Growth of Cardiac Program Opens New Opportunities for Nurses

In November 2021, Salinas Valley Memorial Healthcare System celebrated its 100th TAVR (Transcatheter Aortic Valve Replacement) procedure. Along with over 100 WATCHMAN™ procedures and introduction of the MitraClip™ procedure, these milestones highlight the growth of a program that has dramatically improved care for patients with heart problems in the Monterey County region.

It has also opened opportunities for highly skilled Cath Lab, cardiac surgery and Heart Center nurses to undergo professional growth and expand their roles, says Structural Heart Program Coordinator Anne Timberlake, MSN, MPH, RN, CNS. The nurses have seized those opportunities.

Complex Procedures Demand High-Level Training

The three complex procedures are aimed at addressing structural flaws in the heart. All require an interventional cardiologist with advanced skills and a team of experienced physicians, nurses and technicians working side-by-side in the Cardiac Cath Lab and, during recovery, either in the Intensive Care Unit (ICU) or Heart Center.

“Before we started these programs, patients had to make many trips to Bay Area hospitals to complete all the testing and physician consultations required,” Timberlake says. That has changed, thanks to an enormous investment from everyone involved at SVMHS. This includes, when the TAVR program launched in 2019, a delegation of nurses and physicians traveling out of state to learn the techniques of pioneers in these minimally invasive surgeries.

Bud Hall, shown here with Structural Heart Program Coordinator Anne Timberlake, MSN, MPH, RN, CNS, underwent a successful TAVR procedure for aortic stenosis at SVMH in 2021.

It also includes both Heart Center and ICU staff undergoing comprehensive education to learn how to properly care for these patients post-procedure, says Kelly Flower, MSN/MHA, RN, CCRN-K, CNML, Clinical Manager of Critical Care. “Caring for this patient population has helped the RNs in developing skills to care for more complex patients, [and enabled them to] continue to expand their already seasoned skill set.”

A Well-Designed Workflow

As Structural Heart Program Coordinator, Timberlake first guides patients and their families through a process of diagnostic tests and physician consultations aimed at determining who is eligible for one of these procedures. Next, she joins a multidisciplinary team – which includes the interventional cardiologist, cardiac surgeons, Cath Lab nurses and technicians – at a monthly case conference aimed at identifying the appropriate candidates. Timberlake then meets with the suitable candidates and their families to provide education about the procedure, deliver preoperative instructions and prepare them for what to expect during the hospital stay and recovery period.

“I enjoy this Advanced Practice Registered Nursing role as I’m able to establish an ongoing relationship with patients and participate in their journey. It’s very gratifying to see their quality of life improve afterward as the heart failure symptoms resolve.”
Anne Timberlake, MSN, MPH, RN, CNS, Structural Heart Program Coordinator

Initially, post-procedure, the TAVR patients were admitted to the ICU, but over time it has become standard practice to send the patients directly to the Heart Center, which until these patients are stable, now requires a 3:1 nurse-to-patient ratio. In addition, Timberlake serves as a resource for Heart Center nursing staff.

“The Heart Center has really taken ownership of ensuring the patients are cared for appropriately and get what they need at discharge so they will be successful at home,” says Carla Spencer, MSN, RN, NEA-BC, Director of Critical Care and Emergency Services.

Finally, Timberlake stays in contact with patients at regular intervals to provide support during their recovery and to track their progress during the first year.

The Rewards of Professional Growth

The growth of the cardiac program has not just delivered improvements in patient care, but also rewards for nurses. In addition to the professional development opportunities highlighted above, Timberlake relishes her Advanced Practice Registered Nursing role because, she says, “I’m able to establish an ongoing relationship with patients and participate in their journey…. It’s very gratifying to see their quality of life improve afterward as the heart failure symptoms resolve.”

Christianna Kearns, MBA, RDCS, FACHE, Senior Administrative Director of Cardiovascular and Therapeutic Services, adds, “Having a sophisticated program like this also raises the bar for all heart care at SVMHS. The higher level of skill that it took to launch and sustain this program has also enhanced the other procedures we perform outside of structural heart, ultimately leading to better care and outcomes overall.”