A day in the life of a clinical nurse specialist
"I’m in at 8.00 a.m. answering the Helpline - quite a few messages after a bank holiday weekend. I write them all in the diary and will respond as soon as I can. It’s a slightly unusual day as I am off to the nearby maternity hospital. A lady with a life threatening congenital heart defect has been on bed rest for a number of weeks and today is her elective caesarean section, she wanted a familiar face with her for support. By 11.00 the obstetrician was busy and a tiny but perfect beautiful baby was born. At only 30 weeks gestation the neonatal nurses were ready to look after him and warm him up. The baby had some oxygen and soon ‘pinked up’. Mum and Dad hadn’t yet got to see the baby before I left so I did my best to describe him.
"My bleep was quite lively so I had to dash back to my office to catch up on the calls. These included arranging a prescription for a gentleman on a specialist drug used to treat pulmonary hypertension; I ring the patient to tell him when he can collect his drugs. I also called a lady who reduced her medication following telephone consultation last week; she is fine, less nauseous and her blood pressure and pulse are within normal limits. I will discuss this with the Consultant and call her back later.
"A call comes in from a father, whose 23-year-old daughter’s blood is too thick for her metal valve. She needs intravenous heparin to thin her blood. I chat with the young lady and we find a bed on the new short stay unit, she will come in within the hour. This unit is bright, spacious and new and the plans in place for our new ‘young adult ward’ are similar and will be purpose built offering a nice big day room and kitchen area.
"12.00 Visit to the ward patients before their rest period and then on to Intensive care to review a young man who has had very complex surgery. He is stable but requires a lot of medical support and is sedated on a ventilator. I spend a fair amount of time with the family who I have known for some time. They are coping very well but it is a very tiring and emotional time for them. It is priority for me to ensure that families are well cared for, I cannot imagine how they manage as their children return to surgery as adults. I support parents as best I can by updating them with progress and plans as they emerge, and I have tea and tissues in the office at all times!
"I then had a successful meeting with the Consultant in the catheter laboratory and discussed a few outpatient issues. I now have some extra jobs, these include liaising patient tests e.g., 48 hours heart monitoring tapes, cardio memos and blood tests. I ring patients to explain what to expect and why.
"After lunch I have more messages on the helpline, including a lady who is having difficulty breathing despite home oxygen. She has recently been in atrial fibrillation. This information takes priority as I believe this lady needs to be admitted as an emergency. After discussion with the team we arrange a bed on the young adult ward and she is on her way.
"A student nurse with an interest in congenital heart disease has just asked if she can work with me tomorrow. I am always pleased to teach the next generation of nurses about congenital heart disease. We can attend the multi disciplinary case conference tomorrow morning; this is where the multidisciplinary medical and nursing team meet. The team reviews patient cases, their cardiac catheters or MRI scans, they then discuss future treatment plans. Later we can attend the outpatient clinic where I will meet and greet patients, ensure they have my contact details and that they understand their condition and management plans. I will also take the student to the neonatal unit to see today’s newborn baby and visit mum. We can also visit the intensive care unit; this job can be very diverse and exciting. I never know what might happen next.
"17.00 Just popped over to the maternity hospital, the new mother is doing very well and her heart has coped well with the birth, thanks to the obstetric team who know her cardiac situation well. She is in the high care unit with a specialist midwife and constantly monitored. The baby is having a little help with breathing but looks wonderful and will hopefully meet his Mum properly tomorrow.
"I look forward to meeting 4 new admissions tomorrow - they are coming in for a cardiac catheter. I will also be teaching the cardiac high care nurses in the afternoon.
"18.00 It has been a busy day and I feel emotionally tired, but everything is under control. This is a brilliant job and writing this article has given me the opportunity to reflect on how lucky I am to have a job with such variation and satisfaction. I meet great people and never get bored."
Lynda Tellett, clinical specialist nurse – adult congenital heart disease.