Community-based cardiac nurse or heart failure nurse
Community-based cardiac nurses manage patients discharged from hospital, saving GPs’ time and avoiding unnecessary hospital admissions. Heart failure nurses review and monitor patients with left ventricular dysfunction who are unstable so they can fast-track their admission to a tertiary cardiac centre if necessary.
Community-based cardiac nurses manage patients discharged from hospital, saving GPs' time and avoiding unnecessary hospital admissions. Heart failure nurses review and monitor patients with left ventricular dysfunction who are unstable so they can fast-track their admission to a tertiary cardiac centre if necessary.
Cardiac nurses will see patients booked for an elective procedure for a preparatory assessment to ensure they are well-prepared for an operation. They then pick up patients – both elective and non-elective – discharged from the hospital tertiary centre and review their condition.
These include patients with congenital heart disease and ischaemic heart disease as well as those who have had MIs or CABGs.
The review involves checking wounds and assessing for signs of breathlessness or heart failure. The nurse will also ensure the patient knows what has happened to them, do a quick assessment of their risk factors and provide some tailored lifestyle advice.
The nurse will go through medications, titrate them and order blood, renal, liver or other tests if required, the results of which will go to the GP in a report of their observations and recommendations. The patients will then be referred to a cardiac rehabilitation nurse for community or home-based rehabilitation.
A heart failure nurse looks after patients with left ventricular dysfunction referred by GPSIs in cardiology and hospital cardiologists. Once they are stable the nurse will refer them to a GP who will continue their care with the aid of a community matron if they are housebound.
If patients become decompensated or start having problems they will be referred to the tertiary centre by the heart failure nurse who is able to fast-track them for admission without involving the GP.
Predominantly nurses with experience in cardiac care.
Training and accreditation
Several universities run courses for nurses who wish to specialise in cardiac care. The content of the courses is often flexible to cater for nurses who wish to work in the community as well as in specialised cardiac centres.
The British Association for Nursing in Cardiac Care has published Cardiac Nursing – Acute/Episodic Care Career Pathway Competency Statements.
The Caledonian University in Glasgow – in conjunction with the British Society of Heart Failure, the British Heart Foundation, the University of Leicester and the University of West of England – runs a course for nurses wishing to specialise in heart failure.
Cardiac nurse band 5-6 – £20,225-£32,653; heart failure nurse band 7 – up to £38,352
Maggie Kelly, cardiac lead nurse at Southampton City PCT, says cardiac nurses who work in the community have to feel confident as they work much more autonomously than cardiac nurses in secondary care.
‘There are not many cardiac teams out in the community, so it is different and innovative. We very frequently have to think laterally over things because there are no straightforward criteria.'
She adds that the close bond developed with patients is very rewarding.
‘You try to help patients to become independent, to stop being patients, and become responsible for their own health. When they leave your service and go on to the rest of their lives they have got the confidence to take control of their own disease.
That is a very satisfying feeling. There are some downsides, though, because you can feel very alone and vulnerable.'Community based cardiac nurse or heart failure nurse