Cardiothoracic Advanced Nurse Practitioner Role
The Cardiothoracic Advanced Nurse Practitioner (ANP) role continues to evolve to meet the changing needs of the cardiothoracic service as it expands. The provision of a high-quality patient-focused service, as well as the advancement of the nursing profession and nursing practice, is central to the role of ANP.
The provision of a better health service for all has never been more important as it is currently in Ireland. Innovation in methods of service delivery is driven by the need for quality, efficiency and cost containment.
One such innovation is the role of the ANP, which maintains patient care as the priority. The ANP role integrates the components of clinical expertise, research and education to improve standards of care and improve efficiency and clinical effectiveness, which ultimately increases patient satisfaction.
In 2000, St James’s Hospital, Dublin, Ireland, introduced the ANP role in the cardiothoracic service. This role has evolved to meet the needs of the expanding service. Statistics reveal that coronary heart disease and lung cancer account for a large proportion of deaths in Ireland. While prevention of these diseases is the ultimate aim, for the foreseeable future surgery will play a major role in alleviating the symptoms and prolonging the life of people with these conditions.
Currently, a team of four cardiothoracic registered ANPs and one ANP candidate provide holistic, competent, comprehensive care to the cardiac and thoracic surgical patients in St James’s Hospital. ANPs provides end-to-end management of patient care starting with pre-admission through to patient care on the recover ward.
At the preadmission clinic, the ANP takes a history from the patient and conducts a physical examination. All pre-operative investigations are ordered and reviewed by the ANP before patients are admitted to the hospital for surgery. Attendance at the ANP led pre-admission clinic minimises unexpected cancellations on clinical grounds.
Pre-operative inpatient time is minimised as all pre-operative investigations are completed at the pre-admission clinic where all clinical problems addressed. Consequently, bed use is maximised and there is efficient use of operating theatre time. The clinic also provides an ideal opportunity for the ANP to educate patients and their family about the upcoming surgery.
The ANPs meet the patients again on admission to the ward and in the operating theatre. The ANPs assist the surgeon in theatre, and in the case of coronary bypass surgery, the ANPs harvest the vein conduit. ANPs are competent efficient practitioners in theatre and perform conduit harvesting consistently. This expertise has resulted in a reduction in complications, such as leg wound infections. According to the Cardiac Surgery Patient Auditing and Tracking System (PATS), leg wound infection rates are lower than the international average.
An important aspect of these roles has been the introduction of nurse prescribing in 2008. This has enhanced ANP giving them authority to prescribe appropriately for common pre- and post-operative needs.
The cardiothoracic ANP role continues to evolve to meet the changing needs of the cardiothoracic service as it expands. The provision of a high-quality patient focused service, as well as the advancement of the nursing profession and nursing practice, are central to the role of the ANP. Career progression into the role of cardiothoracic ANP allows experienced expert nurses to remain in direct contact with the patient, which is good for the nurses and their patients.