A day in the life of a clinical nurse specialist

Lynda Tellett, a clinical nurse specialist in the adult congenital heart disease team, shares a typical day at work.

8am

Lynda Tellett

I start my day answering the helpline – we’ve got quite a few messages after the 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’m off to the maternity ward at the nearby Princess Anne Hospital.  A lady with a serious congenital heart defect has been on bed rest for a number of weeks and today is her elective caesarean section, and she wanted a familiar face with her for support.

11am

By 11am, the baby is born. At only 30 weeks gestation, he’s tiny, but perfect and beautiful. The neonatal nurses are ready to look after him and warm him up. The baby has some oxygen, and soon ‘pinks up’. His mum and dad haven’t got to see him yet, so I do my best to describe him before I have to go.

11.30am

My bleep is quite lively so I have to dash back to my office to catch up on the calls. These include 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 medication. I also call a lady who reduced her medication following a telephone consultation last week. She’s 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. It will be purpose built, offering a nice big day room and kitchen area.

12am

I visit the ward patients before their rest period and then go to the intensive care unit to review a young man who has had very complex surgery. He’s stable but requires a lot of medical support and is sedated on a ventilator. I spend a fair amount of time with his family, who I have known for some time. They’re coping very well, but it’s a very tiring and emotional time for them. It’s a priority for me to ensure that families are well cared for - I can’t 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 have a successful meeting with the consultant in the catheter laboratory and discuss a few outpatient issues. I now have some extra jobs: these include liaising patient tests like 48 hour heart monitoring tapes, cardio memos and blood tests. I ring patients to explain what to expect and why. 

2pm

After lunch I have more messages on the helpline, including one from a lady who is having difficulty breathing despite home oxygen. She’s 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.

3pm

A student nurse with an interest in congenital heart disease has asks if she can work with me tomorrow. I’m 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, and then discusses future treatment plans.  Later we can attend the outpatient clinic where I will meet and greet patients, ensuring they have my contact details and that they understand their condition and management plans. I’ll also take the student to the neonatal unit to see today’s newborn baby and visit his mum. We can also visit the intensive care unit. This job can be very diverse and exciting. I never know what might happen next.

5pm

I pop over to the Princess Anne. 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’s in the high care unit with a specialist midwife and is constantly monitored. The baby is having a little help with breathing but looks wonderful and will hopefully meet his mum properly tomorrow.

I’m looking forward to meeting four new admissions tomorrow – they’re coming in for a cardiac catheter. I’ll also be teaching the cardiac high care nurses in the afternoon.

6pm

It’s 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.