Elevating care: Advanced Practice Clinicians in the Heart Center

Visit the Heart Center at Boston Children’s Hospital, and you’ll notice advanced practice clinicians (APCs) everywhere. There’s a reason that nurse practitioners (NPs), clinical nurse specialists (CNS) and physician assistants (PAs) are integrated into every setting including the cardiac preadmission (pre-op) and outpatient clinics, cardiac inpatient care unit (8East), cardiac intensive care unit (CICU), cardiac catheterization laboratory (cath lab) and the cardiovascular operating room (CVOR): they improve patient care at every step of the way. “Advanced Practice Clinicians are key leaders and partners on our care teams as they advance clinical practice and optimize outcomes for patients, and families across the Heart Center” says Patricia Hickey, Vice President of Cardiovascular and Critical Care Services.

The role of the Advanced Practice Clinician:

The Heart Center’s more than 60 APCs assume different roles in each environment, and in every case they are essential to delivering exceptional care, says Michelle Hurtig, Director of Cardiovascular Inpatient Nursing Patient Services.

On surgical and medical inpatient floors, NPs are partners with attending physicians in the care of hospitalized patients. They round with the physician every morning to discuss each patient’s plan of care and collaborate together as the plan is implemented and outcomes are assessed. In the Cardiac Cath Lab setting, PA staff assists with procedures and pre and post-procedural care. In the Cardiac Intensive Care Unit (CICU) and Cardiovascular Operating Room (CVOR), Jason Thornton, Nurse Director of the CICU and CVOR describes how they work collaboratively with cardiac intensivists. The CICU NPs and CNS staff partner with clinical nurses and the interdisciplinary team to care for some of the most critically ill children in the world. Their expertise, skills, care and compassion for our patients and families are unsurpassed. In the CVOR, Physician Assistants (PA) function in key and supportive roles before, during, and after surgery, partnering with the perioperative team to deliver high quality care to our patients and families.

In the outpatient setting, APCs work both collaboratively and independently to provide medical care, says Terry Saia, Nurse Manager of Outpatient Cardiology. Saia manages 23 NPs and 3 PAs in the ambulatory setting, who perform physical assessments, formulate differential diagnoses, prescribe treatments, review diagnostic test results, develop care plans, and measure outcomes. This group cares for patients across the lifespan, beginning with fetal diagnosis and throughout the childhood and adult years.

This highly trained group of professionals provide care to general cardiology patients and subspecialty populations. They are extremely skilled at longitudinal care coordination. Across the cardiovascular continuum of care NPs and PAs also assist with procedures, perform phone triage, and help families manage chronic medical issues within and outside of the hospital environment — at home, at school or at camp.

A benefit to both the patients and the care team

Saia feels the greatest impact that advanced practice clinicians have in the Heart Center is working collaboratively to provide wraparound care for patients and families. Additionally, APCs support and enhance the professional practice of the physician staff by being accessible to patients while physicians are attending on the wards, performing surgery or engaging in other highly specialized procedures and decision making, like reading echocardiograms,” she says. “Advanced practice clinicians elevate everyone’s practice.”

Hurtig adds that NPs are a wonderful resource for other team members including bedside nurses and referring physicians as well. “They value having the consistent presence of an expert who really knows the patients and follows them throughout their journey,” she says.

The Heart Center has embraced advanced practice clinicians as key members of the interdisciplinary care team for many years. As the Heart Center has expanded, Saia has seen many patient care, communication and patient access improvements. She acknowledges the role of advanced practice clinicians in these improvements in the outpatient center, especially in the cardiac preadmission area where “We’ve created a nice work flow with fewer gaps than what we’d have without the synergy. It’s an efficient, well-run system that hasn’t lost the human touch.”

The impact on employee retention

A strong advanced practice staff benefits employees, too. “For staff nurses who have developed an expertise in a particular area, often the next logical step in their career is to go back to school and take on an advanced practice provider role,” says Saia. She and Hurtig reel off countless team members who have come up through the ranks and are now leaders and innovators in the field. “Not only do our advanced practice clinicians work diligently to take care of families, but they’re driving practice behind the scenes as well — disseminating all of the good work they do here out into the community locally, regionally and nationally.”

A staff nurse herself before becoming an NP in 1998, Saia credits employee engagement and retention to the Heart Center’s collaborative model and culture of supporting individual growth.