Stroke Program Coordinator: Interview with Judy Yi, RN

My Specialty

Stroke Program Coordinator: Interview with Judy Yi, RN

Educating and managing a team of front-line providers

By Keith Carlson, RN, BSN, CPC, NC-BC
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Please tell us about your workplace and current position and responsibilities.
I am the stroke program coordinator at Arrowhead Regional Medical Center (ARMC) in Colton. ARMC is the sole county hospital serving San Bernardino County, which is the largest county (22,000 square miles) in the contiguous United States. We are a Level II trauma center, primary stroke center and regional burn center.

As the stroke coordinator for the facility, I’m part of a team responsible for the high-quality stroke care administered at ARMC. I coordinate the entire program, including front-line EMS providers, inpatient staff and post-discharge follow-up.

In the course of my work, I provide a great deal of education to local EMS personnel regarding stroke signs, symptoms and care. That includes educating fire departments, paramedics and EMTs.     Continuing education is the key to success in this team effort.

Are EMS personnel sometimes not up to date on the latest evidence-based information regarding stroke?
I find that some of the paramedics who’ve been in the field since stroke care first emerged on the scene have a different idea of what stroke care is. When I was in nursing school, things were quite different. We all need to be regularly brought up to speed on the latest developments.

How do you educate other professionals?
Here at ARMC, we offer a biannual stroke summit conference. We invite all ancillary, medical and nursing staff to educate them on current best practices in stroke identification and care. I can’t attest for other facilities, but we work to ensure that all of our team members are up to date.

What is the emerging evidence base? What kind of research is happening right now?

The current standard of care for the treatment of acute ischemic stroke is tissue plasminogen activator (t-PA). This is a super clot-dissolving drug that can potentially save a person’s life and minimize neurological deficits after a stroke event. Studies now show that t-PA coupled with neurovascular intervention provides the best patient outcomes.

.In this scenario, the neuro-interventionalist gains access to the blood vessels in the brain to physically remove the blockage (blood clot) in the blood vessel(s) feeding the brain. Restoration of blood flow to the brain is the main goal of therapy.

How has stroke care developed nationally?

Stroke care in the United States is divided by the East Coast and the West Coast, with the East Coast leading the way. If you look at demographics, strokes are far more frequent on the East Coast. They’ve been doing neurovascular intervention for more than 10 years.

Here on the West Coast, neuro-intervention is just now starting to become commonplace. In 2009, ARMC became the first certified primary stroke center in San Bernardino County. These types of centers have been around on the East Coast since about 2003.

We have a dedicated 16-bed stroke unit on the fourth floor and a secondary overflow unit on the sixth floor. The ICU takes the hemorrhagic bleeds and post t-PA patients.

How would you describe the arc of your nursing career?
I started on the emergency department and critical care units 13 years ago, when hospitals were more accepting of new grads for such positions. I’m very grateful for those opportunities. My mom is a 44-year veteran of the ICU and she’s still working now. I knew ER and critical care were my calling from the very start. I love the fast-paced environment and not knowing what will come through those doors. You just have to roll with whatever situation presents itself.

It’s commonly known that burnout occurs in ER nurses after six years. For me, I found that I wanted to do something new, but still be in critical care, so I became a critical care transport nurse manager for a ground transport team. I quickly realized that I got car sick in the back of the rig very easily, so after giving it about three years, I returned to the ER.

Three years ago, I was offered the opportunity to be the stroke coordinator at ARMC, so I traded in my fashionable scrubs and various 12-hour shifts for something more predictable. I enjoy this job immensely, but I have to admit that when I hear the helicopters coming in with a patient on our helipad, I can still feel that same adrenaline rush coming on as I did as a new grad ER nurse treating a critical patient.

I really miss my ER experience, but I manage to remain in the ED areas working with nurses and physicians on a coordinator level.

What fascinates you about stroke care?
For me, it’s all about patient outcomes. As frontline ER nurses, we oftentimes don’t see our patients’ progress. We stabilize them, get them admitted and move on to the next case, so we never get to see the patient’s recovery and discharge.

In this role, I get to see my stroke patients come in at their worst, receive high-quality care, and (most times) walk out of the hospital of their own accord.

Stroke care is truly a team effort. With the support of our administration, the physicians, nursing staff and rehabilitation staff here all work together towards a common goal: achieving the best possible outcomes for each and every one of our stroke patients.

I attribute such outcomes to the fantastic care that we provide. If it weren’t for the team, this would never occur.

Other than interventional radiology, how else has technology impacted the care of stroke patients?
We use a cutting-edge form of telemedicine. A physician can communicate with a patient using a bedside robot that facilitates seamless communication and real-time neurological assessment with the assistance of the nurse at the bedside. The physician can speak with the nurse and patient by utilizing an iPad, smartphone or computer to log into the robot’s specific online communication platform.

What are your recommendations for nurses interested in this area of nursing specialization?
In terms of neurological nursing, I would highly recommend critical care experience in a neurointensive care unit. We also encourage sitting for the exam to become a stroke certified registered nurse (SCRN). This is a national exam recognized by the American Board of Neuroscience Nursing.

Overall, learning about the brain is crucial, as is gaining a deep understanding and experience of neurological pathophysiology, assessment and treatment.

What are your future career plans?
Three years ago, I made a life-changing decision to return to school. I’m now finishing my final quarter of a nurse practitioner program. I plan to stay on at ARMC as the nurse practitioner stroke program coordinator.

My goal is to develop a comprehensive, closed-loop stroke care program, including following stroke patients so that we can assess their recovery at 60, 90 or even 180 days post-discharge. We can say that we’re No. 1 in stroke care, but we have to have measurable outcomes in order to truly demonstrate that.

In the end, I love what I do, I love my job and I love the team I work with!

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