Stroke Nursing, Sarah Burke, Good Samaritan Hospital

Please share some details about your work at Good Samaritan Hospital.

I get the patient in the immediate aftermath of a stroke and coordinate closely with the ER or the neurologist on duty. I arrange for the cath lab, thrombectomies and other timely interventions.

If we’re pre-notified by EMS that a stroke patient is on their way in, we meet them in the ER and I evaluate the patient in concert with the ER physician. We then go to CT. I’m in constant communication with our physicians in making the decision about whether it’s a bleed or ischemia.

When I started this program, we were seeing about 10 patients per month. Then, we started taking 911 calls. Now, we see 70–100 stroke patients per month. I can’t do it all myself, of course. I work with a stroke coordinator as well as a data person.

There are two different kinds of centers for the treatment of stroke. Primary stroke centers provide basic care and tPA, but they don’t treat any patient who’s outside of the four-and-a-half-hour window. These types of centers may or may not do vessel imaging.

In comprehensive centers like ours, we offer high-level stroke care and treat up to 24 hours post-stroke. We have a cath lab, in-house neurosurgeons and other services. We also have a facility-wide stroke care certification, which is very difficult to obtain.

We do our very best for our patients, and I get to impact their care very clearly and directly. I get to see patients from minute one post-stroke to the moment when they walk out of the hospital — the whole gamut. We even do follow-up phone calls to see how patients are doing post-hospitalization.

Also, we’re in the second year of a grant that provides us with funds to employ a community educator and an intern who go out into the community to provide stroke education in the South Los Angeles area. We partner with clinics and farmers’ markets. Now, we want to find access to elementary schools so that we can get those kids educated for life.

How has stroke treatment evolved in the last five to 10 years?

Ten years ago, if you had a stroke in the ER, they’d tell you that you were having a stroke, give you some aspirin and then send you for some rehab in the hopes that you’d regain some modicum of function — if you were lucky. Then, hospitals began giving tPA and we started having access to these advanced certifications in stroke care.

The biggest study on tPA came out in 1997, but it’s only in the last 10 years that we’ve really begun using it. There was a lot of stigma about tPA that we needed to overcome.

Luckily for patients, more and more hospitals have been jumping on the stroke care bandwagon. The Joint Commission now certifies facilities based on the latest requirements and the American Heart Association gives awards for great programs and superlative outcomes.

In 2015, multiple journals said that thrombectomy was highly recommended and effective, noting that one out of four patients has a good outcome. In comparison, good outcomes for STEMI (ST-segment elevation myocardial infarction) are only one in 25!

The 35-year-old I mentioned earlier had a stroke in a vessel feeding his brainstem. If we hadn’t treated him, he would have died. He walked out of the hospital with no deficits of any kind. Now, you can’t even see his stroke on an MRI!

What advice do you have for nurses interested in stroke care and neurology? What do you look for when hiring?

Working in stroke care requires nurses to have NIHSS (NIH stroke scale) certification. It’s free and is good for two years unless your hospital wants you to redo it every year.

As for neuro, we encourage our staff to get certified and take their knowledge to the next level, but certification is not needed in order to enter the field. Certifications are nice, but to someone who really wants it, neuro is fascinating whether you’re pursuing certification or not.

I look for nurses who are passionate and want to work in neuro. To see the brain recover from injury is amazing — you truly can make a difference and save lives. I want people who see the magic and brilliance of that. I also look for willingness. Neuro patients can be difficult and can get very agitated, especially after a TBI.

Many stroke centers support their staff in getting certified. We do some of that in-house. Some hospitals really push certification, but it shouldn’t be something that prevents you from getting hired.

What career plans do you have for the foreseeable future?

I’m actually in graduate school to become an acute care nurse practitioner. I like teaching nurses about stroke care, so I really want to speak at conferences and provide stroke certification classes. This degree will give me the credibility and respect to be involved in research and expand my practice. I have 14 months to go until graduation.

At this time, I don’t want to think about a Ph.D. I’m a mother of three, and I told my kids that I’ll at least take a break after graduation. I may do my Ph.D. or DNP when my kids are a little older, but we’ll wait to see what the future holds!

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

In this Article: Career Advice, Nursing Workforce