My background and first true love in nursing is emergency trauma nursing. The ER I worked in, is a 97 bed Level 1 trauma emergency department who services the whole western side of the state. We see 140,000 patients a year and the volume and acuity alone make me a proud employee. As an ED RN, my least favorite type of patients were stroke patients (go figure considering my role now). When I saw the position availability my initial reaction was “I could really change some of the things I hate most related to the process of handling stroke care.” Thus, here I am now, almost a year into this career change and I am still learning my strengths and weaknesses in this role.
Our team works up approximately 2700 strokes a year and about 1300 of these patients are diagnosed with strokes. Our ED activates at least 120 suspected strokes a month, last rolling calendar year we gave tPA 127 times and provided emergent thrombectomy 47 times. Yes, I'm the one keeping track of those numbers. So aside from data collection and implication of quality metrics, let's walk through what I do for our stroke patients who come to our ED.
On arrival to our ED, I greet the patient and provider team. I ensure the patient gets to CT scan within the American heart recommended target time (20 minutes but our facility are a bunch of overachievers so we promote the magic number 10). If the patient is a candidate for tPA I support the nursing staff by mixing tPA, obtaining a second IV access, ensuring adequate blood pressure control, anything I can do as a second set of hands. Again, only 3% of patients in this ED are strokes so even though we have made waves in stroke care – the nurses are still a bit overwhelmed when they do have to give tPA. Let’s say this patient also is a candidate for thrombectomy, I then coordinate transport to the cath lab, support the cath lab staff, and ensure they receive a clear report on these patients deficits. Regardless if the patient received an intervention, I am following all strokes/ stroke mimics until their MRI is negative/positive. I round on these patients and provide them with community resources, support groups, education, and ensure the family is on board and can recognize signs of a stroke. I am tracking these patients in real time to ensure all joint commission and AHA quality metrics are met.
After these patients leave our facility, if they received intervention they get a call from me after their return home from rehab. If they did not receive intervention – I call them within 7 days to ensure they don’t have questions in their discharge plan and to clear up any inaccurate information. During these calls, I gauge their functional outcomes to report improvement. A lot of the people will attend a stroke support group that I host- and it's so rewarding to see the connection from hospital arrival to their discharge out in the community.
When I'm not in the hospital – I am participating in community outreach and promote stroke awareness and prevention. We have 80 ambulance services that feed our ED, and I have made relationships with our top 10 by rounding with them to ensure they are comfortable activating a stroke alert in the pre-hospital setting. I visit with senior centers and school-aged children to ensure that education can be provided to all because TIME IS BRAIN!
So in summary – I am a stoke program nurse coordinator. I promote stroke awareness in the community, concurrently review charts of stroke patients to ensure the best quality of care, round with stroke patients, support the emergency room staff during acute strokes, support our vascular neurologists and our process through evidence-based research. What a mouthful!