Hi, welcome back to Cardiovascular Nursing Essentials. This module, we're gonna talk about what a modern cardiac nurse is. And I wanna kind of challenge you as we go through this to do some thinking and take some time to reflect. So these are my disclosures, our objectives today. You know, I'm not gonna go heavily into detail but I just wanna get you thinking about what opportunities there are available to you as the cardiovascular nurse. Here's some readings and just some good references if you want additional information. And I'm not gonna read through these but there's actually ANA standards for cardiovascular nursing practice. And I present these and I want you to be familiar with them so you understand the gravity of your job and how important it is. And it's not just about treating the patients. It's a fully comprehensive dynamic role that means you're implementing care plans, you're communicating with different specialties, you're communicating with your patient and pulling different strategies. You're really working towards healthy populations. You're involved in research. There is a lot of expectations with this but don't let it overwhelm you. Let it be something that motivates you. Something you should be familiar with and if you're not, I encourage you to dive into this more as evidence-based practice which is really pulling multiple things together. So it's our experience, things we've learned through our clinical experiences, it's evidence from research and it's patient values that develop evidence-based practice. So it's the integration of those three things that drives us to provide care that is evidence-based meaning it's been proven effective, something you are knowledgeable about and that you're using your critical thinking skills. And it's something that we wanna take into that patient perspective and bringing their personal beliefs, their cultural beliefs and bringing this all together to provide them patient-centered care that will give them the outcomes that align with their goals. And you should have seen some of these throughout and as you're looking at your guidelines, we have these level of evidence that tells us how strong versus how weak some of the evidence in our guidelines are. So as you know, things that are class one, that should be implemented because we know they impact our patients greatly. So for example, when we talk about heart failure and all the guideline-directed medical therapy for our HFREF patients, we saw those class one indications because the evidence, the research shows that those improve morbidity and mortality rates in that population by 70%. Some of our research findings are not as strong. So if they're class two or class three, there's still benefit that outweighs the risk, but we're not quite as certain. There are things that can actually harm the patient or do not provide any benefits. So these are important to know too. These are your class three. So I want you to be familiar with this. You can find these in the references and in our textbooks so that you're familiar with that. Now, not all research is equal. We do not wanna go on Google or WebMD and look for evidence and research to support our patient populations. We need to use reliable data sources. So over here is kind of our levels of evidence and the best studies that will give us the most reliable and valid data are systematic reviews and meta-analysis of randomized clinical trials. There's reduced bias. There's more samples in these trials. So these are the top level that we're looking for when we're doing any sort of research. That doesn't mean these other research methods and study types are not valid or relevant. They have more bias or other things that can enter the study. So I just want you to be familiar. So as you're doing any sort of research, make sure you're looking for the appropriate studies. I do recommend you use databases such as Cochrane Library, PubMed, CENAL. Those are really good sources. And if you have a library at your organization, tap into that. They generally have ways for you to obviously not have to pay for your papers or accessing the publications. And you can also leverage the librarian to help you find what you're looking for. So I urge you to connect with them if you have not had that chance to. And really within healthcare now, it's not if you're doing any quality improvement work, it's when. And so there are several models specifically for evidence-based practice promotion within healthcare that can help guide performance improvement initiatives and make sure that things are going in the proper order and set you up for success. And I challenge you with this, if you have not been involved in a performance improvement or quality improvement initiative within your organization, jump in, see where the opportunities are. And if anything, just allows you to have a voice at the table and really impact patients at a broader level. So you're impacting populations. You can be a change agent for your community to take better care of your patients, heart failure readmissions, post-pacemaker infections, things like that. You really have opportunities, they are abundant. So be a change agent within your community and within your organization. This again is just another model, the Johns Hopkins nursing EBP model. It is a little bit more simplistic than the Iowa model. And I always like to say evidence-based practice starts with a spirit of inquiry. It starts with a question or, hey, I've noticed our length of stay after TAVR patients is really long. Well, why is that? And you can really start diving in, looking for research and evidence and translating that into daily practices within your organization. Perhaps on the outpatient side, maybe it has something to do with refills or time to appointment. What are those opportunities? I urge you to ask questions and have that spirit of inquiry to see where there are opportunities to improve. Within cardiology, we have a vast amount of subspecialties. So if you want to further specialize, there's lots of opportunities, anywhere from general cardiology to cardiothoracic, heart failure, electrophysiology. Are you interested in interventional cardiology or cardiac imaging? Some newer specialties are cardio-oncology, cardio-obstetrics. I encourage you to look at this and see if anything catches your interest. Look into what the roles and opportunities are and see if you have a desire to learn more. With the numbers of people leaving nursing, I just ask you, if you're considering that, think about it. There's so many opportunities. Don't give up hope. Keep looking and try to find something that will fit for you. And again, there's just so many opportunities. So what are some of these specifically expanded roles that you may be interested in and you may not even know they're available? Is it disease management? So disease management is really that chronic disease states. So obviously thinking heart failure, looking at opportunities that span the continuum of care from hospital to community to the ambulatory clinic setting. How are you saving patients money? How are you saving your organization money? All of that stems from the care we provide. So while cost savings is part of it, it's really about the therapies, the care we're providing, the high quality of care. So these are opportunities you can consider if you're interested in something like nurse navigation or nurse coordinator. They give you the opportunity to work with clinicians and patients, providing education, being disease state experts and collaborating for the betterment of these populations. Are you interested in global or population health? These are things that align with like health campaigns and prevention. So thinking about smoking campaigns, are you looking to impact vast numbers