needs of patients such as difficult venepuncture and cannulation, negative pressure dressing/ VAC therapy and wound care, assisting in chest drain insertions, catheterisations, nasogastric insertions, reviewing pre-operative patients, ensuring that they are fit for surgery, making referrals, discharging and most of all attending to emergency calls and resuscitation.

Ultimately, our main goal is to provide a seamless journey from admission to discharge.

Aside from my clinical responsibilities, I also assume my operational role. Being a leader for a group of Cardiac Nurse Practitioners, I am responsible of budget management, rostering, appraisals, recruitment and retention, managing complaints, staff well- being and education and training.

I also take an active role in developing and updating evidence based guidelines, supporting my team in doing audits and research like Safety Discharge Post Pacing Wire Removal, Safety of Chest Drains Insertion and research teams on their projects. I am also involved in developing innovations for the cardiac surgery like Enhanced Recovery Programme, Day of Surgery Admissions & Criteria Nurse-led discharge- to name a few.

On top of these, I also facilitate teaching sessions to our nursing staff. Our team would organise a yearly training day open to all Nurses and AHPs across southwest of England. We invite professors and top cardiac surgeons as speakers for the day.

Why did you choose this area of nursing?

Even back in the Philippines, Cardiology has always been an area which I am interested in but have not had a chance as I was working in Medical-Paediatrics back then. When I arrived in England, it was a blessing that I was assigned in a Cardiac ward. Aside from living in a new country, I had to persevere in learning the foundations of cardiology and cardiac surgery. I developed the passion in this specialty. I find it fulfilling knowing that we are able to better or prolong our patients’ lives.

What are the benefits of working as a Lead Cardiac Advanced Nurse Practitioner?

It is very satisfying to see our patients overcome a major surgery, through our support and guidance. What I also find fulfilling and rewarding in this role is

the opportunity to develop strong and competent advanced nurse practitioners that provides advanced quality nursing to our patients. I feel that in my role, I am able to contribute in delivering health care services efficiently and timely.

How to be a successful Cardiac Advanced nurse practitioner

Qualifying as an ANP includes the 4 pillars of Advanced Nursing such as: Clinical Practice, Leadership and Management, Education and Research.

To be an ANP, you need to have an expertise in your specialty and work towards a Master’s level in Advanced Practice. You need to meet competence in practice as well as be a registered Non-medical Prescriber.

In this role, you also need to have excellent leadership and management skills. Being a role model and having the ability to inspire others to work hard are vital in this job. You also need to know how to establish a good rapport and communication towards your colleagues and patients. It is very important that you are not only a manager but also a leader who guides each member of the team in achieving their own career growth.

Continuous learning and development are also vital in this role. As a lead, I make sure that this is always available to myself and my team where everyone is achieving their Masters in Advanced Practice. I also organise teaching sessions to improve knowledge in all things Cardiac, from the different types of cardiac surgeries to managing post operative complications.

What are the challenges of a Lead Cardiac Advanced Nurse Practitioner?

The main challenge in my role is managing time. I have to ensure that I have time to do my clinical shifts and manage my team at the same time. Other challenges are meeting expectations of patients, relatives and other staff who are unaware of the limitations of my role.

Any advice to other nurses who wants to to consider a role similar with yours?

In my team, I also have two other Filipinos who are now advanced nurse practitioners. I have always encouraged them to follow the advanced nursing pathway. This pathway is very rewarding and can boost you to improve your passion in nursing.

If you are a newly qualified nurse or new UK Filipino nurse looking for your own speciality, Cardiac Surgery or Cardiology is an area where you will find the heart in Nursing. This will be your foundation in becoming an Advanced Nurse Practitioner in the future.

But regardless of whatever nursing specialism you want to pursue, hard work and resilience are key to success. Aside from being hard working and persevering, you also need to have a continuous drive to learn and have an open mindset especially when it comes to change. Do not avoid or fear change, instead embrace it! These will definitely help you be successful in your nursing career!

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