When cardiac nurse practitioner Marci Farquhar-Snow, RN, ACNP-BC, started working at the Mayo Clinic in Arizona 14 years ago, she was the only NP in the cardiology inpatient unit. Since then, a remarkable transformation has taken place on the unit.
Now there are 13 of us, Farquhar-Snow said. Nurse practitioners are working in electrophysiology, cardiothoracic surgery, heart failure, anticoagulation and congenital heart disease.
According to Farquhar-Snow and other NPs, the increased presence of nurse practitioners in all areas of cardiology has become a trend throughout the country as the demand for skilled cardiac clinicians has increased. Cardiology is such a growing field, she said. NPs are an extension of the cardiovascular team, and they help with diagnosis and treatment. This ultimately improves efficiency and patient outcomes.
According to the American Heart Associations Heart Disease and Stroke 2014 Statistical Update, cardiovascular diseases claim more lives than all forms of cancer combined, and more than 2,100 Americans die each day from stroke and cardiovascular diseases. As physicians are increasingly turning to cardiac nurse practitioners as partners, the role of the NP has expanded, Farquhar-Snow said. She recently saw a patient in his 70s as an outpatient who was experiencing chest pain and fatigue, and during her assessment Farquhar-Snow noticed a loud heart murmur. After reviewing his chart, she knew his murmur had progressed since his last visit. She ordered a heart catheterization to determine if the patient had blockage in his coronary artery, and an echocardiogram revealed severe aortic valve stenosis.
The interventional cardiologist called me and explained what he had found, and we decided that he needed to have heart bypass surgery and an aortic valve replacement. The next day the patient had the surgery, she said. Cardiac nurse practitioners today need to have the skills to be able to assess patients quickly and help physicians make those clinical decisions.
Although the demand is high for nurse practitioners trained specifically in cardiology, Farquhar-Snow acknowledges that it can be difficult for NPs in school to find clinical hours for the specialty. In response to this dilemma, in 2009 the Mayo Clinic started offering a cardiology nurse practitioner fellowship at the facility in Arizona.
Nurses who have graduated from a nurse practitioner program are eligible for the one-year fellowship, which includes 300 didactic or classroom hours and more than 1,700 clinical or mentored hours.
Fellows learn everything from cardiovascular diagnostics to interventional cardiology to electrophysiology. The fellowship training helped Alexandrea Bartow, ACNP-BC, secure a position in 2013 as one of eight nurse practitioners who work in the cardiothoracic intensive care unit at the University of Washington Medical Center in Seattle.
The unit previously was run by surgical residents and fellows, but four years ago nurse practitioners took on that role to provide more continuity of care.
We deal with some of the most difficult patients in the hospital, and the respect we get from physicians is phenomenal, Bartow said. The hospital is looking for more cardiac nurse practitioners who can work in the inpatient and outpatient setting, electrophysiology, heart failure, mechanical circulatory support and the cardiothoracic ICU.
Bartow is working with administrators to launch a cardiac nurse practitioner fellowship program at the University of Washington to train NPs for cardiac specialties.
Although fellows delay full-time work for a year and live on a stipend, Bartow believes her fellowship training gave her an advantage over other applicants for the cardiothoracic unit. Right now there are only a handful of cardiac NP fellowship programs available throughout the country.
Some hospitals, such as Columbia University Hospital in New York, offer in-house training programs. Cardiac nurse practitioners from the heart center at Columbia designed a three-to-six month cardiac training program that includes didactic hours, observation and application of skills.
Once trainees demonstrate their proficiency in applying what they have learned, they receive a credential from the hospital to practice as cardiac nurse practitioners.
The training was critical as the role of cardiac NPs started expanding in recent years at the Heart Center, said Marybeth Duffy, DNP-DCC, ACNP-BC, a cardiac nurse practitioner at the center who partnered with another cardiac NP and a cardiologist to develop the training course. When a new critical care unit opened at the heart center in 2009, physicians asked nurse practitioners to run the 10-bed unit.
The attending physicians really appreciate the nurse practitioners because we are there all the time, Duffy said. We save everybody time and money because once we are trained, we are there for the long-term.
The training at Columbia for NPs involves complex skills such as learning to insert arterial and internal jugular lines, take out pacemaker wires and balloon pumps and care for patients on ECMO (extracorporeal membrane oxygenation), Duffy said.
Future in outpatient cardiac care
Although cardiac nurse practitioners who specialize in acute care are currently in demand, analysts predict that the need for cardiac NPs in the outpatient setting will increase dramatically in the near future, said Beth Oliver, RN, DNP, vice president of cardiac services for Mount Sinai Health System in New York. With the shift toward keeping patients out of the hospitals as a result of the Affordable Care Act combined with the anticipated demand for primary care physicians more NPs likely will be needed to provide both cardiac and primary care, she said.
I foresee nurse practitioners taking the lead in patient education, Oliver said. They will be doing more health promotion and health counseling on risk factors for heart disease. This is already starting to happen, but I expect it to expand as the country and the world focus on population health.