His real name is Dr. James A. Fleming, but the nurses at St. Joseph's Hospital in Atlanta call him Lazarus.
Shortness of breath brought the semi-retired U.S. Agency for International Development official to the hospital on Oct. 30.
"What seemed to be a relatively minor complaint was really symptomatic of very serious problems," said Teri Booth, RN, BSN, manager of the hospital's cardiovascular intensive care unit. "Mr. Fleming had just returned from a long, overseas flight and had developed blood clots in his legs and lungs, causing damage and severe stress on his heart. "He was also diagnosed with severe heart disease. Doctors had to perform a quadruple bypass and insert an aortic balloon pump."
When Fleming's heart failed, he was put on an Abiomed device to provide ventricular assistance. Normally used as a bridge to transplant, the device takes over the work of the heart so that the organ can rest and heal.
"After eight days, we were able to take him off the machine," Booth said. "For us to see all the tubes removed and the patient sit up and drink water is one of those miracle moments - when someone so ill, survives."
To put a patient on an Abiomed device for eight days and have his heart recover is a positive outcome, said Marcia Bryant, RN, MSN, CAN, director of cardiovascular services at St. Joseph's.
"In the care of a cardiac patient, it takes everyone - the doctors, nurses, OTs, PTs, pharmacists, dieticians and staff - working collaboratively," she said. "A cardiac nurse has to treat her patient holistically, knowing that so many things are involved. It's critical for everyone to be on her game."
It takes a special nurse to work in cardiac care, so Bryant hires based on personal attributes such as commitment and initiative. The mechanics of the job can be taught, but the dedication required to work on her staff must be there already.
Forming relationships
While it's an everyday event at St. Joseph's, openheart
surgery is a profound experience for the patient
and family, and that's where the nurses come in.
"You form relationships with your patients and
their families, because it's integral to win their trust if
you're going to help them get better," said Tina Taylor,
RN, BSN, staff nurse in the hospital's cardiovascular
intensive care unity. "The doctor releases them
to our responsibility, and it's up to us to put them on
the path to wellness."
St. Joseph's uses a combination of high-tech medical procedures (new drug-eluting stents that release medication over time to prevent clots and inflammation) and hightouch tools of caring (heartshaped pillows) to help patients heal.
"These are working pillows and keepsakes," Bryant said. "Doctors use the heart diagram to explain procedures, and nurses show patients how to hold them against their chest when they cough, a necessary part of recovery."
Fleming's pillow is covered with autographs and well wishes from his nurses. He can't imagine getting better care anywhere. "The doctors had the skill to perform a seven-hour operation, but the rest of the time [six weeks], who is there for you? The nurses are your first line of defense. I'll always be grateful to the nursing staff here," he said. Never knowing the outcome is part of what keeps Booth excited about cardiac nursing.
"You can go from an extremely intense situation to a patient who is functioning and happy. That keeps us ready to take on the next patient," she said. St. Joseph's, which has the 12th-largest cardiac program in the United States, performs about 1,500 open-heart surgeries and 10,000 cardiac catheterizations a year.
Nurses prepare and educate patients before surgery, work in the OR and staff the intensive care and step-down units. They are involved in cardiac research and establishing innovative practices.
Cardiac nurses also took the lead in designing the hospital's new 24-bed CVICU to give better care to patients.
Challenging work
Myla Ratowsky, RN, BSN,
worked in Singapore before joining
St. Joseph's complex cardiology
unit.
"I think heart care is the most challenging because there are so many new interventions. You learn something new every day," she said. "Nurses here are more involved in the decision-making. The doctors respect us and trust us, and our managers keep encouraging us to learn more."
A good preceptor, Ratowsky's co-workers have encouraged her to go back to school and become a clinical education specialist. "We want to keep our nurses challenged, and that's not hard, because St. Joseph's is a powerhouse for nursing," said Anne Pedersen, RN, MSN, director of the medical/interventional cardiac intensive care unit and the Heart Failure and Transplant Center.
The hospital is one of three in the country to have won the Magnet Recognition for Nursing Excellence three times. Formerly a critical care nurse, Pedersen found her niche with open-heart patients and has specialized in cardiac care since 1980.
"I love it. The opportunities are endless," she said. "A cardiac nurse can be a staff or charge nurse, or work in intensive care, surgery, hospice, home health or wellness education."
When Pedersen began working in cardiac care, open-heart patients stayed in the hospital for at least two weeks.
"Now, four to five days is average," Pedersen said. "In that time, our patients go from being entirely dependent on us - we support their breathing, heart rate, blood pressure ... everything - to being independent and able to take care of themselves. That takes a lot of nursing and education skills."
'Every patient is different'
Rana Callaway, RN, BSN,
disagrees with those who call
cardiac care "cookbook nursing"
because of its predictable postoperative
course of recovery
"Nothing could be further from the truth. We all know what should happen, but every patient is different," she said. "The challenge of cardiac is that you're dealing with multisystems. It's not just the heart, but everything to do with it, and today's patients are likely to be older and sicker.
"There are no monitors in the step-down unit and we have a lot of ground to cover in a few days. We rely on our assessment skills and each other."
Megan Cann, RN, says nurses have to be proactive and use their judgment.
"One of the strengths of our heart program is the trusting relationship between doctors and nurses," she said. "If we say we're concerned about something, the doctor listens.
"Continuous education on everything - from the latest techniques to complications - and having a clinical nurse specialist on staff keeps us on our toes."
An interest in geriatrics brought Kristen Greene, RN, BSN, ABA, to cardiac care nursing. She works in the post cardiac interventional unit, where nurses assess patients every 15 minutes, and the turnover is rapid.
"You can't live without your heart, so new research is constantly coming out. I love that about the field," Greene said. Growing up in Atlanta, Greene had always heard that St. Joseph's was the place to go to get the best care for heart trouble.
"This is the farthest hospital from my home, but the commute is worth it. Everything here is extremely progressive, yet the personality of the place is kind and loving," she said. "Being a cardiac nurse here is my idea of heaven."