of patients with healthy habits and arming them with tools and resources and education to be successful? Are you passionate about preventing further disease? Maybe you wanna help with medication adherence and availability. Maybe you're interested in mobile health. There's a multitude of platforms and technology that you can participate in to reach different patients across your community and even in other areas. Thinking about things like cardiac rehab and remote cardiac rehab. So there's endless possibilities. Maybe you're interested in healthcare quality and outcomes. So there's different branches here too. So are you more interested in research? Would you like to participate in clinical trials? Are you interested in clinical registries? So thinking about those cardiology registries, are you interested in abstracting? Are you interested in analyzing the data and working off of those to improve healthcare? So thinking about NCDR, your TVT, your Get With The Guidelines, your LAAO registries, there's more and more that are coming. So these are great opportunities to be involved with data to drive improved care models and improving outcomes for patients. Are you interested in healthcare policy? There's ways to get engaged there to be advocates and help change healthcare policy in our nation. So all of these are wonderful opportunities. If you're looking to further your degree as an advanced practice nurse, as you can see, there are multiple opportunities again, kind of in alignment with the different disease states and other things like leadership, again, more opportunities for research. You could be critical care or you could be disease specific. And there's a lot of talk, of course, in the future is team-based care, which involves APPs and nurses. And we know the impact, the positive impact that team-based care has because we're increasing access to patients, we're increasing their involvement, their satisfaction, we're decreasing burnout. So this is such a wonderful opportunity if you're looking for advancement in your education and your nursing career. Have you considered leadership? Maybe you want an opportunity to impact patients from a different perspective or a different angle. Our nurses within cardiology are change agents and we need to change the way we practice, the way we lead. So maybe you want to be at the forefront of that and lead teams, lead team-based care and lead these changes in healthcare. So as you can see, our models are shifting. We're not quite where we should be and it will take time, but we're really shifting to that prevention. We're shifting to disease state care models, looking at continuum of care versus inpatient versus outpatient, getting rid of those silos. So this is an opportunity to really join leadership, be those change agents and impact, not just your patients, but your clinicians and care teams in a very positive way. One example would be to be involved in that heart team. So looking at organizations that have successful teams of teams, right? And you can be part of the team that leads these initiatives and connects all the teams across the care continuum. And when we're looking at our heart valve programs, you can see there's multiple points and we have to align care and have strategies to make sure our patients don't get missed along the way. So there's wonderful opportunities to be involved, to lead these efforts or participate in them in a clinical team member way. So these are just wonderful examples and considerations for you. Where is cardiology going? What does the future look like? We know there's challenges that we are facing. We're facing increasing aging populations. We're seeing numerous volumes of nurses, physicians and other care team members leaving the field. We need to do a better job at reaching our rural populations. We need to shift to a prevention focus as opposed to an intervention focus. And we really need to shift to providing care outside the hospital as our primary care delivery models. So there's a lot of opportunities and potential strategies that are exciting. Things that help us leverage technology to provide care beyond walls. How are we managing incoming data? How are we making things patient and staff team member friendly so it's easy for them to use and be effective? How are we providing that care at home? Hospital at home is a model that is coming. We will be providing full hospital care at homes. Lots of organizations are working on that or towards that now. How are we providing care remotely, thinking about rural populations or hub and spoke models that need to reach more areas and more patients? So we have a lot of challenges, but we have a lot of opportunities and strategies that we can be successful. And I urge you to get involved, whether that's through organizations, whether that's through certifications, what are your specific goals? It's really beneficial to network with people outside your organization for information sharing, for support, for social purposes. It makes a network for you and you can share ideas and bring them to your organization. So I just wanted to share a few organizations for nursing that may be relevant if you're interested in. And there are several cardiac nursing certifications that range from general cardiology to heart failure. So I encourage you to take a look at these and see if any of them would be a good fit for you. There are other kind of medical or surgical organizations, if you want something that's kind of more broad than just nursing focused. And again, these are all really valuable resources, lots of research that you can benefit from in addition to that network with other organizations and peers. I wanted you to be familiar with some of the potential organizational certifications. So you may be familiar with, the Joint Commission has several cardiology disease specific certifications. You can choose to do them independently or you can do the comprehensive cardiac center certification, which is, as you can see, full service. It ranges from everything from cardiac rehab to cardiac resuscitation, to heart failure, to diagnostic cath, to PCI, ST, elevated MI. It's very comprehensive. So if your organization is not participating and you think there's some interest, I encourage you to check out that information on their website. I also want you to be aware of our CMS programs. These are CMS mandated programs. You've probably heard of the readmission reduction program specific to heart failure. We are shifting from a fee for service model to value-based care. And these are some of those initial steps that were taken by CMS to kind of push providers and organizations into those models. And really these are the kind of the foundation and there will be more changes to come that relate quality of care based on data outcomes in relation to reimbursement and payments. We really wanna focus on quality, not quantity. So with that, I hope you've learned a lot of valuable information. And we are on a mission to transform cardiovascular care and improve heart health for all. And we wanna do this through the quadruple aim. And I say this to you to just take a moment and reflect, maybe it's today, maybe it's over the next couple of weeks and see what you want to challenge yourself with. Do you wanna do more in your organization? Do you wanna connect with others outside of your organization? Think about your future goals. There's endless possibilities within cardiology and within healthcare in general. I urge you to continue bettering yourself. I thank you for taking the time and doing the hard work and joining me in this series. If you have any questions, please don't hesitate to reach out at academyatmedaxiom.com.

cardiac nursing

evidence-based practice

healthcare quality

advanced practice nursing

networking