Cardiac surgery and the acute care nurse practitioner—“the perfect link”

Cardiac surgery and the acute care nurse practitionerm"the perfect link" G e o r g e L. Hicks, Jr, MD, Rochester, N.Y. Section Editor's note: The role of the acute care nurse practitioner in caring for acute and critically ill patients is beginning to become more accepted. This success has come about for many reasons, one of which is having physicians "champion" the role. I have asked Dr. George Hicks to offer some insight into the value-added care provided by acute care nurse practitioners. Dr. Hicks maintains a busy cardiothoracic surgical practice where he collaborates with 10 nurse practitioners, including myself. He is a champion of the acute care nurse practitioner role. --Michael H. Ackerman, DNS, RN, CS, FCCM ardiac surgery in the 1990s has become the most analyzed profession in the history of medicine. The pressures on surgeons, programs, and allied health practitioners have been unparalleled as attempts have been made to bring about cost containment, quality measurements, and the use of new techniques that involve less invasive procedures while maintaining patient satisfaction. Working in an academic environment adds further challenges to these already complex variables. Even the best-intentioned residents involved with a busy cardiothoracic service cannot dedicate the time necessary to direct, follow up, and interface with the numerous people and families one encounters and with the health care services, patient follow-ups, and educational programs that occur on a daily basis. This editorial is written on behalf of the acute care nurse practitioners who, in our academic surgical setting, have evolved into the perfect link and complement between surgeons, residents, patients and t h e i r families, and nursing staff.

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From the Division of Cardiothoracic Surgery, University of Rochester Medical Center. Reprint requests: George L. Hicks, Jr. MD, Division of Cardiothoracic Surgery, University of Rochester Medical Center, PQ Box SURG,601 ElmwoodAve, Rochester,NY 14642. Heart Lung® 1998;27:283-4. Copyright © 1998by Mosby, Inc. 0147-9563/98/$5.00 + 0 2/1192192

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Acute care nurse practitioners are professionals who have spent time as a floor nurse or intensive care nurse and then pursued a graduate degree in clinical skills, involving physical diagnosis, patient management, and therapeutics. In the major teaching institution where I work, the acute care nurse practitioner has provided an invaluable source of standardization and stability in the operating room, intensive care unit, regular floors, and outpatient clinics. They have provided the cardiothoracic service with the essential characteristics of clinical flexibility and an educational resource and liaison between patients and families, nursing, and the outside world at a time when the demands of a busy operating schedule make such communication impossible for surgeons. In modern computerese, acute care nurse practitioners have become our search engines who process numerous bits of information and organize the final product. The practice of cardiac surgery has become an extremely streamlined operation with a careful eye on cost and minimizing the number of days spent in the hospital. The acute care nurse practitioner has become instrumental in effecting and overseeing many of the stages of an optimal hospitalization. Fast-track protocols in the ICU, patient care maps, discharge details (including visiting nurses), medications, and primary care follow-up all come under the purview of the nurse practitioner. Communication of acute clinical changes and problems with family members and communication with referring physicians have become other essential skills in the nurse practitioner's formidable armamentarium. Furthermore, they provide a critical liaison with the bedside nurse to maximize the mixture of efficiency and compassion that typifies quality and patient satisfaction. Problems become better identified and resolved, and patients look to the nurse practitioner as their advocate in a complex and sometimes confusing system. Lastly, the nurse practitioners assume the valuable mantle of educator, maintaining the ever-changing

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floor nurses' understanding and commitment to a demanding patient population and discharge schedule. This editorial should not be construed as an argument against the use of physician's assistants or other health care extenders involved with the care of patients undergoing cardiac surgery. Simply put, in our environment the nurse practitioner, by

training and orientation, has provided the surgeon with an i n v a l u a b l e " p e r f e c t link" in an ever~changing h e a l t h c a r e s y s t e m . This link allows t h e s u r g e o n to focus o n t h e clinical a n d e d u c a t i o n a l r e s p o n s i : b i l i t i e s n e c e s s a r y in a n a c a d e m i c c e n t e r , w h i l e being comforted by the knowledge that constancy of care, c o m m u n i c a t i o n , a n d q u a l i t y a r e m o n i t o r e d by the nurse practitioners.

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