Surgical PNP

In an effort to expand the capacity of attending cardiologists and cardiac surgeons and effectively coordinate the care of cardiovascular patients across the inpatient and outpatient continuum, the Cardiovascular Program (CVP) has increased the number of pediatric nurse practitioners (PNP) from two to nine in recent years.

A surgical PNP was introduced in the early 1980s to the inpatient cardiovascular unit, a 30-bed step-down unit at that time. Today, three surgical PNPs coordinate postoperative care of cardiac surgical patients, from intensive care transfer to discharge. They perform daily physical assessments and in collaboration with the surgical team, develop a management plan for each patient. PNPs manage common postoperative problems such as congestive heart failure, infection, and arrhythmias, and perform procedures such as pacing wire and chest tube removal.

In addition, PNPs provide education to both families and staff regarding each child's needs. Follow-up care, communication among health care providers, and discharge planning are also key elements of the pediatric nurse practitioner's role. With their varied responsibilities, PNPs are important in the organization and daily operation of the inpatient unit.

Heart transplant PNP

In the pediatric heart transplant program, a full-time PNP initiates care during the transplant evaluation, which involves coordinating multiple diagnostic tests and assessments. During this decision-making period, the PNP provides extensive patient and family education and psychosocial support. She develops long-term relationships with these families, as she is involved from listing through the transplant procedure and long-term follow-up.

Since the busy transplant team includes four rotating physicians who care for both inpatients and outpatients, it is often the PNP who provides continuity and consistency. As the first year following transplant requires intensive medical management, the PNP is in frequent contact with families and community caregivers to assess for complications, adjust medications, and provide emotional support.

Arrhythmia and Pacemaker PNP

The Arrhythmia and Pacemaker services have experienced many advantages from the addition of a PNP. In collaboration with the attending electrophysiologist, the PNP is responsible for the complete care of patients with a pacemaker or implantable cardiac defibrillator (ICD).

Care begins at diagnosis and continues through device implantation, including lead and device testing intraoperatively. Following surgery, the PNP assumes responsibility for much of the follow-up by evaluation of patients both during the inpatient stay and for all routine outpatient pacemaker/ICD follow-up. Pacemaker and ICD education and support are provided for patients, family, and staff.

Kawasaki and Preventive Cardiology

The Kawasaki and Preventive Cardiology Programs also have benefited from the presence of pediatric nurse practitioners. The PNP is responsible for the coordination of care of all patients with Kawasaki disease, including hospital admissions and outpatient treatment, and she participates in the diagnostic evaluation, clinical management, and long-term follow-up of these patients. The PNP provides family and staff education about signs and symptoms of Kawasaki disease in the acute and subacute phases of the illness as well as possible etiologies, pathogenesis, and long-term cardiac sequelae.

Currently, Children's Hospital is conducting a clinical trial for children with Kawasaki disease, and the PNP acts as the nurse coordinator.

The Preventive Cardiology Program cares for children and families with primary and secondary dyslipidemias and hypertension. The PNP works closely within the multidisciplinary program to provide families with education, nutrition counseling, and medical assessment and treatment.

Same Day Surgical Admission

The Same Day Surgical Admission Program was developed in recent years to decrease hospital length of stay and coordinate preoperative preparation in the outpatient setting. Presently, 90 percent of surgical patients are seen in this program. The PNP is responsible for preoperative health assessments, physical examinations, laboratory testing, and patient and family education.

In addition to coordinating the multiple services involved in each child's surgical evaluation, the PNP provides the necessary support and guidance through this process.

Satellite programs

The role of the PNP recently has expanded to incorporate a large outpatient satellite program. Currently, there are eleven cardiology satellite clinics throughout Massachusetts and one in southern New Hampshire. The PNP role at these clinics is to provide diagnosis, management, and treatment of children with congenital and acquired heart disease in collaboration with the attending cardiologist.

Mentoring and Leadership

As members of the CVP Nursing Leadership Group, the PNPs have assumed significant responsibilities for the development and mentoring of staff nurses at each clinical level. They function as expert pediatric cardiovascular nursing clinicians and participate in special projects, research, quality improvement, and formal staff education. Many are involved in local and national professional nursing and cardiac organizations. The PNPs, as integral members of the CVP, have contributed significantly to successful patient and family outcomes.