Cardiac Surgery ICU Nursing: Alice Chan, RN, MS, CNS, CCRN
On the cutting edge of quickly-evolving technologies
Can you share with us the history your nursing career?
I am the Service Line Nurse Manager in the Cardiac Surgery ICU and Cardiac ICU at Cedars-Sinai Medical Center in Los Angeles. I felt a passion for cardiac nursing early in my career, even during nursing school, and began practicing on a cardiac unit almost immediately. I also knew I thrived in a large academic medical center environment. My entire career has been in that setting.
About 10 years into my career, I realized that I wanted to have the option to have a broader impact on nursing. I earned my master’s degree as a clinical nurse specialist with a specialty in cardiopulmonary medicine and practiced as a CNS for 10 years before becoming a nurse manager.
I “retired” from UCLA after 22 years, but I knew I couldn’t leave practice. I joined Cedars-Sinai in 2008 as a CNS and now am the nurse manager for cardiac surgery ICU and cardiac ICU. I’ve been fortunate to be at the frontlines of cardiac care as it evolves. I’m thankful that at this point in my career I continue to practice at the very leading edge of cardiac care. There are so many more options now for patients.
What do you really love about cardiac medicine?
I love the people. I love getting work done. At the end of the day, the patients and my colleagues fuel me. That is what keeps me going. The cardiac surgery and cardiology community is close-knit, even internationally. I keep in close contact with colleagues from all stages of my career. That is what I love most. Cardiac surgery in academic medical centers is on the frontier of what’s new. The constantly evolving technologies keep stimulating me and I’m excited about what is next.
Go to the waiting room of a cardiac unit and you see the worry on people’s faces. We work to build relationships with our patients and their families. I see my patients before surgery and follow them post-op as well. It’s the whole continuum of care.
My new love is helping with pediatric cardiology and cardiac surgery. We’ve developed a congenital heart disease program and are cross-training interested nurses so that they can work with both pediatric and adult patients.
How have changes in technology impacted cardiology?
The past 10 years have seen the fastest pace of technological advancement during my career. In the world of mechanical assist devices for the heart, the change from 2005 to 2010 to 2015 has been enormous. I can only imagine what 2020 and 2025 will be like as better battery and drive technology emerges.
The change we’ve seen in assist devices is as visually and functionally significant as what we’ve seen in cellular phones over the same 10-year timeframe. Remember the flip phone in 2005?
The advanced devices that are now available have made an enormous difference in longevity for our patients. For example, recently, a young patient needed a transplant, but we needed to fit her with a device that could bridge the gap until a heart was available. We are able to do that now, but a very few years ago, she would not have survived.
Right now, more than ever, cardiac care is making an enormous difference for patients of all ages. We have more interventional technologies than we ever had in the past. Our program for children with congenital heart problems is new, but we also have new options for older patients. For example, valves can now be repaired via the cath lab rather than open heart surgery, allowing shorter recovery times and providing more options for patients who are not surgical candidates. It is amazing.
As a nurse manager, what do you look for in cardiac nurses?
Cardiac nursing is not for everybody. Cardiac surgery is especially fast-paced, so nurses need to be clinically flexible and adaptable. When you are on the cutting edge, the devices used and surgeries being performed don’t yet have a lot of background. You have to be comfortable practicing at the edge of your competence — really at the edge of our collective competence.
I don’t just look for nurses who did well academically. Rather, I’m looking for someone who can keep pace with the changes in technology and treatment as well as the rapid changes in patients’ conditions from moment to moment. I can train nurses in the actual technicalities of the care, but the nurses’ personalities must allow them to work in this fast-paced environment and develop critical-thinking skills over time.
How much training do your nurses receive before they’re on their own?
Training is always individualized. RNs must be active participants in their development and come to us with a foundation. I give the nurses additional disease-specific training, such as training in the management of patients who are post-op or post-catheterization.
Part of our cardiac training program is done in our simulation center. Our simulation lab is very technologically advanced. We create scenarios with simulated patients who need many different interventions, including a Code Blue. We can even simulate assisting the physician with an open-chest procedure at the bedside.
Tell us more about your interest in nursing research.
I am currently the co-chair of the research council at our facility. We’re responsible for assessing all of the projects that are submitted as potential research initiatives. We have a research conference every year and we mentor the staff in writing an article or abstract, creating a poster or putting together a podium presentation. We receive proposals for projects ranging from cardiac research to quality improvement. I’m currently doing research projects with several colleagues. A good thing about Cedars-Sinai is that you don’t need a Ph.D. to do research. Our CNO is very supportive and there are many resources to assist nurses who want to get involved.
What is your experience of being a woman in a senior position in such a large institution?
I’ve been very lucky. My relationships with the intensivists, surgeons and other physicians are very good — they are always very respectful. It’s a very collaborative environment and the physicians highly value nurses’ opinions.
What are you looking forward to in your career?
I’m looking forward to training many more nurses who will be able to provide excellent care for our patients and assume leadership roles in the future. Patients are getting sicker and the technology is improving, so we need very good nurses to provide such critical care. I would like to mentor nurses who can take over my position when I retire. Succession planning is important to me.
Even though I plan to retire in 10 years or so, I love what I do and I wouldn’t trade this for anything.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.