Neuroscience nursing is a complex, highly specialized nursing subspecialty that's constantly advancing.
Researchers have discovered in recent years early and sometimes aggressive treatment of stroke and traumatic brain injury can preserve function and independence for many patients who in the past had no choice but to live with debilitating disability. [caption id="attachment_57140" align="alignleft" width="200"]
Anna Ver Hage, RN[/caption] "It became part of the guidelines to actually remove clots from large vessels versus saying there's not much we can do after a stroke," said Anna Ver Hage, MSN, RN, AGACNP-BC, CNRN, a speaker for the Relias Neuroscience Nursing Certification Review, which prepares nurses for the exam to become certified as Certified Neurosciences Registered Nurse (CNRN). And today more patients are candidates for advanced treatments. In January 2018, an updated guideline for acute stroke management published in the journal Stroke recommended extending the timeline for mechanical endovascular thrombectomy from the 2013 guideline recommendation of 6 hours post stroke to up to 24 hours after stroke onset in some patients. Advances in traumatic brain injury include the use of new medications to try and stimulate and awaken patients, greatly improving outcomes in some cases. And technology is rapidly changing. Today's MRIs are capable of imaging specific brain tracts.
"To see what damage was done and what the prognosis is going forward is a huge help in the acute phase," said Ver Hage, who is a stroke nurse practitioner who works at Banner Desert Medical Center in Mesa, Ariz.
Years ago, nurses would share with patients and families what staff thought might happen. "With advanced imaging, we can give them a lot better idea about what to expect and what rehab is going to be needed going forward," she said. [caption id="attachment_57141" align="alignright" width="200"]
Tracey Anderson, CNRN[/caption] Neuroscience nursing stands out among other specialties because the diagnoses are life-changing for many patients. Care goes beyond saving a life and can include helping people get back to who they were before an injury from trauma, stroke or brain tumor, said Tracey Anderson, CNRN, FNP-BC, ACNP-BC, a neurosurgery nurse practitioner who works in a private practice covering four hospitals in Southern California. "It's sort of shepherding them through their journey -- whether that's back to wellness or making the most of the time they have left," said Anderson, who serves on the certification board for the American Board of Neuroscience Nursing.
Neuroscience nursing is in demand
The need for neuroscience nursing is growing as the population ages, according to Ver Hage. "We are treating neurologic illnesses and injuries more aggressively than we used to, and I think that has increased substantially the number of nurses that are needed that have neuro expertise," Anderson said.
"A lot of nurses are very uncomfortable with neuro because they just don't feel like they know how to assess the patient. They're afraid they're going to miss something and ultimately they avoid it," she said. "They go into anything but neuro. It's a specialty in terms of a focus where either you love it or hate it. There's not a lot of middle ground and the people that love it never leave."
Many hospitals and health systems are achieving higher levels of stroke care, becoming primary stroke centers, comprehensive stroke centers and more, resulting in the need for more experienced and specialized staff. "There is a big push in those hospitals to get their nurses certified," Ver Hage said. "That's great because you can't run a specialty center without specialty nurses." It's one thing to focus on the expertise of physicians and having a neurologist or vascular surgeon on staff. It's another to focus on the specialization of nurses because the vascular surgeon or neurosurgeon is not there at the bedside evaluating patients 24 hours a day as the nurses are, according to Ver Hage. But learning the specialty isn't easy. It's something nurses generally transition into, according to Ver Hage.
"Neuroscience nursing is not something that you necessarily spend a lot of time on in school, so your training does not really focus on the management of these patients," she said.
Expertise comes from training, education
Learning about the intricacies of the brain and how injuries to different parts of the brain cause very different symptoms and disabilities is a complicated process. It's not like assessing a broken bone, in which healing time and functional outcomes might be pretty clear cut. "With brain injuries we don't have that," Ver Have said. "It's very specific and it's very difficult to learn that without a lot of training and a lot of experience." That's where certification and specific continuing education come in, according to Ver Hage. "Nurses who are certified have taken training courses and have been exposed to these patients on a daily basis," she said.
Because of that training, a neuroscience nurse might assess a patient with dizziness, for example, differently than a medical nurse.
The medical nurse might not think much of it and suggest the patient lie down. The neuroscience nurse is going to consider cerebellar stroke or some other brain injury type and look further into the cause. By obtaining a specialty certification in neuroscience nursing, RNs show their commitment to the patient population under their care. It raises nurses' professional status by demonstrating a level of expertise that others may not have, according to Anderson. Neuroscience nursing is for the nurse who is really looking to make a difference, according to Anderson, not just in patients' lives, but also in families' lives. "Patients look to you as the expert and you need to be the expert," Anderson said. "That's where certification and continuing education becomes critical because if you don't know and you aren't an expert how in the world are you going to help them?" Learn more about our Neuroscience Nursing Certification Review course, with class session starting several times throughout the year. 
